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Acute kidney injury (AKI) can be a complication seen in patients with type 2 diabetes mellitus (T2DM) who are on glucose-lowering agents. Diabetic kidney disease is a major cause of chronic kidney disease, and the presence of diabetes is an independent risk factor for both AKI and poor clinical outcomes.
Sodium glucose co-transporter-2 (SGLT2) inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors, and glucagon-like peptide-1 receptor agonists (GLP-1RAs) are new classes of glucose-lowering agents for treating T2DM. However, little is known about the comparative effects of these three glucose-lowering agents on AKI.
Network meta-analysis is a method that enables comparison of these three
End-stage kidney disease (ESKD), which requires kidney replacement therapy (KRT) or comprehensive conservative management, burdens patients, their families and caregivers, and the healthcare system. The selection of the type of KRT for individual patients is therefore decided based on not only each patient’s medical condition but also his or her family support, social and financial resources, and the healthcare resources he or she receives.
Most decisions regarding KRT have been based on physician- or healthcare system/stakeholder-centered determinations rather than “patient-centered” choices, and thus many patients with ESKD feel insufficiently involved in their treatment options. However, it is also important to
Patients taking renin-angiotensin system inhibitors (RASIs) have slower progression of kidney disease than those taking calcium channel blockers (CCBs), according to a “real-world” study in the
With the use of 2007−2017 data from the Swedish Renal Registry, researchers identified two groups: 2458 new users of RASIs and 2345 patients starting treatment with CCBs. At a median follow-up of 4.1 years, rates of KRT initiation, death from any cause, and major adverse cardiovascular events (MACEs) were compared between the two treatment groups. Patients with stage 3 CKD taking the same medications were studied as
Severe acute respiratory coronavirus 2 (SARS-CoV-2) uses angiotensin-converting enzyme 2 (ACE2) to enter host cells. Early in the pandemic, several basic science studies were often cited and suggested that ACE inhibitors (ACEis) and angiotensin receptor blockers (ARBs) may have an effect to increase the abundance of ACE2 (
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has had a significant impact on transplantation, with mortality rates in transplant recipients ranging from 10% to 20% (
Both
The past decade has seen continual progress in the diagnosis and treatment of primary glomerular diseases. The discovery of disease-causing autoantibodies in membranous nephropathy (MN) and mutations in podocyte genes in focal segmental glomerulosclerosis (FSGS), together with the availability of modern immunosuppressive drugs, has provided new avenues for individualized therapy, and several important studies have been published in the past several years.
Whereas antibodies to the phospholipase A2 receptor (PLA2R) were discovered over 10 years ago and have entered mainstream practice, several novel antigens surfaced in the nephrology literature in 2020 (
Recently, the world of nephrology rejoiced at another “positive” trial in nephrology: Dapagliflozin in Patients with Chronic Kidney Disease (DAPA-CKD) (
In 2020, acute kidney injury (AKI) came to the forefront during the COVID-19 pandemic as nephrologists struggled to understand the pathophysiology of COVID-19-associated AKI and to provide timely and effective nondialytic and dialytic care to the large volume of patients who overwhelmed healthcare facilities. Recently, personal communications among the members of the ASN COVID-19 Response Team have indicated that the rate of AKI requiring kidney replacement therapy (KRT) in the current wave of the pandemic is lower than that experienced in the spring. The decreasing incidence of severe AKI was also documented in a study of >5000 veterans who were
1. Centers for Medicare & Medicaid Services.
2. Sachdeva M, et al. Home dialysis in the time of COVID-19: Reflections on rapidly changing policies [published online ahead of print November 23, 2020].
3. Loupy A, et al. Organ procurement and transplantation during the COVID-19 pandemic.
4. National Institutes of Health. COVID-19 Treatment Guidelines: Corticosteroids. November 3, 2020.
Sodium glucose cotransporter-2 (SGLT2) inhibitors currently approved by the US Food and Drug Administration include empagliflozin (Jardiance), canagliflozin (Invokana), dapagliflozin (Farxiga), and ertugliflozin (Steglatro). Combination formulations are also available: empagliflozin/metformin (Synjardy), canagliflozin/metformin (Invokamet), dapagliflozin/metformin (Xigduo XR), and ertugliflozin/metformin (Segluromet).
For this year’s Kidney Watch, we look once again at the diabetic kidney disease (DKD) space as these agents enter the world of nephrology (
On September 30, 2020, the Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (
