Performance of new and panel CKD‐EPI equations in European adults with type 2 diabetes DOI Creative Commons
Esben Iversen,

Katrine McLain Christensen,

Anne B. Walls

и другие.

Diabetes Obesity and Metabolism, Год журнала: 2024, Номер 26(6), С. 2501 - 2504

Опубликована: Март 6, 2024

Chronic kidney disease (CKD) is a common complication of type 2 diabetes (T2D) characterized by albuminuria and progressive decline in the glomerular filtration rate (GFR).1 CKD setting T2D can be result diabetic nephropathy, non-diabetic renal disease, or combination these factors.2 Regardless aetiology, early diagnosis enables interventions to slow GFR decline, including discontinuation nephrotoxic medications initiation renoprotective medications.3, 4 Reduced also necessitates dose adjustments for renally excreted medications, several antidiabetic agents.5 Improper adjustment lead adverse drug reactions, which are but largely preventable cause hospitalization.6 Therefore, accurate assessment crucial effective management people with T2D. Kidney Disease Improving Global Outcomes (KDIGO) guidelines from 2012 recommend using estimated (eGFR) equations based on creatinine and/or cystatin C evaluation CKD.7 Creatinine least expensive option biomarker choice most clinical settings. Cystatin less common, some settings (notably Sweden) have incorporated it into routine care. The main limitation endogenous markers that their concentration influenced factors other than function. As 'non-renal factors' unique each marker, combining multiple single equation reduces influence non-renal factors. Unsurprisingly, eGFR combine been shown outperform either marker alone general population,8 although this may not true T2D.9 practice those developed Epidemiology Collaboration (CKD-EPI). original CKD-EPI (2009 CKD-EPIcre), (2012 CKD-EPIcys), CKD-EPIcomb) replaced alternative both United States Europe.10, 11 In response criticisms race as variable, group revised exclude race, yielding 2021 CKD-EPIcre CKD-EPIcomb.12 Similarly, CKD-EPIcys was sex 2023 CKD-EPIcys.13 National societies now CKD-EPIcomb over earlier counterparts.14 However, there an ongoing debate about whether recommendation appropriate European populations, Europe continue use 2009 CKD-EPIcre. Given apparent success C, has suggested incorporating additional could further reduce impact 2020, panel (2020 CKD-EPIpanel), includes creatinine, β-trace protein (BTP) β2-microglobulin (B2M).15 Importantly, authors found inclusion BTP B2M resulted strong performance across patient subgroups without explicit race. purpose present study compare different identify equation(s) among adults This post-hoc analysis two trials ('DapKid' 'LIRALBU') performed at Steno Diabetes Center Copenhagen, Herlev, Denmark.16, 17 Both enrolled non-Black (age ≥18 years) T2D, participants who completed were included current analysis. relevant difference between cohorts DapKid trial ≥45 ml/min/1.73 m2, whereas LIRALBU ≥30 m2. A full list exclusion criteria information study's design ClinicalTrials.gov (NCT02914691 NCT02545738). studies, underwent measurements before any planned interventions. measured Copenhagen plasma clearance chromium-51-labelled ethylenediamine tetraacetic acid four-point sampling (180, 200, 220 240 min after injection). Demographic blood samples collected immediately measurement, laboratory standard assays. traceable enzymatic assay [coefficient variation (CV): 4%], immunoturbidimetric (CV: 5%), nephelometry 5%) immunoturbidimetry 4%). CKD-EPIcomb), CKD-EPIpanel) (Table S1). Continuous variables presented median interquartile range, differences evaluated Wilcoxon rank-sum test. Categorical number percentage participants, Fisher's exact Performance relative (mGFR) assessed bias [median value (eGFR-mGFR)] values within ±30% (P30) ± 20% (P20) mGFR values. Bland-Altman plots generated represent levels mGFR. Based visual inspection plots, sensitivity evaluate <120 total, 36 27 trial, combined sample size 63 (Figure Nine individuals participated did complete trials, available characteristics similar final population (data shown). Clinical cohort Table 1. had age 66 years, body mass index 31 kg/m2, 76 glycated haemoglobin 65 mmol/mol, 14.3% female. Compared higher (81 vs. 69 p = .09) (68 58 .001). Otherwise, no substantial cohorts. 2. Bias positive negative all equations. smallest (closest 0) (+0.4 m2) (−0.7 m2); P30 highest (90.5%) 2020 CKD-EPIpanel (93.7%); P20 (74.6%) (79.4%). according Figure S2. Seven ≥120 remaining 56 (mGFR switching S3. Switching would mean eGFR, lower eGFR. conclusion, we relatively low P20, indicating high overall accuracy large interindividual variation. C-based yielded bias, probably because population, such obesity inflammation, contribute increased concentration.18, 19 Removal variable (more positive) worse P30, removal negative) P30. Despite poor equations, small (close alone, demonstrating strength markers. unaffected explained reweighting coefficient. consistent (highest P20), substantially Interestingly, >120 These cases stages damage experiencing hyperfiltration, explain lag decreased concentrations (increased eGFR). Excluding metrics, readers should aware phenomenon when interpreting (or mGFR) findings, creatinine-cystatin if unavailable. Providers recognize conclusions drawn non-Black, primarily male advanced >30 We test Function Consortium (EKFC), more populations.20 will always depend specific scenario presence All accepted responsibility content manuscript approved its submission. conflicts interest declare. peer review history article https://www.webofscience.com/api/gateway/wos/peer-review/10.1111/dom.15536. De-identified data made upon reasonable request. Those submitting request required send protocol, plan statistical analysis, access agreement ensure data. S1. Flow diagram participant completion study. eGFR-mGFR versus equation. List estimate rate. Mean change Please note: publisher responsible functionality supporting supplied authors. Any queries (other missing content) directed corresponding author article.

Язык: Английский

The impact of population ageing on the burden of chronic kidney disease DOI
Nicholas C. Chesnaye, Alberto Ortíz, Carmine Zoccali

и другие.

Nature Reviews Nephrology, Год журнала: 2024, Номер 20(9), С. 569 - 585

Опубликована: Июль 18, 2024

Язык: Английский

Процитировано

34
Mind the gap in kidney care: translating what we know into what we do DOI Creative Commons
Valérie A. Luyckx, Katherine R. Tuttle, Dina Abdellatif

и другие.

Kidney International, Год журнала: 2024, Номер 105(3), С. 406 - 417

Опубликована: Фев. 20, 2024

Historically, it takes an average of 17 years to move new treatments from clinical evidence daily practice. Given the highly effective now available prevent or delay kidney disease onset and progression, this is far too long. The time narrow gap between what we know do. Clear guidelines exist for prevention management common risk factors disease, such as hypertension diabetes, but only a fraction people with these conditions worldwide are diagnosed, even fewer treated target. Similarly, vast majority living unaware their condition, because in early stages often silent. Even among patients who have been many do not receive appropriate treatment disease. Considering serious consequences failure, death, imperative that initiated appropriately. Opportunities diagnose treat must be maximized beginning at primary care level. Many systematic barriers exist, ranging patient clinician health systems societal factors. To preserve improve everyone everywhere, each acknowledged so sustainable solutions developed implemented without further delay. At least 1 10 disease.1Jager K.J. Kovesdy C. Langham R. et al.A single number advocacy communication-worldwide more than 850 million individuals diseases.Kidney Int. 2019; 96: 1048-1050Abstract Full Text PDF PubMed Google Scholar According Global Burden Disease study, 2019, >3.1 deaths were attributed dysfunction, making seventh leading factor death (Figure Supplementary Figure S1).2Institute Health Metrics Evaluation (IHME)GBD compare data visualization.http://vizhub.healthdata.org/gbd-compareDate accessed: November 18, 2023Google However, global mortality all diseases may actually range 5 11 per year if estimated lives lost, especially lower-resource settings, acute injury lack access replacement therapy failure (KF) also counted.3Luyckx V.A. Tonelli M. Stanifer J.W. burden development goals.Bull World Organ. 2018; 414-422DCrossref Scopus (461) These high rates reflect disparities prevention, detection, diagnosis, chronic (CKD).4International Society NephrologyISN Kidney Atlas.3rd ed. 2023https://www.theisn.org/initiatives/global-kidney-health-atlas/Date Death CKD prominent some regions, particularly Central Latin America Oceania (islands South Pacific Ocean), indicating need urgent action.5GBD Chronic CollaborationGlobal, regional, national 1990-2017: analysis Study 2017.Lancet. 2020; 395: 709-733Abstract (2787) poses significant economic burden, costs increasing exponentially progresses, dialysis transplantation, multiple comorbidities complications accumulate over time.6Vanholder Annemans L. Brown E. al.Reducing while delivering quality care: call action.Nat Rev Nephrol. 2017; 13: 393-409Crossref (187) Scholar,7Nguyen-Thi H.Y. Le-Phuoc T.N. Tri Phat N. al.The Vietnam.Health Serv Insights. 2021; 1411786329211036011Google In United States, Medicare fee-for-service spending beneficiaries was $86.1 billion 2021 (22.6% total expenditure).8US Renal Data SystemHealthcare expenditures persons CKD.https://usrds-adr.niddk.nih.gov/2023/chronic-kidney-disease/6-healthcare-expenditures-for-persons-with-ckdDate settings absent, where most paid out pocket. A recent study Vietnam reported cost higher gross domestic product capita.7Nguyen-Thi Australia, has diagnosis could save system $10.2 20 years.9Kidney AustraliaTransforming Australia's health: action detection disease.https://kidney.org.au/uploads/resources/Changing-the-CKD-landscape-Economic-benefits-of-early-detection-and-treatment.pdfDate January 16, 2024Google Although there regional variation causes CKD, highest population-attributable age-standardized CKD-related disease-adjusted life follows: blood pressure (51.4%), fasting plasma glucose level (30.9%), body mass index (26.5%).10Ke Liang J. Liu al.Burden its risk-attributable 137 low-and middle-income countries, 1990-2019: results 2019.BMC 2022; 23: 17Crossref (0) 1). Only 40% 60% those respectively, aware smaller proportions receiving target goals.11Gregg E.W. Buckley Ali M.K. al.Improving outcomes diabetes: setting WHO Diabetes Compact.Lancet. 2023; 401: 1302-1312Abstract (16) Scholar,12Geldsetzer P. Manne-Goehler Marcus M.E. state 44 low-income countries: cross-sectional nationally representative individual-level 1.1 adults.Lancet. 394: 652-662Abstract Moreover, 3 diabetes CKD.13Chu Bhogal S.K. Lin al.AWAREness Diagnosis Treatment Adults With Type 2 (AWARE-CKD T2D).Can J Diabetes. 46: 464-472Abstract large proportion can prevented through healthy lifestyles, control factors, avoidance injury, optimization maternal child health, mitigation climate change, addressing social structural determinants health.3Luyckx Nevertheless, benefits measures seen generations come. meantime, stratification create opportunities institute therapies slow, halt, reverse CKD.14Levin A. Bonventre al.Global 2017 beyond: roadmap closing gaps care, research, policy.Lancet. 390: 1888-1917Abstract (615) Concerningly, awareness strikingly low ≈80% 95% being across world regions 2).15Stengel B. Muenz D. Tu al.Adherence Disease: Improving Outcomes guideline nephrology practice countries.Kidney Int Rep. 6: 437-448Abstract (14) Scholar, 16Chu C.D. Chen M.H. McCulloch C.E. al.Patient CKD: review meta-analysis patient-oriented questions setting.Kidney Med. 3: 576-585.e1Abstract 17Ene-Iordache Perico Bikbov al.Chronic cardiovascular six (ISN-KDDC): study.Lancet Health. 2016; 4: e307-e319Abstract 18Gummidi John O. Ghosh prevalence Uddanam, India.Kidney 5: 2246-2255Abstract (15) 19Kidney (KDIGO) Work GroupKDIGO 2022 Clinical Practice Guideline Management Disease.Kidney 102: S1-S127PubMed 20Nicholas S.B. Daratha K.B. Alicic R.Z. al.Prescription guideline-directed medical CURE-CKD Registry, 2019-2020.Diabetes Obes Metab. 25: 2970-2979Crossref (4) People dying missed detect deliver optimal care! More important, major KF become competing risks.21Grams Yang W. Rebholz C.M. al.Risks adverse events advanced Insufficiency Cohort (CRIC) study.Am Dis. 70: 337-346Abstract (46) Indeed, 2019 showed died dysfunction (1.7 people) itself (1.4 people).2Institute Therefore, priority CKD. Strategies built on strong base past decades 3).19Kidney Scholar,22Kidney Group. KDIGO 2024 Disease. https://doi.org/10.1016/j.kint.2023.10.018Google clear; however, adherence suboptimal Scholar,19Kidney Scholar,20Nicholas Regardless cause, hypertension, forms foundation CKD.19Kidney Scholar,23Kidney Blood Pressure disease.Kidney 99: S1-S87PubMed Beyond lifestyle changes control, initial pharmacologic classes agents proven provide protection renin-angiotensin-aldosterone inhibitors form angiotensin-converting enzyme (ACEIs) angiotensin receptor blockers.14Levin despite knowledge medications important protective effects heart function use remained based real-world electronic records 2). For example, ACEI blocker 20% ≥15 after last approvals type diabetes.24Tuttle K.R. Duru O.K. al.Clinical characteristics adults children: registry.JAMA Netw Open. 2e1918169Crossref (113) show improvement prescribing 70% population, just persist 90 days.20Nicholas illustrate both medication continuity time, potentially related cost, education, polypharmacy, effects.25Ismail W.W. Witry M.J. Urmie J.M. association sharing, prior authorization, specialty drug utilization: review.J Manag Care Spec Pharm. 29: 449-463Google enthusiasm sodium-glucose cotransporter (SGLT2) focused unprecedented therapeutic clearly observed well. relative reductions SGLT2 approach substantial decline glomerular filtration rate, KF, populations several causes, risk.26Heerspink H.J.L. Vart Jongs al.Estimated lifetime benefit novel pharmacological disease: joint randomized controlled trials.Diabetes 3327-3336Crossref (5) Scholar,27Nuffield Department Population Studies GroupSGLT2 Inhibitor Meta-Analysis Cardio-Renal Trialists' Consortium. Impact sodium co-transporter-2 outcomes: collaborative placebo-controlled trials.Lancet. 400: 1788-1801Abstract (200) accrued top standard-of-care inhibitor. Risks all-cause reduced CKD.26Heerspink Addition inhibitor by years, depending when they started.28Fernández-Fernandez Sarafidis Soler al.EMPA-KIDNEY: expanding inhibitors.Clin 16: 1187-1198Crossref every 1000 standard therapy, 83 deaths, 19 hospitalizations, 51 initiations, 39 episodes worsening prevented.29McEwan Boyce Sanchez J.J.G. al.Extrapolated longer-term DAPA-CKD trial: modelling analysis.Nephrol Dial Transplant. 38: 1260-1270Crossref (3) marked underuse other guideline-recommended therapies, including inhibitors, persists 2).20Nicholas Scholar,24Tuttle registry, 5% 6.3% eligible continued glucagon-like peptide-1 agonist days.18Gummidi Notably, commercial insurance community-based versus academic institutions associated lower likelihoods , ACEI, prescriptions CKD.20Nicholas low- countries (LMICs), implementation wider given inconsistent availability medications, generics.30Vanholder Braks al.Inequities care.Nat 19: 694-708Crossref (1) Such unacceptable. addition nonsteroidal mineralocorticoid antagonists demonstrated reduce risks events, diabetes.31Agarwal Filippatos G. Pitt al.Cardiovascular finerenone FIDELITY pooled analysis.Eur Heart 43: 474-484Crossref (297) growing portfolio promising options horizon agonists (NCT03819153, NCT04865770), aldosterone synthase (NCT05182840), dual-to-triple incretins (Supplementary Table S1).26Heerspink Scholar,32Tuttle Bosch-Traberg H. Cherney D.Z.I. al.Post hoc SUSTAIN 6 PIONEER trials suggests semaglutide experience stable compared placebo.Kidney 103: 772-781Abstract (13) Furthermore, already clear safe glucose-lowering aid weight loss.32Tuttle taken practice.33Rubin It change practice-the burgeoning field science seeks speed things up.JAMA. 329: 1333-1336Crossref (9) millions year, long wait. Since launch Organization Action Plan Non-Communicable Diseases (NCDs) 2013, progress NCD plan dedicated units.34World OrganisationMid-point evaluation noncommunicable 2013–2020 (NCD-GAP).https://cdn.who.int/media/docs/default-source/documents/about-us/evaluation/ncd-gap-final-report.pdf?sfvrsn=55b22b89_5&download=trueDate incorporated into strategies approximately one-half countries.4International Policies required integrate within essential packages under universal coverage 4).30Vanholder Multisectoral policies address which amplifiers severity, limiting people's Lack investment promotion, along secondary hinders progress.14Levin Two goals achieve services financial hardship imposed care. alone insufficient ensure adequate care.3Luyckx strengthened prioritized, poor contributes low-resource settings.35Kruk Gage A.D. Joseph N.T. al.Mortality due low-quality era: amenable countries.Lancet. 392: 2203-2212Abstract (443) Quality requires well-trained workforce, accurate diagnostics, reliable infrastructure, supplies should monitored ongoing process 4). LMICs, additional barrier successful CKD.36Kingori Peeters Grietens K. Abimbola S. al.Uncertainties about products globally: lessons multidisciplinary research.BMJ Glob 6e012902Crossref Regulation monitoring manufacturing standards therapies. support regulation assurance will local contexts guidance, outlined elsewhere.37Pan American medicines.https://www.paho.org/en/topics/quality-control-medicinesDate Establishing credible case risks, interventions outcomes, costs, data, help translate theoretical cost-effectiveness (currently established primarily high-income minimal elsewhere) reality.30Vanholder Scholar,38Tuttle Wong St Peter al.Moving breakthrough diabetic disease.Clin Am Soc 17: 1092-1103Crossref (19) Screening include eliciting family history, recognizing potential symptoms (usually advanced—fatigue, appetite, edema, itching etc.), measuring pressure, serum creatinine, urinalysis, urine albumin/protein creatinine ratios, guidelines.19Kidney Scholar,39Kalyesubula Conroy A.L. Calice-Silva V. al.Screening countries.Semin 42151315Abstract Addressing upstream reducing KF. Medications included Essential Medication List (Table provided levels coverage.40Francis Abdul Hafidz M.I. Ekrikpo U.E. al.Barriers accessing medicines 969-973Abstract Pharmaceutical companies affordable prices.Table 1Essential diseaseMedication/technologyExampleReasonOn model list medicinesACE inhibitorEnalapril, lisinoprilDelays strokeYesAngiotensin blockerLosartan, telmisartanDelays strokeYesCalcium channel blockerAmlodipine, verapamilBlood controlYesLoop diureticsFurosemide, torsemideGood GFR low, good failureYesThiazide diureticsHydrochlorothiazide, metolazone, indapamideGood BP, Black populationYesSGLT2 inhibitorEmpagliflozin, canagliflozin, dapagliflozinDiabetes delays deathYesGLP1 agonistSemaglutideDiabetes lossNoMineralocorticoid inhibitorSpironolactone, finerenoneDelays reduces riskCaution: hyperkalemia diseaseYes/noβ-BlockerBisoprololPrevention ischemic diseaseYesStatinsSimvastatinPrevention CAD tra

Язык: Английский

Процитировано

25
Integrated Management of Cardiovascular–Renal–Hepatic–Metabolic Syndrome: Expanding Roles of SGLT2is, GLP-1RAs, and GIP/GLP-1-RAs DOI Creative Commons
Nikolaos Theodorakis, Maria Nikolaou

Biomedicines, Год журнала: 2025, Номер 13(1), С. 135 - 135

Опубликована: Янв. 8, 2025

Cardiovascular-Kidney-Metabolic syndrome, introduced by the American Heart Association in 2023, represents a complex and interconnected spectrum of diseases driven shared pathophysiological mechanisms. However, this framework notably excludes liver-an organ fundamental to metabolic regulation. Building on concept, Cardiovascular-Renal-Hepatic-Metabolic (CRHM) syndrome incorporates liver's pivotal role disease spectrum, particularly through its involvement via dysfunction-associated steatotic liver (MASLD). Despite increasing prevalence CRHM unified management strategies remain insufficiently explored. This review addresses following critical question: How can novel anti-diabetic agents, including sodium-glucose cotransporter-2 inhibitors (SGLT2is), glucagon-like peptide-1 receptor agonists (GLP-1RAs), dual gastric inhibitory polypeptide (GIP)/GLP-1RA, offer an integrated approach managing beyond boundaries traditional specialties? By synthesizing evidence from landmark clinical trials, we highlight paradigm-shifting potential these therapies. SGLT2is, such as dapagliflozin empagliflozin, have emerged cornerstone guideline-directed treatments for heart failure (HF) chronic kidney (CKD), providing benefits that extend glycemic control are independent diabetes status. GLP-1RAs, e.g., semaglutide, transformed obesity enabling weight reductions exceeding 15% improving outcomes atherosclerotic cardiovascular (ASCVD), diabetic CKD, HF, MASLD. Additionally, tirzepatide, GIP/GLP-1RA, enables unprecedented loss (>20%), reduces risk over 90%, improves HF with preserved ejection fraction (HFpEF), MASLD, obstructive sleep apnea. moving organ-specific approach, propose integrates agents into holistic syndrome. paradigm shift moves away fragmented, organ-centric toward more fostering collaboration across specialties marking progress precision cardiometabolic medicine.

Язык: Английский

Процитировано

6
Role of Uremic Toxins, Oxidative Stress, and Renal Fibrosis in Chronic Kidney Disease DOI Creative Commons
Weronika Frąk, Bartłomiej Dąbek,

Marta Balcerczyk-Lis

и другие.

Antioxidants, Год журнала: 2024, Номер 13(6), С. 687 - 687

Опубликована: Июнь 3, 2024

Affecting millions of people worldwide, chronic kidney disease is a serious medical problem. It results in decrease glomerular filtration rate below 60 mL/min/1.73 m, albuminuria, abnormalities urine sediment and pathologies detected by imaging studies lasting minimum 3 months. Patients with CKD develop uremia, as result the accumulation uremic toxins body, patients can be expected to suffer from number consequences such progression renal fibrosis, development atherosclerosis or increased incidence cardiovascular events. Another key element pathogenesis oxidative stress, resulting an imbalance between production antioxidants reactive oxygen species. Oxidative stress contributes damage cellular proteins, lipids DNA increases inflammation, perpetuating dysfunction. Additionally, fibrogenesis involving fibrous tissue kidneys occurs. In our review, we also included examples forms therapy for CKD. To improve condition patients, pharmacotherapy used, described review. Among drugs that prognosis CKD, include: GLP-1 analogues, SGLT2 inhibitors, Finerenone monoclonal antibody—Canakinumab Sacubitril/Valsartan.

Язык: Английский

Процитировано

11
Cardiovascular and non‐renal complications of chronic kidney disease: Managing risk DOI Creative Commons
Peter Rossing, Tine W. Hansen, Thomas Kümler

и другие.

Diabetes Obesity and Metabolism, Год журнала: 2024, Номер 26(S6), С. 13 - 21

Опубликована: Июль 9, 2024

Abstract Chronic kidney disease (CKD) currently affects approximately 850 million people globally and is continuing to increase in prevalence as well importance a cause of death. The excess mortality related CKD mostly caused by an cardiovascular disease. This includes atherosclerotic many promoters atherosclerosis, such blood pressure, lipid levels hypercoagulation, are increased with CKD. Diabetes leading contributing the risk CVD, obesity also increasingly prevalent. Management these factors therefore very important CKD, reduce progression. Heart failure more prevalent and, again, shared. concept foundational pillars management heart has been adapted treatment organ‐protective interventions, renin‐angiotensin system blockade, sodium‐glucose cotransporter‐2 inhibition mineralocorticoid receptor antagonism, reducing for reduced ejection fraction, but progression Atrial fibrillation common former. In this review non‐renal complications discussed, along how should be managed. Many new opportunities have demonstrated organ protection, implementation challenge.

Язык: Английский

Процитировано

5
Mind the gap in kidney care: Translating what we know into what we do DOI Creative Commons
Valérie A. Luyckx, Katherine R. Tuttle, Dina Abdellatif

и другие.

Nephrology, Год журнала: 2025, Номер 30(1)

Опубликована: Янв. 1, 2025

Abstract Historically, it takes an average of 17 years to move new treatments from clinical evidence daily practice. Given the highly effective now available prevent or delay kidney disease onset and progression, this is far too long. The time narrow gap between what we know do. Clear guidelines exist for prevention management common risk factors disease, such as hypertension diabetes, but only a fraction people with these conditions worldwide are diagnosed, even fewer treated target. Similarly, vast majority living unaware their condition, because in early stages often silent. Even among patients who have been many do not receive appropriate treatment disease. Considering serious consequences failure death, imperative that initiated appropriately. Opportunities diagnose treat must be maximized beginning at primary care level. Many systematic barriers exist, ranging patient clinician health systems societal factors. To preserve improve everyone everywhere, each acknowledged so sustainable solutions developed implemented without further delay.

Язык: Английский

Процитировано

0
Atherosclerosis in diabetes mellitus: novel mechanisms and mechanism-based therapeutic approaches DOI
Abdul Waheed Khan, Karin Jandeleit‐Dahm

Nature Reviews Cardiology, Год журнала: 2025, Номер unknown

Опубликована: Янв. 13, 2025

Язык: Английский

Процитировано

0
Mind the gap in kidney care: translating what we know into what we do DOI Creative Commons
Valérie A. Luyckx, Katherine R. Tuttle, Dina Abdellatif

и другие.

Kidney Research and Clinical Practice, Год журнала: 2025, Номер 44(1), С. 6 - 19

Опубликована: Янв. 15, 2025

Historically, it takes an average of 17 years to move new treatments from clinical evidence daily practice. Given the highly effective now available prevent or delay kidney disease onset and progression, this is far too long. The time narrow gap between what we know do. Clear guidelines exist for prevention management common risk factors disease, such as hypertension diabetes, but only a fraction people with these conditions worldwide are diagnosed, even fewer treated target. Similarly, vast majority living unaware their condition, because in early stages often silent. Even among patients who have been many do not receive appropriate treatment disease. Considering serious consequences failure, death, imperative that initiated appropriately. Opportunities diagnose treat must be maximized beginning at primary care level. Many systematic barriers exist, ranging patient clinician health systems societal factors. To preserve improve everyone everywhere, each acknowledged so sustainable solutions developed implemented without further delay.

Язык: Английский

Процитировано

0
Have SGLT-2 inhibitors DELIVERed an EMPhatic win in heart failure and chronic kidney disease? DOI
Awadhesh Kumar Singh, Akriti Singh, Ritu Singh

и другие.

Expert Opinion on Pharmacotherapy, Год журнала: 2025, Номер unknown

Опубликована: Фев. 7, 2025

Introduction Major global guidelines currently recommend sodium-glucose co-transporter-2 inhibitors (SGLT-2i) as the first-line agents in people with type 2 diabetes (T2D) who have either established cardiovascular disease (eCVD), heart failure (HF), or chronic kidney (CKD), regardless of baseline glycated hemoglobin. Moreover, SGLT-2i are included guideline-directed medical therapy one pillars for HF and CKD, T2D. These recommendations based on positive cardio-renal outcomes from several randomized controlled trials (RCTs).

Язык: Английский

Процитировано

0
Spanish Registry of Renal Patients: 2022 Report and evolutive analysis DOI Creative Commons
Borja Quiroga, Beatriz Mahíllo, Auxiliadora Mazuecos

и другие.

Nefrología (English Edition), Год журнала: 2025, Номер unknown

Опубликована: Апрель 1, 2025

Chronic kidney disease (CKD) will be the second leading cause of death in Spain by 2100. The Spanish Renal Disease Registry (REER) records incidence, prevalence and mortality all patients requiring renal replacement therapy (RRT) Spain. Data are provided autonomous regions cities Organización Nacional de Trasplantes. Incidence rates RRT have been calculated (considering population according to annual data from Instituto Estadística), as well on our country during period 2013-2022. incidence rate increased 21% 2013 2019, stabilized thereafter, with a value 152.2 cases per million (pmp) 2022, which 77.8% were haemodialysis (HD), 16.7% peritoneal dialysis (PD) 5.5% received preemptive transplant. Diabetes was CKD (21.8%), followed other causes (21.6%). 2-fold higher men than women, large regional differences (1.93-fold for 2.55-fold women highest lowest rates). 1,391.1 pmp showing progressive increase over last decade, mainly at expense an transplant (765.0 pmp, 55.0%). In 3,404 transplants performed (71.7 pmp), situates it world leader. most frequent donor type after neurological determination (51.5%), circulatory (37%). overall 8.4% (13.8% HD, 10.1% PD 3.9% transplantation). Although has somewhat recent years, continues rise Additional measures must adopted harmonize optimize health care.

Язык: Английский

Процитировано

0