Recent Advances in the Management of CKD – BC Renal PWR 10.01.2021

Dr. David Wheeler presents his talk, “Recent Advances in the Management of Chronic Kidney Disease: New Therapies to improve patient outcomes,” as part of BC Renal’s Province-wide rounds.

0:04:00 - SGLT-2 Inhibitors
He begins by providing a case example of a patient with diabetes who is referred to a nephrologist. He discusses what medication might be appropriate for this patient, noting the RAAS inhibition has been found to slow the progression of diabetic kidney disease, and ACE inhibitors offer similar benefits. He highlights data from the CREDENCE study, which found that Canagliflozin yields significant benefits in terms of end stage renal disease, doubling of serum, and renal or cardiovascular death. Dr. Wheeler also highlights data from the DAPA-CKD study, which explored the effects of dapagliflozin and found similarly beneficial results for patients with and without type 2 diabetes.

0:26:00 – Nonsteroidal mineralocorticoid receptor antagonists (MRAs)
Dr. Wheeler goes on to discuss results from the FIDELIO-DKD study, which explored the use of Finerenone in patients with CKD and type 2 diabetes, with a focus on kidney and cardiovascular endpoints. Cardiovascular benefits were found was irrespective of SGLT-2 inhibitor use at baseline and during the trial.

0:30:00 – Summary and Q&A
He notes that these are great new therapies, but treatment may be limited by hyperkalemia. He doubles back to the patient in the case example he described at the beginning of the talk and explains which medication would be ideal for them. He takes questions from the audience.

Learning Objectives:
To understand the new evidence from clinical trials of SGLT2 inhibitors and mineralocorticoid receptor antagonists in patients with chronic kidney disease.
To consider the safety issues relating to the use of these agents in patients with reduced eGFR.
To discuss how these new agents may be integrated into care pathways for patients with chronic kidney disease in primary and secondary care settings.
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