Session:
Expanding the range of kidney protection by SGLT2i
SGLT2 inhibitors represent a paradigm shift in the management of chronic kidney disease. In recent years, the emergence of sodium-glucose cotransporter 2 (SGLT2) inhibitors has changed the landscape of chronic kidney disease (CKD) treatment. Originally recognized for their efficacy in managing type 2 diabetes mellitus (T2DM), these drugs have significantly expanded their therapeutic target to a broader spectrum of renal disease causes. Beyond glycemic control, this class of drugs exerts beneficial effects on renal hemodynamics and tubulointerstitial injury, and subsequently onset of Randomized Clinical Trials have shown efficacy both in diabetic and non-diabetic kidney diseases.
Moreover, the cardiovascular benefits associated with SGLT2 inhibitors have augmented their use all in cardio-kidney-metabolic disorders.
Future directions are now focused on spreading the use of SGLT2i as optimal treatment for most of the patients with CKD, as their integration into CKD care algorithms and guidelines is now a reality.
Speaker:
Dr. Beatriz Fernandez-Fernandez
Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
Session:
SGLT2i in different patient groups: effect on CKD progression
This session will present recently published results from the EMPA-KIDNEY trial examining the effect of allocation to SGLT2i on annualised rate of decline in kidney function in different subgroups of patients, including diabetes status, baseline estimated glomerular filtration rate (eGFR), baseline urinary albumin to creatinine ratio and cause of kidney disease. The effects on annual rate of change in eGFR from 2 months to final follow-up (chronic slope) will be considered. The importance of considering both acute and relative effects on eGFR slopes will also be discussed.
Speaker:
Dr. Natalie Staplin
Nuffield Department of Population Health, UK
Session:
Obesity as a risk factor of CKD progression: is there a role for GLP-1RA?
There is a global increase in the prevalence of obesity in general, and by 2035 it is expected that more than 1.5 billion people will live with obesity. At the same time chronic kidney disease (CKD) is affecting more than 800 million people globally and is also on the rise, including as a leading cause of mortality. These conditions are interlinked, directly and indirectly, as obesity is a driver for both the increase in diabetes as well as hypertension, the two leading causes of CKD in most countries but also because obesity per se can lead to CKD directly as adipose tissue affects the kidneys though adipokines which may induce CKD although further understanding is needed. Treating obesity with optimized lifestyle with diet and exercise is preferred but complicated and often obtained reductions in weight are not sustained. In recent years we have seen outcome trials with both metabolic surgery and pharmacological induced weight loss with substantial reductions in weight which are maintained, at least as long as the pharmacological interventions continue. In particular new agents based on incretin hormones alone or in combination with other hormones as dual or triple agonists have led to weight reductions of up to 25 % in people with obesity without diabetes and 10-15% in type 2 diabetes, and more potent drugs are in development. It has been suggested these interventions leading to weight loss also reduce progression of CKD, either evaluated by reduction in albuminuria or preserved kidney function (eGFR). This is controversial as estimating kidney function during weight loss is not trivial. Our usual marker of glomerular filtration rate is creatinine from muscles, but to some extend weight loss not only affects adipose tissue but also lean body mass and thus it is debated what is the best way to lose weight, and what is the best way to assess if this is beneficial for CKD? This is relevant both for people with diabetes obesity and CKD but also for non-diabetic obesity and CKD. Data from large outcome studies with GLP1 RA based therapy targeting CKD in type 2 diabetes as primary outcome are awaited and the study of semaglutide in type 2 diabetes with CKD was stopped early for efficacy. Studies of semaglutide with CKD as a secondary outcome in non-diabetic obesity with CVD is awaited and may inform us on the benefit for CKD of pharmacological intervention in non-diabetic obesity with.
Speaker:
Dr. Peter Rossing, MD, DMSc
Københavns Universitet - University of Copenhagen, Denmark
Session:
The impact of GLP-1 RA and SGLT2i on CKD progression in subjects with diabetes
For decades RAS blockade with ACE inhibition or angiotensin II receptor blockers have been standard of care in people with diabetes and chronic kidney disease (CKD). In recent years we have seen in cardiovascular outcome trials in type 2 diabetes, that agents introduced as glucose lowering agents, the sodium glucose cotransporter 2 inhibitors (SGLT2i) and glucagon like peptide 1 receptor agonists (GLP1 RA) were safe when reducing glucose. Importantly we also learned from these studies that the agents improved cardiovascular outcome in subjects with type 2 diabetes and a history of CVD or high risk for CVD, and furthermore secondary endpoints suggested kidney protective benefits as well. Then dedicated kidney outcome trials in type 2 diabetes or CKD with and without diabetes demonstrated that the SGLT2i were able to reduce progression of CKD to kidney failure as well as reduce CV events in this high risk population with CKD and type 2 diabetes. For GLP1 receptor agonists post hoc analyses of the CVOTs suggested potential kidney benefits, particularly reduction in progression of albuminuria or perhaps even less loss of kidney function in subjects with impaired kidney function and albuminuria although the studies were not really designed to address this. The benefits of SGLT2i and GLP1RA on the kidney can be due to multiple mechanisms and the agents may act together in combination for optimal benefit but data to demonstrate this is scarce. The only dedicated kidney outcome trial with a GLP1 RA (semaglutide) is FLOW which was stopped early for success, data are to be presented at ERA. In addition to the RAS inhibition and mineralocorticoid receptor antagonism (finerenone) we may now have multiple options (or pillars) to use for the management of CKD in type 2 diabetes. It has also been suggested it may be useful in type 1 diabetes, but this remains to be investigated further.
Speaker:
Dr. Peter Rossing, MD, DMSc
Københavns Universitet - University of Copenhagen, Denmark
Session:
The impact of GLP-1 RA and twincretins on CKD progression in subjects with CKD
Join Hiddo L. Heerspink from the University Medical Center Groningen as he explores the groundbreaking impact of GLP-1 receptor agonists (GLP-1 RA) and Twincretins on the progression of chronic kidney disease (CKD). In this session, Dr. Heerspink delves into the latest research and clinical trials that highlight how these new therapeutics can potentially slow CKD progression and improve kidney function.
Dr. Heerspink begins by discussing the mechanisms by which GLP-1 RAs and Twincretins work, focusing on their effects on urinary albumin excretion and the estimated glomerular filtration rate (eGFR) decline in patients with type 2 diabetes, whether they have CKD or not. He provides a historical timeline and milestones of clinical trials for CKD therapeutics, shedding light on the evolution of treatment strategies.
As the discussion progresses, Dr. Heerspink shares his vision for the future directions of research and clinical application of GLP-1 RAs and Twincretins in CKD management. This session is essential for healthcare professionals and researchers interested in the latest advancements in CKD treatment and the potential of new therapeutics to significantly improve patient care.
Speaker:
Dr. Hiddo Heerspink
University Medical Center Groningen, Groningen, The Netherlands.
Session:
GLP-1RA and SGLT2i – the cardiology perspective
Join Jonas Spaak, Associate Professor in Cardiology at Danderyd Hospital and the Karolinska Institutet, as he explores the transformative potential of GLP-1 receptor agonists (GLP1-RA) and sodium-glucose co-transporter 2 inhibitors (SGLT2i) from a cardiology perspective. This session delves into the crucial role these medications play in managing complex cardiovascular and metabolic conditions.
Discover how GLP1-RA and SGLT2i are changing the landscape of treatment for patients with diabetes, heart failure, and chronic kidney disease (CKD). Spaak will discuss key insights from major clinical trials and real-world applications, highlighting the impressive outcomes these therapies can achieve.
Gain a better understanding of the practical challenges and opportunities in implementing these treatments in clinical practice. This session is essential for healthcare professionals eager to stay at the forefront of cardiology and metabolic medicine, offering a glimpse into the future of patient care.
Speaker:
Dr. Jonas Spaak
Karolinska Institutet
Session:
Precision Kidney Care: the Time is Now
Join Peter Stenvinkel from the Karolinska Institutet as he presents an enlightening session on the future of kidney care through the lens of precision medicine. In this presentation, Stenvinkel explores how advancements in genomics, biomarkers, and individualized treatment approaches are revolutionizing kidney disease management.
Discover how precision medicine moves beyond traditional, one-size-fits-all treatments by tailoring interventions based on a patient's unique genetic makeup, lifestyle, and environmental factors. This session delves into the potential benefits of precision kidney care, including targeted interventions that prevent disease progression, reduce the need for costly dialysis, and improve transplant outcomes.
Stenvinkel highlights the importance of integrating various ""omics"" technologies, such as genomics and epigenomics, with clinical data to develop personalized treatment plans. He also discusses the role of biobanks in advancing research and the opportunities for using bioactive nutrients and targeted therapies to combat kidney disease.
Explore the future of kidney care with insights on how precision medicine can identify patients at risk of accelerated aging, optimize drug selection and dosing, and ultimately enhance patient outcomes. This session is a must-watch for healthcare professionals and researchers dedicated to improving the lives of patients with kidney disease through cutting-edge precision medicine techniques.
Speaker:
Dr. Peter Stenvinkel
Karolinska Institutet
Session:
Gender and CKD progression: can novel therapeutics make a difference?
Join Associate Professor Karolina Kublickiene from the Karolinska Institutet as she explores the significant impact of gender and sex differences on chronic kidney disease (CKD) progression and the potential of novel therapeutics to make a difference. This session delves into the intricate ways sex and gender influence health outcomes and disease mechanisms, particularly in the context of CKD.
Kublickiene will present compelling arguments for integrating sex and gender dimensions into CKD research and treatment, highlighting how these factors can shape disease risk, progression, and therapeutic responses. She will discuss the biological attributes of sex, including chromosomes, gene expression, and hormones, alongside the socially-constructed roles and identities defined by gender.
The session will cover the latest insights into how gender disparities affect access to healthcare and outcomes, emphasizing the need for gender-sensitive approaches in CKD management. Through real-world examples, Kublickiene will illustrate the differential impacts of novel therapeutics on men and women, examining the unique benefits and challenges faced by each group.
Attendees will gain a deeper understanding of the importance of personalized treatment plans that account for sex and gender differences, and the role of precision medicine in improving CKD outcomes. This session is essential for healthcare professionals and researchers dedicated to advancing knowledge and innovation in kidney disease care, ensuring that therapeutic interventions are effective for all patients.
Don't miss this opportunity to learn about the transformative potential of gendered innovations in CKD treatment and how novel therapeutics can bridge the gap in healthcare disparities.
Speaker:
Dr. Karolina Kublickiene
Karolinska Institutet
Session:
CKD progression and its prevention: the practical use of GLP-1RA and SGLT2i
Join Thomas Ebert from the University of Leipzig as he provides an in-depth exploration of the practical application of GLP-1 receptor agonists (GLP-1RA) and sodium-glucose co-transporter 2 inhibitors (SGLT2i) in preventing the progression of chronic kidney disease (CKD). This session will cover the latest evidence and clinical insights into when and how to effectively implement these modern anti-CKD therapies.
Dr. Ebert will discuss the timing and initiation of GLP-1RA and SGLT2i treatments, addressing critical questions such as their efficacy across different age groups and treatment durations. He will delve into the concept of the legacy effect, examining whether these treatments provide long-term benefits in both microvascular and macrovascular complications.
The session will also highlight the safety and adverse event profiles of these therapies in patients with CKD, including insights into gastrointestinal side effects, hyperkalemia, and malnutrition. Additionally, Dr. Ebert will present data on the use of GLP-1RA and SGLT2i in patients with Type 1 Diabetes, focusing on their impact on CKD progression and overall renal function.
Attendees will gain valuable knowledge on the nuanced application of GLP-1RA and SGLT2i, understanding their benefits, risks, and the clinical considerations necessary for optimizing patient outcomes. This session is essential for nephrologists, endocrinologists, and healthcare professionals involved in the management of CKD, offering practical guidance on integrating these therapeutics into clinical practice.
Don't miss this opportunity to stay at the forefront of CKD treatment advancements and learn how to leverage GLP-1RA and SGLT2i to improve patient care.
Speaker:
Dr. Thomas Ebert
Medical University Leipzig, Germany
