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September 29, 2019
Veverimer: A Promising Investigational Agent for Long-Term Treatment of Metabolic Acidosis in Chronic Kidney Disease: Veverimer is an oral non-absorbed acid binder that sequesters hydrochloric acid in the gastrointestinal tract, preventing its absorption and thereby raising serum bicarbonate concentrations. In a randomized one-year clinical trial in CKD patients with metabolic acidosis, patients taking veverimer achieved greater increases in serum bicarbonate and were more likely to achieve increases ≥4 mmol/L and/or into the reference range than patients taking placebo. Overall, veverimer was well tolerated, with adverse event rates similar to placebo. Veverimer effectively raises serum bicarbonate levels in stage IIIb–IV CKD patients via a sodium-independent mechanism. If approved by the U.S. FDA, it may provide a new option for patients with severe CKD and sodium- or volume-dependent comorbidities who may otherwise require renal replacement therapy for acidosis control.
July 26, 2019
New KDOQI US Commentary on the 2017 ACC/AHA Hypertension Guideline: The Kidney Disease Outcomes Quality Initiative (KDOQI) commented on the recommendations of the 2017 American College of Cardiology and the American Heart Association (ACC/AHA) Hypertension guidelines, related to individuals at risk of chronic kidney disease (CKD) or with non-dialysis dependent CKD. The KDOQI work group is supportive of a systolic blood pressure (SBP) goal of <130 mmHg for individuals with CKD stages 1-3, with an exception for those with a previous stroke where the SBP goal is modified to <140 mmHg. Any first-line antihypertensive agent (a thiazide, angiotensin-converting enzyme (ACE) inhibitor, angiotensin II receptor blocker (ARB) or calcium channel blocker (CCB)) may be initiated to treat hypertension, but an ACE inhibitor or ARB may be preferable if moderate-to-severe albuminuria is present. Due to lack of evidence, the group provides no comments on the optimal blood pressure management in CKD stage 4-5, but highlights the urgent research need in this area.
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.