The link between heart function or failure and kidney function or failure is considerable.
“In the setting of heart failure, the most important determinant of survival is kidney function; and vice versa in patients with kidney disease, the most important determinant of survival is cardiac status,” said Peter A. McCullough, MD, MPH, Professor of Medicine and Vice Chair of Internal Medicine at Baylor University Medical Center. “That really is the essence of cardiorenal syndrome, and so we’re very keen on therapies that favorably affect both systems. And we’re very keen on clinical strategies where we can leverage this understanding for better outcomes.”
Dr. McCullough will discuss the pathophysiology of cardiorenal syndrome during the symposium Cardiorenal–Metabolic Axis in Diabetes, which begins at 8:00 a.m. CT Sunday, June 14, during the Virtual 80th Scientific Sessions.
“Diabetes-dedicated professionals can be very successful at managing diabetes, but they want to be equally successful in reducing the risks of heart failure hospitalizations, myocardial infarctions, stroke, and cardiovascular death,” Dr. McCullough said. “They want to be equally successful in reducing the progression of kidney disease and reducing the chances of patients ending up on dialysis, or at least forestalling dialysis to the point where it’s no longer really a clinical issue in someone’s life. That kind of dream is now possible with modern therapy.”
Two of the symposium’s speakers will review landmark trials focused on renal outcomes. Biykem Bozkurt, MD, PhD, FHFSA, FACC, FAHA, will review Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF), and Katherine R. Tuttle, MD, FACP, FASN, FNKF, will review Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE).
“The CREDENCE trial was the first trial of an SGLT2 (sodium-glucose transport protein 2) inhibitor that specifically enrolled people with diabetes and chronic kidney disease and had kidney disease outcomes as the primary endpoints for the trial,” said Dr. Tuttle, Professor of Medicine at the University of Washington and Executive Director for Research at Providence Health Care. “This was the one that really provided the definitive evidence for kidney protection.”
Kidney disease occurs in nearly half of people with type 2 diabetes and a third of people with type 1 diabetes. SGLT2 inhibitors have been shown to significantly reduce the progression from kidney disease to kidney failure and reduce the risk of cardiovascular death.
SGLT2 inhibitors are not potent glucose-lowering agents and their potency goes down as kidney function goes down, Dr. Tuttle explained. However, by protecting the kidneys, they reduce major rates of complications, such as cardiovascular death and kidney failure.
Another speaker, Melissa L. Magwire, RN, MSN, CDE, will review the impact of blood pressure, lipid and glycemic control on cardiovascular outcomes. The heart and kidneys should be approached as one system rather than separately, she said.
“These are not singular diseases,” said Dr. Magwire, Program Director of the Cardiometabolic Center Alliance at Saint Luke’s Health System. “It’s not diabetes on its own. It’s not atherosclerotic cardiovascular disease on its own. It’s not renal on its own. They really are all tied in together.”
Jennifer B. Green, MD, will examine how guidelines for keeping people with diabetes and cardiovascular and/or renal complications healthy have evolved in response to recent trial results. She made the case that events like the Virtual 80th Scientific Sessions remain essential despite the ongoing novel coronavirus pandemic.
“Translation of evidence to practice might be even more important in the era of COVID-19,” said Dr. Green, Professor of Medicine at Duke University School of Medicine. “There’s good evidence that patients are delaying care—either routine care or care for acute complications—so making sure that we are providing robust, guideline-based care to our patients at home should be a priority for all of us so our patients are able to remain as healthy as they can.”