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Edgar V. Lerma

Patients and physicians have new choices for treating hyperkalemia in 2016. The FDA recently approved patiromer calcium sorbitex (Relypsa, Redwood City, CA) and will likely reach a decision on sodium zirconium cyclosilicate (ZS-9) (ZS Pharma, San Mateo, CA) this year.

Recent approval of the new heart failure medication EntrestoTM (LCZ696; sacubitril/valsartan) has reinvigorated an interest by the health care community to optimize treatment regimens that include life-saving therapies such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). These agents belong to a larger category of drugs known as renin-aldosterone-angiotensin-system (RAAS) inhibitors, and are known in some patients

Edgar V. Lerma

Advancement in hypoxia-inducible factor (HIF) stabilizers for treating anemia of chronic kidney disease (CKD) is a prime area to watch in 2020.

Anemia is a major complication of CKD. Defining anemia as serum hemoglobin ≤12 g/dL in women and ≤13 g/dL in men, one study found that with an estimated 14% of the US adult population having CKD during 2007–2010, anemia was twice as prevalent in people with CKD (15.4%) compared with the general population (7.6%). Anemia prevalence increased with stage of CKD, from 8.4% at stage 1 to 53.4% at stage 5 (1). Among 22.8% of CKD

Edgar V. Lerma

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Appropriate and timely management of hyperkalemia is an important component of a nephrology practice. Hyperkalemia can result from increased K+ intake in the diet, impaired distribution between intracellular and extracellular spaces, and decreased kidney excretion. Risk factors associated with the development of hyperkalemia include older age, male sex, diabetes, underlying kidney disease, as well as intake of certain medications that affect the renin angiotensin aldosterone system (RAAS).

Prior to the advent of sodium zirconium cyclosilicate (SZC) and patiromer, only sodium polystyrene sulfonate (SPS) was available as a potassium exchange resin (1). Approved by the

Michelle G.A. Lim and Edgar V. Lerma

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 (1).

On September 30, 2020, the Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2) was published. There continues to be increased discussion surrounding the

Edgar V. Lerma and Helbert Rondon-Berrios

The conventional first-line therapy for any patient presenting with hypotonic hyponatremia due to SIAD (syndrome of inappropriate antidiuresis) is that of fluid restriction. However, we recognize that fluid restriction alone does not always work. The Expert Panel Recommendations on Diagnosis, Evaluation, and Treatment of Hyponatremia, published in 2013, identified certain criteria that are predictive of which patients are less likely to respond to fluid restriction alone (1). These include a urine-to-plasma electrolyte ratio ([urine Na + urine K]/plasma sodium [PNa]) >1 or a high urine osmolality (>500 mOsm/kg H2O).

It has been suggested that those patients

Edgar V. Lerma and Michelle G.A. Lim

Diabetic kidney disease (DKD) has been in the forefront of industry publications during these challenging yet exciting times. With the advent of recognition of sodium glucose co-transporter 2 (SGLT2) inhibitors and their particular outcome benefits in patients with type 2 diabetes who are particularly prone to developing complications related to cardiovascular (CV) disease, there has been revitalization of our understanding of the mineralocorticoid receptor and the central role it plays in inflammation and fibrosis involving the kidneys.

A nonsteroidal mineralocorticoid antagonist—finerenone—was highlighted in several major randomized controlled trials (1, 2) that enrolled adult patients with chronic

Brendon L. Neuen, Edgar V. Lerma, and Joel Topf

Our top area to watch for 2019 is the advent of sodium glucose cotransporter 2 (SGLT2) inhibitors, oral anti-hyperglycemic agents that have been recently approved for the treatment of type 2 diabetes mellitus (T2DM).

Aside from their glucose-lowering effect, SGLT2 inhibitors have also been shown to reduce blood pressure, body weight, and albuminuria. These multiple beneficial metabolic effects have contributed, at least in part, to reductions in cardiovascular and renal outcomes observed in large cardiovascular outcome trials. As a result, the American Diabetes Association’s 2019 Standards of Medical Care in Diabetes (1) now recommends SGLT2 inhibitors as second-line

Caitlyn Vlasschaert, Jade M. Teakell, Harish Seethapathy, Shuhan He, and Edgar V. Lerma

Emoji are text-embedded pictograms used to communicate and provide context in written electronic messages. Billions of emoji are sent worldwide every day (1). There currently exist anatomical heart, brain, and lung emoji but no kidney emoji. Chronic kidney disease (CKD) affects 1 in every 10 people (2), yet kidney health literacy is limited in the general population (3) and even in those with CKD (4). The introduction of a kidney emoji would help jumpstart a global conversation about kidney health in the general population. Here are the steps needed to transform this