When Nephrology Meets Endocrinology

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One of the sessions that caught my attention at the 2017 NKF
Spring Clinical Meeting in Orlando, Florida was “Beyond RAAS Inhibitors: Novel
Drugs for Diabetic Kidney Disease” by Katherine Tuttle,MD. There was a lot of hype around the SLGT-2
inhibitors
at this year’s NephMadness. 
Even though they lost in the semifinal round, many participants felt
that it was one of the sleeper teams that could win it all. 
If I had to give Dr. Tuttle’s session a name I would call it
“When Endocrinology Meets Nephrology”, because of the topic and the speaker’s
background as an endocrinologist and a nephrologist. She went through the past,
present and future in diabetic nephropathy therapies. Some of the information
that struck me was the fact that 10% of the patients with diabetic kidney
disease progress to ESRD (dialysis and kidney transplant) and 90% die of other
causes (CVD or infection) without reaching ESRD. This means we still need to
make some improvements in cardiovascular disease prevention among diabetic
patients.


During this presentation, Dr. Tuttle referred to the “Empagliflozin
and Progression of Kidney Disease in Type 2 Diabetes
” and the LEADER
trial  which are two of the most
important trials looking at SGLT-2 inhibitors and GLP-1 analogues. For those
who are not familiar, I want to share a visual abstract to give a quick and
clear idea about the EMPA-REG OUT COME trial. 
With the EMPA-REG data already showing improvement in kidney
function, Dr. Tuttle left us with great news that GLP-1 receptor agonists have
ongoing trials looking at renal outcomes: 
–         
Participants with type 2 diabetes and eGFR >
60 ml/min
–         
Lixisenatide vs basal insulin
–         
Measured GFR and renal plasma flow, albuminuria, inflammatory
biomarkers
–         
Participants with type 2 diabetes and CKD stages
3-4
–         
Dulaglutide vs basal insulin
–         
HbA1C, 8-point self monitoring for blood
pressure, hypoglycemia
–         
eGFR, albuminuria, ESRD and CVD events
The future looks bright for both of these novel agents for
diabetes, in addition to hopeful positive effects on kidney and cardiovascular
outcomes as well!
– post by Dr. Pablo Garcia, Nephrology Social Media Collective Intern

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