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VIDEO: Improving treatment options yielding better results for comorbidities in patients with diabetes
WASHINGTON – There are a number of good options for managing kidney disease and hyperkalemia in patients with diabetes, but clinicians must be aware of contraindications, said George L. Bakris, MD, Director of the ASH Comprehensive Hypertension Center at the University of Chicago Medicine, at the American College of Physicians Internal Medicine Meeting.
Kidney disease is a significant comorbidity for patients with diabetes, resulting in an average reduction in kidney function of 5-8 ml/min/year, Bakris said. However, appropriate use of ACE inhibitors and angiotensin receptor blockers, and effective management of cholesterol glucose, this rate is 2 ml/min/year for many patients.
“We haven’t stopped it, but we have made a significant impact in it, he said.
ACE inhibitors and angiotensin receptor blockers should be used in patients with advanced kidney diseases, however they are not appropriate for use in normotensive patients with diabetes, as they have not been shown to have a protective effect, and may be associated with significant side effects, Bakris said.
Patients with estimated glomerular filtration rates (eGFR) below 30-45 mL/min/1.73 m2 are considered to be at very high risk for developing hyperkalemia and require treatment. Patients with eGFR greater than 60 mL/min/1.73 m2 are at low risk, but should avoid NSAIDs, should not be prescribed high doses of ACE inhibitors or angiotensin receptor blockers, and should be counseled to avoid high potassium food, such as tomatoes, potatoes and bananas, Bakris said.
Newer treatment options will assist in the management of hyperkalemia, with patiromer (Veltassa, Relypsa) approved late last year, and ZS-9 (sodium zirconium cyclosilicate, ZS Pharma Inc.) currently under FDA review, and expected to be available by the end of the year, Bakris said. These potassium binding agents are expected to replace kayexalate as preferred therapies, he added.