POCN's Chronic Kidney Disease Center of Excellence

Author: Kimberly Cantillon,

  • Albuminuria: A Key Marker of Health Vulnerability and Increased Hospitalization Risk in Older Adults

    Albuminuria: A Key Marker of Health Vulnerability and Increased Hospitalization Risk in Older Adults

    Albuminuria is common among older adults, particularly those with diabetes, and is linked to increased hospitalization rates. In a study of 3,110 adults with a mean age of 78 years, 21% had albuminuria at baseline. Over a median follow-up of 9.75 years, hospitalization rates were significantly higher in participants with albuminuria (65.85 per 100 patient-years) compared to those without (37.55 per 100 patient-years). Adjusted analyses showed that albuminuria was associated with a 39% higher risk of all-cause hospitalization and a 56% higher risk of prolonged hospital stays. These associations were consistent regardless of diabetes status.

    Albuminuria was also linked to hospitalizations across a range of conditions, including circulatory, endocrine, genitourinary, respiratory, and injury-related illnesses. These findings suggest that albuminuria is a marker of generalized health vulnerability in older adults, highlighting its potential role in identifying individuals at higher risk for various age-related diseases.

    Reference: Barzilay JI, Buzkova P, Shlipak MG, Bansal N, Garimella P, Mukamal KJ. Hospitalization Rates in Older Adults With: The Cardiovascular Health Study. J Gerontol A Biol Sci Med Sci. 2020;75(12):2426-2433. doi: 10.1093/gerona/glaa020.

  • Higher Rates of Cardiac Dysfunction Found in Patients With Chronic Kidney Disease

    Higher Rates of Cardiac Dysfunction Found in Patients With Chronic Kidney Disease

    Researchers of a study investigating cardiac structure and function in patients with chronic kidney disease (CKD) found a higher prevalence of left ventricular (LV) hypertrophy and diastolic dysfunction compared with healthy controls. Among 825 outpatients with CKD and 175 matched controls, 9% of patients with CKD exhibited LV hypertrophy compared to 1.7% of controls, with hypertrophy independently associated with increased urine albumin-to-creatinine ratio. Additionally, patients with CKD with lower estimated glomerular filtration rate (<60 ml/min/1.73m²) had significantly reduced global longitudinal strain, while systolic function, measured by left ventricular ejection fraction, was slightly lower in patients with CKD compared to controls.

    The study also revealed that diastolic dysfunction was more common in patients with CKD (55%) than in controls (34%). Despite a lower prevalence of hypertrophy compared to previous studies, similar findings were reported for systolic and diastolic dysfunction. The variations in cardiac remodeling among CKD patients may be influenced by treatment, demographics, comorbidities, and underlying renal pathology, emphasizing the complex relationship between CKD and cardiovascular health.

    Reference: Landler NE, Olsen FJ, Christensen J, et al. Associations Between Albuminuria, Estimated GFR and Cardiac Phenotype in a Cohort with Chronic Kidney Disease: The CPH-CKD ECHO Study. J Card Fail. 2022;28(11):1615-1627. doi: 10.1016/j.cardfail.2022.09.002.

  • Elevated Urine Albumin-to-Creatinine Ratio Found to Increase Heart Failure Risk in Patients With Type 2 Diabetes

    Elevated Urine Albumin-to-Creatinine Ratio Found to Increase Heart Failure Risk in Patients With Type 2 Diabetes

    A study aimed to explore the relationship between urine albumin-to-creatinine ratio (uACR) and new-onset heart failure (HF) in patients with type 2 diabetes (T2D). Researchers analyzed data from 9,287 Chinese participants with T2D without prior HF, dividing them into three groups based on uACR levels: normal, microalbuminuria, and macroalbuminuria. Over a median follow-up of 4.05 years, 216 cases of new-onset HF were recorded. The study found that higher uACR levels were associated with a significantly increased risk of HF, with progressively higher risk from microalbuminuria to macroalbuminuria. Even a 1 standard deviation increase in ln(uACR) was linked to a notable rise in HF risk. These findings were consistent across different subgroups, such as sex, blood pressure, and kidney function.

    The study concluded that elevated uACR, even at levels below the normal range, is an independent risk factor for new-onset HF in patients with T2D. Additionally, incorporating uACR into existing HF risk models improved their predictive accuracy. This suggests that monitoring uACR could be valuable for early detection and prevention of HF in T2D populations.

    Reference: Tao J, Sang D, Zhen L, et al. Elevated urine albumin-to-creatinine ratio increases the risk of new-onset heart failure in patients with type 2 diabetes. Cardiovasc Diabetol. 2023;22(1):70. doi: 10.1186/s12933-023-01796-6.

  • Albuminuria in Heart Failure: A Strong Predictor of Risk and Outcomes

    Albuminuria in Heart Failure: A Strong Predictor of Risk and Outcomes

    Albuminuria is prevalent in patients with heart failure (HF) and independently associated with increased risk of adverse outcomes. The causes and mechanisms linking albuminuria to HF progression and outcomes are not well understood. However, interventions that reduce albuminuria may potentially lower the risk of developing HF or prevent the progression of existing HF. Chronic kidney disease is an independent risk factor for HF and is associated with poor prognosis. Reduced estimated glomerular filtration rate and albuminuria are both independent predictors of HF exacerbation and mortality, with albuminuria reflecting structural kidney damage and glomerular hemodynamics.

    Studies show that higher baseline positive symptom scores in patients with treatment-resistant schizophrenia (TRS) predict better treatment response, while other baseline characteristics do not significantly predict outcomes. Clozapine and other atypical antipsychotics have the highest response rates among TRS treatments. The review emphasizes that while albuminuria is a strong marker for HF risk, it remains unclear whether it is merely indicative of early kidney dysfunction or causative in HF progression.

    Reference: Khan MS, Shahid I, Anker SD, et al. Albuminuria and Heart Failure: JACC State-of-the-Art Review. J Am Coll Cardiol. 2023;81(3):270-282. doi: 10.1016/j.jacc.2022.10.028.

  • EMPA-KIDNEY Trial Shows Empagliflozin Reduces CKD Progression and Cardio Risks

    EMPA-KIDNEY Trial Shows Empagliflozin Reduces CKD Progression and Cardio Risks

    The EMPA-KIDNEY trial evaluated empagliflozin’s effectiveness in patients with chronic kidney disease (CKD) at various stages of progression. Participants with an estimated glomerular filtration rate (eGFR) between 20 and less than 90 ml per minute per 1.73 m², and significant albuminuria, were randomized to receive either empagliflozin (10 mg daily) or a placebo. The primary outcomes assessed included indicators of kidney disease progression such as end-stage kidney disease, significant eGFR decline, or death from renal or cardiovascular causes.

    Results from this study of 6609 patients over two years demonstrated that 13.1% in the empagliflozin group faced kidney disease progression or cardiovascular death, versus 16.9% in the placebo group, marking a notable benefit (hazard ratio 0.72). The benefits of empagliflozin were consistent across patients with or without diabetes and various eGFR ranges. The similarity in serious adverse events between both groups supports empagliflozin as a safe, effective option for mitigating CKD progression and associated cardiovascular risks.

    Reference: The EMPA-KIDNEY Collaborative Group, Herrington WG, Staplin N, et al. Empagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2023 Jan 12;388(2):117-127. doi: 10.1056/NEJMoa2204233. Epub 2022 Nov 4. PMID: 36331190; PMCID: PMC7614055.

  • Advancing Therapies: Non-Steroidal MR Antagonists in the Spotlight for Treating Chronic Conditions

    Advancing Therapies: Non-Steroidal MR Antagonists in the Spotlight for Treating Chronic Conditions

    MR overactivation, implicated in various pathologies including chronic kidney disease (CKD) and type 2 diabetes mellitus, underscores the importance of mineralocorticoid receptor (MR) modulation. Steroidal MR antagonists (MRA) have been pivotal in treating conditions like heart failure, yet their side effects limit their use. Novel non-steroidal MRA, such as finerenone, offer promise with improved safety profiles and demonstrated efficacy in preclinical and clinical settings. Beyond their renal effects, non-steroidal MRAs exhibit systemic impacts, potentially mitigating inflammation, fibrosis, and metabolic dysfunction associated with MR overactivation.

    The development of non-steroidal MRA represents a significant advancement, offering a nuanced approach to MR modulation. Clinical trials like FIDELIO-DKD and FIGARO-DKD have demonstrated the efficacy of finerenone in reducing cardiovascular and renal outcomes in patients with CKD and type 2 diabetes. Moreover, ongoing research into MR modulation, including novel compounds and combinations with other agents like SGLT2 inhibitors, suggests a dynamic landscape in the management of cardiorenal and metabolic syndromes.

    Reference: Savarese G, Lindberg F, Filippatos G, Butler J, Anker SD. Mineralocorticoid receptor overactivation: targeting systemic impact with non-steroidal mineralocorticoid receptor antagonists. Diabetologia. 2024 Feb;67(2):246-262. doi: 10.1007/s00125-023-06031-1. Epub 2023 Dec 21. PMID: 38127122; PMCID: PMC10789668.

  • Finerenone Promising for Reducing CKD and Cardiovascular Risks in Type 2 Diabetes

    Finerenone Promising for Reducing CKD and Cardiovascular Risks in Type 2 Diabetes

    In a double-blind trial involving 5734 patients with chronic kidney disease (CKD) and type 2 diabetes, finerenone, a selective mineralocorticoid receptor antagonist, was compared to placebo. The primary outcome, a composite of kidney failure, a significant decrease in estimated glomerular filtration rate (eGFR), or death from renal causes, occurred less frequently in the finerenone group (17.8%) compared to the placebo group (21.1%). Similarly, the key secondary outcome, a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure, was less common in the finerenone group (13.0%) compared to placebo (14.8%). Adverse events were similar between the groups, but hyperkalemia-related discontinuations were higher with finerenone.

    Overall, these findings suggest that finerenone treatment in patients with CKD and type 2 diabetes led to reduced risks of CKD progression and cardiovascular events compared to placebo, demonstrating its potential as a therapeutic option in this population.

    Reference: Bakris GL, Agarwal R, Anker SD, et al. Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes. N Engl J Med. 2020 Dec 3;383(23):2219-2229. doi: 10.1056/NEJMoa2025845. Epub 2020 Oct 23. PMID: 33264825.

  • Finerenone Reduces Heart, Kidney Risks in Diabetes CKD Study

    Finerenone Reduces Heart, Kidney Risks in Diabetes CKD Study

    The FIDELITY analysis consolidated data from the FIDELIO-DKD and FIGARO-DKD studies, targeting patients with type 2 diabetes across different stages of chronic kidney disease (CKD). This analysis aimed to assess the safety and efficacy of finerenone compared to placebo. Over three years, among 13,026 participants, those treated with finerenone experienced significantly fewer major cardiovascular events and kidney failures than those on placebo.

    Findings reveal that finerenone, a selective nonsteroidal mineralocorticoid receptor antagonist, effectively reduces cardiovascular and kidney disease progression in type 2 diabetes patients with CKD. The study emphasized the importance of screening for albuminuria to identify at-risk patients, particularly as 40% of participants with a higher estimated glomerular filtration rate were included based on albuminuria. This underscores finerenone’s role in mitigating severe health complications and managing CKD-related cardiovascular risks.

    Reference: Agarwal R, Filippatos G, Pitt B, et al. Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis. Eur Heart J. 2022 Feb 10;43(6):474-484. doi: 10.1093/eurheartj/ehab777. Erratum in: Eur Heart J. 2022 May 21;43(20):1989. PMID: 35023547; PMCID: PMC8830527.

  • Canagliflozin Trial Shows Kidney and Heart Benefits in Diabetes Patients

    Canagliflozin Trial Shows Kidney and Heart Benefits in Diabetes Patients

    Type 2 diabetes is a leading cause of kidney failure globally, with few effective treatments. A trial investigated the effects of canagliflozin, an SGLT2 inhibitor, versus placebo in patients with type 2 diabetes and chronic kidney disease who were already on renin-angiotensin system blockers. This study focused on preventing end-stage kidney disease, significant increases in serum creatinine, or deaths related to renal and cardiovascular issues.

    The trial ended early due to encouraging interim results, showing a 30% reduction in major kidney and cardiovascular outcomes in the canagliflozin group compared to placebo. Notably, the risks of end-stage kidney disease decreased by 34%, and cardiovascular incidents, including heart attacks, strokes, and heart failure hospitalizations, were significantly reduced. There were no notable increases in adverse effects such as amputations or fractures, underscoring canagliflozin’s potential as a protective treatment for heart and kidney health in this patient group.

    Reference: Perkovic V, Jardine MJ, Neal B, et al. Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. N Engl J Med. 2019 Jun 13;380(24):2295-2306. doi: 10.1056/NEJMoa1811744. Epub 2019 Apr 14. PMID: 30990260.

  • Dapagliflozin Shows Promise in Reducing CKD and Heart Risks

    Dapagliflozin Shows Promise in Reducing CKD and Heart Risks

    The dapagliflozin trial investigated the drug’s efficacy in patients with chronic kidney disease (CKD), both with and without type 2 diabetes. The study involved 4304 participants with varying degrees of kidney function and significant albuminuria, who were randomized to receive either 10 mg of dapagliflozin daily or a placebo. The primary goal was to track major outcomes including a 50% or more decline in glomerular filtration rate (GFR), progression to end-stage kidney disease, or death from kidney or heart conditions.

    After about 2.4 years of monitoring, only 9.2% of the dapagliflozin group experienced primary outcomes compared to 14.5% in the placebo group, reflecting a hazard ratio of 0.61. The drug markedly lowered the risks of severe kidney decline, kidney disease progression, and death from kidney or cardiovascular causes. Lower overall mortality was also observed in the dapagliflozin group, with these protective effects consistent among all participants, regardless of diabetes status, highlighting its potential in slowing CKD progression and reducing cardiovascular risks.

    Reference: Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2020 Oct 8;383(15):1436-1446. doi: 10.1056/NEJMoa2024816. Epub 2020 Sep 24. PMID: 32970396.