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href="/view/meta-analysis-finds-sglt2-inhibitors-boost-hemoglobin-hematocrit-in-ckd"><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:absolute;top:0;left:0;bottom:0;right:0"><img alt="" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="fill" class="object-contain" style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F0ceff512086771a9641e2a82d69b33efe580ba95-5733x3780.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, 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text-[19px] font-[500]" href="/view/meta-analysis-finds-sglt2-inhibitors-boost-hemoglobin-hematocrit-in-ckd">Meta-Analysis Finds SGLT2 Inhibitors Boost Hemoglobin, Hematocrit in CKD</a></div><div class="pb-2"><div><span class="text-md "><span class="mr-1 italic">By </span><a class="mr-1 text-sky-800 hover:text-primary" href="/authors/giuliana-grossi"><i>Giuliana Grossi</i></a></span></div></div><a href="/view/meta-analysis-finds-sglt2-inhibitors-boost-hemoglobin-hematocrit-in-ckd"><a href="/view/meta-analysis-finds-sglt2-inhibitors-boost-hemoglobin-hematocrit-in-ckd"><p class="mt-1 text-gray-800 text-[13px] line-clamp-6 text-hidden">The analysis supports the integration of sodium-glucose cotransporter 2 (SGLT2) inhibitors into treatment paradigms for patients with chronic kidney disease (CKD) not only for their established benefits but also for addressing anemia.</p></a></a></div></div><div class="flex-wrap w-[60%] flex "><a class="flex w-[50%] flex-col sm:pl-[35px] pl-[20px] pb-[35px] 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href="/view/fda-approves-atrasentan-for-proteinuria-reduction-in-primary-iga-nephropathy"><span class="text-sm text-gray-500">April 3rd 2025</span></a><div><a class="text-[14px]" href="/view/fda-approves-atrasentan-for-proteinuria-reduction-in-primary-iga-nephropathy"><p class="line-clamp-4 text-hidden font-[500]">FDA Approves Atrasentan for Proteinuria Reduction in Primary IgA Nephropathy</p></a></div><div class="py-2"><div><span class="text-md "><span class="mr-1 italic">By </span><a class="mr-1 text-sky-800 hover:text-primary" href="/authors/julia-bonavitacola"><i>Julia Bonavitacola</i></a></span></div></div></div></a><a class="flex w-[50%] flex-col sm:pl-[35px] pl-[20px] pb-[35px] " href="/view/disparities-in-ckd-associated-cardiac-arrest-across-demographics"><div class="w-full lg:h-[134px] h-[100px] relative bg-default-logo-background "><span 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lg:h-[243px] xl:h-[311px] pb-[90px] pt-2 sm:pt-4 lg:pt-3 xl:pt-4 pl-3 xs:pl-4 sm:pl-6 pr-3 rounded-tl-none lg:rounded-tl-md rounded-bl-md rounded-br-md lg:rounded-br-none" style="background:var(--primary)"><h2 class="text-md sm:text-lg xl:text-xl leading-tight lg:leading-none xl:sleading-tight text-white font-bold font-lora my-2">Population Health Management of Chronic Kidney Disease (CKD)</h2><p class=" font-light font-rubik text-white text-xs xl:text-sm">An expert panel discusses chronic kidney disease (CKD), its impact on cardiovascular disease, and the methods of treatment used on the patient populations.</p><div style="color:var(--primary)"><a class="font-bold font-rubik text-xs flex items-center gap-2 mt-2.5 xs:mt-4 lg:mt-2.5 xl:mt-3.5 py-2 px-3 cursor-pointer max-w-fit bg-white hover:bg-gray-300 rounded-md" href="https://www.ajmc.com/peer-exchange/population-health-management-of-chronic-kidney-disease-ckd">Visit Now</a></div></div><div class="w-full max-h-[385px] 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hidden">Advertisement</div><div id="div-gpt-ad-infeed-1"></div></div></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/fda-expands-furosemide-injection-label-to-treat-edema-in-ckd"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/e150dacd04aa1aec8b6718c0b24affe897f03503-5072x3469.jpg?fit=crop&auto=format" alt="Doctor holding card that says furosemide | Image credit: MQ-Illustrations – stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">March 7th 2025</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/fda-expands-furosemide-injection-label-to-treat-edema-in-ckd">FDA Expands Furosemide Injection Label to Treat Edema in CKD</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/hayden-e-klein">Hayden E. Klein</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/fda-expands-furosemide-injection-label-to-treat-edema-in-ckd"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Furosemide injection was previously approved to treat congestion from fluid buildup in adults with chronic heart failure.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/weight-fluctuation-threatens-kidney-health-in-type-1-diabetes"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/55d41d36d80a29154c8e2e562c8b3ba5e90d8110-1200x738.jpg?fit=crop&auto=format" alt="Yo-Yo Dieting | Image Credit: © Karen Roach-stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">February 4th 2025</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/weight-fluctuation-threatens-kidney-health-in-type-1-diabetes">Weight Fluctuation Threatens Kidney Health in Type 1 Diabetes</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/maggie-l-shaw">Maggie L. Shaw</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/weight-fluctuation-threatens-kidney-health-in-type-1-diabetes"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Chronic kidney disease has been linked to yo-yo dieting (also known as body-weight cycling) in the general population, which interested investigators in potential links between these weight fluctuations and increased risk of renal events among a population with type 1 diabetes.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex md:hidden justify-center items-center"></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/a-standardized-care-pathway-increases-optimal-dialysis-starts"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png?fit=crop&auto=format" alt="AJMC" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">December 17th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/a-standardized-care-pathway-increases-optimal-dialysis-starts">A Standardized Care Pathway Increases Optimal Dialysis Starts</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/roy-g-marcus-md">Roy G. Marcus, MD</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/david-m-miller-mba">David M. Miller, MBA</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/brian-h-nathanson-phd">Brian H. Nathanson, PhD</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/douglas-eckhardt-mba">Douglas Eckhardt, MBA</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/steven-henry-pharmd">Steven Henry, PharmD</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/katherine-kwon-md">Katherine Kwon, MD</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/rohit-sharma-md">Rohit Sharma, MD</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/nirav-vakharia-md">Nirav Vakharia, MD</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/a-standardized-care-pathway-increases-optimal-dialysis-starts"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The authors observed a significant increase in optimal starts for dialysis and in peritoneal dialysis rates after implementing a standardized end-stage renal disease transition pathway.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/transforming-kidney-care-policy-risk-stratification-and-collaborative-models"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/d79c993ad4d9e3983bc0d532aad3e304b33becd6-1200x800.jpg?fit=crop&auto=format" alt="Park City Utah | Image Credit: © SeanPavonePhoto - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">December 12th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/transforming-kidney-care-policy-risk-stratification-and-collaborative-models">Transforming Kidney Care: Policy, Risk Stratification, and Collaborative Models</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/kyle-munz">Kyle Munz</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/transforming-kidney-care-policy-risk-stratification-and-collaborative-models"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Experts at a recent Institute for Value-Based Medicine event emphasized the importance of early intervention, policy innovation, and proactive collaboration to transform the management of kidney disease and optimize patient outcomes. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/dallas-nephrology-associates-journey-to-value-based-care"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/f1c7b1577c47343f55e333ebb755b917ebfc1656-1280x854.jpg?fit=crop&auto=format" alt="kidneys and stethoscope | Image Credit: © filins - stock.adpbe.com" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">December 10th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/dallas-nephrology-associates-journey-to-value-based-care">Dallas Nephrology Associates’ Journey to Value-Based Care</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/belinda-tommey-mha">Belinda Tommey, MHA</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/paul-skluzacek-md">Paul Skluzacek, MD</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/melissa-echols-bsn">Melissa Echols, BSN</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/leann-phelps-msn">LeAnn Phelps, MSN</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/mollyn-shew">Mollyn Shew</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/alexander-liang-md">Alexander Liang, MD</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/dallas-nephrology-associates-journey-to-value-based-care"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Preventing or delaying the onset of end-stage kidney disease is vital. By implementing a results-driven, value-based approach, Dallas Nephrology Associates has demonstrated improved patient outcomes and value for payers.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/fostering-interdisciplinary-communication-how-cardio-renal-metabolic-care-models-optimize-care-delivery"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/fe5518cddca7201dc4d49f9db84f25b1e3d83a86-1280x720.jpg?fit=crop&auto=format" alt="Viet Le, PA-C, Intermountain Health" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">October 19th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/fostering-interdisciplinary-communication-how-cardio-renal-metabolic-care-models-optimize-care-delivery">Fostering Interdisciplinary Communication: How Cardio-Renal-Metabolic Care Models Optimize Care Delivery </a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/kyle-munz">Kyle Munz</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/fostering-interdisciplinary-communication-how-cardio-renal-metabolic-care-models-optimize-care-delivery"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Viet Le, PA-C, Intermountain Health, gives insights into the benefits cardio-renal-metabolic care models provide for patients in need. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div><div><div class="text-[8px] text-center text-gray-500 hidden">Advertisement</div><div id="div-gpt-ad-infeed-7"></div></div></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/population-health-strategies-are-vital-for-tackling-improving-ckd-care"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/575653e9a67332f83957873fdf797dccddf24eb1-2876x1622.png?fit=crop&auto=format" alt="Navdeep Tangri, MD, PhD, FRCP" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">October 18th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/population-health-strategies-are-vital-for-tackling-improving-ckd-care">Population Health Strategies Are Vital for Tackling, Improving CKD Care</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/kyle-munz">Kyle Munz</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/population-health-strategies-are-vital-for-tackling-improving-ckd-care"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Navdeep Tangri, MD, PhD, FRCP, University of Manitoba, speaks to the value of population health strategies in clinical approaches to care delivery for patients with chronic kidney disease (CKD). </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/long-term-benefits-show-the-value-of-upfront-investments-in-value-based-care"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/f5f64021c99fa2258424b00381db99daef72c0ac-5242x3744.jpg?fit=crop&auto=format" alt="Value-based care calls for long-term thinking about sustained benefit | image credit: momius - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">October 17th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/long-term-benefits-show-the-value-of-upfront-investments-in-value-based-care">Long-Term Benefits Show the Value of Upfront Investments in Value-Based Care</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/kyle-munz">Kyle Munz</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/long-term-benefits-show-the-value-of-upfront-investments-in-value-based-care"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Miriam Godwin, CMMI, National Kidney Foundation, touches on the gaps in kidney care that public policy can address, as well as the importance of thinking about the long-term benefits of value-based care. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex md:hidden justify-center items-center"></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/identifying-chronic-kidney-disease-stage-3-with-excess-disease-burden"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png?fit=crop&auto=format" alt="AJMC" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">June 24th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/identifying-chronic-kidney-disease-stage-3-with-excess-disease-burden">Identifying Chronic Kidney Disease Stage 3 With Excess Disease Burden</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/austin-campbell-phd">Austin Campbell, PhD</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/lihao-chu-phd">Lihao Chu, PhD</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/stanley-crittenden-md">Stanley Crittenden, MD</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/abe-sutton-jd">Abe Sutton, JD</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/adam-boehler-bs">Adam Boehler, BS</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/identifying-chronic-kidney-disease-stage-3-with-excess-disease-burden"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">A high-risk cohort of beneficiaries with chronic kidney disease (CKD) stage 3 have a profile similar to patients with CKD stages 4 and 5, indicating potential benefit of earlier nephrology intervention.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/leveraging-patient-activation-to-improve-kidney-health-in-high-risk-patients"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/f1c7b1577c47343f55e333ebb755b917ebfc1656-1280x854.jpg?fit=crop&auto=format" alt="Kidney and stethoscope lies on a blue background | Image Credit: © filins - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">June 10th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/leveraging-patient-activation-to-improve-kidney-health-in-high-risk-patients">Leveraging Patient Activation to Improve Kidney Health in High-Risk Patients</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/shanoor-n-seervai-mpp">Shanoor N. Seervai, MPP</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/elizabeth-montgomery-bs">Elizabeth Montgomery, BS</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/hilary-hatch-phd">Hilary Hatch, PhD</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/kelsey-jones-pratt-mpa">Kelsey Jones Pratt, MPA</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jai-seth-msc">Jai Seth, MSc</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/stella-e-sechopoulos-ba">Stella E. Sechopoulos, BA</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/judith-h-hibbard-drph">Judith H. Hibbard, DrPH</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/leveraging-patient-activation-to-improve-kidney-health-in-high-risk-patients"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Frequency of patient-provider conversations and patient activation are the 2 most significant predictors of a high-risk patient’s behaviors to prevent kidney disease.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/defragmentation-of-care-in-complex-patients-with-eskd-improves-clinical-outcomes"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png?fit=crop&auto=format" alt="AJMC" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">May 13th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/defragmentation-of-care-in-complex-patients-with-eskd-improves-clinical-outcomes">Defragmentation of Care in Complex Patients With ESKD Improves Clinical Outcomes</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/nathan-moore-md">Nathan Moore, MD</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/david-roer-md">David Roer, MD</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/defragmentation-of-care-in-complex-patients-with-eskd-improves-clinical-outcomes"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">A novel program utilizing an approach to defragment care for patients with end-stage kidney disease (ESKD) resulted in better patient outcomes.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/fda-approves-vadadustat-for-anemia-in-patients-with-ckd-undergoing-dialysis"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/8e557a24aed72361bc9d8a449a405e2e62ef6d82-7048x4024.jpg?fit=crop&auto=format" alt="FDA Approval. | Image Credit: Looker_Studio - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">March 28th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/fda-approves-vadadustat-for-anemia-in-patients-with-ckd-undergoing-dialysis">FDA Approves Vadadustat for Anemia in Patients With CKD Undergoing Dialysis</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/cameron-santoro">Cameron Santoro</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/fda-approves-vadadustat-for-anemia-in-patients-with-ckd-undergoing-dialysis"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The FDA approved vadadustat (Vafseo), an oral medication, to treat anemia in adult patients with chronic kidney disease (CKD) on dialysis for at least 3 months. This fills a need for a new treatment option as anemia is common in these patients and can significantly impact their quality of life.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div><div><div class="text-[8px] text-center text-gray-500 hidden">Advertisement</div><div id="div-gpt-ad-infeed-13"></div></div></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/dr-madeleine-mcdowell-ckd-harder-earlier-socially-challenged-neighborhoods"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/69ee91fe3e01de58e5eca790447f2828ff2ab27c-400x400.jpg?fit=crop&auto=format" alt="Madeleine McDowell, MD | Image Credit: LinkedIn" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">October 6th 2023</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/dr-madeleine-mcdowell-ckd-harder-earlier-socially-challenged-neighborhoods">Dr Madeleine McDowell: CKD Hits Harder and Earlier in Socially Challenged Neighborhoods</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/dr-madeleine-mcdowell-ckd-harder-earlier-socially-challenged-neighborhoods"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The data show the average age of dialysis in the least vulnerable neighborhoods was 68.2 years old, but 59.4 years—almost a decade earlier—in the most vulnerable.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/dr-madeleine-mcdowell-discusses-how-ckd-disparities-social-challenges-impact-health-care-access"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/69ee91fe3e01de58e5eca790447f2828ff2ab27c-400x400.jpg?fit=crop&auto=format" alt="Madeleine McDowell, MD | Image Credit: LinkedIn" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">October 4th 2023</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/dr-madeleine-mcdowell-discusses-how-ckd-disparities-social-challenges-impact-health-care-access">Dr Madeleine McDowell Discusses How CKD Disparities, Social Challenges Impact Health Care Access</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/dr-madeleine-mcdowell-discusses-how-ckd-disparities-social-challenges-impact-health-care-access"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Madeleine McDowell, MD, hopes these data insights will help change providers' behavior in terms of adopting earlier and more regular screening for chronic kidney disease (CKD).</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/predicting-hospitalizations-for-patients-with-chronic-kidney-disease"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png?fit=crop&auto=format" alt="AJMC" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">September 18th 2023</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/predicting-hospitalizations-for-patients-with-chronic-kidney-disease">Predicting Hospitalizations for Patients With Chronic Kidney Disease</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/steph-karpinski-ms">Steph Karpinski, MS</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/scott-sibbel-phd-mph">Scott Sibbel, PhD, MPH</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/kathryn-gray-ma">Kathryn Gray, MA</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/adam-g-walker-phd">Adam G. Walker, PhD</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jiacong-luo-md">Jiacong Luo, MD</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/carey-colson-mba">Carey Colson, MBA</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/juliana-stebbins-mph">Juliana Stebbins, MPH</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/steven-m-brunelli-md-msce">Steven M. Brunelli, MD, MSCE</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/predicting-hospitalizations-for-patients-with-chronic-kidney-disease"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The authors developed an algorithm that uses medical claims to identify patients with chronic kidney disease who are at greatest risk of being hospitalized within 90 days.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/medicare-policy-proposal-jeopardizes-care-for-those-on-dialysis"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/d0325805e4fd25df9227eeacb118e8ccbaf0dd99-612x408.jpg?fit=crop&auto=format" alt="[Nurse recording dialysis] Credit: iStock" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">September 8th 2023</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/medicare-policy-proposal-jeopardizes-care-for-those-on-dialysis">Contributor: Medicare Policy Proposal Jeopardizes Care for Those on Dialysis </a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/lavarne-a.-burton">LaVarne A. Burton </a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/hrant-jamgochian">Hrant Jamgochian</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/lori-hartwell">Lori Hartwell</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/medicare-policy-proposal-jeopardizes-care-for-those-on-dialysis"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">CEOs of 3 kidney care organizations explain flaws in CMS' recent reimbursement proposal. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex md:hidden justify-center items-center"></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><div class="jsx-ad50481d5ee26850"><a class="jsx-ad50481d5ee26850" href="/view/have-racial-disparities-in-home-dialysis-utilization-changed-over-time-"><span style="box-sizing:border-box;display:inline-block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative;max-width:100%"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;max-width:100%"><img style="display:block;max-width:100%;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0" alt="" aria-hidden="true" src="data:image/svg+xml,%3csvg%20xmlns=%27http://www.w3.org/2000/svg%27%20version=%271.1%27%20width=%27288%27%20height=%27200%27/%3e"/></span><img alt="Site Logo" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="intrinsic" class="max-h-[200px]" style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="Site Logo" srcSet="/_next/image?url=%2Fajmc_logo_inverted.png&w=384&q=75 1x, /_next/image?url=%2Fajmc_logo_inverted.png&w=640&q=75 2x" src="/_next/image?url=%2Fajmc_logo_inverted.png&w=640&q=75" decoding="async" data-nimg="intrinsic" style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="max-h-[200px]" loading="lazy"/></noscript></span></a></div><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">March 17th 2023</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/have-racial-disparities-in-home-dialysis-utilization-changed-over-time-">Have Racial Disparities in Home Dialysis Utilization Changed Over Time?</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/virginia-wang-phd">Virginia Wang, PhD</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/lindsay-zepel-ms">Lindsay Zepel, MS</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/cynthia-j-coffman-phd">Cynthia J. Coffman, PhD</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/clarissa-j-diamantidis-md-mhs">Clarissa J. Diamantidis, MD, MHS</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/sarah-hudson-scholle-drph-mph">Sarah Hudson Scholle, DrPH, MPH</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/matthew-l-maciejewski-phd">Matthew L. Maciejewski, PhD</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/have-racial-disparities-in-home-dialysis-utilization-changed-over-time-"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Medicare prospective payment for dialysis modestly increased availability and use of home-based dialysis treatment but did not affect historic racial disparities in home dialysis.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><div class="jsx-ad50481d5ee26850"><a class="jsx-ad50481d5ee26850" href="/view/health-care-costs-associated-with-unrecognized-progression-to-late-stage-kidney-disease"><span style="box-sizing:border-box;display:inline-block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative;max-width:100%"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;max-width:100%"><img style="display:block;max-width:100%;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0" alt="" aria-hidden="true" src="data:image/svg+xml,%3csvg%20xmlns=%27http://www.w3.org/2000/svg%27%20version=%271.1%27%20width=%27288%27%20height=%27200%27/%3e"/></span><img alt="Site Logo" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="intrinsic" class="max-h-[200px]" style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="Site Logo" srcSet="/_next/image?url=%2Fajmc_logo_inverted.png&w=384&q=75 1x, /_next/image?url=%2Fajmc_logo_inverted.png&w=640&q=75 2x" src="/_next/image?url=%2Fajmc_logo_inverted.png&w=640&q=75" decoding="async" data-nimg="intrinsic" style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="max-h-[200px]" loading="lazy"/></noscript></span></a></div><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">February 16th 2023</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/health-care-costs-associated-with-unrecognized-progression-to-late-stage-kidney-disease">Health Care Costs Associated With Unrecognized Progression to Late-Stage Kidney Disease</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/donna-spencer-phd">Donna Spencer, PhD</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/stephan-dunning-mba">Stephan Dunning, MBA</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jeff-mcpheeters-ba">Jeff McPheeters, BA</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jennifer-st-clair-russell-phd-msed-mches">Jennifer St. Clair Russell, PhD, MSEd, MCHES</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/christopher-hane-phd">Christopher Hane, PhD</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/health-care-costs-associated-with-unrecognized-progression-to-late-stage-kidney-disease"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Unrecognized disease progression is associated with higher health care costs both for patients with end-stage kidney disease and late-stage (stages G4-G5) chronic kidney disease.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div><div><div class="text-[8px] text-center text-gray-500 hidden">Advertisement</div><div id="div-gpt-ad-infeed-19"></div></div></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><div class="jsx-ad50481d5ee26850"><a class="jsx-ad50481d5ee26850" href="/view/transition-to-dialysis-planning-health-care-use-and-mortality-in-end-stage-renal-disease"><span style="box-sizing:border-box;display:inline-block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative;max-width:100%"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;max-width:100%"><img style="display:block;max-width:100%;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0" alt="" aria-hidden="true" src="data:image/svg+xml,%3csvg%20xmlns=%27http://www.w3.org/2000/svg%27%20version=%271.1%27%20width=%27288%27%20height=%27200%27/%3e"/></span><img alt="Site Logo" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="intrinsic" class="max-h-[200px]" style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="Site Logo" srcSet="/_next/image?url=%2Fajmc_logo_inverted.png&w=384&q=75 1x, /_next/image?url=%2Fajmc_logo_inverted.png&w=640&q=75 2x" src="/_next/image?url=%2Fajmc_logo_inverted.png&w=640&q=75" decoding="async" data-nimg="intrinsic" style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="max-h-[200px]" loading="lazy"/></noscript></span></a></div><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">February 14th 2023</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/transition-to-dialysis-planning-health-care-use-and-mortality-in-end-stage-renal-disease">Transition-to-Dialysis Planning, Health Care Use, and Mortality in End-Stage Renal Disease</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/insiya-poonawalla-phd-ms">Insiya Poonawalla, PhD, MS</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/kanchan-barve-ms-mba">Kanchan Barve, MS, MBA</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/meghan-cockrell-mph">Meghan Cockrell, MPH</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/amal-agarwal-do-mba">Amal Agarwal, DO, MBA</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/adrianne-w-casebeer-phd-ms-mpp">Adrianne W. Casebeer, PhD, MS, MPP</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/suzanne-w-dixon-mph-ms-rdn">Suzanne W. Dixon, MPH, MS, RDN</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/yong-li-phd">Yong Li, PhD</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/transition-to-dialysis-planning-health-care-use-and-mortality-in-end-stage-renal-disease"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">A planned transition to dialysis was associated with improved outcomes and lower mortality. These findings may inform care coordination policies for end-stage renal disease.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/bloodstream-infection-risk-associated-with-race-ses-among-patients-on-hemodialysis"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/c7e03dcc52dfef98654ab2180f7a9b7daa3c7707-5760x3840.jpg?fit=crop&auto=format" alt="Black male patient. " width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">February 7th 2023</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/bloodstream-infection-risk-associated-with-race-ses-among-patients-on-hemodialysis">Bloodstream Infection Risk Associated With Race, SES Among Patients on Hemodialysis</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/matthew-gavidia">Matthew Gavidia</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/bloodstream-infection-risk-associated-with-race-ses-among-patients-on-hemodialysis"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Data released in the CDC’s latest Morbidity and Mortality Weekly Report indicate that patients with end-stage kidney disease on hemodialysis who are Black, Hispanic/Latino, or of lower socioeconomic status (SES) are at greater risk of Staphylococcus aureus bloodstream infections, with Hispanic/Latino ethnicity cited as an independent risk factor.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/fda-approves-daprodustat-for-anemia-from-ckd-in-adult-dialysis-patients"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/8b20740b52ac5c4e6835f85be8a147b3fda78023-550x239.jpg?fit=crop&auto=format" alt="white FDA logo on blue background" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">February 7th 2023</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/fda-approves-daprodustat-for-anemia-from-ckd-in-adult-dialysis-patients">FDA Approves Daprodustat for Anemia From CKD in Adult Dialysis Patients</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/fda-approves-daprodustat-for-anemia-from-ckd-in-adult-dialysis-patients"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Daprodustat (Jesduvroq, GSK) is the first oral hypoxia-inducible factor prolyl hydroxylase inhibitor to gain approval in the United States.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/top-5-most-read-ckd-content-of-2022"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/0504804cef45d0a1ca776137b2affb39c74fd4aa-3187x1625.png?fit=crop&auto=format" alt="The Top 5 CKD Articles of 2022" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">December 27th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/top-5-most-read-ckd-content-of-2022">Top 5 Most-Read CKD Content of 2022</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/julia-bonavitacola">Julia Bonavitacola</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/top-5-most-read-ckd-content-of-2022"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The top 5 most-read articles about chronic kidney disease (CKD) focused on finerenone benefits, anticoagulants, dementia association, and more.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/icymi-top-content-from-kidney-week-2022"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/1da539659ffb8881812b6fa221aa5a95971a966c-3600x2400.jpg?fit=crop&auto=format" alt="Kidneys" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">December 23rd 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/icymi-top-content-from-kidney-week-2022">ICYMI: Top Content From Kidney Week 2022</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/julia-bonavitacola">Julia Bonavitacola</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/icymi-top-content-from-kidney-week-2022"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Kidney Week 2022 focused on effectiveness of treatment for chronic kidney disease, health misinformation, and outcomes in chronic kidney disease, among other topics.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/kidney-tubular-secretion-associated-with-faster-egfr-decline"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/61661393d4d237f125b57f9dc23581acb9ff0dec-6000x5000.jpg?fit=crop&auto=format" alt="Kidneys" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">December 22nd 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/kidney-tubular-secretion-associated-with-faster-egfr-decline">Kidney Tubular Secretion Associated With Faster eGFR Decline</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/julia-bonavitacola">Julia Bonavitacola</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/kidney-tubular-secretion-associated-with-faster-egfr-decline"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Lower estimated tubular secretion was found to be associated with a faster decline of estimated glomerular filtration rate (eGFR) but wasn’t associated with progression of chronic kidney disease or cardiovascular disease.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div><div><div class="text-[8px] text-center text-gray-500 hidden">Advertisement</div><div id="div-gpt-ad-infeed-25"></div></div></div><div class="jsx-ad50481d5ee26850 flex md:hidden justify-center items-center"></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/oral-roxadustat-improved-hemoglobin-levels-in-patients-with-ckd"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/acd56bfc304dc2a2652410d6cfe89f64078d7c10-1000x667.jpg?fit=crop&auto=format" alt="Kidneys" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">December 19th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/oral-roxadustat-improved-hemoglobin-levels-in-patients-with-ckd">Oral Roxadustat Improved Hemoglobin Levels in Patients With CKD</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/julia-bonavitacola">Julia Bonavitacola</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/oral-roxadustat-improved-hemoglobin-levels-in-patients-with-ckd"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">A retrospective study found roxadustat to be more effective in improving hemoglobin levels in patients who had with chronic kidney disease (CKD) compared with recombinant human erythropoietin. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/icd-implantation-associated-with-lower-risk-of-mortality-in-patients-with-ckd"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/ac82b7b9ee2d03efb6dbab547ca1cafac70976a7-3600x2400.jpg?fit=crop&auto=format" alt="Kidneys with heart in the background" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">December 15th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/icd-implantation-associated-with-lower-risk-of-mortality-in-patients-with-ckd">ICD Implantation Associated With Lower Risk of Mortality in Patients With CKD</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/julia-bonavitacola">Julia Bonavitacola</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/icd-implantation-associated-with-lower-risk-of-mortality-in-patients-with-ckd"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Implantable cardioverter defibrillators (ICDs) were found to have a beneficial effect on mortality in patients with chronic kidney disease (CKD).</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/doac-prescriptions-gradually-displaced-warfarin-in-af-ckd-treatment"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/807dcdcc4990e5fb5efa035bd5a8d14391c39234-4980x3320.jpg?fit=crop&auto=format" alt="Doctor holding model of kidney" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">December 13th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/doac-prescriptions-gradually-displaced-warfarin-in-af-ckd-treatment">DOAC Prescriptions Gradually Displaced Warfarin in AF, CKD Treatment</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/julia-bonavitacola">Julia Bonavitacola</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/doac-prescriptions-gradually-displaced-warfarin-in-af-ckd-treatment"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Prescriptions for treatment of atrial fibrillation (AF) and chronic kidney disease (CKD) have primarily been prescriptions for direct oral anticoagulants (DOACs), displacing warfarin as the primary treatment.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/ckd-associated-with-abdominal-aortic-aneurysm"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/b0bce91174af8ed058feac4b79591262ce20c0a1-1800x1200.jpg?fit=crop&auto=format" alt="Kidneys" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">December 9th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/ckd-associated-with-abdominal-aortic-aneurysm">CKD Associated With Abdominal Aortic Aneurysm</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/julia-bonavitacola">Julia Bonavitacola</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/ckd-associated-with-abdominal-aortic-aneurysm"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">A cohort study found that chronic kidney disease (CKD) was associated with the development of abdominal aortic aneurysm, with risk increasing as CKD stage advanced.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/patients-with-ckd-report-burden-could-improve-through-communication-with-physicians"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/7e55568b50042f9f9ed5cb0543a00e1aca8d3d24-3600x2400.jpg?fit=crop&auto=format" alt="Kidneys" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">December 7th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/patients-with-ckd-report-burden-could-improve-through-communication-with-physicians">Patients With CKD Report Burden Could Improve Through Communication With Physicians</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/julia-bonavitacola">Julia Bonavitacola</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/patients-with-ckd-report-burden-could-improve-through-communication-with-physicians"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Speaking with patients diagnosed with chronic kidney disease (CKD) about the burdens associated with care could help improve understanding of the disease and their communication with health care professionals.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/kidney-failure-free-survival-increased-with-ace-sglt2-inhibitors"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/acd56bfc304dc2a2652410d6cfe89f64078d7c10-1000x667.jpg?fit=crop&auto=format" alt="Kidneys" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">December 1st 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/kidney-failure-free-survival-increased-with-ace-sglt2-inhibitors">Kidney Failure–Free Survival Increased With ACE, SGLT2 Inhibitors </a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/julia-bonavitacola">Julia Bonavitacola</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/kidney-failure-free-survival-increased-with-ace-sglt2-inhibitors"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Treatment with an angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blocker and sodium-glucose cotransporter-2 (SGLT2) inhibitor combination demonstrated better outcomes in kidney failure.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div></div><div class="w-full text-center flex justify-center pb-24"><a class="px-4 py-2 border-y border-r bg-primary text-white" href="/compendium/ckd?page=1">1</a><a class="px-4 py-2 border-y border-r " href="/compendium/ckd?page=2">2</a><a class="px-4 py-2 border-y border-r " href="/compendium/ckd?page=3">3</a><a class="px-4 py-2 border-y border-r " href="/compendium/ckd?page=4">4</a><a class="px-4 py-2 border-y border-r " href="/compendium/ckd?page=5">5</a><a class="px-4 py-2 border-y border-r " href="/compendium/ckd?page=6">6</a><a class="px-4 py-2 border-y border-r " href="/compendium/ckd?page=7">7</a><a class="px-4 py-2 border-y border-r " href="/compendium/ckd?page=8">8</a><div class="px-4 py-2 border-y border-r">...</div><a class="px-4 py-2 border-y border-r" href="/compendium/ckd?page=12">12</a><a class="px-4 py-2 border-y border-r" href="/compendium/ckd?page=2">></a></div></div></div><div class="flex-none w-[300px] z-[9999] relative hidden md:block"><div style="top:5rem" class="sticky custom-spacing"><div class="collapse-container " style="overflow:hidden;max-height:900px;transition:max-height .4s ease-in-out"></div></div></div></div><div id="div-gpt-ad-pixel" style="width:1px;height:1px" class=""></div><noscript><iframe src="https://www.googletagmanager.com/ns.html?id=GTM-NK5KQXS" height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript><div id="footerOuterWrap" class=" mx-auto flex"><div class="bg-[#00598D] xl:w-[70%] w-[70%] py-12 pl-auto"><div class="xxl:w-[75%] w-[90%] 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"},{"_id":"27c0a4cb-daec-4c70-8a43-a4431f065d26","title":"Have Racial Disparities in Home Dialysis Utilization Changed Over Time?","thumbnail":null,"summary":"Medicare prospective payment for dialysis modestly increased availability and use of home-based dialysis treatment but did not affect historic racial disparities in home dialysis.","published":"2023-03-17T13:00:00.000Z","updatedOn":null,"contentCategory":{"_createdAt":"2020-04-03T20:03:53Z","_rev":"Q2ZL7ihdIB33NiMMcGccmh","_type":"contentCategory","name":"Articles","_id":"3f4b3ced-7c9d-4fc4-967f-fe993087cce2","_updatedAt":"2023-09-29T14:32:27Z"},"url":"have-racial-disparities-in-home-dialysis-utilization-changed-over-time-","authors":[{"displayName":"Virginia Wang, PhD","url":"virginia-wang-phd"},{"displayName":"Lindsay Zepel, MS","url":"lindsay-zepel-ms"},{"displayName":"Cynthia J. Coffman, PhD","url":"cynthia-j-coffman-phd"},{"displayName":"Clarissa J. 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The blood pressure target was 110 to 130 mm Hg and 130 to 150 mm Hg in a population of patients between 60 and 80 years old. They showed that cardiovascular outcomes are incredibly improved by treatment to a lower blood pressure target of 110 to 130 mm Hg. Well, it is a population of Chinese patients: 90% are Han Chinese, so it validates the results of the SPRINT trial to China.","_key":"a4e2b1ddb67d"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"5c0e2986aecc0"}],"_type":"block","style":"normal","_key":"bd830a32d8fa"},{"_key":"de05d18bbfe3","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Basically, what we found in the SPRINT trial in the United States is similarly what is being found in China. The goal here is that the broad application of blood pressure lowering to huge population segments, even when they are 60 years of age or older, can show benefit against cardiovascular disease down the road. That’s really noteworthy. 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In the place I practice, the cost of these drugs is less than a month’s supply of insulin. If these drugs have so many cardioprotective benefits, they ought to be used by a broader population of patients, and they ought to be used by all the specialists who treat patients who are vulnerable, especially those with kidney disease and HFpEF [heart failure with preserved ejection fraction] and HFrEF [heart failure with reduced ejection fraction].","_key":"5883061cbbf1"}],"_type":"block","style":"normal","_key":"69e81514913b"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"f6b8092213440"}],"_type":"block","style":"normal","_key":"70527cbf29ff"},{"style":"normal","_key":"21a373ca4da4","markDefs":[],"children":[{"_key":"715eaf508c350","_type":"span","marks":[],"text":"The insurance companies need to rethink their strategy and ask, what is best for the patient? If the patient is less short of breath and out of the hospital, it saves the patient the misery of coming into the hospital. Also, heart failure hospitalization is a very expensive therapy for patients and payers. If we can access this therapy at an earlier stage of disease and keep patients out of the hospital, it would be best for all people concerned. Let’s not forget, the patient is the center of the universe here; it’s not about the payers or the prescribers or the partnership between the payers and the prescriber. It’s really about the patients, and they ought to get this therapy now and not 2 years from now because we will lose lives and see patients on dialysis or in the hospital short of breath if we don’t start prescribing these drugs."}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"fa5c143798a90"}],"_type":"block","style":"normal","_key":"8c19fe087421"},{"children":[{"_key":"8447d2ec78a50","_type":"span","marks":[],"text":"HFpEF is a totally under-researched field right now. With HFrEF, we have made great strides, and we have all kinds of recommendations. I participated in a conference with NHLBI [National Heart, Lung, and Blood Institute] as a nephrologist, and looked at the data for 2 or 3 days, mostly presented by cardiologists on HFpEF. I was sobered to see that, despite years of research, there’s not much out there for patients with HFpEF. With such a robust result in HFpEF with empagliflozin, I think that times are changing, and I hope that this drug will meet success and get approved for this indication because it’s really an unmet need in patients with HFpEF. These are patients who are a much larger population compared to HFrEF. But I’m intrigued by the data from the FIDELITY analysis. It’s not HFrEF, it’s not HFpEF. It’s really stage B heart failure, an earlier stage of heart failure, which is the subclinical systolic dysfunction in type 2 diabetes and CKD [chronic kidney disease] that’s simply detected by the presence of albuminuria."}],"_type":"block","style":"normal","_key":"54f82dd9bbf5","markDefs":[]},{"_key":"a0cc56ab1cc1","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"f0b74535458b0"}],"_type":"block","style":"normal"},{"style":"normal","_key":"2ee646d43ab1","markDefs":[],"children":[{"_type":"span","marks":[],"text":"You don’t even need an echocardiogram to estimate the ejection fraction. All you need is to test the urine, and we can reduce the risk of heart failure hospitalization by a good 22% in this population if we simply prescribe finerenone. This is an earlier-stage population that has really poor HFrEF, which really drives the outcomes. Only 7.7% of the patients in the FIDELITY analysis had HFrEF. We are talking about stage B heart failure, and we are talking about cardiovascular protection. I believe that the FINEARTS-HF study, which is being done in HFpEF with finerenone, will provide more provocative data regarding the role of finerenone and HFpEF. But as far as I’m concerned, if you have type 2 diabetes and albuminuria, you don’t even need an ejection fraction. You just need albuminuria, and you can prescribe this and reduce the risk of heart failure. Actually, in the same session of the European Society of Cardiology meeting, we had a presentation of data that showed therapies that can affect people with HFpEF, but also stage B heart failure, which is a precursor of any heart failure. You can achieve reduction in heart failure hospitalization. That’s truly incredible news for people with heart failure.","_key":"8da91acbab340"}],"_type":"block"},{"markDefs":[],"children":[{"marks":[],"text":"","_key":"74c72318b284","_type":"span"}],"_type":"block","style":"normal","_key":"be87df6001b3"},{"_type":"block","style":"normal","_key":"28dad979b45c","markDefs":[],"children":[{"_type":"span","marks":["strong","em"],"text":"Transcript edited for clarity.","_key":"14399e1d826d"}]}],"_updatedAt":"2021-10-15T16:19:22Z","documentGroupMapping":[{"_key":"daadd1209d8e","_ref":"a06fa91b-ed75-4bb1-ab2a-77152c6732d1","_type":"reference"}]},{"_updatedAt":"2021-10-13T16:42:10Z","body":[{"videoID":"6271751241001","source":"brightcove","_key":"e3a0f05699c1","_type":"video"},{"style":"normal","_key":"e2f2b545bb19","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"45ef97b84605"}],"_type":"block"},{"_type":"block","style":"normal","_key":"5a5b5b4ffe93","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Transcript:","_key":"185d5b646548"}]},{"children":[{"_type":"span","marks":["strong"],"text":"Rajiv Agarwal, MD, MS: ","_key":"58cc1c4eb2a4"},{"_type":"span","marks":[],"text":"The results presented were published in the ","_key":"7259a93ed6bf"},{"text":"New England Journal of Medicine","_key":"c9a346774bcc","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":" by Dr Milton Packer and colleagues. They compared the results of kidney failure outcomes in the EMPEROR-Reduced and EMPEROR-Preserved trials. In the EMPEROR-Reduced trial, kidney failure outcome favors empagliflozin. This is the 40% kidney failure composite. But when you look at the EMPEROR-Preserved trial, there’s no difference in that regard between the 2 drugs. When you look at the surface to see what’s happening, it turns out that a number of things might be happening. One, when you take patients with HFrEF [heart failure with reduced ejection fraction], it might improve their cardiac output. It might improve the kidney perfusion. It might do many things that might not happen in the HFpEF [heart failure with preserved ejection fraction] population; therefore, you’re seeing a kidney-specific benefit. In fact, when you look at the slopes, there’s a greater preservation of the slope in HFrEF compared with HFpEF.","_key":"6be42694f77c"}],"_type":"block","style":"normal","_key":"935e971d8957","markDefs":[]},{"markDefs":[],"children":[{"text":"","_key":"e1e7108377df0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"c374db309c09"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"There’s a statistical benefit in the slope preservation in both trials, but it’s greater in patients with HFrEF. It tells you that the heart and kidney are strongly interlinked. If we improve heart function in HFrEF by improving ejection fraction, it might preserve the slopes but also protect from kidney failure, as we saw in the HFrEF trial. In the HFpEF trial, although there’s a preservation of the slope, there’s no signal for harm in terms of the kidney failure outcomes that look at 40% eGFR [estimated glomerular filtration rate] decline, etc. I don’t think the results are internally inconsistent. There are probably differences in the level of albuminuria in the 2 populations, and other characteristics that are hard to control for across trials that might contribute to these differences in these seemingly disparate outcomes. But I don’t think this is of great surprise. To the patient, it means you can use these drugs. They’ll keep you out of the hospital, breathing better, and they’re not dangerous to the kidney. If you have HFrEF, it might even protect your kidney. But if you have HFpEF, it’s not harmful for your kidneys.","_key":"47f27640558c0"}],"_type":"block","style":"normal","_key":"c23532f6bfa2"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"27662d710b8b0"}],"_type":"block","style":"normal","_key":"9e8b21f6f657"},{"style":"normal","_key":"136f2a356b16","markDefs":[],"children":[{"_type":"span","marks":[],"text":"For the cardiologists and primary care physicians who treat these patients, these are incredibly useful drugs. The challenge is going to be how we get the prescriptions written for these drugs because, as you saw in the FIDELITY analysis, barely 7% of patients who might be otherwise eligible for the drugs are on SGLT2 inhibitors. What I often see is that everybody passes the buck to the endocrinologist, and they say, “It’s a diabetes drug. It’s not my drug. The endocrinologist ought to write it.” Or the cardiologist might say, “It’s not my drug. The endocrinologist will write it.” I’ve seen nephrologists and primary care physicians say the same thing. These are drugs that might have an adverse effect of glucose-lowering, but they have an important benefit on the kidney and the heart as much like the ACE inhibitors and ARBs.","_key":"1de309c329180"}],"_type":"block"},{"markDefs":[],"children":[{"marks":[],"text":"","_key":"0126f62edbb20","_type":"span"}],"_type":"block","style":"normal","_key":"85110025e1d8"},{"markDefs":[],"children":[{"_key":"0ccb657b83e30","_type":"span","marks":[],"text":"They had an adverse effect of blood pressure lowering, but they really protect the kidney and heart. Just as ACE inhibitors and ARBs have become the mainstream therapies for all physicians out there, SGLT2 inhibitors ought to be embraced by anybody who’s treating patients with type 2 diabetes and albuminuria and kidney disease, including HFpEF and HFrEF, particularly the cardiologists. They need to learn about it because they need to start prescribing these drugs. That’s the only way forward."}],"_type":"block","style":"normal","_key":"0e218b4f3b70"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"13cabd59248f"}],"_type":"block","style":"normal","_key":"d8cd28b209e6"},{"markDefs":[],"children":[{"_type":"span","marks":["strong","em"],"text":"Transcript edited for clarity. 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From EMPEROR-Preserved: CV Outcomes in Patients With HFpEF","seoTag":["chronic kidney disease","CKD","ESC Congress 2021","EMPEROR-Preserved trial","heart failure","preserved ejection fraction","HFpEF","CV outcomes","empagliflozin","EGFR decline","EGFR"],"body":[{"_type":"video","videoID":"6272503317001","source":"brightcove","_key":"64e84d61f0b2"},{"_key":"a275431eacc9","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"d44e2e3e1a79"}],"_type":"block","style":"normal"},{"_key":"66a3ba134d80","markDefs":[],"children":[{"_key":"3520838eac68","_type":"span","marks":["strong"],"text":"Transcript:"}],"_type":"block","style":"normal"},{"style":"normal","_key":"3360032a3677","markDefs":[],"children":[{"marks":["strong"],"text":"Rajiv Agarwal, MD, MS: ","_key":"58b4b5c3d1a0","_type":"span"},{"text":"The EMPEROR-Preserved trial was done in patients with heart failure with preserved ejection fraction [HFpEF], and they were randomized to a fixed dose of empagliflozin 10 mg vs 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The results were nothing short of spectacular. They saw an improvement in the composite outcome of hospitalization for heart failure, MI [myocardial infarction], stroke, or cardiovascular death. These results are practice changing, especially in the context of patients with heart failure with preserved ejection fraction. This population hasn’t had any therapies previously approved.","_key":"33f568a6cbc8","_type":"span","marks":[]}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"c11df6688bb60"}],"_type":"block","style":"normal","_key":"ef7460412fbc"},{"children":[{"_type":"span","marks":[],"text":"Most of the available therapies are for HFrEF, or heart failure with reduced ejection fraction. This is the first time we’re showing an incredible benefit. We also showed, in this trial, that you have improvement in the slopes of decline of GFR [glomerular filtration rate], but there’s not any difference in the placebo group or the treatment group in the kidney failure composite outcome, which is 40% decline in eGFR [estimated glomerular filtration rate], ESRD [end-stage renal disease], or death from kidney failure. All in all, the study tells us that this might be a valuable drug for patients with heart failure with preserved ejection fraction, for which there are no approved therapies out there.","_key":"74404d14dc4f0"}],"_type":"block","style":"normal","_key":"45be0dcba93a","markDefs":[]},{"style":"normal","_key":"87dd9347634c","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"b0b3a82d05e60"}],"_type":"block"},{"style":"normal","_key":"f8990e804cf8","markDefs":[],"children":[{"text":"There’s an interesting result in the EMPEROR-Preserved trial in that the slopes of the GFR are different between placebo and empagliflozin. In fact, empagliflozin seems to be preserving the slope of eGFR decline. Yet when you look at the outcome of 40% decline in eGFR, kidney failure, or renal death, it’s no different. People might think that these are disparate results: how can you have protection of eGFR but no difference in outcomes? Well, there might also be different constructs that we’re looking at. In people who have 40% decline in eGFR events and end-stage kidney failure events, these are more distal events. The eGFR slope events can be analyzed in anyone who has a measurement of serum creatinine at a given time point. You can calculate the slopes easily, whereas with kidney failure outcome, it takes time to evolve.","_key":"d8bc7c0d40a40","_type":"span","marks":[]}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"8200878e29a90"}],"_type":"block","style":"normal","_key":"af38a502456c"},{"style":"normal","_key":"ca5e1a88c8ad","markDefs":[],"children":[{"text":"Second, whenever you’re using a drug that has hemodynamic effects, you’re disadvantaging the drug that has the hemodynamic effect in reaching an earlier time point, such as a 40% eGFR decline. What do I mean by that? You’re looking at the time to first event, so if somebody has a 40% eGFR decline event, you take that person out of the pool. They don’t contribute to the second event of end-stage kidney disease for this end point. If you’re looking at empagliflozin, it basically reduces your eGFR acutely; therefore, you’re closer to the 40% eGFR decline end point compared with placebo. You might not see a difference in that end point. However, if you raise the bar to 57%, you might see a difference. If you raise the bar even higher to end-stage kidney disease, you might see a difference. But this isn’t a trial being done in patients with large amount of propionic acidemia, which is the primary driver of end-stage kidney disease in people with type 2 diabetes and CKD [chronic kidney disease].","_key":"9f4bbb3194d30","_type":"span","marks":[]}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"2766d3d64aba0"}],"_type":"block","style":"normal","_key":"9b64bf553b61"},{"_key":"0e86043da89f","markDefs":[],"children":[{"_type":"span","marks":[],"text":"We have to be careful in looking at these end points in isolation because you might say it’s not protecting the kidney in this population. Well, it is in terms of slopes, but it’s not showing you harm in terms of end-stage kidney disease. I’d say that the 40% eGFR decline end point and end-stage kidney disease is more about the harm that you’re measuring with empagliflozin and HFpEF, and you have no signal for harms. There may be some benefit, in the sense that the slopes are different between the 2 drugs. They’re probably 2 different constructs, and it’s of little surprise to nephrologists when they look at these data.","_key":"79ccd7c7e1660"}],"_type":"block","style":"normal"},{"_key":"b86ca559d1fd","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"9be05945f93c"}],"_type":"block","style":"normal"},{"style":"normal","_key":"aff04796c817","markDefs":[],"children":[{"_type":"span","marks":["strong","em"],"text":"Transcript edited for clarity. 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Agarwal, MD, MS: ","_key":"f855e4caeb11"},{"_type":"span","marks":[],"text":"The SGLT2 inhibitors are an absolutely amazing class of drugs, and 7% of the patients in the FIDELITY analysis were on SGLT2 inhibitors. When we look at the outcomes of patients who are on both drugs, and we look at the outcomes of patients who are not on SGLT2 inhibitors, the benefits are similar between the 2 drugs. You have an interaction ","_key":"0a0242ad4721"},{"_type":"span","marks":["em"],"text":"P","_key":"8f48b6b808a6"},{"_type":"span","marks":[],"text":" value of .41. In both cases, the upper bound of the hazard ratio of cardiovascular benefit is below 1, which means that in both situations you have cardiovascular protection. Remember, the SGLT2 inhibitor group was not a randomized population. When we ask, does the combination do more good? You can’t really draw a cause-and-effect relationship simply because they had a bigger benefit with SGLT2 inhibitors because you’re not randomizing the SGLT2 inhibitor group.","_key":"75982c84540e"}],"_type":"block"},{"_type":"block","style":"normal","_key":"16ebe256fabb","markDefs":[],"children":[{"_key":"5c1076eb2d510","_type":"span","marks":[],"text":""}]},{"markDefs":[],"children":[{"text":"It might also mean that these are patients who are treated at sites that know what they’re doing, and they might see a better benefit from finerenone. These patients might have persisted with finerenone for a longer period. They might have characteristics that differ from people who are not on SGLT2 inhibitors. Believing a cause-and-effect relationship between combination vs not in combination is dangerous. However, if you look at a recent basic science study that looked at empagliflozin 10 mg vs finerenone 10 mg vs a combination of the 2 in rodents who had kidney disease, we found that when you use a combination, you achieve more than either drug alone in the rodent kidney.","_key":"3621776b39790","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"7db6a243ef24"},{"_key":"1b281dc13318","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"fff09d195a9a0"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"fefff3081b0a","markDefs":[],"children":[{"_type":"span","marks":[],"text":"We have some basic science data to support the use of the combination. Whether that should be the strategy in the future, it’s quite possible and likely that the 2 will be beneficial together, mostly because when we combine an SGLT2 inhibitor with finerenone, there’s less likelihood of hyperkalemia. In fact, we’ve done this analysis. I presented these data at the World Congress of Nephrology in April 2021 that showed in people who are SGLT2 inhibitor users at baseline, in the FIDELIO-DKD trial, the risk of hyperkalemia was lower. If it can lower the risk of hyperkalemia and cause a greater persistence of the drug to occur, then it’s possible that the 2 are better together than just 1 alone.","_key":"e01b3fd2a03c0"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"3f9dba9fbd7b0"}],"_type":"block","style":"normal","_key":"bc342ba3d343"},{"_type":"block","style":"normal","_key":"2075b30fd9a3","markDefs":[],"children":[{"marks":[],"text":"This is the central message, that we shouldn’t be comparing and competing with the drugs because the prognosis of a patient who goes on dialysis who has type 2 diabetes is worse than that of a patient with colon cancer. That’s the population that we should be targeting with a maximized therapy to prevent them going from dialysis. Finerenone clearly shows that you can reduce the risk by 20%.","_key":"e5b85eec37ef0","_type":"span"}]},{"_key":"fbbd4b94a763","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"c9a237c90f5f"}],"_type":"block","style":"normal"},{"style":"normal","_key":"5a8bfbfc4676","markDefs":[],"children":[{"_type":"span","marks":["strong","em"],"text":"Transcript edited for clarity.","_key":"73dfa0eee4d3"}],"_type":"block"}],"_createdAt":"2021-09-16T19:51:36Z","_id":"405844a8-c9bb-4791-a724-b743c4b8697b","internalTag":["chronic kidney disease"],"published":"2021-10-01T13:30:00.000Z","is_visible":true},{"taxonomyMapping":[{"parent":{"_ref":"297fa3d1-5216-46eb-bf51-66c5f77c3c8a","_type":"reference"},"_createdAt":"2020-07-30T14:48:10Z","_type":"taxonomy","name":"Chronic Kidney Disease","_id":"compendium_renal","_updatedAt":"2022-01-13T14:27:20Z","summary":[{"_type":"block","style":"normal","_key":"1727203cde0f","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The ","_key":"2f8c95be9668"},{"_type":"span","marks":["em"],"text":"AJMC","_key":"82fef8febf7a"},{"_type":"span","marks":["superscript"],"text":"®","_key":"c75867627e55"},{"marks":[],"text":" Chronic Kidney Disease compendium is a comprehensive resource for clinical news and expert insights on the condition and treatment of loss of kidney function.","_key":"f5b29d9e2cb1","_type":"span"}]}],"identifier":"ckd","_rev":"qwh0Cdr0GP6xeI5pUNoFuT"}],"body":[{"_type":"video","videoID":"6271749886001","source":"brightcove","_key":"8caf29d5c3d6"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"1358b91e9eea"}],"_type":"block","style":"normal","_key":"217f3476611d"},{"_key":"77db79cada00","markDefs":[],"children":[{"marks":["strong"],"text":"Transcript:","_key":"4b93a253a567","_type":"span"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"42784a859507","markDefs":[],"children":[{"marks":["strong"],"text":"Rajiv Agarwal, MD, MS: ","_key":"9a706a0a0bbd","_type":"span"},{"_type":"span","marks":[],"text":"The most important recognition from this analysis is that if you’re a primary care doctor, a cardiologist, an endocrinologist, or a nephrologist, you can no longer rely on eGFR [estimated glomerular filtration rate] to detect kidney disease. That was yesterday, and that was 10 years ago. In 2021, you have to be looking at urine. If you have an ACR [albumin-to-creatinine ratio] of more than 30 mg/g, you need to be on finerenone if you have type 2 diabetes. Why? Because you’ve got CKD [chronic kidney disease]. If a patient’s potassium is 5 mmol/L or less, you can support them on finerenone and appreciate these risks.","_key":"a11c30cb2f7e"}]},{"style":"normal","_key":"40d21bc02bb0","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"166168ec01890"}],"_type":"block"},{"markDefs":[],"children":[{"_key":"b95ec76c3aa40","_type":"span","marks":[],"text":"The big benefits in this population include hospitalization for heart failure. Even when we look at the pooled analysis, there’s a 22% relative risk reduction for heart failure hospitalization in the pooled analysis, and the "},{"_type":"span","marks":["em"],"text":"P","_key":"b95ec76c3aa41"},{"text":" value is .003. Cardiovascular [CV] death is reduced about 12%, which isn’t significant because the upper bound of the hazard ratio is 1.02. But the composite outcome, the CV outcome, is 14%. It’s largely driven by heart failure hospitalization, somewhat by CV death, and nonfatal MI [myocardial infarction] reduced by 9%. Stroke isn’t really impacted. What we’re learning is that if you want to protect the heart, you can simply look at the urine and get an idea that this patient is at high cardiovascular risk. You don’t need any ejection fraction, HFrEF [heart failure with reduced ejection fraction], or HFpEF [heart failure with preserved ejection fraction]. All you need is the fraction of the urine albumin. That’s it: albumin-to-creatinine ratio. If that’s elevated, then you’re a candidate for finerenone.","_key":"b95ec76c3aa42","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"2aa7a0862cb3"},{"children":[{"_type":"span","marks":[],"text":"","_key":"46ea2a85cda30"}],"_type":"block","style":"normal","_key":"e075e73fa763","markDefs":[]},{"_type":"block","style":"normal","_key":"cf93f76fc5e2","markDefs":[],"children":[{"text":"That’s how it can change your practice. You don’t need to order an echocardiogram. You’d simply need to look at the urine albumin-to-creatinine ratio. Any patient who comes to your office can pee in a cup, and you send it to the lab and get a result. If it comes back elevated and the patient has type 2 diabetes, then they’re eligible for finerenone. It’s not academic anymore, because you’re making a dent in the heart and kidney failure outcome. When we look at the kidney failure outcome, the data are even more incredible. When we look at any component of the kidney failure outcome, short of renal death, we saw only 6 patients in the 2 trials—6 patients of 13,000—who died from kidney failure.","_key":"e27377f4b47e0","_type":"span","marks":[]}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"8bff5064fc420"}],"_type":"block","style":"normal","_key":"2c5d18e55555"},{"children":[{"_type":"span","marks":[],"text":"We can’t compute a confidence interval for the hazard ratio that’s of clinical value. However, when we look at end-stage kidney disease—that means going on dialysis or transplantation—it’s reduced 20%. eGFR less than 15 mL/min is reduced 19%. The 57% eGFR decline is reduced 30%. No matter how you look at it, the data look very promising for kidney failure, especially if you can tell your patient that if they take this drug, then they have a 20% less chance of going on dialysis than if they don’t take the drug. 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","title":"Practical Implications of the FIDELITY Pooled Analysis ","_type":"article","url":{"current":"practical-implications-of-the-fidelity-pooled-analysis","_type":"slug"},"authorMapping":[{"_id":"0196936f-d86c-48fa-9d45-f7195f01cd2b","_updatedAt":"2021-09-16T19:27:02Z","lastName":"Agarwal","displayName":"Rajiv Agarwal, MD, MS","_rev":"nJf5FqvrO53bKIkThBHwCa","_type":"author","url":{"current":"rajiv-agarwal-md-ms","_type":"slug"},"firstName":"Rajiv","_createdAt":"2021-09-16T19:27:02Z","company":"Indiana University School of Medicine"}],"published":"2021-10-01T13:00:00.000Z","is_visible":true},{"authorMapping":[{"firstName":"Rajiv","_createdAt":"2021-09-16T19:27:02Z","company":"Indiana University School of Medicine","_id":"0196936f-d86c-48fa-9d45-f7195f01cd2b","_updatedAt":"2021-09-16T19:27:02Z","lastName":"Agarwal","displayName":"Rajiv Agarwal, MD, MS","_rev":"nJf5FqvrO53bKIkThBHwCa","_type":"author","url":{"current":"rajiv-agarwal-md-ms","_type":"slug"}}],"contentCategory":{"_type":"contentCategory","name":"Videos","_id":"ee14ccb3-3542-4414-9046-927be1198c76","_updatedAt":"2020-04-03T20:03:44Z","_createdAt":"2020-04-03T20:03:44Z","_rev":"Yw6MEKZDMdk6hC2JCPjfiB"},"_id":"f2306403-4901-402a-9ac5-49070ebd0bf3","seoTag":["chronic kidney disease","CKD","ESC Congress 2021","type 2 diabetes","FIDELITY analysis","finerenone","mineralocorticoid receptor antagonist","patient population","CV disease","high-risk disease","CV outcomes","kidney failure outcomes "],"showSocialShare":true,"_type":"article","body":[{"_type":"video","videoID":"6271751573001","source":"brightcove","_key":"2d261ec8697a"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"b99b26707972"}],"_type":"block","style":"normal","_key":"d610ec31d703"},{"children":[{"_type":"span","marks":["strong"],"text":"Transcript:","_key":"f7e53c87d1f6"}],"_type":"block","style":"normal","_key":"407bb13c4a8a","markDefs":[]},{"children":[{"text":"Rajiv Agarwal, MD, MS: ","_key":"446cd0d413c5","_type":"span","marks":["strong"]},{"text":"Before I tell you the results, I can tell you that when you look at the pooled data, this is not your usual patient you might see in the clinic. This is an incredibly well-treated population of a high-risk patient group. They all have type 2 diabetes and chronic kidney disease [CKD], with an age of 65 on average. The median duration of diabetes was 15 years, glycated hemoglobin was 7.7%, blood pressure was 137/76 mm Hg, and 46% of patients had a history of cardiovascular disease. Heart failure, not enriched, was 7.7%. Remember, we excluded people with symptomatic HFrEF [heart failure with reduced ejection fraction] … Statins were used in 72% of patients, and GLP-1 and SGLT2 inhibitors were used in about 7% of patients. We are looking at a benefit on top of this ideally treated group of patients, not a poorly treated group of patients.","_key":"8712e3afdbc5","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"6a8a19af6c8f","markDefs":[]},{"_key":"5315e0ba56f5","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"f327c635658f0"}],"_type":"block","style":"normal"},{"children":[{"marks":[],"text":"If we were to look at a poorly treated group of patients, I would expect that the benefit would be even larger. Imagine you have a lot of albuminuria, a lot of heart failure, a lot of blood pressure: you might see an effect that is even larger. Forty percent of patients in the FIDELITY analysis had an eGFR [estimated glomerular filtration rate] of more than 60. Now that means that if you are simply looking at eGFR to diagnose chronic kidney disease, you have to change your practice. You’ll miss 40% of the patients who are otherwise eligible for finerenone because you never checked for albuminuria. If they have albuminuria, they’re eligible for participating in the trial, and 40% of patients were in the eGFR silent zone. Their creatinine’s not elevated, and you‘re not going to detect them as having CKD unless you look at the urine and figure out the UACR [urine albumin-to-creatinine ratio].","_key":"ddecebbccfdd0","_type":"span"}],"_type":"block","style":"normal","_key":"ebf02a1ea688","markDefs":[]},{"_key":"a99a9599b027","markDefs":[],"children":[{"_key":"669d873370270","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal"},{"style":"normal","_key":"01b42458d3a2","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The mean eGFR in this population is actually 57.6. This is a very well preserved eGFR, but we have a broad characterization of patients. A third of the patients have an eGFR of less than 45. A quarter of the patients have an eGFR between 45 and 60. You have a very broad range of patients who participated in this study, and what we see is a reduction in cardiovascular death, nonfatal MI [myocardial infarction], nonfatal stroke, and hospitalization for heart failure by 14%. The ","_key":"7d935bfc56260"},{"_type":"span","marks":["em"],"text":"P","_key":"7d935bfc56261"},{"_type":"span","marks":[],"text":" value is .0018, and the NNT [number needed to treat] after 3 years is 46. If you look at the kidney end point, which is the 57% composite, we have a 23% reduction in relative risk with a ","_key":"7d935bfc56262"},{"marks":["em"],"text":"P ","_key":"7d935bfc56263","_type":"span"},{"_type":"span","marks":[],"text":"value of .0002, and NNT after 3 years is 60. They were very respectable numbers regarding these events as seen in the FIDELITY analysis. It adds to a growing pool of data showing that you can indeed impact cardiovascular and kidney failure outcomes across a broad range of eGFRs and albuminuria to prevent both cardiovascular disease and kidney failure risk.","_key":"7d935bfc56264"}],"_type":"block"},{"markDefs":[],"children":[{"text":"","_key":"8d6ac6a02ddf0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"17c165da93f6"},{"markDefs":[],"children":[{"_key":"b19a0714262f0","_type":"span","marks":[],"text":"In other words, it’s never too early to start. If you have albuminuria, you can start. You can start as late as an eGFR of 25 or more, provided the potassium is 5 mmol/L or less. It’s a very broad population of patients you can treat. For the first time, we’re demonstrating that it can protect the heart and the kidneys together in this composite analysis."}],"_type":"block","style":"normal","_key":"8ba3a87f85de"},{"_type":"block","style":"normal","_key":"980f9b55fe3f","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"55b39063514f"}]},{"markDefs":[],"children":[{"_type":"span","marks":["strong","em"],"text":"Transcript edited for clarity.","_key":"c492f1ec09a9"}],"_type":"block","style":"normal","_key":"0d7dc3e2b7c6"}],"title":"Results From the FIDELITY Pooled Analysis ","thumbnail":{"asset":{"_id":"image-4734fc1c8ebf04ed17fba799fdcdba2ad2e90f23-1920x1080-png","_createdAt":"2021-09-16T19:30:41Z","metadata":{"_type":"sanity.imageMetadata","palette":{"lightMuted":{"population":10.85,"background":"#b9bebe","_type":"sanity.imagePaletteSwatch","foreground":"#000","title":"#fff"},"vibrant":{"background":"#095c94","_type":"sanity.imagePaletteSwatch","foreground":"#fff","title":"#fff","population":1.01},"dominant":{"population":12.09,"background":"#045281","_type":"sanity.imagePaletteSwatch","foreground":"#fff","title":"#fff"},"_type":"sanity.imagePalette","darkMuted":{"population":2.68,"background":"#374c63","_type":"sanity.imagePaletteSwatch","foreground":"#fff","title":"#fff"},"muted":{"_type":"sanity.imagePaletteSwatch","foreground":"#fff","title":"#fff","population":1.93,"background":"#a4776b"},"lightVibrant":{"background":"#c2ceea","_type":"sanity.imagePaletteSwatch","foreground":"#000","title":"#000","population":0.5},"darkVibrant":{"background":"#045281","_type":"sanity.imagePaletteSwatch","foreground":"#fff","title":"#fff","population":12.09}},"hasAlpha":true,"lqip":"data:image/png;base64,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","dimensions":{"height":1080,"_type":"sanity.imageDimensions","width":1920,"aspectRatio":1.7777777777777777},"isOpaque":false},"_type":"sanity.imageAsset","mimeType":"image/png","sha1hash":"4734fc1c8ebf04ed17fba799fdcdba2ad2e90f23","size":1770979,"uploadId":"mgSxiraHYM1nXqD2pvUQGmaOoVotTEyf","path":"images/0vv8moc6/ajmc/4734fc1c8ebf04ed17fba799fdcdba2ad2e90f23-1920x1080.png","_updatedAt":"2021-09-16T19:30:41Z","_rev":"brqKDVvZvDI5HT8W5J1VoE","url":"https://cdn.sanity.io/images/0vv8moc6/ajmc/4734fc1c8ebf04ed17fba799fdcdba2ad2e90f23-1920x1080.png","assetId":"4734fc1c8ebf04ed17fba799fdcdba2ad2e90f23","originalFilename":"Agarwal_HS.png","extension":"png"}},"documentGroup":{"_ref":"a06fa91b-ed75-4bb1-ab2a-77152c6732d1","_type":"reference"},"_createdAt":"2021-09-16T19:42:41Z","url":{"current":"results-from-the-fidelity-pooled-analysis","_type":"slug"},"_updatedAt":"2021-09-28T16:26:09Z","summary":"A review of results from the FIDELITY pooled analysis analyzing finerenone’s impact on cardiorenal morbidity and mortality in patients with type 2 diabetes and CKD. ","internalTag":["chronic kidney disease"],"factCheckAuthorMapping":null,"taxonomyMapping":[{"summary":[{"_type":"block","style":"normal","_key":"1727203cde0f","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The ","_key":"2f8c95be9668"},{"_type":"span","marks":["em"],"text":"AJMC","_key":"82fef8febf7a"},{"_type":"span","marks":["superscript"],"text":"®","_key":"c75867627e55"},{"marks":[],"text":" Chronic Kidney Disease compendium is a comprehensive resource for clinical news and expert insights on the condition and treatment of loss of kidney function.","_key":"f5b29d9e2cb1","_type":"span"}]}],"identifier":"ckd","_rev":"qwh0Cdr0GP6xeI5pUNoFuT","parent":{"_ref":"297fa3d1-5216-46eb-bf51-66c5f77c3c8a","_type":"reference"},"_createdAt":"2020-07-30T14:48:10Z","_type":"taxonomy","name":"Chronic Kidney Disease","_id":"compendium_renal","_updatedAt":"2022-01-13T14:27:20Z"}],"documentGroupMapping":[{"_ref":"a06fa91b-ed75-4bb1-ab2a-77152c6732d1","_type":"reference","_key":"e63e84c92e3a"}],"published":"2021-09-24T14:30:00.000Z","is_visible":true,"_rev":"zz9a80pM1bh59F2Kf97m4e","updatedOn":null,"link":"/view/results-from-the-fidelity-pooled-analysis"},{"showSocialShare":true,"documentGroupMapping":[{"_type":"reference","_key":"8a40b0303156","_ref":"a06fa91b-ed75-4bb1-ab2a-77152c6732d1"}],"url":{"current":"an-overview-of-the-fidelity-pooled-analysis-design","_type":"slug"},"_type":"article","updatedOn":null,"factCheckAuthorMapping":null,"published":"2021-09-24T14:00:00.000Z","title":"An Overview of the FIDELITY Pooled Analysis Design","documentGroup":{"_ref":"a06fa91b-ed75-4bb1-ab2a-77152c6732d1","_type":"reference"},"body":[{"_type":"video","videoID":"6271751774001","source":"brightcove","_key":"052dc269e89e"},{"_key":"df10e9f586f8","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"f523bcc9f607"}],"_type":"block","style":"normal"},{"children":[{"text":"Transcript:","_key":"560515e98904","_type":"span","marks":["strong"]}],"_type":"block","style":"normal","_key":"a39b708ac846","markDefs":[]},{"style":"normal","_key":"feee017f9a13","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Rajiv Agarwal, MD, MS: ","_key":"e169a3668f41"},{"_type":"span","marks":[],"text":"FIDELITY is not a trial, it’s an analysis. It’s a pooled individual level analysis that was prespecified. We prespecified that we would take all the data from FIDELIO-DKD and FIGARO-DKD, and we would pool them to get to the outcomes that we are interested in: the kidney outcomes and the cardiovascular outcomes. Together, we have 13,171 patients from 48 countries in more than 1000 sites who have participated in the 2 trials, as a population randomized to finerenone or a placebo. The follow-up is 3 years, median duration. So we have a lot of years of follow-up in this trial, and we are taking everybody who has an optimized ACE [angiotensin-converting enzyme inhibitor] or ARB [angiotensin receptor blocker]. They have all type 2 diabetes and CKD [chronic kidney disease].","_key":"73fb87673667"}],"_type":"block"},{"style":"normal","_key":"7ba04037fd56","markDefs":[],"children":[{"_key":"b806befd969a0","_type":"span","marks":[],"text":""}],"_type":"block"},{"markDefs":[],"children":[{"marks":[],"text":"They all have serum potassium of 4.8 mmol/L or less at baseline and run-in. But remember that after the run-in period, we have a 2-week gap between that and randomization. Many patients during that time can have an increase in potassium, and that didn’t matter: they could still get randomized to one of the two treatments. Many times, we had potassium levels of more than 5 mmol/L in the trial. They were still included in the randomization scheme. We excluded patients with symptomatic HFrEF [heart failure with reduced ejection fraction]. We prespecified the cardiovascular composite in the FIDELITY analysis, which was the same as before in the FIGARO trial. There’s a 4-point MACE [major adverse cardiac event] end point, which is CV [cardiovascular] death, nonfatal MI [myocardial infarction], nonfatal stroke, and hospitalization for heart failure.","_key":"e84a9172ac410","_type":"span"}],"_type":"block","style":"normal","_key":"fa3ebcb640db"},{"markDefs":[],"children":[{"_key":"b48a2147bc890","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"e416cf588f55"},{"style":"normal","_key":"24018fed79b3","markDefs":[],"children":[{"_type":"span","marks":[],"text":"We also have the kidney composite, which was a 57% decline in eGFR [estimated glomerular filtration rate]; kidney failure, an eGFR of less than 15 and going on dialysis; or death from kidney failure. Those were the 2 outcomes that we fixed, and now we can really analyze people who have stage 1 to stage 4 kidney disease and albuminuria ranging from 30 to 5000 mg/g: nearly all the patients who the nephrologists typically sees. The patients who are not included are the people who have an eGFR of less than 25 and who have no albuminuria in this trial. The strength of this analysis allows you to pool and look at the effects on both the cardiovascular and kidney failure outcomes in this very large population.","_key":"60d699a804620"}],"_type":"block"},{"_type":"block","style":"normal","_key":"9c9c11bd31be","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"a20016ab3b56"}]},{"_key":"e1033cfb3d8d","markDefs":[],"children":[{"_type":"span","marks":["strong","em"],"text":"Transcript edited for clarity. 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infarction]; nonfatal stroke; or a hospitalization for heart failure. The key secondary end point was renal outcome, which is defined as a 40% decline in eGFR [estimated glomerular filtration rate] from baseline confirmed within 30 days; kidney failure, which is either dialysis or transplantation or eGFR persistently reduced to less than 15; or death from renal disease. Basically, we have cardiovascular outcome as the primary outcome. Before I tell you the results, I can tell you that the typical patient in the study had diabetes for 14-and-a-half years and was 64 years old; 70% of patients were men. The mean systolic blood pressure was 136/77 mm Hg. Everybody was on an ACE [angiotensin-converting enzyme inhibitor] or an ARB [angiotensin receptor blocker]. Cardiovascular disease was present in 45% of patients, and 7.8% of the population had a history of heart failure. On top of that, 71% of patients were on statins. That’s an incredibly well-treated population, especially when 8.4% of these patients were on an SGLT2 inhibitor and 7.5% were on GLP-1 receptor agonist therapy.","_key":"3e44392c7f78","_type":"span"}],"_type":"block","style":"normal","_key":"5661fd730f53"},{"children":[{"_type":"span","marks":[],"text":"","_key":"9c97695630be0"}],"_type":"block","style":"normal","_key":"c84537444ccd","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"These are incredibly well-treated patients, and we are asking, given this individual, can we use finerenone versus a placebo? Will that reduce cardiovascular events? The answer was that we absolutely reduce the risk of cardiovascular outcome by 13%, a relative risk reduction of 13%. The ","_key":"dd6275ee7c910"},{"marks":["em"],"text":"P","_key":"dd6275ee7c911","_type":"span"},{"marks":[],"text":" value is .026, and the number needed to treat after 3-and-a-half years of exposure to this medicine to prevent 1 cardiovascular outcome—the primary outcome we defined in this trial—was 47. This was a very robust result given that the only reason these patients have been identified as having a high cardiovascular risk was not because they have poorly controlled hypertension or poorly controlled diabetes, are smokers, or have dyslipidemia. The sole reason is because they have kidney disease, and the majority of these people have an eGFR in the silent zone of more than 60. We are identifying them on the basis of albuminuria.","_key":"dd6275ee7c912","_type":"span"}],"_type":"block","style":"normal","_key":"76f5029a55d6","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"","_key":"2a3ebe8923500"}],"_type":"block","style":"normal","_key":"072a7a2f4d89","markDefs":[]},{"_type":"block","style":"normal","_key":"2a5ee30d8d89","markDefs":[],"children":[{"text":"This is really a landmark finding in this trial. Given the fact that if you look at the components of the end point—the atherosclerotic events, for example, MI or stroke—they’re not as much effected. It’s primarily driven for hospitalization for heart failure. That’s a big deal because in these patients who are hospitalized for heart failure, the mortality is enormous, the cost to the society is enormous, and the progression to future end-stage renal disease is enormous. We’ve cut the risk of hospitalization for heart failure by 29%. The hazard ratio is 0.71 with a ","_key":"235c12a2a74d0","_type":"span","marks":[]},{"text":"P","_key":"235c12a2a74d1","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":" value of .004, and that was a big deal in this trial. Cardiovascular deaths were reduced by about 10%, which is not statistically significant, but hospitalization for heart failure was the big story in the study.","_key":"235c12a2a74d2"}]},{"children":[{"_type":"span","marks":[],"text":"","_key":"621c45d8a13c0"}],"_type":"block","style":"normal","_key":"f18b898420d5","markDefs":[]},{"_type":"block","style":"normal","_key":"b19369df0efb","markDefs":[],"children":[{"_key":"74de6ce1a3780","_type":"span","marks":[],"text":"The secondary end point that we had in this trial was the kidney end point, and that was defined as a 40% reduction in eGFR, kidney failure, or death from renal causes. The hazard ratio here was 13%, just like the cardiovascular outcome. However, the upper bound of the confidence interval was 1.01, which gives us a "},{"_key":"74de6ce1a3781","_type":"span","marks":["em"],"text":"P "},{"_key":"74de6ce1a3782","_type":"span","marks":[],"text":"value of .069. Nominally, this end point wasn’t met. However, let’s look at it a little deeper, because 40% is a novel end point that we have started using in patients with diabetes and kidney disease. It’s not the typical end point that we have used in the past. In the captopril study published in 1993, it was a doubling of serum creatinine. In the 2 landmark trials with an ARB, called IDNT and RENAAL, it was a doubling of serum creatinine. In the CREDENCE trial, which was with canagliflozin in patients with kidney disease and macroalbuminuria, it was doubling of serum creatinine. Doubling of serum creatinine is approximately a 57% decline in eGFR. If you look at that end point, which was a key secondary end point in FIGARO, there was a 23% reduction in the risk of the outcome, so you have a hazard ratio of 0.77 with a "},{"text":"P","_key":"74de6ce1a3783","_type":"span","marks":["em"]},{"marks":[],"text":" value of .041. You basically have the upper bound of the hazard ratio as 0.99.","_key":"74de6ce1a3784","_type":"span"}]},{"_key":"0668853286b3","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"5b74c10a5de20"}],"_type":"block","style":"normal"},{"style":"normal","_key":"5ea287f7f29f","markDefs":[],"children":[{"text":"Statistically, it’s significant. But just to point this out, the results are internally consistent with the FIDELIO-DKD trial, because it shows a renal benefit provided that we use a more conventional end point rather than the more novel end point. The most important outcome to a patient with kidney disease is going on dialysis. If you go on dialysis and have type 2 diabetes, mortality is very similar to metastatic colon cancer. Here in the FIGARO trial, the hazard ratio is 0.64, so we have a 36% relative risk reduction in end-stage renal disease in this population. The ","_key":"3e985c65c4140","_type":"span","marks":[]},{"text":"P ","_key":"3e985c65c4141","_type":"span","marks":["em"]},{"marks":[],"text":"value is significant at .046, so we have a very robust finding, especially when we use the more sensible end points of end-stage kidney disease or 57% decline in eGFR composite.","_key":"3e985c65c4142","_type":"span"}],"_type":"block"},{"children":[{"text":"","_key":"ae90a85d93270","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"e288bf75b449","markDefs":[]},{"markDefs":[],"children":[{"text":"The other signal that we have in the FIGARO trial is that of hyperkalemia. We have a small signal for hyperkalemia. About 1.2% of the patients permanently discontinued the study drug. We have over 7000 patients, and 46 in the finerenone arm permanently discontinued the drug versus 13 in the placebo group. So, 0.4% versus 1.2%. Look at it another way: almost 99% of the patients who are prescribed this drug will continue on the drug for a very long time. They won’t permanently discontinue the study drug because of hyperkalemia. Yes, hyperkalemia is going to occur because it’s an MRA [mineralocorticoid receptor antagonist]. It’s going to occur in people who have type 2 diabetes and kidney disease. We expect this to happen, but it’s manageable, and it’s a low risk. But we are saving hearts and we are saving kidneys, and that’s really the message of FIGARO, so let’s not get let down by the hyperkalemia signal and say that we shouldn’t be using the drug because of hyperkalemia. We should be using it because we can save hearts, we can save kidneys, and the hyperkalemia signal is manageable.","_key":"7c49cf8ddeaf0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"1b73f24600eb"},{"style":"normal","_key":"453ab8c8f755","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"d59e38fe3df3"}],"_type":"block"},{"_type":"block","style":"normal","_key":"85860e47a8cf","markDefs":[],"children":[{"text":"Transcript edited for clarity. 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It’s looking at the effect of finerenone on cardiovascular outcomes in these high-risk patients. By the way of background, I can tell you that these are people who we don’t really think of as at high risk of cardiovascular disease. But as we have known for the last 20 years, if we note a decline in kidney function, it is associated with an increase in CV risk. If we note an increase in albuminuria, we note an increase in CV risk. And when we put the two together, we identify a grade, which is called a KDIGO [Kidney Disease: Improving Global Outcomes] heat map, that tells us the future risk of cardiovascular morbidity and mortality and end-stage kidney disease.","_key":"6200f61ddcdc","_type":"span"}],"_type":"block","style":"normal","_key":"cd42f5f9c8ac"},{"_type":"block","style":"normal","_key":"1546ae65aba7","markDefs":[],"children":[{"_key":"8e7ee90e27d90","_type":"span","marks":[],"text":""}]},{"markDefs":[],"children":[{"marks":[],"text":"We have known for a long time that patients who have very high albumin, what we used to call macroalbuminuria, are at a very high risk of progressing from early stages of kidney disease to the later stages of kidney disease and end-stage kidney disease. However, when they have moderately elevated albuminuria, or what we call microalbuminuria—somewhere between 30 and 299 mg/g of creatinine—these are people who will probably have a cardiovascular event before they will have a kidney failure event.","_key":"1dd77e1907030","_type":"span"}],"_type":"block","style":"normal","_key":"8cbf5ad30d40"},{"style":"normal","_key":"a88c1e3a0cbc","markDefs":[],"children":[{"_key":"eec95d45e8bf0","_type":"span","marks":[],"text":""}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"In this trial, 62% of patients had an eGFR [estimated glomerular filtration rate] that was 60 or more, and therefore, 62% of patients in the FIGARO trial were simply identified because they had albuminuria. This is the high-risk population that we are studying. We are asking whether MR [mineralocorticoid receptor] blockade versus a standard-of-care placebo on top of ACE [angiotensin-converting enzyme inhibitor] or ARB [angiotensin receptor blocker] use will reduce the incidence of a cardiovascular outcome. In summary, that’s the trial design of FIGARO.","_key":"0f36973af6fd0"}],"_type":"block","style":"normal","_key":"0041b6847fbb","markDefs":[]},{"_key":"d7e2ab7d5cf6","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"f263eb036f8c"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":["strong","em"],"text":"Transcript edited for Clarity","_key":"6628a6553a23"}],"_type":"block","style":"normal","_key":"3da2167f0363"}]}],"videoNonSeriesData":[{"is_visible":true,"_rev":"GDxtsU92Gso0PkC01GVTp1","published":"2024-09-04T18:00:58.864Z","body":[{"disableAutoPlayVideo":false,"source":"brightcove","_key":"3e92bc4ecbdc","videoObject":{"videoDescription":"dr manisha jhamb, CKD, chronic kidney disease","_type":"videoDetails","videoTitle":"UPMC's Dr Manisha Jhamb Urges Better Kidney Disease Awareness, Integrated Care","thumbnail":{"asset":{"_ref":"image-2909e3bf1bdd96f782f15931fa74df6a6b7f1e38-2880x1624-png","_type":"reference"},"_type":"image"},"videoDuration":"PT2M43S"},"_type":"video","videoID":"6361504711112"},{"_type":"block","style":"normal","_key":"f738e280123a","markDefs":[{"_key":"7035190fe818","nofollow":false,"blank":true,"_type":"link","href":"https://www.ajmc.com/compendium/ckd"},{"nofollow":false,"blank":true,"_type":"link","href":"https://www.ajmc.com/topic/center-on-health-equity-and-access","_key":"5a355b0b9a98"}],"children":[{"_type":"span","marks":[],"text":"Manisha Jhamb, MD, MPH, nephrologist, director of the Center for Population Health Management, and associate professor of medicine in the renal-electrolyte division at the University of Pittsburgh Medical Center, is enthusiastic about CMS's announcement of negotiated drug prices under the Inflation Reduction Act (IRA), especially for patients with ","_key":"607754da403f0"},{"_type":"span","marks":["7035190fe818"],"text":"kidney disease","_key":"18cb85c681e5"},{"text":" facing ","_key":"387eed1683ae","_type":"span","marks":[]},{"_key":"f24da7264e44","_type":"span","marks":["5a355b0b9a98"],"text":"affordability and access issues"},{"_key":"fce57ef084e2","_type":"span","marks":[],"text":". "}]},{"_key":"cc16e6f6af72","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"1406d24274d4"}],"_type":"block","style":"normal"},{"style":"normal","_key":"a74e9940ed89","markDefs":[],"children":[{"_type":"span","marks":[],"text":"However, she noted that kidney disease awareness remains a major barrier as many patients are unaware they have it until it's advanced. Lastly, looking ahead to 2025, Jhamb is focused on holistically integrating cardio-renal-metabolic care and developing comprehensive treatment guidelines for multiple subspecialties.","_key":"c2c0a7f9c446"}],"_type":"block"},{"markDefs":[],"children":[{"marks":[],"text":"","_key":"12289927f990","_type":"span"}],"_type":"block","style":"normal","_key":"00e74677d5cd"},{"markDefs":[],"children":[{"marks":["em"],"text":"This transcript has been lightly edited for clarity.","_key":"a2ebc3463df5","_type":"span"}],"_type":"block","style":"normal","_key":"78d4c5c995ea"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"573c8d6f0346"}],"_type":"block","style":"normal","_key":"5fbf5e88dade"},{"markDefs":[],"children":[{"_type":"span","marks":["strong","underline"],"text":"Transcript","_key":"4123be977e9e"}],"_type":"block","style":"normal","_key":"ecbd4005bea5"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"99ddf5bf6c40"}],"_type":"block","style":"normal","_key":"7b39addb325a"},{"children":[{"_key":"c6f2db16a80c0","_type":"span","marks":["strong"],"text":"CMS recently announced the negotiated drug prices for the first 10 drugs under the IRA. What is your reaction to the announced prices?"}],"_type":"block","style":"normal","_key":"ee4118858d55","markDefs":[]},{"_type":"block","style":"normal","_key":"00e92ba00d22","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"6ae0bbe70395"}]},{"markDefs":[],"children":[{"text":"I'm very excited. This is a big step, especially for our patients with kidney disease, who a lot of times may have affordability and access issues for these medications. These are truly life-changing medicines for these patients, so it's really great to see the movement going forward to make these medications more accessible, especially for our patients who have a lot of social risk factors. ","_key":"6beb1ab5270b0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"25191a000d94"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"99e9aa0474a6"}],"_type":"block","style":"normal","_key":"e519556310d5"},{"style":"normal","_key":"0ed670720a0f","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Kidney disease disproportionately affects some of our minority populations, including Blacks and Hispanics; for those patients, this is a great step forward.","_key":"a13e1f81bae6"}],"_type":"block"},{"_key":"bd6f039fcec7","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"43845b03ef82"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"e93deca1d1a8","markDefs":[],"children":[{"text":"What are some of the most prevalent barriers to care among patients with chronic kidney disease?","_key":"4633cd77a60f0","_type":"span","marks":["strong"]}]},{"style":"normal","_key":"2a079f6b69ff","markDefs":[],"children":[{"marks":[],"text":"","_key":"148d0a9df957","_type":"span"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"I think first and foremost is just awareness of having kidney disease. One in 9 patients with kidney disease don't even know they have it. Even those with stage 4, or pretty advanced kidney disease, half of them don't know they have it. So, that is one of the biggest barriers. Kidney disease is a silent disease, people don't have any symptoms from it until it's too advanced.","_key":"af94401cccad0"}],"_type":"block","style":"normal","_key":"86e8694a568b"},{"children":[{"_type":"span","marks":[],"text":"","_key":"a6f240c12590"}],"_type":"block","style":"normal","_key":"5433307a200d","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"In addition to that, a lot of times we are not talking—their providers, their clinicians are not talking to them enough about kidney disease and what we can do about this. The big challenge for that is for over 20 years, we never had medications. There were a few medications in the past, but now it's exciting to see newer drug classes coming into this field. ","_key":"2b79a22f75ad"}],"_type":"block","style":"normal","_key":"275aadd27f78"},{"_type":"block","style":"normal","_key":"a9fd5be5e67e","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"0dbf282c3879"}]},{"markDefs":[],"children":[{"_key":"f9c76f3d4314","_type":"span","marks":[],"text":"The challenge right now is to make sure everybody has access and affordability to these medications, [and that] our clinicians are comfortable prescribing these and are working towards implementing some of these guidelines in clinical practice."}],"_type":"block","style":"normal","_key":"6f31cd6e9e72"},{"style":"normal","_key":"a90191fea5be","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"6da9642aaea9"}],"_type":"block"},{"_key":"7d22e7a37764","markDefs":[],"children":[{"marks":["strong"],"text":"What changes in the cardio-renal-metabolic landscape are you keeping an eye on for 2025?","_key":"db4fdb8ba3530","_type":"span"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"4f3e7ffc7191","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"76333017093f"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"I think one of the big things is how we approach cardio-renal-metabolic care in [a more holistic fashion], both for the primary care physician to implement and also for the patient to understand and adhere to. 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I am Dr Ryan Haumschild, director of pharmacy services at Emory Health Care in the Winship Cancer Institute. Joining me today in this discussion are my colleagues Dr John Anderson, internal medicine physician at TriStar Centennial Medical Center; Dr Ken Cohen, executive director of translational research at Optum Health; Dr Jennifer Green, professor of medicine, Division of Endocrinology at Duke University; and Dr Suzanne Nicholas, professor of medicine and clinical hypertension, specialist, Division of Nephrology, at the David Geffen School of Medicine at UCLA [University of California, Los Angeles]. Today, our panel of experts will describe the burden of CKD—including its impact on patients and payers—review the latest evidence and treatment guidelines [that] inform decision-making in CKD, and discuss unmet needs in future directions of the treatment of CKD. Thank you. Let’s begin.","_key":"567d5ce9698f5"}],"_type":"block"},{"_key":"52977148e8d4","markDefs":[],"children":[{"text":"","_key":"7cba71d126490","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"8b696c48510f","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Ryan Haumschild, PharmD, MS, MBA: ","_key":"b08e563125710"},{"_type":"span","marks":[],"text":"For our viewing audience, let’s first start giving an overview of chronic kidney disease, as well as the interconnectivity of cardiorenal metabolic syndrome. So if we can, let’s get started with Dr Nicholas. Dr Nicholas, what is the status of chronic kidney disease in the United States? And [could you] characterize it a little bit further, such as maybe the incidence and the prevalence? What does it look like by stage? And lastly, how has CKD changed over time?","_key":"b08e563125711"}]},{"markDefs":[],"children":[{"marks":[],"text":"","_key":"0375f2e2bee00","_type":"span"}],"_type":"block","style":"normal","_key":"589c3590e5d8"},{"style":"normal","_key":"13307d5d3997","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Susanne B. Nicholas, MD, MPH, PhD: ","_key":"1eaf7fbe6d710"},{"_type":"span","marks":[],"text":"Those are all excellent questions, and I’m really pleased that we’re talking about chronic kidney disease today, primarily because this is a significant public health issue not only in the United States but around the world. Currently, around 37 million adults in the United States have chronic kidney disease. That’s a huge number. It’s about 14% to 15% of our population. And unfortunately, the vast majority of these individuals don’t even know that they have chronic kidney disease. And when we look at the numbers worldwide, about 850 million individuals worldwide have chronic kidney disease. The reason why we’re talking about this today and why we’re still concerned about this is because of the huge morbidity and mortality risk that patients with chronic kidney disease have, particularly when it comes to cardiovascular disease. As a result, it’s very related or, I should say, interrelated. And so it’s important that we speak about not just chronic kidney disease but also cardiovascular disease. Now, chronic kidney disease, it’s a disease that’s an abnormality, when you look at the definitions and abnormality of the kidneys, whether we’re looking at function or structure that has been present for more than 3 months. And there are ways that we can diagnose chronic kidney disease in patients. But it’s important that once we diagnose these individuals that we [are able] to stage their disease based on their level of kidney function. And that allows us to do many things. For one, it allows us to risk-stratify these individuals when it comes to their rate of progression of chronic kidney disease to kidney failure. But also when it comes to their cardiovascular risk. So chronic kidney disease is based on stages 1 through 5 where stage 1 is normal kidney function. And…stage 5 is kidney failure. Most patients are within chronic kidney disease stage 3. So you can imagine that for an individual who has chronic kidney disease, it’s going to be important for them to know where they are in the scheme of things so that providers can initiate the right therapies for these individuals and follow them over time to decrease their risk of progression [of] kidney failure as well as their cardiovascular risk. Now, you’ve asked about the incidence of chronic kidney disease. It turns out that the incidence of chronic kidney disease has been increasing over the years. However, it’s difficult to pinpoint the actual incidence, primarily because it varies [based] on many different factors, such as different countries where we look at incidence, but also on age groups as well as whether [the patient is] male or female or other factors. We did a study recently…myself and my colleagues, we have a very large chronic kidney disease registry, and we look specifically at the incidence of chronic kidney disease in patients with diabetes, diabetes being the most common cause of chronic kidney disease. And we were able to identify the incidence rate ratio for different racial ethnic groups when it comes to chronic kidney disease in these patients. And we identify that the individuals who are Native Hawaiian Pacific Islanders have the highest incidence rate ratio, followed by Black and African American individuals, as well as Alaska Natives and American Indians, and then followed by Hispanic [individuals]. So that tells us a number of different things. These are racial and ethnic minority groups who have very high risk for chronic kidney disease. And it’s one of the groups whom we really should be focusing on as well.","_key":"1eaf7fbe6d711"}],"_type":"block"},{"style":"normal","_key":"2cd102088d51","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"56dc520759b00"}],"_type":"block"},{"_key":"e0ffe824d31e","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Ryan Haumschild, PharmD, MS, MBA: ","_key":"9d7d80d0ff7b0"},{"marks":[],"text":"Thank thank you so much for that great overview. Not only did you go through the disease state with us, but really the prevalence and how sometimes underrepresented populations may be disproportionately affected and how we really solve that.","_key":"9d7d80d0ff7b1","_type":"span"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"3b8b19257c760"}],"_type":"block","style":"normal","_key":"e43cba0bc7ed"},{"children":[{"_type":"span","marks":["em"],"text":"Transcript is AI-generated and edited for clarity and readability.","_key":"1a6b7df740a10"}],"_type":"block","style":"normal","_key":"0b10fa37feee","markDefs":[]}],"_updatedAt":"2023-09-13T20:15:29Z","summary":"A panel of medical experts begin a discussion addressing the incidence and prevalence of chronic kidney disease (CKD).","_id":"f8e5c8f9-6e7a-467c-92a8-4e34ae76dbe0","_type":"article","link":"/view/current-status-of-chronic-kidney-disease-in-the-us","updatedOn":null,"is_visible":true,"seoTag":["CKD","chronic kidney 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And so how do we be more intentional about identifying those populations earlier and create earlier interventions?… And so that gets us started as we think a little bit about what the interplay between CKD is and between cardiovascular disease and type 2 diabetes or metabolic syndrome. Dr Green, I’ll turn to you. How does CKD interact with cardiovascular disease and type 2? Do they compound upon each other? Can CKD exacerbate heart disease and type 2 diabetes or vice versa?...","_key":"94b349f09cc01"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"d2ca9d0647980"}],"_type":"block","style":"normal","_key":"1361dedc1f47"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Jennifer B. Green, MD: ","_key":"577f2597b7e10"},{"_type":"span","marks":[],"text":"Thanks for asking that question. And also thank you for asking it early on in our conversation. We tend to think about these conditions as being separate or individual conditions. In fact, there’s a tremendous amount of overlap, and it’s very common for a given individual to have all these problems, or at least more than 1 of them. And unfortunately, if you have 2 conditions of those that you had mentioned, so type 2 diabetes plus, for example, heart failure or chronic kidney disease, your outcomes are expected to be worse. You will be at greater risk for adverse outcomes than someone who just has a diagnosis of 1 of those conditions. So unfortunately, the risk is compounded when you have more of those conditions. But they’re probably different manifestations of a single underlying degree of metabolic risk that we need to appreciate and really treat as a whole entity…rather than focusing on 1 aspect of these complications and addressing only a portion of the individual’s risk.","_key":"577f2597b7e11"}],"_type":"block","style":"normal","_key":"82dca6c5650b"},{"_key":"d192b07fc58e","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"3277c8fdc3250"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Ryan Haumschild, PharmD, MS, MBA: ","_key":"01d260c681010"},{"_type":"span","marks":[],"text":"It really plays into almost that cardiovascular renal metabolic syndrome that we hear so much about in CRM [cardio‐renal‐metabolic] and that interplay with CKD. And one of the things you talked about is a lot of these patients might have more than 1 comorbidity. And when they do, it poses more of a significant risk to their health but also the cost of care. And so, Dr Cohn, as we bring in your expertise, we know that CKD and patients with multiple comorbidities pose an increased economic burden, especially when those patients progress through CKD, if not identified early by their primary care physician…. Could you characterize some of the economic costs, whether it’s directed [at] the comorbidities or CKD directly? What are the key cost drivers? And is this affected by comorbidities? They drive the cost even higher. And maybe lastly, how do you see the burden of cost or the economic burden changing over time?","_key":"01d260c681011"}],"_type":"block","style":"normal","_key":"afde59fe34e8"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"62409c950da90"}],"_type":"block","style":"normal","_key":"2499387c4405"},{"children":[{"_key":"8aaea5dd87700","_type":"span","marks":["strong"],"text":"Ken Cohen, MD: "},{"text":"Just as a frame of reference for the total cost in 2019, Medicare spent over $89 billion associated with managing chronic kidney disease, and it falls into 2 broad categories. Obviously, renal replacement therapy is very expensive, but that’s a very smaller subset of patients with CKD. A lot of the spend is in earlier stages of CKD and really falls into 2 different buckets. One is cardiovascular, so a myocardial infarction, stroke, and admission for congestive heart failure are all very significantly elevated in the CKD population relative to non-CKD. The others are specific complications of the CKD itself, and those include things like hyperkalemia. Crashing into dialysis is a very expensive way of entering renal replacement therapy for those who haven’t been identified in advance. So those are some of the major cost drivers. There are also significant disease comorbidities where diabetes, for example, has a high prevalence of neuropathy. So, too, [with] CKD. You put those two together, and advanced neuropathy winds up with chronic peripheral leg disease, diabetic wound infections, peripheral arterial disease. All of those are major cost drivers. And as you progress through stages of CKD, the cost increases. So for example, the cost of managing CKD [stages] 4 and 5 is about 50% higher than managing 2 and 3. So as [the disease] progresses, costs rise. So all [of this] paints a gloomy picture for what we spend on CKD management.","_key":"8aaea5dd87701","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"37f80bc3deeb","markDefs":[]},{"children":[{"text":"","_key":"08da6a368b0e0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"3c4be6f3269e","markDefs":[]},{"children":[{"marks":["strong"],"text":"Ryan Haumschild, PharmD, MS, MBA: ","_key":"f79e769096230","_type":"span"},{"_type":"span","marks":[],"text":"I appreciate you characterizing the changes over time because I think a lot of times as providers, we know a patient [is] deteriorating, but also as a payer, if we don’t get ahead of this, if we don’t invest in identifying these patients early and stop that progression of disease, there could be greater costs on the horizon. And really, as we evaluate that, looking at the total cost of care, whether it be dialysis in more advanced CKD or whether it’s earlier on where we have cardiovascular complications that make disease more difficult to treat. And so how do we evaluate that whole patient, make sure we’re developing a plan not just for CKD, not just for cardiovascular, but the interplay between them? As we transition, it’s really important, as we talk about cost control and early identification, to make sure that patients are being seen by the right provider. And I think sometimes, traditionally we might think that’s only going to be a nephrologist. But really, a lot of times these patients…whether it’s serum creatinine or the albumin, it really happens in the primary care or the outpatient environment. And so, Dr Anderson, I know that you have a lot of familiarity of courting care for a lot of patients. And so as we talk about [patients with] CKD, maybe you can help characterize for us who really takes care of a [patient with] CKD. Is it the hospitalist? Is it the primary care physician, cardiologist, nephrologist, endocrinologist? And who ideally should coordinate care? And what are some of those best practices that we can share with our viewing audience?","_key":"f79e769096231"}],"_type":"block","style":"normal","_key":"99b80268c2c3","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"","_key":"1affeb1aced50"}],"_type":"block","style":"normal","_key":"d1d98e033f2e","markDefs":[]},{"children":[{"_type":"span","marks":["strong"],"text":"John E. Anderson, MD:","_key":"bfe2e915e7d70"},{"text":"I think the simple answer to your question is every one of you listed. Right? But since we know that diabetes is the No. 1 cause of progression of chronic kidney disease, the vast majority of type 2 diabetes in the United States, 90%-plus is taken care of by primary care providers and clinicians. And that means physicians, nurse practitioners, [and] physician assistants. So we really have the opportunity to be on the front line of managing these people. And we have a lot of things in primary care that we’re responsible for. Cardio-renal-metabolic is probably the chief of the things that we need to be doing. So we need to be screening these patients. We do lipid panels once a year. We do basic metabolic panels once a year. So we’re pretty good…. What we’ve not been good at is doing uACR [urine albumin-creatinine ratio] and screening for albuminuria. And that’s probably a legacy of “so what?” For years we’d have somebody on maximum RAAS [renin-angiotensin-aldosterone system] inhibition, blood pressure at target, trying to control their diabetes, telling them to not take anti-inflammatories, and that type of thing. But we really had nothing else to offer them until the past few years. Now it is much more imperative that we do both the renal function as well as your uACR. That’s the urine albumin creatinine ratio because frequently microalbuminuria will precede a decrease in kidney function. And to your point, trying to identify these people early.... Anybody who has a touchpoint with these patients does not get to abdicate responsibility for their care. And so for many years: Here’s my silo, and here’s when I got to stay in it, and here’s the cardiology silo, and here’s the nephrology silo, and here’s the endocrinology silo. We really can’t do that anymore because there is so much interplay across these disease states that anybody seeing that individual patient in the office needs to say, “What are we not doing to maximize care?”","_key":"bfe2e915e7d71","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"c1aac6196b7b","markDefs":[]},{"markDefs":[],"children":[{"_key":"0113420c33b40","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"90f642cff865"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Ryan Haumschild, PharmD, MS, MBA: ","_key":"1887d33cbc540"},{"marks":[],"text":"It’s a great call out…. We put a lot on our primary care providers, but at the same time, this is really part of that core evaluation. And so sometimes a lot of the labs might be ordered, but uACR might be [an] additional lab that can be ordered that could provide better earlier detection as we’re managing the patient as a whole. And I think that’s a really great comment. And I think hopefully we’re creating awareness here as we’re working with our payers and our primary care provider colleagues that are watching it…. 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They've got to come in and get injections at least once a month, sometimes even more often than once a month. So, if they have an oral option that mitigates that, it's going to be something that's going to really help them a lot.","_key":"25e82c47a1e10"}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"","_key":"68a3baa5bc970"}],"_type":"block","style":"normal","_key":"19e587ad913d","markDefs":[]},{"_type":"block","style":"normal","_key":"55aec88cedeb","markDefs":[],"children":[{"_type":"span","marks":[],"text":"It's going to still be important to monitor their hemoglobin. 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on empagliflozin in chronic kidney disease (CKD) showed the drug had similar efficacy across subgroups, but more data is needed to really understand the benefit of the drug in CKD, said","_key":"e7ef714e9f050"},{"_type":"span","marks":["em"],"text":"Jennifer Green, MD, professor of medicine at Duke University School of Medicine, member of Duke Clinical Research Institute, and EMPA-KIDNEY collaborator.","_key":"e7ef714e9f051"}]},{"markDefs":[],"children":[{"marks":[],"text":"","_key":"40751672f4af0","_type":"span"}],"_type":"block","style":"normal","_key":"5a422e3d46ac"},{"_key":"baf91d5d7900","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"What impact did race and other demographic factors have regarding efficacy of empagliflozin in CKD?","_key":"6fd421704f200"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"There are very detailed data regarding the effects of empagliflozin compared to placebo, across a very wide number of 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We saw no differences in the effect of empagliflozin, or the benefit of empagliflozin, in women compared to men, or in people who were in different locations around the world. The effect appears to be very, very consistent. I'm happy to say, that in the United States, we successfully enrolled a very, very diverse patient population—really representative of people with kidney disease in this country.","_key":"cca7a030769c0"}],"_type":"block","style":"normal","_key":"5bb4975e8941","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"6d86d9cbe1e80"}],"_type":"block","style":"normal","_key":"a630d5e4ffdc"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Can you review the mechanism of action for empagliflozin and discuss why this class of drugs appears to affect not only diabetes, but also kidney disease?","_key":"0a267f426f920"}],"_type":"block","style":"normal","_key":"0af4fc81e766"},{"children":[{"text":"Everyone wants to know why the SGLT2 [sodium-glucose cotransporter 2] inhibitors provide the clear cardiovascular and kidney benefits that have been clearly proven in EMPA-KIDNEY. These drugs were first created because we know that they reduce glucose reabsorption in the kidney. With people with type 2 diabetes, blood glucose levels will be lowered because there's more glucose put out into the urine.","_key":"d367034aa0ed0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"77fa0c9615d3","markDefs":[]},{"style":"normal","_key":"1810b6dc44f8","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"c5f8ed213b8f0"}],"_type":"block"},{"markDefs":[],"children":[{"text":"Now, that does not explain the vast array of organ benefits that we see with use of empagliflozin under a variety of theoretical physiologic effects that might be of benefit, such as positive changes in blood pressure, hematocrit levels, and probably favorable hemodynamic changes in the kidney. We don't know those exact reasons with certainty at this time. However, I would encourage people to continue to investigate that, but not wait for that information to be available before implementing these effective medications in clinical practice.","_key":"a159a0c807ba0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"89ff08af3fb0"},{"style":"normal","_key":"c2da658de144","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"f6ed8bfedc680"}],"_type":"block"},{"markDefs":[],"children":[{"text":"The rates of hospitalization for heart failure deaths from cardiovascular causes, as well as death from any cause, was improved, but remain nonsignificant for those given empagliflozin vs placebo. What takeaways should clinicians understand about these findings, and what additional research is warranted here?","_key":"aad8722d6df40","_type":"span","marks":["strong"]}],"_type":"block","style":"normal","_key":"1e5797fab5dd"},{"_key":"5ce057db21f8","markDefs":[],"children":[{"text":"There were numerically fewer of those events in the patients who received empagliflozin compared to those who received placebo, but the reduction was not statistically significant. Remember that the trial was powered specifically to answer the question related to the primary outcome, and there were not very many of the kinds of events that you mentioned that had time to occur during the trial. Thus, the trial probably was not powered and did not go on long enough for us to accumulate enough of those events to really determine the effect of the medication with confidence.","_key":"fd1bdddf6cf90","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"010638370d770"}],"_type":"block","style":"normal","_key":"aa7121c2318c"},{"markDefs":[],"children":[{"text":"However, what we did see, with respect to the results, are very similar to findings in other trials, which studied SGLT2 inhibitors in similar patient populations. Remember that the trial was halted early due to significant efficacy in reaching or reducing the primary outcome. In fact, the median duration of follow up in EMPA-KIDNEY at 2 years was shorter than that in the other 2 CKD trials in the class.","_key":"864171badf320","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"c4fafa76c0ad"},{"style":"normal","_key":"9f9af78fdd9a","markDefs":[],"children":[{"marks":[],"text":"","_key":"e1f46b4674820","_type":"span"}],"_type":"block"},{"_key":"bd630fbc28c7","markDefs":[],"children":[{"_key":"77a48884faa90","_type":"span","marks":["strong"],"text":"Speaking generally, what sorts of insurance barriers, if any, have you had trying to prescribe “flozins” for patients?"}],"_type":"block","style":"normal"},{"_key":"b1c403fa5935","markDefs":[],"children":[{"_key":"f14e8d58c2c10","_type":"span","marks":[],"text":"I prescribe SGLT2 inhibitors very often for diabetes, kidney disease, and cardiovascular disease, and sometimes for all of those things in the same patient. We don't have enough time to review the different strategies and opportunities that seem to work best depending on an individual's particular insurance coverage or lack thereof. 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Before we conclude, I’d like to get final thoughts from each of you. Let’s start with Dr Feldman. Leave us with some parting thoughts for our viewers based on this discussion.","_key":"c5146a665e3a1"}],"_type":"block","style":"normal","_key":"44832c409e64"},{"_type":"block","style":"normal","_key":"4b17da4a61be","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"2e94843fb6670"}]},{"style":"normal","_key":"8954f82eee2a","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Jeffrey Feldman, MD:","_key":"9c404230a57c0"},{"_key":"9c404230a57c1","_type":"span","marks":[],"text":" I want to point out that we have to be more preventive in treating disease before it becomes chronic and progressive, with reference to diabetes and CKD [chronic kidney disease]. We haven’t talked about how there are now studies available, particularly SGLT2 studies, and Dr Agarwal said some studies are going to be done with MRAs [mineralocorticoid receptor antagonists], that CKD with or without diabetes can be treated, and [you can] slow the progression. When you slow the progression, you have fewer [poor] cardiovascular outcomes, including heart failure, which is No. 1, and patients feel better. Quality-of-life studies are on the horizon. The SGLT2 inhibitors all have [good] quality of life. People are doing better. When people are doing better, they’re happier and can enjoy their life, even though they have chronic kidney disease."}],"_type":"block"},{"_key":"82edc9d23c0f","markDefs":[],"children":[{"_key":"04b6939dfc680","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal"},{"style":"normal","_key":"877b2b2d20ab","markDefs":[],"children":[{"_type":"span","marks":[],"text":"I’ll close with something I heard one day on the radio as I was coming home that made me smile. As the Beatles said, “Here comes the sun.” I’ll close with that. The new medications, new implementation, using social determinants of health, and using a team approach with the patient in the center will improve patient outcomes. I thank you all.","_key":"3428da3cb7e20"}],"_type":"block"},{"_key":"d9dd4f5d26be","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"27a858e926b00"}],"_type":"block","style":"normal"},{"_key":"a3d51a533c9f","markDefs":[],"children":[{"marks":["strong"],"text":"Ryan Haumschild, PharmD, MS, MBA:","_key":"2ea78ce8337a0","_type":"span"},{"_key":"2ea78ce8337a1","_type":"span","marks":[],"text":" Thank you for that positive outlook. I’m excited about the future treatment landscape as well. Dr Agarwal, I’m curious about your final thoughts for our viewers."}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"9669513e2e180"}],"_type":"block","style":"normal","_key":"9f6093f3e630"},{"_key":"55032c32bd54","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Rajiv Agarwal, MD, MS: ","_key":"956102effacb0"},{"marks":[],"text":"I’m going to make a remark that is probably important for every physician who is listening. It has to do with the social history that we take. When we ask our medical students to take a social history, you’ll hear about smoking, drugs, or alcohol, and that’s where it ends. We need to do a lot better. Every time I do rounds on patients or I see outpatients, I’m truly humbled how much social factors play an important role in the genesis, progression, and acute illnesses of the patients. If we don’t address them, we have simply put a Band-Aid on.","_key":"956102effacb1","_type":"span"}],"_type":"block","style":"normal"},{"style":"normal","_key":"79e83ba337c6","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"e44ae4ee518b0"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Social determinants of health has understandably become an important topic. It has become an important area of emphasis, including at Humana. Paul Sapia pointed out the initiatives, and I applaud them. But at an individual physician level, we have to do better. You need to find out how your patients live, where they live, and whether they have any activities going on. Do they have a pet? Do they take it for a walk? Or are they only watching television? I’ve visited homes of patients, and a simple 5-minute trip will tell me exactly how and why the patient got there because I know what they’re doing and where they’re living. We need to explore that much more when we see our patients on a day-to-day basis rather than leave it to the textbooks. That’s all.","_key":"a5b6facddf520"}],"_type":"block","style":"normal","_key":"085993ad487b"},{"_type":"block","style":"normal","_key":"b526b2dc8796","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"fe39e37a8e1d0"}]},{"_type":"block","style":"normal","_key":"76ab0589d7f6","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Ryan Haumschild, PharmD, MS, MBA:","_key":"0e0d981d12e60"},{"_type":"span","marks":[],"text":" Excellent thoughts. Thank you. Dr Pitt, what final thoughts do you have for us?","_key":"0e0d981d12e61"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"9d77cb512ec50"}],"_type":"block","style":"normal","_key":"a4cca96461cb"},{"style":"normal","_key":"7ba44d7a493c","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Bertram Pitt, MD:","_key":"6826402780eb0"},{"_type":"span","marks":[],"text":" I’ve been around quite a while, and over my lifetime there has been dramatic change in how we treat heart failure and renal disease. We have tools now that we can move to prevention and even stop the progression and development of disease. But I’m also excited about the future. There are clues that we can make a big difference.","_key":"6826402780eb1"}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"","_key":"f6bf4da4885a0"}],"_type":"block","style":"normal","_key":"44240b3343af","markDefs":[]},{"children":[{"_key":"39c27a36866d0","_type":"span","marks":[],"text":"In the discussion, Dr Feldman alluded to inflammation and autoimmunity. There are new modalities that we can [use to] begin to attack this, which hasn’t been attacked. There are lots of things for the future. But most importantly, we have tools now that we have to learn how to use. Maybe there are things coming in the future—I think there are—but if we don’t use the tools we have right now, we’ve missed a tremendous opportunity. We have very potent tools, with the SGLT2 [inhibitors] and now the nonsteroidal MRAs, such as finerenone."}],"_type":"block","style":"normal","_key":"b9bed01a9baf","markDefs":[]},{"_key":"c2bca00821e8","markDefs":[],"children":[{"marks":[],"text":"","_key":"733eb0a9f9d00","_type":"span"}],"_type":"block","style":"normal"},{"style":"normal","_key":"108783736507","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Ryan Haumschild, PharmD, MS, MBA:","_key":"c7752183a1d10"},{"_key":"c7752183a1d11","_type":"span","marks":[],"text":" [We have] excellent new therapies. How can we make sure that we’re utilizing them and getting patient access? I’m going to have our valued managed care colleague, Paul, give our final thought from our panel."}],"_type":"block"},{"_key":"585e17edfa69","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"e56c27d5a76a0"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Paul Sapia, MHA:","_key":"3be47c039c7f0"},{"_type":"span","marks":[],"text":" We’ve all touched on the social determinants of health and understanding those zip code issues and community issues that exist. Dr Agarwal talked about going into the home and being able to see [their living situation]. Is there food in the home? Is it clean? Is the air conditioning working? Those are all important things. As we look at our clinician partners and our other types of provider partners who are going into the home to help people get things like food and nutrition, how do we get a lens into the patient’s home to understand?","_key":"3be47c039c7f1"}],"_type":"block","style":"normal","_key":"f43cd58ea313"},{"_key":"fe613b025448","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"348962b716e10"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_key":"a986d0dbea610","_type":"span","marks":[],"text":"The other part that I touched on earlier is the caregivers and family support. [In addition] to behavior change with the member, the family members and caregivers have to support that behavior change. It’s important to educate why we have to do this, why this is important, how to do it, and give them tools to be able to do it. If we look at prevention, we’ve got the data and analytics, and we understand what’s going on with community, so we could focus a lot of these efforts on the specific communities that have high incidences of diabetes, heart disease, and obesity, and start to change what’s going on within those zip codes and areas. Thank you very much. I appreciate being a part of the panel."}],"_type":"block","style":"normal","_key":"04d86677406c"},{"_type":"block","style":"normal","_key":"29027a21e327","markDefs":[],"children":[{"marks":[],"text":"","_key":"92fd833a3c530","_type":"span"}]},{"children":[{"_type":"span","marks":["strong"],"text":"Ryan Haumschild, PharmD, MS, MBA:","_key":"03fed9e9949e0"},{"_key":"03fed9e9949e1","_type":"span","marks":[],"text":" Thank you all, again. And thank you to our viewing audience. 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Haumschild, PharmD, MS, MBA:","_key":"f94481b6ca4c0"},{"_key":"f94481b6ca4c1","_type":"span","marks":[],"text":" Lastly, I want us to talk about the future of CKD [chronic kidney disease] management. We talked about innovative therapies, focusing on disparities of care and how we can make an impact. I want to explore the unmet needs and additional considerations in treatment. I’ll start with Dr Agarwal. What health disparities has your institution identified with patients with CKD? What steps are you or your institution doing to address these health disparities? What can be done to improve outcomes in this patient population?"}],"_type":"block","style":"normal","_key":"f71168ea3a4e","markDefs":[]},{"_type":"block","style":"normal","_key":"3b4573e470e9","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"f8738853fc410"}]},{"_type":"block","style":"normal","_key":"8f9fc2af294c","markDefs":[],"children":[{"text":"Rajiv Agarwal, MD, MS: ","_key":"6473062f62d00","_type":"span","marks":["strong"]},{"_type":"span","marks":[],"text":"Great question, Ryan. One key issue is education. As a society, blood pressure and cholesterol are in common parlance. CKD draws a blank. If you were to stand in Times Square and ask somebody, “What does CKD mean to you?” I don’t think many people would [know] what it stands for. We have to raise awareness of chronic kidney disease. The National Kidney Foundation has done a fabulous job, but we have to get out the message that chronic kidney disease is real and silent, and there’s something that can be done about it because we aren’t in the 1990s or 2000s anymore. We now have treatments that can help.","_key":"6473062f62d01"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"38053dc192b90"}],"_type":"block","style":"normal","_key":"503c8802604a"},{"children":[{"marks":[],"text":"Educating physicians is important. I hate the word ","_key":"c59decc82adf0","_type":"span"},{"_type":"span","marks":["em"],"text":"providers","_key":"c59decc82adf1"},{"marks":[],"text":" because I didn’t go to provider school. I’m not a provider, I’m a physician. Education of my colleagues is important because my colleagues in primary care are overwhelmed with information from so many fields. If they aren’t educated about advances with the motive to make a difference in their patients’ lives, how can they do it? Paul said a very important word: why. Why should I know it? If your common theme is to make a difference in your patients’ lives, then this is the reason you need to know it. What’s the minimum information I need to know? That’s what we need to provide in terms of education. People say, “This too simple.” I say, “Make it third-grade level [so that] everybody gets it. Don’t make it PhD level, because nobody will understand.” What stays with them is what they can act on.","_key":"c59decc82adf2","_type":"span"}],"_type":"block","style":"normal","_key":"22861734a7b4","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"f09a3516b6040"}],"_type":"block","style":"normal","_key":"48dcd9c60bc2"},{"children":[{"_key":"60caeac7f59e0","_type":"span","marks":[],"text":"The second issue is prevention. In the past, we always looked at treatment. Now it’s prevention. We now have agents that can prevent the onset of cardiovascular disease and kidney disease progression. But the most important [part] is access. If I don’t have the ability to prescribe the approved drugs, how can I make a difference? If the patients can’t afford these drugs that might be able to work, how am I going to make a difference? That will need everybody at the table—patients, physicians, payers, the government, researchers—to come together and say, “We aren’t doing research to build ivory towers. We’re doing it to make a difference in the lives of our patients.” If you can’t prescribe and make a difference in patients’ lives, then research isn’t worth anything. I’ll close there."}],"_type":"block","style":"normal","_key":"39d0f4bc123d","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"1f24247974b40"}],"_type":"block","style":"normal","_key":"d0e0e33064e1"},{"style":"normal","_key":"573f1b563fe7","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Ryan Haumschild, PharmD, MS, MBA:","_key":"fc15dbcf06450"},{"_type":"span","marks":[],"text":" Excellent. Thank you for that. Dr Feldman, how about you? At your institution, what are some of the specific strategies you’re using to focus on health disparities with patients with CKD? What are the next steps to improve the overall population health?","_key":"fc15dbcf06451"}],"_type":"block"},{"markDefs":[],"children":[{"text":"","_key":"08fd77827a4a0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"1d5be9ae1e82"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Jeffrey Feldman, MD:","_key":"ada35fa464e30"},{"marks":[],"text":" For the past many years, using diabetes as the stepping stone, we have had a work group across our hospital working with primary care. We meet once a month. All high-risk patients are sent for CKD [testing] if they have diabetes. One issue we’re looking at is disparities of care. The other issue, as Dr Agarwal correctly stated, is implementation of this science in getting the patients the medications, which is very difficult and requires a team. Basically, we’ve been using a team, our medical assistants. I’m fortunate to have 3 good [medical assistants] focused on patient care, putting the patient at the center, taking questions and calls about the medications, and trying to get them assistance to get them all the resources that help people and prevent progression of diseases, as we’ve talked about over the last hour and a half or so.","_key":"ada35fa464e31","_type":"span"}],"_type":"block","style":"normal","_key":"ded888ccdfe0"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"00491245a9ed0"}],"_type":"block","style":"normal","_key":"28e234a57282"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Ryan Haumschild, PharmD, MS, MBA:","_key":"0249af371e1c0"},{"_key":"0249af371e1c1","_type":"span","marks":[],"text":" Dr Pitt, how do you and your institution focus on health disparities here?"}],"_type":"block","style":"normal","_key":"550c9b22525e"},{"_key":"470adceb0a8c","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"e150338465b60"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":["strong"],"text":"Bertram Pitt, MD:","_key":"8eaec27dc0a20"},{"_type":"span","marks":[],"text":" A lot of the points have already been made, but guidelines have failed us in many ways, and people don’t follow them. There’s an opportunity. We talked about the tools we have, but we need to have further studies to prove their cost-effectiveness and utility. There’s a lot of opportunity to move these tools into prevention and stop before—Dr Feldman talked about end-stage renal disease, but we have to go much earlier in hypertension and the risk factors and prevent the development of CKD and heart failure. If we wait until we have it, the game is up. It’s too costly. We need our friends in family practice and internists to do this. Education is important, but education alone probably won’t do it. We need to have incentives. I’m sure our friends at Humana are thinking about all these things. Given the tools we have, there’s a tremendous opportunity to change the game.","_key":"8eaec27dc0a21"}],"_type":"block","style":"normal","_key":"d94a61e1d243","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"","_key":"440d6ee96c680"}],"_type":"block","style":"normal","_key":"7fbb7612ead5","markDefs":[]},{"children":[{"_type":"span","marks":["strong"],"text":"Ryan Haumschild, PharmD, MS, MBA:","_key":"ca410a7385720"},{"_type":"span","marks":[],"text":" Paul, from your perspective, with payers, payer pathways, and the different issues going on, [are there] any specific initiatives that you’re focused on with health disparities in CKD?","_key":"ca410a7385721"}],"_type":"block","style":"normal","_key":"2ac87baf7f02","markDefs":[]},{"children":[{"marks":[],"text":"","_key":"e1dfe98fa78a0","_type":"span"}],"_type":"block","style":"normal","_key":"32d760418b50","markDefs":[]},{"style":"normal","_key":"c9e65edb155f","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Paul Sapia, MHA:","_key":"7600e5ffbcdc0"},{"_key":"7600e5ffbcdc1","_type":"span","marks":[],"text":" Yes. That’s a great question. Everybody has touched on it. We touched on it earlier, starting to look at behavior change and the health-related social needs that members are experiencing within [their] community. One thing that we haven’t talked about is looking at the influential people within a community, such as pastors, faith leaders, senior services people, teachers, and principals, to help us tell the story about why behavior change is important and why we can do those types of things."}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"c0f3abd140cd0"}],"_type":"block","style":"normal","_key":"c37cf422453d"},{"style":"normal","_key":"baa684200045","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Then [we want to] connect people to those resources within communities. We have tons of safety net providers, free services, and other things that are available to people, but they don’t [know] what’s available for them. [It’s important to] connect those resources to the clinicians and medical professionals who are helping to address those members. That’s a big key point. We have to start to explain why and get the people who can tell the story for us to help create behavior change. We have too many people seeking care at the emergency department who don’t have a medical home. How do we get people to think differently about a primary care physician as a gatekeeper to help them navigate the health system and the resources available to them? 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finerenone have improved outcomes for patients with CKD [chronic kidney disease]. We’ve discussed this in the clinical trial results. Is there a potential role to use these agents in combination to promote a reduction in disease progression or in CV [cardiovascular] risk?","_key":"351c8d65ca521"}],"_type":"block"},{"style":"normal","_key":"0c07ba32e0f9","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"b15d221373ea0"}],"_type":"block"},{"_key":"143cbdc364ad","markDefs":[],"children":[{"marks":["strong"],"text":"Bertram Pitt, MD:","_key":"3e3f211a4b0e0","_type":"span"},{"_type":"span","marks":[],"text":" It’s still very early in the game, but there are preclinical data that if you take a low dose of finerenone and a low dose of an SGLT2 inhibitor, such as empagliflozin, at least in an animal model, you get better results than with either one alone, and you reduce mortality. We’ve already talked about the fact that when you add an SGLT2 to an MRA [mineralocorticoid receptor antagonist], you have less hyperkalemia. There are lots of reasons to think that this combination is going to be very useful in not only treating CKD and heart failure but also preventing them.","_key":"3e3f211a4b0e1"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"d29167f63f53","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"cf5f7cc1792c0"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"I’d like to make a few comments [regarding things] that maybe were already alluded to. Dr Agarwal talked about hyperkalemia, but of people who discontinue these agents, only about 1% or so discontinue the agents because of hyperkalemia. With our old friends, the steroidal MRAs, it was a much higher percentage who discontinue, and many people don’t start. If you aren’t on an MRA, at least with heart failure, you have a tremendous increase in risk. The increased tolerability that you get with agents such as finerenone is important.","_key":"1c6c8aab821a0"}],"_type":"block","style":"normal","_key":"9f1e5c7cbde9"},{"children":[{"marks":[],"text":"","_key":"21bc6b99697e0","_type":"span"}],"_type":"block","style":"normal","_key":"2b7ede1787de","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Another thing I’d like to mention is that when you start an agent such as finerenone, you sometimes have a rise in creatinine, which is a hemodynamically mediated effect because of the small drop in blood pressure. Some clinicians have become nervous and stop agents because of the rise in creatinine, but if you persist, you protect the kidneys and the heart. This is transient hemodynamics. This is an important point. You shouldn’t get nervous when you see a slight increase in creatinine when you start these agents because [it helps] in the long run.","_key":"6e09f1cba6ae0"}],"_type":"block","style":"normal","_key":"c45d75721566"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"ad8526b7ca0f0"}],"_type":"block","style":"normal","_key":"944ef8a3a4c4"},{"markDefs":[],"children":[{"marks":[],"text":"We’ve said a lot of good things about these agents. Dr Agarwal said that maybe there isn’t much new, but there’s a need for new things. We talked about these patients with diabetes, and Dr Feldman said all the good things that we do, but one thing that we haven’t done is reduce stroke. There isn’t any evidence that SGLT2 inhibitors have reduced stroke, nor did we find that finerenone reduces stroke. In a patient with diabetes, especially with renal disease or heart failure, stroke is a major thing that we have to think about. There are new drugs and opportunities coming that will be able to reduce stroke. The game isn’t [over]. It’s very exciting, but there’s more to come.","_key":"14d5f5d2b49c0","_type":"span"}],"_type":"block","style":"normal","_key":"4d4e602de2e4"},{"_type":"block","style":"normal","_key":"aa39872d6ae3","markDefs":[],"children":[{"marks":[],"text":"","_key":"adaff8f5c6800","_type":"span"}]},{"style":"normal","_key":"160240974b06","markDefs":[],"children":[{"marks":["strong"],"text":"Ryan Haumschild, PharmD, MS, MBA:","_key":"b5455b2562950","_type":"span"},{"_type":"span","marks":[],"text":" Excellent overview. It’s exciting. There’s more to come, and we have to modernize the way we’re treating these patients early.","_key":"b5455b2562951"}],"_type":"block"},{"children":[{"text":"","_key":"4c04673179b30","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"6da42f6fba9e","markDefs":[]},{"_type":"block","style":"normal","_key":"a7e93063962d","markDefs":[],"children":[{"_key":"da2fae02a1ba0","_type":"span","marks":[],"text":"I now want to hear from our payer colleague, Paul, because as we introduce new therapies, we provide great outcomes for patients, but we also introduce new costs when we think about managing the covered lives and the per member, per million standpoint. Paul, how are payers balancing these high costs of new treatments for CKD with the risk of disease progression and total cost of care? Are there barriers from a utilization management standpoint? Are there patients who could benefit from these therapies but might not have access due to utilization management strategies or payer policies?"}]},{"_type":"block","style":"normal","_key":"1f7a71a52fe2","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"ea9e685ac9fe0"}]},{"markDefs":[],"children":[{"marks":["strong"],"text":"Paul Sapia, MHA:","_key":"f2b4008ef33d0","_type":"span"},{"_key":"f2b4008ef33d1","_type":"span","marks":[],"text":" That’s a great question, Ryan. It isn’t really what I work in on the utilization management point, and not being a clinician, I probably shouldn’t answer the clinical questions. We have 3 great clinical panelists here. But the talk about utilization management is looking at the appropriateness of care and making sure our providers understand the testing, screenings, and the new therapies that are available. One thing we have to do as a payer is balance the cost of care with the treatment of the member to make sure it’s the appropriate care for the member. We have clinical experts throughout Humana who look at that. That isn’t something I work on. But it’s making sure we’re educating providers on the appropriateness and what’s the right medication."}],"_type":"block","style":"normal","_key":"59b39948bc7c"},{"_type":"block","style":"normal","_key":"3dd8ff833116","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"064db3a972c00"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"All of our physician colleagues here have talked about the challenges, such as medication adherence. 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Are you starting to consider it for unique patients? Are you starting to use it in combination with SGLT2 inhibitors based on some of the data that we’ve seen thus far?","_key":"88da533d35fd1","_type":"span"}],"_type":"block","style":"normal","_key":"a36738950d8c","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"","_key":"ee01ba8767c90"}],"_type":"block","style":"normal","_key":"29c8390293f9","markDefs":[]},{"style":"normal","_key":"81763b5b8305","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Jeffrey Feldman, MD: ","_key":"4d10f1e2377b0"},{"_type":"span","marks":[],"text":"What Dr Agarwal alluded to is that the IDNT and RENAAL trials were in 2000 and 2001, and there are multiple other drugs that were tried between 2001 and 2015 or 2016 when SGLT2 inhibitors came on, and then last year when finerenone came on. [Before SGLT2 inhibitors and finerenone,] they all were dreadfully unsuccessful, and we had nothing in our toolbox to slow the process.","_key":"4d10f1e2377b1"}],"_type":"block"},{"children":[{"marks":[],"text":"","_key":"fe140fb421ae0","_type":"span"}],"_type":"block","style":"normal","_key":"bace37f73d1f","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"One thing is that when a patient comes to me, they think the first thing I’m going to do is say, “You’re ready for dialysis.” Basically, I use the guideline-directed therapy to slow the loss of renal function—what Dr Agarwal said—the decrease in serum creatinine by doubling, the [reduction] of eGFR [estimated glomerular filtration rate] by 57%. 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That means that if somebody comes to me with an eGFR of 45 mL/min and I use combination therapy, normal loss of renal function in a diabetic with hypertension would be 4 or 5 mL/min a year. They would have been looking at dialysis in about 5 or 6 years. In addition, as their eGFR drops, they’re at risk for heart failure and coronary events and strokes.","_key":"f7abc57037530","_type":"span","marks":[]}],"_type":"block"},{"markDefs":[],"children":[{"_key":"b9528a214dab0","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"89b14d72a9c9"},{"markDefs":[],"children":[{"text":"By using these medicines and slowing the loss of renal function, the loss of eGFR, on a yearly basis, you can assure people that they will have fewer cardiovascular events and less heart failure, and probably prevent the need for dialysis if they live that long.","_key":"43d2eed0f6a40","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"71ba6fd529e2"},{"_type":"block","style":"normal","_key":"fa01a4bb0ada","markDefs":[],"children":[{"_key":"9a77180b8c2f0","_type":"span","marks":[],"text":""}]},{"children":[{"_type":"span","marks":[],"text":"People used to get a transplant. When I started transplants, it would last for 8 or 10 years. We called that dialysis vacation. Now we have medications to do the same thing that transplants do, and they should be used in combination, because the combination on top of ACEs and ARBs with SGLT2 inhibitors and MRAs, you can reduce the loss of eGFR filtration, decrease the albumin-to-creatinine ratio, and bring it into a more normal range, hopefully someday down to about 1.5 or even 1 mL/min with newer stuff coming onto the market, ie, GLP-1 RAs [receptor agonists], which are most likely also renoprotective.","_key":"775e82c099c60"}],"_type":"block","style":"normal","_key":"eabe81a21c7e","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"","_key":"5c882f9152220"}],"_type":"block","style":"normal","_key":"3f9923474e87","markDefs":[]},{"children":[{"marks":["strong"],"text":"Ryan Haumschild, PharmD, MS, MBA:","_key":"2ddb061ce5fa0","_type":"span"},{"_key":"2ddb061ce5fa1","_type":"span","marks":[],"text":" [I have] a brief question for you. Have your patients provided any feedback as you’ve started to use finerenone on its ease of use or tolerability compared with previous treatments?"}],"_type":"block","style":"normal","_key":"dd36f70a8138","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"d4bd1632ed410"}],"_type":"block","style":"normal","_key":"cbe1b8340da3"},{"style":"normal","_key":"1fe399973f93","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Jeffrey Feldman, MD: ","_key":"de9b38892bd30"},{"_type":"span","marks":[],"text":"As Dr Agarwal alluded to, unfortunately, these are still MRAs, and hyperkalemia is a real issue. I’ll close out the session with the economic value; we do have treatment for hyperkalemia so you don’t have to stop these medicines. You can continue the medicines and use the alluded-to potassium binders, a low potassium diet, and keep the patients on their medicines, and they feel better. 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The first-in-class nonsteroidal mineralocorticoid receptor antagonist [MRA], finerenone, was approved in July 2021 based on the positive results of the phase 3 FIDELIO-DKD study. We want to talk about the introduction of this new therapy and how it broadens the treatment landscape for patients with CKD [chronic kidney disease] and potentially cardiovascular [CV] disease. Dr Agarwal, do you want to talk a little about this study and this new treatment? If you could, also talk about the follow-up study, FIGARO-DKD, which demonstrated its ability to improve cardiovascular outcomes and the strong association between CKD and cardiovascular risk. How do data from this study impact the treatment and management strategies for this patient population?","_key":"f9f15d4e1ddd1","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"bc4681537dc0"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"526d5bd261d30"}],"_type":"block","style":"normal","_key":"390f48d7f2fd"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Rajiv Agarwal, MD, MS: ","_key":"d5a8b61e584a0"},{"_key":"d5a8b61e584a1","_type":"span","marks":[],"text":"In the first trial, FIDELIO-DKD, we look at the kidney failure outcome. In the second trial, FIGARO-DKD, we’ll look at the cardiovascular protection outcome. All these patients had type 2 diabetes. The kidney failure outcome had been looked at numerous times before, for example in RENAAL, IDNT, and CREDENCE was ongoing at that time. We had no information then, but at least we know that IDNT and RENAAL worked."}],"_type":"block","style":"normal","_key":"a7366bc3f5df"},{"children":[{"text":"","_key":"bef697c9fd150","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"6616a2cecb6a","markDefs":[]},{"children":[{"marks":[],"text":"FIDELIO-DKD was done in a group of patients who had more advanced kidney disease, so they were limited to a GFR [glomerular filtration rate] between 25 and 75 mL/min, and had to have a UACR [urine albumin-to-creatinine ratio] between 30 and 5000 mg/g. These patients were excluded if they had heart failure with reduced ejection fraction because there’s level 1A evidence that spironolactone was effective in these patients. They also required them to have up to a 16-week run in, during which ACE [angiotensin-converting enzyme] inhibitors or ARBs [angiotensin receptor blockers] were maximized, and they also excluded people who had potassium of more than 4.8 mmol/L at screening at baseline to get into the trial. They selected a population that they thought would benefit from the drug.","_key":"99477a7a81e70","_type":"span"}],"_type":"block","style":"normal","_key":"e75ef2a92868","markDefs":[]},{"style":"normal","_key":"c97c30575a54","markDefs":[],"children":[{"marks":[],"text":"","_key":"9ae4b1c832820","_type":"span"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"We were walking on eggshells here. We didn’t know whether it was going to work because we had 2 negative trials, and everybody was laughing and saying, “You’re still continuing these trials?” Then when the trial results came out, we had hit the primary end point, the kidney failure outcome, and we also hit the secondary outcome, the cardiovascular outcome, which were both positive.","_key":"5c6ca87183220"}],"_type":"block","style":"normal","_key":"7ac143bce706"},{"children":[{"marks":[],"text":"","_key":"c70b106a49db0","_type":"span"}],"_type":"block","style":"normal","_key":"7df6425f6da3","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Even though it’s an MRA, it isn’t spironolactone. That’s a hugely positive result of FIDELIO-DKD, and that’s the basis for the FDA approval of the drug in July 2021 for the use in people with type 2 diabetes and kidney disease for the prevention of myocardial infarction [MI], stroke, cardiovascular death, and kidney failure. That’s basically the indication of the drug. They hadn’t even seen the FIGARO-DKD data.","_key":"c9255b9a5ff20"}],"_type":"block","style":"normal","_key":"fe2321641c8e"},{"markDefs":[],"children":[{"_key":"f013502b3e470","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"ec98f690f1c5"},{"style":"normal","_key":"042978fa180f","markDefs":[],"children":[{"marks":[],"text":"FIGARO-DKD is the more ambitious trial, because it’s looking at protection of cardiovascular outcomes in people who have simply kidney disease. We’re saying that if you have kidney disease and type 2 diabetes, you are at heightened cardiovascular risk, and you can reduce that risk if you use finerenone. There’s a 14% relative risk reduction on top of other standard of care. People are getting solid therapies. Their baseline blood pressure is about 138 mm Hg, their A1C [glycated hemoglobin] is about 7.7%, and about 71% of these patients are on statins. Everybody is on ACEs or ARBs. This drug on top of other effective therapies is reducing the relative risk by 14% in cardiovascular outcomes. That risk is primarily driven by reduction in heart failure outcomes. It isn’t by reducing MIs or strokes, but mostly heart failure outcomes and reduction in CV deaths. That’s where the major signal is for this drug.","_key":"859baeb8aa5b0","_type":"span"}],"_type":"block"},{"_type":"block","style":"normal","_key":"0baf1560418b","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"efd082ba39fd0"}]},{"children":[{"_type":"span","marks":[],"text":"The thing to appreciate about this drug is that 62% of the patients in the FIGARO-DKD trial had a GFR above 60 mL/min. If you’re screening these patients based on GFR, you aren’t going to make any impact. This drug is for primary care physicians, not for cardiologists or nephrologists alone. It would work in your cardiology or nephrology practice, but if you’re looking at a patient with type 2 diabetes with albuminuria, that’s where you want to start using the drug, because you’re reducing the risk of heart failure hospitalizations and kidney failure.","_key":"7bf67777e7040"}],"_type":"block","style":"normal","_key":"a91f2fa9c069","markDefs":[]},{"markDefs":[],"children":[{"text":"","_key":"edd7034e73ab0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"9f3fa23baaf9"},{"_type":"block","style":"normal","_key":"0dadce0f8c04","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The FIGARO-DKD trial didn’t meet its primary end point of the kidney failure. But if you look at the outcome of 57% reduction in eGFR [estimated glomerular filtration rate], ESRD [end-stage renal disease], or renal death, and a 57% reduction in eGFR is a doubling of serum creatinine. That’s the criteria we used in RENAAL, IDNT, and CREDENCE. If you use those criteria, you have a 23% relative risk reduction in that outcome, which is statistically significant.","_key":"a49dfcf8d4f90"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"3b49594eb3630"}],"_type":"block","style":"normal","_key":"b40771588d5d"},{"style":"normal","_key":"82b944f0767a","markDefs":[],"children":[{"_type":"span","marks":[],"text":"In effect, it’s a glitch in the way we’re defining the outcomes. But if you define the outcome using the more conventional way, we still have a positive outcome for kidney failure. It’s telling you that on top of existing therapy, you can reduce cardiovascular risk and kidney failure risk in people with type 2 diabetes and chronic kidney disease. It has expanded the population. About 1000 patients in this trial were on an SGLT2 inhibitor. If you exclude those patients and reanalyze the data, the data don’t change. In other words, it wasn’t flying because people were on SGLT2 inhibitors. But if you include those data and look at only the population of patients who are on baseline SGLT2 inhibitors, the point estimate of the hazard ratio is 0.63. It’s even lower than the point estimate when you aren’t on an SGLT2. With the hazard ratio, the upper bound is 1, which is protective even in the presence of SGLT2 inhibitors. When you use these 2 drugs in combination, we have found with the SGLT2 inhibitor in our post hoc analyses that the risk of hyperkalemia appears to be mitigated when we use them together.","_key":"42d06eaa4b760"}],"_type":"block"},{"_type":"block","style":"normal","_key":"575392b64996","markDefs":[],"children":[{"text":"","_key":"35f8600790c20","_type":"span","marks":[]}]},{"style":"normal","_key":"d3bacdeb8938","markDefs":[],"children":[{"text":"That’s what we have learned about these trials. [This is] a new class of drug. There’s nothing on the horizon that’s being developed, because most of the companies that were using nonsteroidal MRAs have walked out. We have other trials that are going to be done, including the FINE-CKD trial, which is looking at the slope of CKD in people who don’t have diabetes. Another trial, FINEARTS-HF, is looking at people with heart failure with preserved injection fraction and their outcomes. There are more data to come, but it’s an amazing advance, especially to help people with type 2 diabetes and CKD.","_key":"7cebbfca1f8f0","_type":"span","marks":[]}],"_type":"block"},{"style":"normal","_key":"6eb4bfe2ade8","markDefs":[],"children":[{"_type":"span","marks":["strong","em"],"text":"Transcript edited for clarity.","_key":"1d3dfdd31c10"}],"_type":"block"}],"_type":"article","documentGroup":{"_ref":"f5699f27-b294-4107-9556-8280976c097e","_type":"reference"},"link":"/view/the-role-of-mras-in-ckd-and-cv-treatment","_id":"4ebc08dc-771a-4fae-9417-c02e218fefbc","_rev":"05YXFgvJQwGBosfyzHo1jO","internalTag":["CKD"],"taxonomyMapping":[{"_createdAt":"2020-10-14T04:51:21Z","_rev":"ChnBnF2xw1R5u2UJBDlozJ","_type":"taxonomy","name":"Video Series","_id":"999720cf-b3b3-4d42-935d-beb17775844e","_updatedAt":"2022-01-06T09:02:13Z","identifier":"video-series"},{"_createdAt":"2020-03-30T20:08:04Z","sortOrder":1,"_rev":"XH8IynABFFUkUnvZmkb21z","_type":"taxonomy","_id":"02c6c999-e6fe-4275-98ca-ceef28f91e14","_updatedAt":"2022-01-19T10:37:00Z","summary":[{"children":[{"_type":"span","marks":["em"],"text":"AJMC","_key":"8f85c4bb6762"},{"marks":[],"text":"® ","_key":"10038819bd05","_type":"span"},{"_type":"span","marks":["em"],"text":"Peer Exchange","_key":"721da0888c89"},{"_type":"span","marks":[],"text":"® peer-to-peer panel discussions feature authoritative insights, opinions, and perspectives on important issues facing today's managed care professionals.","_key":"37d23a56a63e"}],"_type":"block","style":"normal","_key":"b0f5dba695a8","markDefs":[]}],"identifier":"peer-exchange","name":"Peer Exchange"},{"name":"Clinical","_updatedAt":"2022-02-18T12:13:55Z","summary":[{"children":[{"_type":"span","marks":[],"text":"The ","_key":"e80c79954e08"},{"_type":"span","marks":["em"],"text":"AJMC","_key":"a8e0f75c5d05"},{"_type":"span","marks":["superscript"],"text":"®","_key":"f7d4dddf7edd"},{"_key":"0f03d46e3b3a","_type":"span","marks":[],"text":" clinical page includes all the published content across AJMC.com, "},{"marks":["em"],"text":"The American Journal of Managed Care","_key":"cc409f2da7da","_type":"span"},{"marks":["superscript"],"text":"®","_key":"2babb3e59bb3","_type":"span"},{"_key":"d86a5bb12052","_type":"span","marks":[],"text":" and "},{"_type":"span","marks":["em"],"text":"Evidence-Based Oncology","_key":"40b2eaba6c17"},{"_type":"span","marks":[],"text":"™ on a variety of specialties, including dermatology, cardiology, oncology, and rheumatology.","_key":"b59bef533cdf"}],"_type":"block","style":"normal","_key":"dd8ad578cd0b","markDefs":[]}],"identifier":"clinical","parent":{"_type":"reference","_ref":"15012229-f713-4f0a-8f82-7667530bb382"},"_createdAt":"2020-05-04T23:46:13Z","_type":"taxonomy","_id":"topic_clinical","_rev":"HexDiduX8d6Nqnq1ECriVF"},{"_type":"taxonomy","_id":"compendium_renal","_updatedAt":"2022-01-13T14:27:20Z","_createdAt":"2020-07-30T14:48:10Z","name":"Chronic Kidney Disease","summary":[{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"The ","_key":"2f8c95be9668"},{"_type":"span","marks":["em"],"text":"AJMC","_key":"82fef8febf7a"},{"_type":"span","marks":["superscript"],"text":"®","_key":"c75867627e55"},{"_key":"f5b29d9e2cb1","_type":"span","marks":[],"text":" Chronic Kidney Disease compendium is a comprehensive resource for clinical news and expert insights on the condition and treatment of loss of kidney function."}],"_type":"block","style":"normal","_key":"1727203cde0f"}],"identifier":"ckd","parent":{"_ref":"297fa3d1-5216-46eb-bf51-66c5f77c3c8a","_type":"reference"},"_rev":"qwh0Cdr0GP6xeI5pUNoFuT"}]}],"topArticlesData":[{"title":"Meta-Analysis Finds SGLT2 Inhibitors Boost Hemoglobin, Hematocrit in CKD","url":"meta-analysis-finds-sglt2-inhibitors-boost-hemoglobin-hematocrit-in-ckd","thumbnail":{"_type":"mainImage","alt":"KidneyDisease_Fotolia_104934985_Subscription_XXL.jpg","asset":{"_ref":"image-0ceff512086771a9641e2a82d69b33efe580ba95-5733x3780-jpg","_type":"reference"}},"published":"2025-04-08T18:58:45.775Z","updatedOn":null,"factCheckAuthors":null,"_id":"6ad0697e-44b2-4b2c-a777-e7d68636296f","summary":"The analysis supports the integration of sodium-glucose cotransporter 2 (SGLT2) inhibitors into treatment paradigms for patients with chronic kidney disease (CKD) not only for their established benefits but also for addressing anemia.","source":null,"authors":[{"displayName":"Giuliana Grossi","url":"giuliana-grossi"}]},{"published":"2025-04-03T15:20:08.242Z","_id":"4d0c72b9-12d8-4353-b289-1c135451b114","url":"fda-approves-atrasentan-for-proteinuria-reduction-in-primary-iga-nephropathy","thumbnail":{"_type":"mainImage","alt":"Kidney | Image credit: Crystal light - 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