George Bakris, MD, discusses how nephrologists can work with other specialists and what the highlight of Kidney Week was.
One of the major themes during the American Society of Nephrology (ASN) Kidney Week in Washington, D.C. was different medical specialists coming together in research for new treatments.
George Bakris, professor of Medicine, University of Chicago Medical Center, explained in an interview with MD Magazine® how that relationship can better come together.
MD Magazine: How do nephrologists forge a synergy with other specialists?
Bakris: This has a lot to do with culture. If the drug is marketed as a glucose lowering drug then you're going to give it to people with diabetes.
Now we know it's far more than a glucose lowering drug and we also know from a side-effect profile if in advanced kidney disease a lot of the stuff that was thought to be associated with this drug class is not true.
Acute kidney injury was seen but nowhere near as much as was thought. Hyperkalemia is not seen at all. There was concern about fractures not seen anywhere and the people that get 1 of the greatest benefits were the people that came into the trial with amputations and those people did not have a higher risk of amputations.
So, I think a lot of the original scary tactics never was borne out to be true in the highest risk group that you would expect to see.
So, the endocrinologist can feel free to give this for glycemic control. There's nothing wrong with that and in fact the new label for canagliflozin is to really get it down to a GFR of 30, you can give it.
In fact, you can continue to give it if it gets below 30.
The cardiologist has the heart failure benefit the data are very clear. So, there's no reason for the cardiologist not to give it.
However, there is a concern about diabetic ketoacidosis amongst people taking insulin who stopped their insulin either because they got sick or for whatever reason and as long as they don't stop their insulin that's not going to be an issue.
For the primary care physician, the reality is these drugs protect kidneys and save lives. So, there's no reason not to give these drugs because the benefit far, far, far outweighs the risk based on the analysis in this highest risk group.
MD Magazine: What has been the biggest buzz during Kidney Week?
Bakris: So, I think the highlights of the meeting is we're getting a lot more information about a new class of drugs called HIF inhibitors for anemia and there's data being presented on that.
We're getting a lot of information about uric acid and outcome trials looking at allopurinol and progression of disease.
The CREDENCE, I think is the gorilla in the room. You can argue that that's a bias of mine, but I think it really is a gorilla in the room.
Then there's a lot of insights into novel mechanisms related to kidney disease related issues and that grows every year. I'm not sure that's a buzz but all of this information grows and I think that cumulatively if you apply this information when you can't apply it you'll have better protection of kidney function.