UKidney Nephrology News and Insights

Excitement for the SGLT2 inhibitor class continued at the 2019 ASN Kidney Week. Evidence continues to accumulate from analyses of the CREDENCE trial which originally showed - for the first time in a randomized controlled study with hard renal outcomes - that patients taking canagliflozin experienced slower decline in their kdiney function and a reduction in the incidence of end-stage renal failure requiring dialysis or kidney transplant. In the CREDENCE study, patients with an estimated eGFR below 30 ml/min were excluded from the trial. However, patients who had a eGFR > 30 ml/min at the time of screening but in whom the eGFR fell below 30 ml/min by the time of randomization were nevertheless included in the study.

Category: Anemia and Iron Metabolism: Clinical  

Authors: Chao H. Sun MD, FASN; Elizabeth A. Barranco MD; Lona Poole, MD; Meraf Eyassu RN; Cameron S. Liu PhD; Donna L. Kline; Thomas B. Neff; Kin-Hung Peony Yu, MD

Roxadustat, an oral hypoxia-inducible factor prolyl hydroxylase inhibitor, stimulates erythropoiesis by increasing erythropoietin, and regulates iron metabolism.

An open-label, extension study originally included 14 subjects with non-dialysis-dependent chronic kidney disease (NDD-CKD) and 1 subject with dialysis-dependent chronic kidney disease (DD-CKD). After enrollment, 2 of the subjects ended up being excluded from analyses – one with NDD-CKA withdrew consent two weeks post-enrollment and one with DD-CKD was excluded.

Session: Global Challenges of CKD

Sub-session: Global Kidney Health Atlas: Why We Need It and How It May Affect CKD Worldwide

Presenter: David W. Johnson DrMed, MBBS, PhD, FASN

David W. JohnsonDavid W. Johnson, MBBS, led the session of the global challenges of CKD with his presentation on the Global Kidney Health Atlas (GKHA), why a report like this is needed and how it may impact CKD worldwide.

The GKHA gathers “data [from all over the globe] to determine the status of existing resources, structures and organizations available to patients with CKD and AKI”.

Category: Bone and Mineral Metabolism

Authors: Sarah M. Azer, Mayo Clinic; Lisa E. Vaughan, MS; Peter Tebben, MD; David J. Sas DO, MPH

This study compared laboratory, imaging, clinical characteristics of patients with suspected or confirmed 24 Hydroxylase (24HD) “to other disorders of vitamin D-mediated hypercalcemia such as, sarcoidosis (S), lymphoma (L), and exogenous vitamin D toxicity (EVT).” Patients with 24 Hydroxylase (24HD) “have clinical and laboratory differences compared to other causes of vitamin D mediated hypercalcemia.” For patients with hypercalcemia who present at a young age, have a positive family history, and have nephrocalcinosis, clinicians should suspect 24HD.

Session: Hot off the Press: The Advancing Kidney Health Initiative and More

Sub-session: KidneyX: Redesign Dialysis, Patient Innovators Challenge, and Beyond

Presenter: Nick Uehlecke

Nick UehleckeDuring one of the final sessions at ASN Kidney Week 2019, doctors and patients tuned in on the latest-breaking developments in public policy, specifically, the focus on the Advancing American Kidney Health Initiative and congressional and regulatory policy changes that are underway.

Session: Global Challenges of CKD

Sub-session: CKD in the United States and Europe: Juxtaposing the Epidemiology and Evolution

Presenter: Kitty J. Jager, MD, PhD, Academic Medical Center

There are marked differences in chronic kidney disease (CKD) prevalence and incidence trends between the Unites States and Europe. Even within countries there are enormous disparities.

During a deep dive into the granularity of available data, Kitty J. Jager, MD, PhD, Academic Medical Center, pointed out how, where, and sometimes why such differences in prevalence and incidence of CKD exist. Identifying and interpreting this data, Dr. Jager suggested, is critical to reducing the burden of CKD.

Session: High-Impact Clinical Trials

Sub-session: Effects of Vitamin D and Omega-3 Fatty Acid Supplementation on Kidney Function and Damage in Type 2 Diabetes

Presenter: Ian H. de Boer, MD, MS, Division of Nephrology and Kidney Research Institute, University of Washington

Ian H. de BoerIt’s official. Two supplement darlings — Vitamin D and omega-3 fatty acid (often sold as fish oil) — do not help people with type 2 diabetes stave off chronic kidney disease. That’s according to a five-year study of kidney function, which included 1,312 adults with type 2 diabetes.

Poster: SIERRAS: A Phase 3, Open-Label, Randomized, Active-Controlled Study of the Efficacy and Safety of Roxadustat in the Maintenance Treatment of Anemia in Subjects with ESRD on Stable Dialysis

Authors: Chaim Charytan, MD, Nephrology Associates, PC, New Rochelle, New York, et al

Roxadustat (ROXA) is an oral hypoxia–inducible factor prolyl hydroxylase inhibitor that stimulates erythropoiesis and regulates iron metabolism. And the drug — a novel first-in-class treatment for certain people with anemia from chronic kidney disease (CKD) — is being closely watched as its Phase III program pooled analyses continue to prompt headline-worthy news. In short, ROXA shows positive efficacy and no increased cardiovascular risk in patients with anemia from chronic kidney disease.

Session: Hot Off the Press: The Advancing American Kidney Health Initiative and More

Sub-Session: Deep Dive on New Kidney Care Delivery Models

Presenter: Tom Duvall, Acting Division Director for the Division of Special Populations and Projects at the Center for Medicare and Medicaid Innovation

Even on the final day of Kidney Week 2019, the remaining attendees’ energy level and riveted interest remained high — particularly in the morning session devoted to late-breaking developments in public policy.  Case in point, the sub-session on new kidney care delivery models, present by Tom Duvall, Acting Division Director for the Division of Special Populations and Projects at the Center for Medicare and Medicaid Innovation (CMMI), which contains the CEC Model, the KCC Model, and the ETC Model.

Session: High-Impact Clinical Trials

Presenter: Robert Provenzano, MD, FACP, FASN, Chief Medical Officer, Nephrology Practice Solutions & Vice President, Medical Affairs

Before a packed crowd, Robert Provenzano, MD, FASM, DaVita Healthcare, presented pooled efficacy and cardiovascular (CV) safety analyses from the pivotal Phase III program assessing roxadustat for the treatment of patients with anemia from chronic kidney disease (CKD).

Session: High-Impact Clinical Trials

Presenter: Finnian R. McCausland, MBBCh, MMSc, FRCPI, PG CertMedEd, Assistant Professor, Harvard Medical School

Finnian R. McCausland

Looking out to a booked-solid room, Finnian R. McCausland, MBBCh, relayed the results of a trial concerning the effects of angiotensin-neprilysin inhibition on renal outcomes in patients with preserved ejection fraction.

Session: Linking lifestyle, BP, and kidney diseases: What is the evidence?

Presenter: Hoon-Ki Sung, MD, PhD

Dr. Hoon Ki SungIntermittent fasting (IF) is currently a popular new “diet trend,” especially among well-known Hollywood stars, like Jennifer Anniston. But what does the research have to say about it, specifically, its effect on reducing obesity? And, what other health benefits might it offer?

Session: Diet and Acid in CKD: Where Do We Stand?

Subsession: Plant-Based Diets: Pros and Cons in CKD

Presenter: Juan Jesus Carrero, MD, PharmD, PhD, Karolinska Institutet

It’s a hot topic. It’s more than hot. And if the SRO turnout to hear Dr. Carrero discuss plant-based diets in terms of CKD is any indication, the subject is red hot.

The session began with a brief review of current dietary recommendations for those with chronic kidney disease (CKD), which traditionally focuses on quantity — from adjusting protein intake to restricting single micronutrients (sodium, phosphorus, potassium, and calcium) to ensuring sufficient energy.

Presenter: Leyuan Xu, PhD, Yale University

Authors: Leyuan Xu, PhD, Yale University, Lloyd G. Cantley MD, FASN, Yale University School of Medicine

Leyuan XuAbnormal accumulation of macrophages, dendritic cells, and T cells may lead to progressive interstitial fibrosis, sustained inflammation, and kidney injury in the setting of maladaptive kidney repair following IRI. Blocking homing chemokines may serve as a therapeutic target to attenuate CKD progression.

Poster: Racial/Ethnic Disparities in Atrial Fibrillation Treatment and Outcomes in US Dialysis Patients

Presenter: Adan Z. Becerra PhD, Social & Scientific Systems

Authors: Paul L. Kimmel, MD, FASN, National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), Salina Paulette Waddy, MD, Atlanta Veterans Administration, Allen J. Solomon, MD, The George Washington University, Adan Z. Becerra PhD, Social & Scientific Systems, Julia B. Ward, PhD, MPH, Social & Scientific Systems, Inc., Kevin Chan, MD, MS, MGH, Chyng-Wen Fwu PhD, Social & Scientific Systems, Inc., Jenna M. Norton MPH, NIH/NIDDK, Paul Eggers PhD, Kevin C. Abbott, MD, MPH, The National Institutes of Health, NIDDK,

Increased racial/ethnic disparities in stroke rates among end-stage renal disease (ESRD) dialysis patients with atrial fibrillation (AF) are partially explained by lower use of oral anticoagulants among Blacks, Hispanics, and Asians. The reasons for these racial disparities in practice are unknown, although the results support an identified need to develop strategies that will maximize stroke prevention in minority populations and resolve system barriers between patient/physician that may block optimal treatment.

Session: Linking Lifestyle, BP, and Kidney Diseases: What Is the Evidence

Presenter: Danielle L. Kirkman, PhD

Dr. Danielle KirkmanIn this standing room only session, Danielle L. Kirkman, PhD, from the Virginia Commonwealth University, led the discussion surrounding the links between lifestyle, blood pressure, and kidney diseases with her presentation entitled, “The Physiology Behind the Effect of Exercise on Hypertension and Kidney.”

Advancement, progress, breakthrough, headway – these nouns pop up routinely on the ASN Kidney Week 2019 mobile app. Here’s one continuing story that comes with particularly grand plans – and so far everything is on a steady course toward success.