Saturday, April 22, 2017

When Nephrology Meets Endocrinology

One of the sessions that caught my attention at the 2017 NKF Spring Clinical Meeting in Orlando, Florida was “Beyond RAAS Inhibitors: Novel Drugs for Diabetic Kidney Disease” by Katherine Tuttle,MD. There was a lot of hype around the SLGT-2 inhibitors at this year’s NephMadness.  Even though they lost in the semifinal round, many participants felt that it was one of the sleeper teams that could win it all. 

If I had to give Dr. Tuttle’s session a name I would call it “When Endocrinology Meets Nephrology”, because of the topic and the speaker’s background as an endocrinologist and a nephrologist. She went through the past, present and future in diabetic nephropathy therapies. Some of the information that struck me was the fact that 10% of the patients with diabetic kidney disease progress to ESRD (dialysis and kidney transplant) and 90% die of other causes (CVD or infection) without reaching ESRD. This means we still need to make some improvements in cardiovascular disease prevention among diabetic patients.

During this presentation, Dr. Tuttle referred to the “Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes” and the LEADER trial  which are two of the most important trials looking at SGLT-2 inhibitors and GLP-1 analogues. For those who are not familiar, I want to share a visual abstract to give a quick and clear idea about the EMPA-REG OUT COME trial. 

With the EMPA-REG data already showing improvement in kidney function, Dr. Tuttle left us with great news that GLP-1 receptor agonists have ongoing trials looking at renal outcomes: 

-          Participants with type 2 diabetes and eGFR > 60 ml/min
-          Lixisenatide vs basal insulin
-          Measured GFR and renal plasma flow, albuminuria, inflammatory biomarkers

-          Participants with type 2 diabetes and CKD stages 3-4
-          Dulaglutide vs basal insulin
-          HbA1C, 8-point self monitoring for blood pressure, hypoglycemia
-          eGFR, albuminuria, ESRD and CVD events

The future looks bright for both of these novel agents for diabetes, in addition to hopeful positive effects on kidney and cardiovascular outcomes as well!

- post by Dr. Pablo Garcia, Nephrology Social Media Collective Intern

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