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Content Update

May 10, 2019

Beneficial Cardiorenal Effects of SGLT2 Inhibitors: Type 2 diabetes (T2D) is a significant risk factor for additional health problems, such as chronic kidney disease (CKD) and cardiovascular events. Current guidelines suggest use of an SGLT2 inhibitor or GLP-1 agonist for T2D patients with established atherosclerotic cardiovascular disease (ASCVD) or CKD but do not address cardiorenal outcomes in patients without ASCVD or CKD. Three recent clinical trials provide evidence of cardiorenal benefits of SGLT2 inhibitors in patients with T2D. The two drugs evaluated, canagliflozin and dapagliflozin, prevented and reduced hospitalizations due to heart failure and progressive kidney disease. The studies included patients with and without prior cardiovascular events, as well as varying levels of kidney function, and found no heterogeneity. Together with the known beneficial effects of empagliflozin, this new information indicates that cardiorenal benefits are a class effect of SGLT2 inhibitors.

Content Update

Jan. 14, 2019

New Evidence Supports Use of High-Dose IV Iron to Treat Anemia in Patients Undergoing Maintenance Hemodialysis: A randomized controlled trial of high-dose vs. low-dose IV iron sucrose in adults with end-stage renal disease on maintenance hemodialysis found that high-dose iron was noninferior to low-dose iron with respect to the primary composite outcomes of myocardial infarction, nonfatal stroke, hospitalization for heart failure, or death from any cause. The median monthly iron dose was 264 mg in the high-dose group and 145 mg in the low-dose group. The cumulative dose of erythropoiesis-stimulating agents (ESAs) was 19.4% lower in the high-dose group. Patients who received high-dose iron required fewer blood transfusions and lower ESA doses to maintain target Hb concentrations, indicating an ESA dose-sparing effect. Although these results are promising, further study is needed to determine optimal iron dosing, generalizability to other iron formulations, and long-term effects of high-dose iron.

LEARNING OBJECTIVES

LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. List the risk factors that increase susceptibility for chronic kidney disease (CKD).

  2. Explain the mechanisms associated with progression of CKD.

  3. Outline the desired outcomes for treatment of CKD.

  4. Develop a therapeutic approach to slow progression of CKD including lifestyle modifications and pharmacologic therapies.

  5. Identify specific consequences associated with CKD.

  6. Design an appropriate therapeutic approach for specific consequences associated with CKD.

  7. Recommend an appropriate monitoring plan to assess the effectiveness of pharmacotherapy for CKD and specific consequences.

  8. Educate patients with CKD about the disease state, the specific consequences, lifestyle modifications, and pharmacologic therapies used for treatment of CKD.

INTRODUCTION

The kidney is made up of approximately 2 million nephrons that are responsible for filtering, reabsorbing, and excreting solutes and water. The kidney has three primary functions: excretory (excrete fluid, electrolytes, and solutes); metabolic (metabolize vitamin D and some drugs, such as insulin and some beta-lactams); and endocrine (produce erythropoietin [EPO]). As the number of functioning nephrons declines, the primary functions of the kidney that are affected ...

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