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Treatment goals, benefits in CKD, CVD may need revisiting
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PHILADELPHIA — Lack of data may lead to changes in treatment goals and benefits for patients with cardiovascular disease and chronic kidney disease in addition to diabetes, according to a speaker here.
“We are missing a lot of important data. In diabetic kidney disease, we don’t have any randomized clinical trials examining different [blood pressure] goals on renal outcomes, and there are also no trials that look at the impact of reducing proteinuria, independent of BP, and renal disease progression in these patients,” Matthew R. Weir, MD, director of the nephrology division, at the University of Maryland School of Medicine, said.
Weir offered these considerations for new therapies in this patient population:
- Are therapies complementary with renin-angiotensin-aldosterone system blockers?
- Is the effect only seen if systolic BP is 110 mm Hg, 120 mm Hg, 130mm Hg or higher?
- Does the effect persist after the drug is discontinued?
- Is the change in albuminuria a sufficient surrogate measure, or is a visible stabilization of estimated glomerular filtration rate needed?
- Are they incremental to intensive traditional risk factor modification?
Understanding the mechanism of glucose-lowering agents is “still very poor,” Weir said.
“Mechanistically, we need to learn more about this because we are often interdigitating these therapies with other known therapies that may be beneficial for both the heart and even the kidneys,” Weir said.
“The bottom line is we still need to intensify our traditional treatment efforts. ... The playing field is now changing for the first time in several years with some of these newer clinical trials, and I think the Standards of Care could change in the future as a result. Ultimately, we will need to evaluate the benefit/risk ratio both traditional and newer therapies,” he concluded. – by Janel Miller
Reference:
Weir MR. Predicting, preventing and managing CKD and CVD progression in people with T2DM: How to improve upon traditional approaches. Presented at: Heart in Diabetes Clinical Education Conference; July 13-15, 2018; Philadelphia.
Disclosure: Weir reports he is a scientific advisor to Akebia, Astra, Bayer, BI, Boston Scientific, Janssen, Lexicon, MSD, Relypsa and Vifor, and he receives grant funding from the National Institute of Diabetes and Digestive and Kidney Diseases and National Heart, Lung, and Blood Institute.