1
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Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the Gap in Kidney Care: Translating What We Know Into What We Do. Am J Hypertens 2024; 37:640-649. [PMID: 39004933 PMCID: PMC11247168 DOI: 10.1093/ajh/hpae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 07/16/2024] Open
Affiliation(s)
- Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA
- Nephrology Division, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico
| | - Winston W S Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Fiona Loud
- ISN Patient Liaison Advisory Group, Brussels, Belgium
| | | | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Bill Wang
- ISN Patient Liaison Advisory Group, Brussels, Belgium
| | - Siu-Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Janez A, Muzurovic E, Bogdanski P, Czupryniak L, Fabryova L, Fras Z, Guja C, Haluzik M, Kempler P, Lalic N, Mullerova D, Stoian AP, Papanas N, Rahelic D, Silva-Nunes J, Tankova T, Yumuk V, Rizzo M. Modern Management of Cardiometabolic Continuum: From Overweight/Obesity to Prediabetes/Type 2 Diabetes Mellitus. Recommendations from the Eastern and Southern Europe Diabetes and Obesity Expert Group. Diabetes Ther 2024:10.1007/s13300-024-01615-5. [PMID: 38990471 DOI: 10.1007/s13300-024-01615-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/20/2024] [Indexed: 07/12/2024] Open
Abstract
The increasing global incidence of obesity and type 2 diabetes mellitus (T2D) underscores the urgency of addressing these interconnected health challenges. Obesity enhances genetic and environmental influences on T2D, being not only a primary risk factor but also exacerbating its severity. The complex mechanisms linking obesity and T2D involve adiposity-driven changes in β-cell function, adipose tissue functioning, and multi-organ insulin resistance (IR). Early detection and tailored treatment of T2D and obesity are crucial to mitigate future complications. Moreover, personalized and early intensified therapy considering the presence of comorbidities can delay disease progression and diminish the risk of cardiorenal complications. Employing combination therapies and embracing a disease-modifying strategy are paramount. Clinical trials provide evidence confirming the efficacy and safety of glucagon-like peptide 1 receptor agonists (GLP-1 RAs). Their use is associated with substantial and durable body weight reduction, exceeding 15%, and improved glucose control which further translate into T2D prevention, possible disease remission, and improvement of cardiometabolic risk factors and associated complications. Therefore, on the basis of clinical experience and current evidence, the Eastern and Southern Europe Diabetes and Obesity Expert Group recommends a personalized, polymodal approach (comprising GLP-1 RAs) tailored to individual patient's disease phenotype to optimize diabetes and obesity therapy. We also expect that the increasing availability of dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) agonists will significantly contribute to the modern management of the cardiometabolic continuum.
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Affiliation(s)
- Andrej Janez
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.
| | - Emir Muzurovic
- Department of Internal Medicine, Endocrinology Section, Clinical Centre of Montenegro, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Pawel Bogdanski
- Department of Treatment of Obesity, Metabolic Disorders and Clinical Dietetics, University of Medical Sciences, Poznan, Poland
| | - Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warszawa, Poland
| | - Lubomira Fabryova
- MetabolKLINIK sro, Department for Diabetes and Metabolic Disorders, Lipid Clinic, MED PED Centre, Biomedical Research Centre of Slovak Academy of Sciences, Slovak Health University, Bratislava, Slovak Republic
| | - Zlatko Fras
- Preventive Cardiology Unit, Division of Medicine, University Medical Centre Ljubljana and Chair of Internal Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Cristian Guja
- Clinic of Diabetes, Nutrition and Metabolic Diseases, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Martin Haluzik
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 140 21, Prague 4, Czech Republic
| | - Peter Kempler
- Department of Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Nebojsa Lalic
- Faculty of Medicine, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Dana Mullerova
- Faculty of Medicine in Pilsen, Department of Public Health and Preventive Medicine and Faculty Hospital in Pilsen, 1st Internal Clinic, Charles University, Pilsen, Czech Republic
| | - Anca Pantea Stoian
- Diabetes, Nutrition and Metabolic Diseases Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dario Rahelic
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
- Catholic University of Croatia School of Medicine, Zagreb, Croatia
- Josip Juraj Strossmayer, University of Osijek School of Medicine, Osijek, Croatia
| | - José Silva-Nunes
- NOVA Medical School, New University of Lisbon, Lisbon, Portugal
- Department of Endocrinology, Diabetes and Metabolism, Unidade Local de Saúde São José, Lisbon, Portugal
| | - Tsvetalina Tankova
- Department of Endocrinology, Faculty of Medicine, Medical University, Sofia, Bulgaria
| | - Volkan Yumuk
- Division of Endocrinology, Metabolism and Diabetes, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Manfredi Rizzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (Promise), School of Medicine, University of Palermo, Palermo, Italy
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3
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Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the gap in kidney care: translating what we know into what we do. Clin Exp Nephrol 2024:10.1007/s10157-024-02518-2. [PMID: 38970648 DOI: 10.1007/s10157-024-02518-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 07/08/2024]
Abstract
Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages, it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
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Affiliation(s)
- Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, 105 W 8th Avenue, Suite 250 E, Spokane, WA, 99204, USA
- Nephrology Division, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico, Mexico
| | - Winston W S Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Fiona Loud
- ISN Patient Liaison Advisory Group, Cranford, USA
| | | | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636, Thessaloniki, Greece.
| | | | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Bill Wang
- ISN Patient Liaison Advisory Group, Cranford, USA
| | - Siu-Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Harbin, Hong Kong, China
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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4
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Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WW, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the gap in kidney care: translating what we know into what we do. J Bras Nefrol 2024; 46:e2024E007. [PMID: 38991207 PMCID: PMC11239182 DOI: 10.1590/2175-8239-jbn-2024-e007en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/01/2023] [Indexed: 07/13/2024] Open
Abstract
Historically, it takes an average of 17 years for new treatments to move from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. Now is the time to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions are diagnosed worldwide, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because it is often silent in the early stages. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from the patient to the clinician to the health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
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Affiliation(s)
- Valerie A. Luyckx
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Department of Public and Global Health, Zurich, Switzerland
- Harvard Medical School, Brigham and Women’s Hospital, Department of Medicine, Renal Division, Boston, Massachusetts, USA
- University of Cape Town, Department of Paediatrics and Child Health, Cape Town, South Africa
| | - Katherine R. Tuttle
- Providence Inland Northwest Health, Providence Medical Research Center, Spokane, Washington, USA
- University of Washington, Department of Medicine, Nephrology Division, Seattle, Washington, USA
| | - Dina Abdellatif
- Cairo University Hospital, Department of Nephrology, Cairo, Egypt
| | - Ricardo Correa-Rotter
- National Medical Science and Nutrition Institute Salvador Zubiran, Department of Nephrology and Mineral Metabolism, Mexico City, Mexico
| | - Winston W.S. Fung
- University of Hong Kong, Prince of Wales Hospital, Department of Medicine and Therapeutics, The Chinese Shatin, Hong Kong, China
| | - Agnès Haris
- Péterfy Hospital, Nephrology Department, Budapest, Hungary
| | - Li-Li Hsiao
- Harvard Medical School, Brigham and Women’s Hospital, Department of Medicine, Renal Division, Boston, Massachusetts, USA
| | | | | | - Fiona Loud
- ISN Patient Liaison Advisory Group, Brussel, Belgium
| | | | - Stefanos Roumeliotis
- Aristotle University of Thessaloniki, AHEPA University Hospital Medical School, 2nd Department of Nephrology, Thessaloniki, Greece
| | | | - Ifeoma Ulasi
- University of Nigeria, College of Medicine, Department of Medicine, Ituku-Ozalla, Enugu, Nigeria
| | - Bill Wang
- ISN Patient Liaison Advisory Group, Brussel, Belgium
| | - Siu-Fai Lui
- The Chinese University of Hong Kong, Jockey Club School of Public Health and Primary Care, Division of Health System, Policy and Management, Hong Kong, China
| | - Vassilios Liakopoulos
- Aristotle University of Thessaloniki, AHEPA University Hospital Medical School, 2nd Department of Nephrology, Thessaloniki, Greece
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van Raalte DH, Bjornstad P, Cherney DZI, de Boer IH, Fioretto P, Gordin D, Persson F, Rosas SE, Rossing P, Schaub JA, Tuttle K, Waikar SS, Heerspink HJL. Combination therapy for kidney disease in people with diabetes mellitus. Nat Rev Nephrol 2024; 20:433-446. [PMID: 38570632 DOI: 10.1038/s41581-024-00827-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/05/2024]
Abstract
Diabetic kidney disease (DKD), defined as co-existing diabetes and chronic kidney disease in the absence of other clear causes of kidney injury, occurs in approximately 20-40% of patients with diabetes mellitus. As the global prevalence of diabetes has increased, DKD has become highly prevalent and a leading cause of kidney failure, accelerated cardiovascular disease, premature mortality and global health care expenditure. Multiple pathophysiological mechanisms contribute to DKD, and single lifestyle or pharmacological interventions have shown limited efficacy at preserving kidney function. For nearly two decades, renin-angiotensin system inhibitors were the only available kidney-protective drugs. However, several new drug classes, including sodium glucose cotransporter-2 inhibitors, a non-steroidal mineralocorticoid antagonist and a selective endothelin receptor antagonist, have now been demonstrated to improve kidney outcomes in people with type 2 diabetes mellitus. In addition, emerging preclinical and clinical evidence of the kidney-protective effects of glucagon-like-peptide-1 receptor agonists has led to the prospective testing of these agents for DKD. Research and clinical efforts are geared towards using therapies with potentially complementary efficacy in combination to safely halt kidney disease progression. As more kidney-protective drugs become available, the outlook for people living with DKD should improve in the next few decades.
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Affiliation(s)
- Daniël H van Raalte
- Department of Endocrinology and Metabolism, Amsterdam University Medical Centers, VUMC, Amsterdam, The Netherlands.
- Diabetes Center, Amsterdam University Medical Centers, VUMC, Amsterdam, The Netherlands.
- Research Institute for Cardiovascular Sciences, VU University, Amsterdam, The Netherlands.
| | - Petter Bjornstad
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - David Z I Cherney
- Department of Medicine, Division of Nephrology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ian H de Boer
- Division of Nephrology and Kidney Research Institute, University of Washington, Seattle, Washington, USA
| | - Paola Fioretto
- Department of Medicine, University of Padua, Unit of Medical Clinic 3, Padua, Italy
| | - Daniel Gordin
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Sylvia E Rosas
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jennifer A Schaub
- Nephrology Division, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Katherine Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA
- Department of Medicine, University of Washington School of Medicine, Spokane and Seattle, Washington, USA
- Nephrology Division, Kidney Research Institute and Institute of Translational Health Sciences, University of Washington, Spokane and Seattle, Washington, USA
| | - Sushrut S Waikar
- Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- The George Institute for Global Health, Sydney, New South Wales, Australia
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6
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Donald EM, Driggin E, Choe J, Batra J, Vargas F, Lindekens J, Fried JA, Raikhelkar JK, Bae DJ, Oh KT, Yuzefpolskaya M, Colombo PC, Latif F, Sayer G, Uriel N, Clerkin KJ, DeFilippis EM. Cardio-Renal-Metabolic Outcomes Associated With the Use of GLP-1 Receptor Agonists After Heart Transplantation. Clin Transplant 2024; 38:e15401. [PMID: 39023081 DOI: 10.1111/ctr.15401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 06/09/2024] [Accepted: 06/24/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND The use of glucagon-like-peptide 1 receptor agonists (GLP1-RA) has dramatically increased over the past 5 years for diabetes mellitus type 2 (T2DM) and obesity. These comorbidities are prevalent in adult heart transplant (HT) recipients. However, there are limited data evaluating the efficacy of this drug class in this population. The aim of the current study was to describe cardiometabolic changes in HT recipients prescribed GLP1-RA at a large-volume transplant center. METHODS We retrospectively reviewed all adult HT recipients who received GLP1-RA after HT for a minimum of 1-month. Cardiometabolic parameters including body mass index (BMI), lipid panel, hemoglobin A1C, estimated glomerular filtration rate (eGFR), and NT-proBNP were compared prior to initiation of the drug and at most recent follow-up. We also evaluated for significant dose adjustments to immunosuppression after drug initiation and adverse effects leading to drug discontinuation. RESULTS Seventy-four patients were included (28% female, 53% White, 20% Hispanic) and followed for a median of 383 days [IQR 209, 613] on a GLP1-RA. The majority of patients (n = 56, 76%) were prescribed semaglutide. The most common indication for prescription was T2DM alone (n = 33, 45%), followed by combined T2DM and obesity (n = 26, 35%). At most recent follow-up, mean BMI decreased from 33.3 to 31.5 kg/m2 (p < 0.0001), HbA1C from 7.3% to 6.7% (p = 0.005), LDL from 78.6 to 70.3 mg/dL (p = 0.018) and basal insulin daily dose from 32.6 to 24.8 units (p = 0.0002). CONCLUSION HT recipients prescribed GLP1-RA therapy showed improved glycemic control, weight loss, and cholesterol levels during the study follow-up period. GLP1-RA were well tolerated and were rarely associated with changes in immunosuppression dosing.
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Affiliation(s)
- Elena M Donald
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Elissa Driggin
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Jason Choe
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Jaya Batra
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Fabian Vargas
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Jordan Lindekens
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Justin A Fried
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Jayant K Raikhelkar
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - David J Bae
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Kyung T Oh
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Paolo C Colombo
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Farhana Latif
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Gabriel Sayer
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Nir Uriel
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Kevin J Clerkin
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Ersilia M DeFilippis
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
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7
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Smetana GW, Romeo GR, Rosas SE, Burns RB. How Would You Manage This Patient With Type 2 Diabetes and Chronic Kidney Disease? Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Ann Intern Med 2024; 177:800-811. [PMID: 38857499 DOI: 10.7326/m24-0764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2024] Open
Abstract
Nearly 15% of U.S. adults have diabetes; type 2 diabetes (T2D) accounts for more than 90% of cases. Approximately one third of all patients with diabetes will develop chronic kidney disease (CKD). All patients with T2D should be screened annually for CKD with both a urine albumin-creatinine ratio and an estimated glomerular filtration rate. Research into strategies to slow the worsening of CKD and reduce renal and cardiovascular morbidity in patients with T2D and CKD has evolved substantially. In 2022, a consensus statement from the American Diabetes Association and the Kidney Disease: Improving Global Outcomes recommended prioritizing the use of sodium-glucose cotransporter-2 inhibitors and metformin and included guidance for add-on therapy with glucagon-like peptide 1 receptors agonists for most patients whose first-line therapy failed. It also recommended nonsteroidal mineralocorticoid receptor antagonists for patients with hypertension that is not adequately controlled with angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers. Here, an endocrinologist and a nephrologist discuss the care of patients with T2D and CKD and how they would apply the consensus statement to the care of an individual patient with T2D who is unaware that he has CKD.
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Affiliation(s)
- Gerald W Smetana
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (G.W.S., R.B.B.)
| | - Giulio R Romeo
- Joslin Diabetes Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (G.R.R., S.E.R.)
| | - Sylvia E Rosas
- Joslin Diabetes Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (G.R.R., S.E.R.)
| | - Risa B Burns
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (G.W.S., R.B.B.)
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8
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Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WW, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the Gap in Kidney Care: Translating What We Know into What We Do. Kidney Int Rep 2024; 9:1541-1552. [PMID: 38899169 PMCID: PMC11184315 DOI: 10.1016/j.ekir.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/18/2023] [Accepted: 12/01/2023] [Indexed: 06/21/2024] Open
Abstract
Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
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Affiliation(s)
- Valerie A. Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Katherine R. Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA
- Nephrology Division, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico
| | - Winston W.S. Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | | | - Siu-Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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9
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McFarlin BE, Duffin KL, Konkar A. Incretin and glucagon receptor polypharmacology in chronic kidney disease. Am J Physiol Endocrinol Metab 2024; 326:E747-E766. [PMID: 38477666 DOI: 10.1152/ajpendo.00374.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/10/2024] [Indexed: 03/14/2024]
Abstract
Chronic kidney disease is a debilitating condition associated with significant morbidity and mortality. In recent years, the kidney effects of incretin-based therapies, particularly glucagon-like peptide-1 receptor agonists (GLP-1RAs), have garnered substantial interest in the management of type 2 diabetes and obesity. This review delves into the intricate interactions between the kidney, GLP-1RAs, and glucagon, shedding light on their mechanisms of action and potential kidney benefits. Both GLP-1 and glucagon, known for their opposing roles in regulating glucose homeostasis, improve systemic risk factors affecting the kidney, including adiposity, inflammation, oxidative stress, and endothelial function. Additionally, these hormones and their pharmaceutical mimetics may have a direct impact on the kidney. Clinical studies have provided evidence that incretins, including those incorporating glucagon receptor agonism, are likely to exhibit improved kidney outcomes. Although further research is necessary, receptor polypharmacology holds promise for preserving kidney function through eliciting vasodilatory effects, influencing volume and electrolyte handling, and improving systemic risk factors.
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Affiliation(s)
- Brandon E McFarlin
- Lilly Research Laboratories, Lilly Corporate CenterIndianapolisIndianaUnited States
| | - Kevin L Duffin
- Lilly Research Laboratories, Lilly Corporate CenterIndianapolisIndianaUnited States
| | - Anish Konkar
- Lilly Research Laboratories, Lilly Corporate CenterIndianapolisIndianaUnited States
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10
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Mahzari MM, Alluhayyan OB, Almutairi MH, Bayounis MA, Alrayani YH, Omair AA, Alshahrani AS. Safety and efficacy of semaglutide in post kidney transplant patients with type 2 diabetes or Post-Transplant diabetes. J Clin Transl Endocrinol 2024; 36:100343. [PMID: 38623181 PMCID: PMC11016780 DOI: 10.1016/j.jcte.2024.100343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/17/2024] Open
Abstract
Objective Type 2 diabetes mellitus (T2DM) and post-transplant diabetes mellitus (PTDM) are common in renal transplant recipients. Semaglutide has demonstrated efficacy and safety in patients with T2DM. To date, only a limited number of studies have investigated its use in renal transplant patients. This study assessed the safety and efficacy of semaglutide in post-renal transplant patients. Methods A retrospective study was conducted at king Abdulaziz Medical City-Riyadh, Saudi Arabia. The subjects of the study were adults and adolescents (>14 years) who had undergone a kidney transplant and had pre-existing T2DM or PTDM. The study subjects were given semaglutide during the study period, from January 2018 to July 2022. The data were collected over a period of 18 months. Results A total of 39 patients were included, 29 (74 %) of whom were male. A significant decrease in hemoglobin A1c (HbA1c) was observed during the follow-up period when compared to baseline (8.4 %±1.3 % at baseline vs. 7.4 %±1.0 % at 13-18 months (p < 0.001). A significant reduction in weight was also noted at follow-up as compared to baseline (99.5 kg ± 17.7 vs 90.7 kg ± 16.8 at 13-18 months (p < 0.001). No significant changes were found in renal graft function markers. Conclusion Semaglutide was found to significantly reduce HbA1c levels and weight in post renal transplant patients with diabetes. No significant changes in markers of renal graft function were observed.
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Affiliation(s)
- Moeber Mohammed Mahzari
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 22490, Saudi Arabia
- Department of Medicine, King Abdulaziz Medical City, Riyadh, Ministry of National Guard-Health Affairs, Riyadh 14611, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia
| | - Omar Buraykan Alluhayyan
- Department of Medicine, King Abdulaziz Medical City, Riyadh, Ministry of National Guard-Health Affairs, Riyadh 14611, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia
| | - Mahdi Hamad Almutairi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 22490, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia
| | - Mohammed Abdullah Bayounis
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 22490, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia
| | - Yazeed Hasan Alrayani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 22490, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia
| | - Amir A. Omair
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 22490, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia
| | - Awad Saad Alshahrani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 22490, Saudi Arabia
- Department of Medicine, King Abdulaziz Medical City, Riyadh, Ministry of National Guard-Health Affairs, Riyadh 14611, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia
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11
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Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the gap in kidney care: Translating what we know into what we do. J Ren Care 2024; 50:79-91. [PMID: 38770802 DOI: 10.1111/jorc.12495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 04/15/2024] [Indexed: 05/22/2024]
Abstract
Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
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Affiliation(s)
- Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Medicine, Brigham and Women's Hospital, Renal Division, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA
- Department of Medicine, Nephrology Division, University of Washington, Seattle, Washington, USA
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico
| | - Winston W S Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Department of Medicine, Brigham and Women's Hospital, Renal Division, Harvard Medical School, Boston, Massachusetts, USA
| | - Makram Khalife
- ISN Patient Liaison Advisory Group, ISN, Brussel, New Jersey, Belgium
| | | | - Fiona Loud
- ISN Patient Liaison Advisory Group, ISN, Brussel, New Jersey, Belgium
| | | | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marianella Sierra
- ISN Patient Liaison Advisory Group, ISN, Brussel, New Jersey, Belgium
| | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Bill Wang
- ISN Patient Liaison Advisory Group, ISN, Brussel, New Jersey, Belgium
| | - Siu-Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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12
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Caruso I, Giorgino F. Renal effects of GLP-1 receptor agonists and tirzepatide in individuals with type 2 diabetes: seeds of a promising future. Endocrine 2024; 84:822-835. [PMID: 38472620 PMCID: PMC11208186 DOI: 10.1007/s12020-024-03757-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/18/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE Chronic kidney disease (CKD) is one of the most common complications of type 2 diabetes (T2D), and CKD-related disability and mortality are increasing despite the recent advances in diabetes management. The dual GIP/GLP-1 receptor agonist tirzepatide is among the furthest developed multi-agonists for diabetes care and has so far displayed promising nephroprotective effects. This review aims to summarize the evidence regarding the nephroprotective effects of glucagon-like peptide-1 receptor agonists (GLP-1RA) and tirzepatide and the putative mechanisms underlying the favorable renal profile of tirzepatide. METHODS A comprehensive literature search was performed from inception to July 31st 2023 to select research papers addressing the renal effects of GLP-1RA and tirzepatide. RESULTS The pathogenesis of CKD in patients with T2D likely involves many contributors besides hyperglycemia, such as hypertension, obesity, insulin resistance and glomerular atherosclerosis, exerting kidney damage through metabolic, fibrotic, inflammatory, and hemodynamic mechanisms. Tirzepatide displayed an unprecedented glucose and body weight lowering potential, presenting also with the ability to increase insulin sensitivity, reduce systolic blood pressure and inflammation and ameliorate dyslipidemia, particularly by reducing triglycerides levels. CONCLUSION Tirzepatide is likely to counteract most of the pathogenetic factors contributing to CKD in T2D, potentially representing a step forward in incretin-based therapy towards nephroprotection. Further evidence is needed to understand its role in renal hemodynamics, fibrosis, cell damage and atherosclerosis, as well as to conclusively show reduction of hard renal outcomes.
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Affiliation(s)
- Irene Caruso
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Giorgino
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy.
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13
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Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the Gap in Kidney Care: Translating What We Know Into What We do. Can J Kidney Health Dis 2024; 11:20543581241252506. [PMID: 38764602 PMCID: PMC11102772 DOI: 10.1177/20543581241252506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/12/2024] [Indexed: 05/21/2024] Open
Abstract
Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages, it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary-care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
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Affiliation(s)
- Valerie A. Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - Katherine R. Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, USA
| | | | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Winston W. S. Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Makram Khalife
- Patient Liaison Advisory Group, International Society of Nephrology, Brussels, Belgium
| | | | - Fiona Loud
- Patient Liaison Advisory Group, International Society of Nephrology, Brussels, Belgium
| | - Vasundhara Raghavan
- Patient Liaison Advisory Group, International Society of Nephrology, Brussels, Belgium
| | - Stefanos Roumeliotis
- 2nd Department of Nephrology, American Hellenic Educational Progressive Association University Hospital Medical School, Aristotle University of Thessaloniki, Greece
| | - Marianella Sierra
- Patient Liaison Advisory Group, International Society of Nephrology, Brussels, Belgium
| | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Nigeria
| | - Bill Wang
- Patient Liaison Advisory Group, International Society of Nephrology, Brussels, Belgium
| | - Siu-Fai Lui
- Division of Health System, Policy and Management, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, American Hellenic Educational Progressive Association University Hospital Medical School, Aristotle University of Thessaloniki, Greece
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14
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Brøsen JMB, Bomholt T, Borg R, Persson F, Pedersen-Bjergaard U. Hyperglycaemia in people with diabetes and chronic kidney disease. Ugeskr Laeger 2024; 186:V01240051. [PMID: 38808757 DOI: 10.61409/v01240051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Assessment and treatment of hyperglycaemia in people with diabetes and chronic kidney disease (CKD) are challenging. In advanced CKD HbA1c can be unreliable, and treatment adjustments should be supported by other glucose measurements (e.g., continuous glucose monitoring (CGM) or blood glucose measurements). Glucose-lowering treatments should be evaluated based on CKD and an individualised assessment of risk factors especially hypoglycaemia. This review aims at providing an overview of the options for glycaemic monitoring and glucose-lowering treatments in people with diabetes and CKD.
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Affiliation(s)
- Julie Maria Bøggild Brøsen
- Endokrinologisk og Nefrologisk Afdeling, Københavns Universitetshospital - Nordsjællands Hospital - Hillerød
| | - Tobias Bomholt
- Nefrologisk Afdeling, Københavns Universitetshospital - Rigshospitalet
| | - Rikke Borg
- Medicinsk Afdeling, Sjællands Universitetshospital, Roskilde
- Institut for Klinisk Medicin, SUND, Københavns Universitet
| | | | - Ulrik Pedersen-Bjergaard
- Endokrinologisk og Nefrologisk Afdeling, Københavns Universitetshospital - Nordsjællands Hospital - Hillerød
- Institut for Klinisk Medicin, SUND, Københavns Universitet
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15
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Tuttle ML, Fang JC, Sarnak MJ, McCallum W. Epidemiology and Management of Patients With Kidney Disease and Heart Failure With Preserved Ejection Fraction. Semin Nephrol 2024:151516. [PMID: 38704338 DOI: 10.1016/j.semnephrol.2024.151516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
Heart failure with preserved ejection fraction (HFpEF) comprises approximately one-half of all diagnoses of heart failure. There is significant overlap of this clinical syndrome with chronic kidney disease (CKD), with many shared comorbid conditions. The presence of CKD in patients with HFpEF is one of the most powerful risk factors for adverse clinical outcomes, including death and heart failure hospitalization. The pathophysiology linking HFpEF and CKD remains unclear, but it is postulated to consist of numerous bidirectional pathways, including endothelial dysfunction, inflammation, obesity, insulin resistance, and impaired sodium handling. The diagnosis of HFpEF requires certain criteria to be satisfied, including signs and symptoms consistent with volume overload caused by structural or functional cardiac abnormalities and evidence of increased cardiac filling pressures. There are numerous overlapping metabolic clinical syndromes in patients with HFpEF and CKD that can serve as targets for intervention. With an increasing number of therapies available for HFpEF and CKD as well as for obesity and diabetes, improved recognition and diagnosis are paramount for appropriate management and improved clinical outcomes in patients with both HFpEF and CKD.
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Affiliation(s)
| | - James C Fang
- Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Mark J Sarnak
- Division of Nephrology, Tufts Medical Center, Boston, MA
| | - Wendy McCallum
- Division of Nephrology, Tufts Medical Center, Boston, MA.
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16
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Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the gap in kidney care: Translating what we know into what we do. J Family Med Prim Care 2024; 13:1594-1611. [PMID: 38948565 PMCID: PMC11213387 DOI: 10.4103/jfmpc.jfmpc_518_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/10/2024] [Accepted: 04/19/2024] [Indexed: 07/02/2024] Open
Abstract
Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition because in the early stages, it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
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Affiliation(s)
- Valerie A. Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Katherine R. Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA
- Nephrology Division, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico
| | - Winston W. S. Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Makram Khalife
- ISN Patient Liaison Advisory Group, ISN, Brussels, Belgium
- Patient Representatives of the Patient Liaison Advisory Group of the International Society of Nephrology
| | | | - Fiona Loud
- ISN Patient Liaison Advisory Group, ISN, Brussels, Belgium
- Patient Representatives of the Patient Liaison Advisory Group of the International Society of Nephrology
| | - Vasundhara Raghavan
- ISN Patient Liaison Advisory Group, ISN, Brussels, Belgium
- Patient Representatives of the Patient Liaison Advisory Group of the International Society of Nephrology
| | - Stefanos Roumeliotis
- 2 Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marianella Sierra
- ISN Patient Liaison Advisory Group, ISN, Brussels, Belgium
- Patient Representatives of the Patient Liaison Advisory Group of the International Society of Nephrology
| | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Bill Wang
- ISN Patient Liaison Advisory Group, ISN, Brussels, Belgium
- Patient Representatives of the Patient Liaison Advisory Group of the International Society of Nephrology
| | - Siu-Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Vassilios Liakopoulos
- 2 Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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17
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Wang N, Zhang C. Oxidative Stress: A Culprit in the Progression of Diabetic Kidney Disease. Antioxidants (Basel) 2024; 13:455. [PMID: 38671903 PMCID: PMC11047699 DOI: 10.3390/antiox13040455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/01/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Diabetic kidney disease (DKD) is the principal culprit behind chronic kidney disease (CKD), ultimately developing end-stage renal disease (ESRD) and necessitating costly dialysis or kidney transplantation. The limited therapeutic efficiency among individuals with DKD is a result of our finite understanding of its pathogenesis. DKD is the result of complex interactions between various factors. Oxidative stress is a fundamental factor that can establish a link between hyperglycemia and the vascular complications frequently encountered in diabetes, particularly DKD. It is crucial to recognize the essential and integral role of oxidative stress in the development of diabetic vascular complications, particularly DKD. Hyperglycemia is the primary culprit that can trigger an upsurge in the production of reactive oxygen species (ROS), ultimately sparking oxidative stress. The main endogenous sources of ROS include mitochondrial ROS production, NADPH oxidases (Nox), uncoupled endothelial nitric oxide synthase (eNOS), xanthine oxidase (XO), cytochrome P450 (CYP450), and lipoxygenase. Under persistent high glucose levels, immune cells, the complement system, advanced glycation end products (AGEs), protein kinase C (PKC), polyol pathway, and the hexosamine pathway are activated. Consequently, the oxidant-antioxidant balance within the body is disrupted, which triggers a series of reactions in various downstream pathways, including phosphoinositide 3-kinase/protein kinase B (PI3K/Akt), transforming growth factor beta/p38-mitogen-activated protein kinase (TGF-β/p38-MAPK), nuclear factor kappa B (NF-κB), adenosine monophosphate-activated protein kinase (AMPK), and the Janus kinase/signal transducer and activator of transcription (JAK/STAT) signaling. The disease might persist even if strict glucose control is achieved, which can be attributed to epigenetic modifications. The treatment of DKD remains an unresolved issue. Therefore, reducing ROS is an intriguing therapeutic target. The clinical trials have shown that bardoxolone methyl, a nuclear factor erythroid 2-related factor 2 (Nrf2) activator, blood glucose-lowering drugs, such as sodium-glucose cotransporter 2 inhibitors, and glucagon-like peptide-1 receptor agonists can effectively slow down the progression of DKD by reducing oxidative stress. Other antioxidants, including vitamins, lipoic acid, Nox inhibitors, epigenetic regulators, and complement inhibitors, present a promising therapeutic option for the treatment of DKD. In this review, we conduct a thorough assessment of both preclinical studies and current findings from clinical studies that focus on targeted interventions aimed at manipulating these pathways. We aim to provide a comprehensive overview of the current state of research in this area and identify key areas for future exploration.
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Affiliation(s)
| | - Chun Zhang
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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18
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Moreno-Pérez O, Reyes-García R, Modrego-Pardo I, López-Martínez M, Soler MJ. Are we ready for an adipocentric approach in people living with type 2 diabetes and chronic kidney disease? Clin Kidney J 2024; 17:sfae039. [PMID: 38572499 PMCID: PMC10986245 DOI: 10.1093/ckj/sfae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Indexed: 04/05/2024] Open
Abstract
We are entering a new era in the management of adiposity-based chronic disease (ABCD) with type 2 diabetes (T2D) and related chronic kidney disease (CKD). ABCD, T2D and CKD can affect almost every major organ system and have a particularly strong impact on the incidence of cardiovascular disease (CVD) and heart failure. ABCD and the associated insulin resistance are at the root of many cardiovascular, renal and metabolic (CKM) disorders, thus an integrated therapeutic framework using weight loss (WL) as a disease-modifying intervention could simplify the therapeutic approach at different stages across the lifespan. The breakthrough of highly effective WL drugs makes achieving a WL of >10% possible, which is required for a potential T2D disease remission as well as for prevention of microvascular disease, CKD, CVD events and overall mortality. The aim of this review is to discuss the link between adiposity and CKM conditions as well as placing weight management at the centre of the holistic CKM syndrome approach with a focus on CKD. We propose the clinical translation of the available evidence into a transformative Dysfunctional Adipose Tissue Approach (DATA) for people living with ABCD, T2D and CKD. This model is based on the interplay of four essential elements (i.e. adipocentric approach and target organ protection, dysfunctional adiposity, glucose homeostasis, and lifestyle intervention and de-prescription) together with a multidisciplinary person-centred care. DATA could facilitate decision-making for all clinicians involved in the management of these individuals, and if we do this in a multidisciplinary way, we are prepared to meet the adipocentric challenge.
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Affiliation(s)
- Oscar Moreno-Pérez
- Department of Endocrinology and Nutrition, General University Hospital Dr Balmis of Alicante, Institute of Health and Biomedical Research of Alicante (ISABIAL), Alicante, Alicante, Spain
- Department of Clinical Medicine, Miguel Hernández University, San Juan, Alicante, Spain
| | - Rebeca Reyes-García
- Endocrinology Unit, University Hospital of Torrecárdenas, Almería, Almería, Spain; CIBER de Fragilidad y Envejecimiento Saludable “CIBERFES”, Instituto de Salud Carlos III
| | - Inés Modrego-Pardo
- Department of Endocrinology and Nutrition, University Hospital Marina Baixa, Villajoyosa, Alicante, Spain
| | - Marina López-Martínez
- Department of Nephrology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Research, Barcelona, Spain; Centro de Referencia en Enfermedad, Glomerular Compleja del Sistema Nacional de Salud de España (CSUR), Barcelona, Spain. GEENDIAB, RICORS2024
| | - María José Soler
- Department of Nephrology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Research, Barcelona, Spain; Centro de Referencia en Enfermedad, Glomerular Compleja del Sistema Nacional de Salud de España (CSUR), Barcelona, Spain. GEENDIAB, RICORS2024
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19
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Muta Y, Kobayashi K, Toyoda M, Tone A, Suzuki D, Tsuriya D, Machimura H, Shimura H, Takeda H, Yokomizo H, Takeshita K, Chin K, Kanasaki K, Tamura K, Miyauchi M, Saburi M, Morita M, Yomota M, Kimura M, Hatori N, Nakajima S, Ito S, Tsukamoto S, Murata T, Matsushita T, Furuki T, Hashimoto T, Umezono T, Takashi Y, Kawanami D. Influence of the combination of SGLT2 inhibitors and GLP-1 receptor agonists on eGFR decline in type 2 diabetes: post-hoc analysis of RECAP study. Front Pharmacol 2024; 15:1358573. [PMID: 38601470 PMCID: PMC11005912 DOI: 10.3389/fphar.2024.1358573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
Accumulating evidence has demonstrated that both SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP1Ra) have protective effects in patients with diabetic kidney disease. Combination therapy with SGLT2i and GLP1Ra is commonly used in patients with type 2 diabetes (T2D). We previously reported that in combination therapy of SGLT2i and GLP1Ra, the effect on the renal composite outcome did not differ according to the preceding drug. However, it remains unclear how the initiation of combination therapy is associated with the renal function depending on the preceding drug. In this post hoc analysis, we analyzed a total of 643 T2D patients (GLP1Ra-preceding group, n = 331; SGLT2i-preceding group, n = 312) and investigated the differences in annual eGFR decline. Multiple imputation and propensity score matching were performed to compare the annual eGFR decline. The reduction in annual eGFR decline in the SGLT2i-preceding group (pre: -3.5 ± 9.4 mL/min/1.73 m2/year, post: -0.4 ± 6.3 mL/min/1.73 m2/year, p < 0.001), was significantly smaller after the initiation of GLP1Ra, whereas the GLP1Ra-preceding group tended to slow the eGFR decline but not to a statistically significant extent (pre: -2.0 ± 10.9 mL/min/1.73 m2/year, post: -1.8 ± 5.4 mL/min/1.73 m2/year, p = 0.83) after the initiation of SGLT2i. After the addition of GLP1Ra to SGLT2i-treated patients, slower annual eGFR decline was observed. Our data raise the possibility that the renal benefits-especially annual eGFR decline-of combination therapy with SGLT2i and GLP1Ra may be affected by the preceding drug.
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Affiliation(s)
- Yoshimi Muta
- Department of Endocrinology and Diabetes, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kazuo Kobayashi
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Masao Toyoda
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Atsuhito Tone
- Department of Internal Medicine, Diabetes Center, Okayama Saiseikai General Hospital, Okayama, Japan
| | | | - Daisuke Tsuriya
- Division of Endocrinology and Metabolism, 2nd Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | | | | | | | - Hisashi Yokomizo
- Department of Endocrinology and Diabetes, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kei Takeshita
- Division of Endocrinology and Metabolism, 2nd Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | | | - Keizo Kanasaki
- Department of Internal Medicine 1, Endocrinology and Metabolism, Shimane University Faculty of Medicine, Shimane, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | | | - Masuo Saburi
- Department of Diabetology, Endocrinology and Metabolism, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Miwa Morita
- Department of Internal Medicine 1, Endocrinology and Metabolism, Shimane University Faculty of Medicine, Shimane, Japan
| | - Miwako Yomota
- Department of Internal Medicine 1, Endocrinology and Metabolism, Shimane University Faculty of Medicine, Shimane, Japan
| | - Moritsugu Kimura
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | | | | | - Shun Ito
- Department of Internal Medicine, Sagamihara Red Cross Hospital, Kanagawa, Japan
| | - Shunichiro Tsukamoto
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Takashi Murata
- Department of Clinical Nutrition, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
- Diabetes Center, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Takaya Matsushita
- Department of Diabetology, Endocrinology and Metabolism, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | | | - Takuya Hashimoto
- Division of Endocrinology and Metabolism, 2nd Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | | | - Yuichi Takashi
- Department of Endocrinology and Diabetes, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Daiji Kawanami
- Department of Endocrinology and Diabetes, Fukuoka University School of Medicine, Fukuoka, Japan
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20
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Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the gap in kidney care: translating what we know into what we do. Kidney Int 2024; 105:406-417. [PMID: 38375622 DOI: 10.1016/j.kint.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/18/2023] [Accepted: 12/01/2023] [Indexed: 02/21/2024]
Abstract
Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
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Affiliation(s)
- Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA; Nephrology Division, Department of Medicine, University of Washington, Seattle, Washington, USA.
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico
| | - Winston W S Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | | | - Siu-Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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21
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Fadini GP, Longato E, Morieri ML, Del Prato S, Avogaro A, Solini A. Long-term benefits of dapagliflozin on renal outcomes of type 2 diabetes under routine care: a comparative effectiveness study on propensity score matched cohorts at low renal risk. THE LANCET REGIONAL HEALTH. EUROPE 2024; 38:100847. [PMID: 38328413 PMCID: PMC10847023 DOI: 10.1016/j.lanepe.2024.100847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 12/29/2023] [Accepted: 01/11/2024] [Indexed: 02/09/2024]
Abstract
Background Despite the overall improvement in care, people with type 2 diabetes (T2D) experience an excess risk of end-stage kidney disease. We evaluated the long-term effectiveness of dapagliflozin on kidney function and albuminuria in patients with T2D. Methods We included patients with T2D who initiated dapagliflozin or comparators from 2015 to 2020. Propensity score matching (PSM) was performed to balance the two groups. The primary endpoint was the change in estimated glomerular filtration rate (eGFR) from baseline to the end of observation. Secondary endpoints included changes in albuminuria and loss of kidney function. Findings We analysed two matched groups of 6197 patients each. The comparator group included DPP-4 inhibitors (40%), GLP-1RA (22.3%), sulphonylureas (16.1%), pioglitazone (8%), metformin (5.8%), or acarbose (4%). Only 6.4% had baseline eGFR <60 ml/min/1.73 m2 and 15% had UACR >30 mg/g. During a mean follow-up of 2.5 year, eGFR declined significantly less in the dapagliflozin vs comparator group by 1.81 ml/min/1.73 m2 (95% C.I. from 1.13 to 2.48; p < 0.0001). The mean eGFR slope was significantly less negative in the dapagliflozin group by 0.67 ml/min/1.73 m2/year (95% C.I. from 0.47 to 0.88; p < 0.0001). Albuminuria declined significantly in new-users of dapagliflozin within 6 months and remained on average 44.3 mg/g lower (95% C.I. from -66.9 to -21.7; p < 0.0001) than in new-users of comparators. New-users of dapagliflozin had significantly lower rates of new-onset CKD, loss of kidney function, and a composite renal outcome. Results were confirmed for all SGLT2 inhibitors, in patients without baseline CKD, and when GLP-1RA were excluded from comparators. Interpretation Initiating dapagliflozin improved kidney function outcomes and albuminuria in patients with T2D and a low renal risk. Funding Funded by the Italian Diabetes Society and partly supported by a grant from AstraZeneca.
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Affiliation(s)
- Gian Paolo Fadini
- Division of Metabolic Diseases, Department of Medicine, University of Padova, 35128 Padova, Italy
- Laboratory of Experimental Diabetology, Veneto Institute of Molecular Medicine, 35128 Padova, Italy
| | - Enrico Longato
- Department of Information Engineering, University of Padova, 35100 Padua, Italy
| | - Mario Luca Morieri
- Division of Metabolic Diseases, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Stefano Del Prato
- Department of Clinical & Experimental Medicine, University of Pisa and Sant’Anna School of Advanced Studies, 56126 Pisa, Italy
| | - Angelo Avogaro
- Division of Metabolic Diseases, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Anna Solini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy
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22
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Drucker DJ. Prevention of cardiorenal complications in people with type 2 diabetes and obesity. Cell Metab 2024; 36:338-353. [PMID: 38198966 DOI: 10.1016/j.cmet.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/06/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024]
Abstract
Traditional approaches to prevention of the complications of type 2 diabetes (T2D) and obesity have focused on reduction of blood glucose and body weight. The development of new classes of medications, together with evidence from dietary weight loss and bariatric surgery trials, provides new options for prevention of heart failure, chronic kidney disease, myocardial infarction, stroke, metabolic liver disease, cancer, T2D, and neurodegenerative disorders. Here I review evidence for use of lifestyle modification, SGLT-2 inhibitors, GLP-1 receptor agonists, selective mineralocorticoid receptor antagonists, and bariatric surgery, for prevention of cardiorenal and metabolic complications in people with T2D or obesity, highlighting the contributions of weight loss, as well as weight loss-independent mechanisms of action. Collectively, the evidence supports a tailored approach to selection of therapeutic interventions for T2D and obesity based on the likelihood of developing specific complications, rather than a stepwise approach focused exclusively on glycemic or weight control.
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Affiliation(s)
- Daniel Joshua Drucker
- The Department of Medicine, Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto, ON M5G1X5, Canada.
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23
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Fu WJ, Huo JL, Mao ZH, Pan SK, Liu DW, Liu ZS, Wu P, Gao ZX. Emerging role of antidiabetic drugs in cardiorenal protection. Front Pharmacol 2024; 15:1349069. [PMID: 38384297 PMCID: PMC10880452 DOI: 10.3389/fphar.2024.1349069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/26/2024] [Indexed: 02/23/2024] Open
Abstract
The global prevalence of diabetes mellitus (DM) has led to widespread multi-system damage, especially in cardiovascular and renal functions, heightening morbidity and mortality. Emerging antidiabetic drugs sodium-glucose cotransporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RAs), and dipeptidyl peptidase-4 inhibitors (DPP-4i) have demonstrated efficacy in preserving cardiac and renal function, both in type 2 diabetic and non-diabetic individuals. To understand the exact impact of these drugs on cardiorenal protection and underlying mechanisms, we conducted a comprehensive review of recent large-scale clinical trials and basic research focusing on SGLT2i, GLP-1RAs, and DPP-4i. Accumulating evidence highlights the diverse mechanisms including glucose-dependent and independent pathways, and revealing their potential cardiorenal protection in diabetic and non-diabetic cardiorenal disease. This review provides critical insights into the cardiorenal protective effects of SGLT2i, GLP-1RAs, and DPP-4i and underscores the importance of these medications in mitigating the progression of cardiovascular and renal complications, and their broader clinical implications beyond glycemic management.
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Affiliation(s)
- Wen-Jia Fu
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute of Nephrology, Zhengzhou University, Zhengzhou, China
- Henan Province Research Center for Kidney Disease, Zhengzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
| | - Jin-Ling Huo
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute of Nephrology, Zhengzhou University, Zhengzhou, China
- Henan Province Research Center for Kidney Disease, Zhengzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
| | - Zi-Hui Mao
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute of Nephrology, Zhengzhou University, Zhengzhou, China
- Henan Province Research Center for Kidney Disease, Zhengzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
| | - Shao-Kang Pan
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute of Nephrology, Zhengzhou University, Zhengzhou, China
- Henan Province Research Center for Kidney Disease, Zhengzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
| | - Dong-Wei Liu
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute of Nephrology, Zhengzhou University, Zhengzhou, China
- Henan Province Research Center for Kidney Disease, Zhengzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
| | - Zhang-Suo Liu
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute of Nephrology, Zhengzhou University, Zhengzhou, China
- Henan Province Research Center for Kidney Disease, Zhengzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
| | - Peng Wu
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute of Nephrology, Zhengzhou University, Zhengzhou, China
- Henan Province Research Center for Kidney Disease, Zhengzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
| | - Zhong-Xiuzi Gao
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute of Nephrology, Zhengzhou University, Zhengzhou, China
- Henan Province Research Center for Kidney Disease, Zhengzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
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24
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Taber-Hight E, Gilmore A, Friedman AN. Anti-obesity pharmacotherapy in adults with chronic kidney disease. Kidney Int 2024; 105:269-280. [PMID: 37926421 DOI: 10.1016/j.kint.2023.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/20/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023]
Abstract
Obesity is a leading risk factor for the development and progression of kidney disease and a major barrier to optimal management of patients with chronic kidney disease. While in the past anti-obesity drugs offered only modest weight loss efficacy in exchange for various safety and tolerability risks, a wave of safer, more tolerable, and more effective treatment options is transforming the management of obesity. This review evaluates current and future pharmacologic anti-obesity therapy in adults through a kidney-oriented lens. It also explores the goals of anti-obesity treatment, describes the underlying putative mechanisms of action, and raises important scientific questions that deserve further exploration in people with chronic kidney disease.
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Affiliation(s)
- Elizabeth Taber-Hight
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ashley Gilmore
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Allon N Friedman
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
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25
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Neumiller JJ, Alicic RZ, Tuttle KR. Optimization of guideline-directed medical therapies in patients with diabetes and chronic kidney disease. Clin Kidney J 2024; 17:sfad285. [PMID: 38213492 PMCID: PMC10783256 DOI: 10.1093/ckj/sfad285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Indexed: 01/13/2024] Open
Abstract
Diabetes is the leading cause of chronic kidney disease (CKD) and kidney failure worldwide. CKD frequently coexists with heart failure and atherosclerotic cardiovascular disease in the broader context of cardio-kidney-metabolic syndrome. Diabetes and CKD are associated with increased risk of all-cause and cardiovascular death as well as decreased quality of life. The role of metabolic and hemodynamic abnormalities has long been recognized as an important contributor to the pathogenesis and progression of CKD in diabetes, while a more recent and growing body of evidence supports activation of both systemic and local inflammation as important contributors. Current guidelines recommend therapies targeting pathomechanisms of CKD in addition to management of traditional risk factors such as hyperglycemia and hypertension. Sodium-glucose cotransporter-2 inhibitors are recommended for treatment of patients with CKD and type 2 diabetes (T2D) if eGFR is ≥20 ml/min/173 m2 on a background of renin-angiotensin system inhibition. For patients with T2D, CKD, and atherosclerotic cardiovascular disease, a glucagon-like peptide-1 receptor agonist is recommended as additional risk-based therapy. A non-steroidal mineralocorticoid receptor antagonist is also recommended as additional risk-based therapy for persistent albuminuria in patients with T2D already treated with renin-angiotensin system inhibition. Implementation of guideline-directed medical therapies is challenging in the face of rapidly accumulating knowledge, high cost of medications, and lack of infrastructure for optimal healthcare delivery. Furthermore, studies of new therapies have focused on T2D and CKD. Clinical trials are now planned to inform the role of these therapies in people with type 1 diabetes (T1D) and CKD.
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Affiliation(s)
- Joshua J Neumiller
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, USA
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, WA, USA
| | - Radica Z Alicic
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Nephrology Division, Kidney Research Institute, and Institute of Translational Health Sciences, University of Washington, Seattle, WA, USA
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26
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Gouveri E, Popovic DS, Papanas N. Potential New Therapeutic Implications of Semaglutide: New Colours of the Rainbow? Diabetes Ther 2024; 15:13-18. [PMID: 37950798 PMCID: PMC10786794 DOI: 10.1007/s13300-023-01506-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/26/2023] [Indexed: 11/13/2023] Open
Abstract
Semaglutide is a potent glucagon-like peptide 1 receptor agonist for the management of type 2 diabetes mellitus. In addition to this, it has emerging potential clinical implications. First, there is accumulating preliminary data on its potential role in type 1 diabetes mellitus. In this setting, we need to know which patient subgroups may benefit more. Furthermore, its role in non-alcoholic fatty liver and in non-alcoholic steatohepatitis is emerging. Other potential therapeutic implications of semaglutide include kidney disease, Alzheimer disease and pulmonary diseases. Nonetheless, we still need much more information on its long-term efficacy, safety and utility in these new implications before any definitive conclusions may be drawn for everyday practice.
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Affiliation(s)
- Evanthia Gouveri
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, 68100, Alexandroupolis, Greece
| | - Djordje S Popovic
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Vojvodina, Novi Sad, Serbia
- Medical Faculty, University of Novi Sad, Novi Sad, Serbia
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, 68100, Alexandroupolis, Greece.
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27
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Mawardi HH, Almazrooa SA, Dakhil SA, Aboalola AA, Al-Ghalib TA, Eshky RT, Niyazi AA, Mawardi MH. Semaglutide-associated hyposalivation: A report of case series. Medicine (Baltimore) 2023; 102:e36730. [PMID: 38206684 PMCID: PMC10754586 DOI: 10.1097/md.0000000000036730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/29/2023] [Indexed: 01/13/2024] Open
Abstract
RATIONALE Obesity and diabetes of different types are considered global health risks with rising prevalence. In addition to low-calorie diet and daily exercise, several treatment options have been introduced to help patient in needs. Semaglutide (Ozempic) is one popular agent, which attracted the attention of both physicians and patients due to its positive outcome in improving glucose control and weight loss. However, no reports on the effect of semaglutide use on the oral cavity and specifically xerostomia are available in the literature. We are reporting 3 cases for patients who were using semaglutide and developed secondary xerostomia. PATIENT CONCERNS Three female patients with median age of 34 (range 27-46) presented to the oral medicine clinic with chief complaint of xerostomia. All patients were overweight with a mean body mass index of 35.6 (range 35-37) and have been using semaglutide for weight loss for a mean duration of 11.3 weeks (range 6-16). DIAGNOSES All 3 patients had severe dryness in the mouth with minimal frothy saliva with mean modified Schirmer test of 9 mL at 3 minutes (range 8-10 mL). Following exclusion of other possible underlying medical problems, the diagnosis of semaglutide-induced hyposalivation was given to all patients. INTERVENTIONS The patients' management varied between discontinuation of the drug, the use of pilocarpine, and conservative symptomatic management. OUTCOMES The patients resumed acceptable salivary flow. LESSONS We are reporting for the first time hyposalivation associated with the use of semaglutide. Further prospective, larger studies are warranted to confirm these findings.
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Affiliation(s)
- Hani Haytham Mawardi
- Department of Oral and Diagnostic Sciences, King Abdul-Aziz University – Faculty of Dentistry, Jeddah, Saudi Arabia
| | - Soulafa Adnan Almazrooa
- Department of Oral and Diagnostic Sciences, King Abdul-Aziz University – Faculty of Dentistry, Jeddah, Saudi Arabia
| | - Siraj Ahmed Dakhil
- Department of Endodontics, King Abdul-Aziz University – Faculty of Dentistry, Jeddah, Saudi Arabia
| | - Ali Anwar Aboalola
- Department of Maxillofacial Surgery and Diagnostic Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Dental Services, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
| | | | - Rawah Talal Eshky
- Department of Preventive Dental Sciences, Taibah University – College of Dentistry, Medina, Saudi Arabia
| | | | - Mohammed Haytham Mawardi
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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Tan SK, Cooper ME. Is clinical trial data showing positive progress for the treatment of diabetic kidney disease? Expert Opin Emerg Drugs 2023; 28:217-226. [PMID: 37897430 DOI: 10.1080/14728214.2023.2277762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/27/2023] [Indexed: 10/30/2023]
Affiliation(s)
- Seng Kiong Tan
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Diabetes Centre, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Mark E Cooper
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
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Tuttle KR, Bosch-Traberg H, Cherney DZI, Hadjadj S, Mosenzon O, Rasmussen S, Bain SC. The authors reply. Kidney Int 2023; 104:619. [PMID: 37599024 DOI: 10.1016/j.kint.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/12/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA; Nephrology Division, Kidney Research Institute, Seattle, Washington, USA; Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA.
| | - Heidrun Bosch-Traberg
- Medical and Science Department, NovoNordisk A/S, Medical and Science, Søborg, Denmark
| | - David Z I Cherney
- Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Samy Hadjadj
- Département d'Endocrinologie, Diabétologie et Nutrition, Nantes Université, l'Institut du Thorax, Nantes, France
| | - Ofri Mosenzon
- Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Regeneron Pharmaceuticals Inc., New York, New York, USA
| | - Søren Rasmussen
- Biostatistics Department, Novo Nordisk A/S, Biostatistics, Søborg, Denmark
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30
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Xu Y, Faucon AL, Fu EL, Carrero JJ. Routine care data and the benefits of GLP1 receptor agonists on slowing kidney function decline. Kidney Int 2023; 104:618-619. [PMID: 37599022 DOI: 10.1016/j.kint.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/12/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Yang Xu
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Anne-Laure Faucon
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Epidemiology, Centre for Epidemiology and Population Health, Paris-Saclay University, Paris, France
| | - Edouard L Fu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Division of Pharmacoepidemiology and Pharmacoeconomics, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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31
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Rossing P, Bain SC, Bosch-Traberg H, Sokareva E, Heerspink HJL, Rasmussen S, Mellbin LG. Effect of semaglutide on major adverse cardiovascular events by baseline kidney parameters in participants with type 2 diabetes and at high risk of cardiovascular disease: SUSTAIN 6 and PIONEER 6 post hoc pooled analysis. Cardiovasc Diabetol 2023; 22:220. [PMID: 37620807 PMCID: PMC10463803 DOI: 10.1186/s12933-023-01949-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Semaglutide is a glucose-lowering treatment for type 2 diabetes (T2D) with demonstrated cardiovascular benefits; semaglutide may also have kidney-protective effects. This post hoc analysis investigated the association between major adverse cardiovascular events (MACE) and baseline kidney parameters and whether the effect of semaglutide on MACE risk was impacted by baseline kidney parameters in people with T2D at high cardiovascular risk. METHODS Participants from the SUSTAIN 6 and PIONEER 6 trials, receiving semaglutide or placebo, were categorised according to baseline kidney function (estimated glomerular filtration rate [eGFR] < 45 and ≥ 45-<60 versus ≥ 60 mL/min/1.73 m2) or damage (urine albumin:creatinine ratio [UACR] ≥ 30-≤300 and > 300 versus < 30 mg/g). Relative risk of first MACE by baseline kidney parameters was evaluated using a Cox proportional hazards model. The same model, adjusted with inverse probability weighting, and a quadratic spline regression were applied to evaluate the effect of semaglutide on risk and event rate of first MACE across subgroups. The semaglutide effects on glycated haemoglobin (HbA1c), body weight (BW) and serious adverse events (SAEs) across subgroups were also evaluated. RESULTS Independently of treatment, participants with reduced kidney function (eGFR ≥ 45-<60 and < 45 mL/min/1.73 m2: hazard ratio [95% confidence interval]; 1.36 [1.04;1.76] and 1.52 [1.15;1.99]) and increased albuminuria (UACR ≥ 30-≤300 and > 300 mg/g: 1.53 [1.14;2.04] and 2.52 [1.84;3.42]) had an increased MACE risk versus those without. Semaglutide consistently reduced MACE risk versus placebo across all eGFR and UACR subgroups (interaction p value [pINT] > 0.05). Semaglutide reduced HbA1c regardless of baseline eGFR and UACR (pINT>0.05); reductions in BW were affected by baseline eGFR (pINT<0.001) but not UACR (pINT>0.05). More participants in the lower eGFR or higher UACR subgroups experienced SAEs versus participants in reference groups; the number of SAEs was similar between semaglutide and placebo arms in each subgroup. CONCLUSIONS MACE risk was greater for participants with kidney impairment or damage than for those without. Semaglutide consistently reduced MACE risk across eGFR and UACR subgroups, indicating that semaglutide provides cardiovascular benefits in people with T2D and at high cardiovascular risk across a broad spectrum of kidney function and damage. TRIAL REGISTRATIONS NCT01720446; NCT02692716.
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32
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Michos ED, Bakris GL, Rodbard HW, Tuttle KR. Glucagon-like peptide-1 receptor agonists in diabetic kidney disease: A review of their kidney and heart protection. Am J Prev Cardiol 2023; 14:100502. [PMID: 37313358 PMCID: PMC10258236 DOI: 10.1016/j.ajpc.2023.100502] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 04/07/2023] [Accepted: 05/12/2023] [Indexed: 06/15/2023] Open
Abstract
Importance Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of morbidity and mortality for patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). However, testing for albuminuria among patients with T2D is substantially underutilized in clinical practice; many patients with CKD go unrecognized. For patients with T2D at high cardiovascular risk, or with established CVD, the glucagon-like peptide-1 receptor agonists (GLP1-RA) have been shown to reduce ASCVD in cardiovascular outcome trials, while potential kidney outcomes are being explored. Observations A recent meta-analysis found that GLP1-RA reduced 3-point major adverse cardiovascular events by 14% [HR, 0.86 (95% CI, 0.80-0.93)] in patients with T2D. The benefits of GLP1-RA to reduce ASCVD were at least as large among people with estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. GLP1-RA also conferred a 21% reduction in the composite kidney outcome [HR, 0.79 (0.73-0.87)]; however, this result was achieved largely through reduction in albuminuria. It remains uncertain whether GLP1-RA would confer similar favorable results for eGFR decline and/or progression to end-stage kidney disease. Postulated mechanisms by which GLP1-RA confer protection against CVD and CKD include blood pressure lowering, weight loss, improved glucose control, and decreasing oxidative stress. Ongoing studies in T2D and CKD include a kidney outcome trial with semaglutide (FLOW, NCT03819153) and a mechanism of action study (REMODEL, NCT04865770) examining semaglutide's effect on kidney inflammation and fibrosis. Ongoing cardiovascular outcome studies are examining an oral GLP1-RA (NCT03914326), GLP1-RA in patients without T2D (NCT03574597), and dual GIP/GLP1-RA agonists (NCT04255433); the secondary kidney outcomes of these trials will be informative. Conclusions and relevance Despite their well-described ASCVD benefits and potential kidney protective mechanisms, GLP1-RA remain underutilized in clinical practice. This highlights the need for cardiovascular clinicians to influence and implement use of GLP1-RA in appropriate patients, including those with T2D and CKD at higher risk for ASCVD.
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Affiliation(s)
- Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Blalock 524-B, 600N. Wolfe Street, Baltimore, MD 21287, United States
| | - George L. Bakris
- Department of Medicine, University of Chicago Medicine, Chicago, IL, United States
| | | | - Katherine R. Tuttle
- Providence Medical Research Center, Providence Health Care, Spokane, WA, United States
- Nephrology Division, Kidney Research Institute and Institute of Translational Health Sciences, University of Washington, Seattle, WA, United States
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33
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Neumiller JJ, Alicic RZ, Tuttle KR. Incorporating Evidence and Guidelines for Personalized Care of Diabetes and Chronic Kidney Disease. Semin Nephrol 2023; 43:151427. [PMID: 37857231 DOI: 10.1016/j.semnephrol.2023.151427] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Chronic kidney disease (CKD) represents a particularly challenging diabetes complication. Diabetes now is responsible for half of all cases of CKD, thus making diabetes the most common cause of kidney failure worldwide. In patients with diabetes, CKD frequently coexists with heart failure and atherosclerotic cardiovascular disease, which together are associated with marked increases in the risk of cardiovascular and all-cause mortality. Fortunately, new therapeutic agents from several classes now are available with proven benefits for kidney and heart protection when used in patients with type 2 diabetes and CKD. Agents from the sodium-glucose cotransporter-2 inhibitor, glucagon-like peptide-1-receptor agonist, and nonsteroidal mineralocorticoid-receptor antagonist classes now are considered standard of care to improve kidney, heart, and overall survival outcomes in patients with type 2 diabetes. Efforts to educate health care providers on the benefits of these therapies are critically needed to help increase their utilization and improve clinical outcomes. Care decisions should be driven by a holistic view of patient priorities and goals with consideration of a multimodal therapeutic approach to maximize heart and kidney benefits.
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Affiliation(s)
- Joshua J Neumiller
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA; Providence Medical Research Center, Providence Inland Northwest Health, Spokane, WA.
| | - Radica Z Alicic
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, WA; Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, WA; Department of Medicine, University of Washington School of Medicine, Seattle, WA; Nephrology Division, Kidney Research Institute, Institute of Translational Health Sciences, University of Washington, Seattle, WA
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