During the 85^th Scientific Sessions, a renowned researcher heralded a sea change in the treatment and management of diabetes and chronic kidney disease (CKD) from slowing progression to maintaining kidney health.

Speaking at the panel discussion, Saving Kidneys and Lives Ushers in a New Era for Kidney Diseases in Diabetes, on Sunday, June 22, Katherine R. Tuttle, MD, Executive Director for Research at Providence Inland Northwest Health and Clinical Professor of Medicine at the University of Washington, called on the community to implement strategies for CKD detection and awareness to realize “transformative benefits” from groundbreaking therapies: sodium glucose cotransporter-2 (SGLT2) inhibitors, non-steroidal mineralocorticoid antagonists (ns-MRAs), and glucagon-like peptide-1 receptor agonists (GLP-1 RAs).

Following Dr. Tuttle’s presentation, a panel of experts examined some of the logistical, cultural, and systematic challenges inherent in fulfilling the potential of these drugs.

Defined as a clinical diagnosis of albuminuria, low estimated glomerular filtration rate (eGFR) irrespective of known causes, CKD affects hundreds of millions of people across the globe and is projected to be the world’s fifth-leading cause of death by 2024, according to the most recent 2017 Global Burden of Disease Study.

The disease is closely linked to diabetes. Diabetes-related kidney disease (DKD) develops in approximately 40% of people living with diabetes and is the leading cause of CKD worldwide.

Dr. Tuttle noted that CKD, like diabetes, carries immense incidental harm. Much as living with diabetes means living with the complications of diabetes, living with CKD means running a gamut of complications—many deadly—before even reaching kidney failure.

“Our traditional focus has been that CKD leads to kidney failure—that’s true—but we now know people die on their way to kidney failure,” Dr. Tuttle said.

Likewise, Dr. Tuttle added, diabetes does not exist in isolation. Rather, it is a disease that opens multiple pathways for pathologies and complications affecting different organs and systems.

But just as diseases trigger effects throughout the body, so can therapies.

Dr. Tuttle outlined a series of successful trials of non-steroidal MRAs and GLP-1 RAs leading to these drugs being recommended as risk-based therapies for albuminuria, hyperglycemia, cardiovascular disease (CVD), and weight management.

A trilogy of trials for SGLT2 inhibitors for CKD—CREDENCE, DAPA CKD, and EMPA-KIDNEY—were all stopped early because they demonstrated clear evidence of benefit.

“When heart function improves, so does kidney function. So, we’ve essentially unlocked a kidney mechanism that is restored, or at least partially restored, to normal by giving SGLT2 inhibitors,” Dr. Tuttle said. “It’s a beautiful story of the interaction between heart and kidney that had been buried in physiology for a long time but has come back to life with this therapy.”

Pointing to the kidney-stabilization results of trials such as SUSTAIN 6 and PIONEER 6, Dr. Tuttle noted that semaglutide is the first GLP-1 RA proven to improve kidney, CVD, and survival outcomes in people with type 2 diabetes and CKD.

More successes came with FLOW, a kidney outcomes trial with once-weekly semaglutide in people with type 2 diabetes and CKD, which also stopped early after demonstrating clear, positive efficacy.

As successful as these and anticipated therapies are, Dr. Tuttle warned, several barriers—including costs, access, and adherence—threaten to undermine potential recoveries.

The panel of experts that followed Dr. Tuttle echoed her concerns about implementation, and shared ideas for improving patient care.

“It’s clear that we need more care coordination and medication coordination,” said Wendy St. Peter, PharmD, Professor in the Department of Pharmaceutical Care & Health Systems, University of Minnesota.

Jay Shubrook, DO, Professor at Touro University, noted the value of team-based care and said clinicians must build this team by communicating more directly with pharmacologists, other medical providers, and patients.

This communication should also include a familiarity with the costs of drug therapies and an ability to help patients navigate coverage and payments, added John B. Buse, MD, PhD, the Verne S. Caviness Distinguished Professor and Director of the Diabetes Care Center, University of North Carolina School of Medicine.

Patrick O. Gee, PhD, JLC, Founder and Chief Executive Hope Dealer of iAdvocate, Inc., a nonprofit focused on kidney disease, provided the example of a “nightmare” situation as a cautionary tale for when medical teams do not cooperate.

“A fight broke out between my transplant nephrologist and my endocrinologist as to who was going to manage my diabetes,” Mr. Gee said. “My nephrologist pulled me to the side and actually paid me to miss my appointment with my endocrinologist. Imagine me having to be the moderator between these two while trying to recover from my transplant.”

For Mr. Gee, this led to an important lesson he shares with anyone else living with diabetes: “You have the right, as an advocate for your health, to terminate your physician—and that’s exactly what I did.”

On-demand access to recorded presentations will be available to registered participants following the conclusion of the 85th Scientific Sessions, from June 25–August 25.