VIDEO: New therapies revolutionize CKD care

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I think, you know, this is actually a really exciting time in terms of the treatment for chronic kidney disease. You know, this is one of the first times that in probably about 30 years that we have therapies that sort of apply to all patients who have chronic kidney disease. You know, there've been a lot of developments in terms of specific kidney diseases and things like that. But honestly over the last couple of years we've had a couple of really groundbreaking studies that sort of looked at interventions that applied to, again, the entire CKD population. You know, like I said, this is the first time in probably 30 years that we've had that kind of broad based intervention.

You know, probably the biggest development, like I said, in the last couple years has been the recognition of the use of drugs called SGLT2 inhibitors, sodium glucose co-transporter type two inhibitors. So these inhibitors were originally developed for the treatment of diabetics. So the medications basically just not to get down and dirty into the physiology too much, but you know, you have a million little filters in each kidney, the blood goes by, the filter, whatever passes through the filter becomes urine. But obviously a lot ends up in that early stages of urine that has to be drawn back out of the urine. And one of those substances is glucose. And what these medications do is it prevents that reabsorption of glucose.

So basically pee out extra glucose. So that was, you know, the initial study sort of looked at this class of medications in terms of efficacy for the treatment of diabetes. You know, if your blood sugar's high, you lose extra glucose, that helps the diabetics in general. But what we've found over probably the last four or five years is that these medications basically block that reabsorption of the glucose. So you end up working with more glucose in the urine. What they found is as that extra substance, if you will, goes through the kidney, it triggers the kidney a response called the tubule-glomerular feedback.

But basically the long and short of it is that extra substance that goes through the urine, sort of causes the filter to relax and decreases the pressure in those filters, because the pressure inside the filter is one of the main drivers for scar formation in the kidney, so these medications, as they cause those filters to relax, sort of protects the kidneys from further injury. And that's basically like a final common pathway for just about any form of kidney disease, whether it's due to diabetes, hypertension, vascular disease, you name it, autoimmunity conditions. Any of those can really benefit from that decompression of the kidney filters. So this is really changing how we practice nephrology in terms of the widespread utilization of these medications.