There is no denying that machine learning and artificial intelligence (AI) are very much in vogue across the healthcare landscape. AI was a key topic in the president’s address by Mark Okusa, MD, FASN, at last year’s ASN Kidney Week in San Diego. As more healthcare information becomes digital, it is tempting to get excited about the potential for data-backed tools despite the limited deployment of AI in the clinic. Creating risk models in healthcare takes more than just computing power and advanced algorithms; it requires a deep knowledge of the underlying medical problems and a tight integration with clinical
In the era of evidence-based medicine, high-quality clinical trials are the key to the development of sound practice guidelines. Many landmark trials have enabled us to make significant progress in our approach to diabetic nephropathy, the leading cause of ESKD worldwide, although we are still short of a cure. The two enduring lessons learned from these trials are that glucose control and BP control by renin-angiotensin-aldosterone system (RAAS) antagonists helps reduce the risk of diabetic kidney disease but do not entirely prevent it. The main trials that constitute the basis of this dual approach are briefly discussed here, along with
The treatment landscape of management of type 2 diabetes has changed substantially over the past few years. Before the various cardiovascular outcome trials (CVOT) for the dipeptidyl peptidase 4 (DPP-4) inhibitors, glucagon-like peptide 1 receptor analogs (GLP-1RA) and the sodium glucose co-transporter 2 (SGLT-2) inhibitors (reviewed in other articles in this issue), it was generally recommended that metformin should be the initial treatment along with lifestyle modifications for people with type 2 diabetes. The choice of second agent was left open, with little apparent benefit of one drug class over another, even in patients with known cardiovascular disease (CVD) or
The epidemic increase in the prevalence of diabetes mellitus (DM) has led to an increase in the incidence and prevalence of DM-associated complications, including diabetic kidney disease (DKD). Two major concerns in DKD are progression to ESKD and the high risk for cardiovascular morbidity and mortality. Treatments based on inhibition of the renin angiotensin system (RAS) alone have significant effects on microalbuminuria, an early marker of vascular dysfunction, but not necessarily of progressive DKD (1). Indeed, RAS inhibitors can reduce the rates of cardiovascular morbidity and mortality (2).
After a long period of very few drug choices for the management of type 2 diabetes, during the past 15 years a range of new drug classes has been developed (1). One of these is the dipeptidyl peptidase 4 (DPP-4) inhibitors, including drugs such as sitagliptin, saxagliptin, vildagliptin, alogliptin, and linagliptin.
These agents inhibit the enzyme DPP-4, which acts to degrade glucagon-like peptide-1 (GLP-1), an incretin hormone. GLP-1 triggers glucose-dependent insulin secretion, reduces glucagon release, and delays gastric emptying (2). The action of GLP-1 depends on the presence of the N-terminal amino acids, which are cleaved
Radica Z. Alicic, Emily J. Cox, and Katherine R. Tuttle
A multitude of clinical effects beyond glycemic control have placed glucagon-like peptide-1 (GLP-1) receptor agonists front and center in the fields of diabetology, cardiology, and nephrology. These incretin-based antihyperglycemic agents reduce the risk of new or worsening kidney disease and decrease the risk of cardiovascular death and atherosclerotic events (1–5). In the wake of these findings, the American Diabetes Association Standards of Care for treatment of hyperglycemia in type 2 diabetes now state that GLP-1 receptor agonists with proven cardiovascular benefits (liraglutide > semaglutide > exenatide extended release) should be added to the therapeutic regimen if
Effective, safe glycemic control is a global priority because uncontrolled diabetes contributes to a substantial burden of morbidity and mortality related to chronic kidney disease (CKD), ESKD, and cardiovascular disease (CVD) (1, 2). However, achieving this goal in patients with advanced kidney disease is complicated by evolving safety recommendations and contraindications to several existing antihyperglycemic medications when kidney function is substantially impaired (2). Amid robust evidence for inhibition of the renin-angiotensin system as the mainstay of managing diabetic kidney disease and growing attention to the significant cardiovascular, kidney, and survival benefits of sodium glucose
The outlook for people diagnosed with type 2 diabetes and chronic kidney disease today is more hopeful than it has ever been. A broad array of treatments are available, and the last decade has seen an explosion of evidence from high-quality, properly powered, randomized trials that have defined the benefits and risks of many of these treatment options.
The 2008 decision by the U.S. Food and Drug Administration (FDA) and other regulatory agencies to require the conduct of cardiovascular safety trials for all new diabetes medications (1) has directly led to the generation of evidence that can guide
If it seems like you’ve been seeing more published papers on diabetic kidney disease in recent years, you’re not mistaken. The number of DKD studies has risen rapidly and steadily over the past two decades, according to a review and meta-analysis published in the journal Medicine. And this study included a time period prior to the more recent spate of clinical trials.
More than 27,500 DKD papers were published from 2000 to 2017, reports the bibliometric analysis by Lu-Xi Zou, PhD, of Zhejian University and Ling Sun, MD, of’ Xuzhou Central Hospital, China. Their open access study provides
Accreditation organizations are independent organizations with no direct ties to a government entity. They apply to CMS for deemed status and must report survey information to CMS.
In February 2018, Congress passed a law allowing deemed status for ESRD facilities, which had been specifically prohibited by the 1972 law that provided Medicare coverage for ESRD. The 2018 law allowed accreditation organizations to apply to the Centers for Medicare and Medicaid Services (CMS) for deemed status. The following is an interview with Glenda Payne, an owner of National Dialysis Accreditation Commission (NDAC), the first accreditation organization to earn deemed status from