Diabetic kidney disease (DKD) is among the most frequent complications of diabetes, with approximately 50% of patients with end-stage renal disease attributed to diabetes in developed countries, according to the National Institutes of Health (NIH), and prevention and treatment of DKD is currently based on optimal glucose and blood pressure control.
Three experts will discuss new approaches to DKD treatment in Beyond Antihyperglycemic and Antihypertensive Agents for Diabetic Kidney Disease on Monday, June 26, at 3:15 p.m. PT in Room 28 of the San Diego Convention Center. This symposium also will be available via livestream for registered meeting participants.
Incorporation of novel kidney-protective and cardio-protective agents into standard diabetes care is transforming disease management from an approach centered on glycemic control to one centered on risk reduction, said Christine Limonte, MD, Assistant Professor in the Division of Nephrology at the University of Washington. She will discuss whether diabetes care professionals are following guidelines in using these new therapies to protect against DKD.
These agents—sodium-glucose cotransporter-2 (SGLT 2) inhibitors, glucagon-like peptide 1 (GLP-1) receptor agonists, and non-steroidal mineralocorticoid receptor antagonists—have been incorporated into guidelines for standard diabetes care by professional societies for endocrinology, nephrology, and cardiology. Understanding current use patterns of these agents and the factors that may be hindering their implementation is essential to improving kidney and cardiovascular outcomes in people with diabetes, she said.
“I will review how the current clinical use of these agents diverges from professional society guideline recommendations and will draw attention to population disparities in their use,” Dr. Limonte said. “I will also discuss barriers to the broad implementation of these novel agents and potential strategies for addressing them.”
She hopes to communicate the importance of the need for concerted, holistic effort across medical specialties toward improving screening for chronic kidney disease in diabetes and increasing knowledge among providers about novel agents.
Recently, therapies such as SGLT2 inhibitors and non-steroidal mineralocorticoid receptor antagonists have emerged to prevent the progression of DKD and cardiovascular adverse events in patients with proteinuric DKD, said Ashish Verma, MD, FASN, Assistant Professor of Medicine, Renal Section, Boston University Chobanian & Avedisian School of Medicine.
Dr. Verma will speak about future therapies targeting mitochondrial dysfunction and oxidative stress to mitigate DKD. System biology methods have allowed the elucidation of signaling pathways and networks involved in the progression of DKD that have not been appreciated, he said. He will discuss therapies that target different signaling pathways, like Janus kinase/signal transducers and activators of transcription (JAK/STAT), transforming growth factor beta (TGF-beta), and intracellular Nnicotinamide adenine dinucleotide-positive (NAD+) levels. He also will provide a closer look at a phase 2 clinical trial studying NAD+ supplementation in patients with DKD.
“We still have a long way to go to have therapies for patients with DKD phenotypes without proteinuria,” Dr. Verma said. “The more therapies we will have for DKD, the less risk patients will have for end-stage kidney disease.”
Kalie L. Tommerdahl, MD, Assistant Professor of Pediatrics-Endocrinology, University of Colorado School of Medicine, will address new developments in the treatment of children and adolescents with diabetes.