Outcome of use of a novel Modulator of Oxidative Phosphorylation on kidney function in patients with Chronic Kidney disease

Abstract

Abstract Introduction CKD is a contributor to illness and is associated with a diminished quality of life and reduced life expectancy. Several studies have proposed and evaluated therapeutic options of curbing the progression of the disease and decline in kidney function as measured by the glomerular filtration rate . Although these medications have been shown to be helpful in minimizing the rate of decline of CKD progression , currently no therapeutic option is available for patients to restore or repair any already incident loss of glomerular function leading to an improvement in renal function from their baseline . A new pathway targeting NAD+ pathway has been proposed by animal studies . In this article we studied the effect of utilizing a novel drug QRX3 , a promoter of NAD/NAD+ oxidative phosphorylation pathway and its effect of glomerular filtrate rate in patients with chronic kidney disease. Methodology We invited and screened patients presenting for evaluation and follow up at a nephrology outpatient clinic . 45 patients were screened for the study. Diabetes and Hypertension were the causes of CKD in the study population . 17 patients with estimated glomerular filtration rate between 9 and 48 mls/min/1.73m2 and meeting criteria were included in the study and were started on the novel medication in addition to their standard CKD management. The primary outcome was a mean and percentage change in glomerular filtration rate at 3 months and at 6 months. Results Using analysis of the data for all participants, the mean change in renal function by eGFR was from 29 mls per minute to 35.5 mls per minute at three months (P-0.027 Confidence interval 22.68 to 35.43, DF 16 , SE 3.01 ) ,which was sustained at 35.2 mls per minute at six months ( p=0.07 DF 11 Confidence interval 23.1 to 40.05 , SE 3.8) . This reflected a percentage mean increase of 20.9 % for all the study participants. This effect was similar for percentage increase from the mean eGFR at 3 months for both stage 3 and 4 ( P= 0.0086 for CKD 3 and P=0.02 for CKD 4 ) when compared to CKD stage 5 patients. Conclusion Among patients with slowly declining chronic kidney disease , the use of a novel drug target of NAD/NAD+ oxidative phosphorylation pathway resulted in a mean improvement in their kidney function above baseline ,an effect that was sustained even at 6 months.