AHA Scientific Statement Highlights Cardiorenal Benefit of N
Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...
To protect the heart and kidneys, sodium glucose cotransporter 2 (SGLT2) inhibitors and glucagon like peptide-1 (GLP-1) receptor agonists should be considered for people with type 2 diabetes and chronic kidney disease (CKD), the American Heart Association (AHA) advises in a new scientific statement.

The following are key points to remember from this AHA scientific statement on cardiorenal protection with the newer antidiabetic agents in patients with diabetes and chronic kidney disease (CKD):

1. CKD with type 2 diabetes (T2D) is a major public health problem, resulting in significant cardiovascular and renal adverse outcomes worldwide.

2. Despite the widespread use of standard-of-care therapies for CKD with T2D over the past few decades, rates of progression to end-stage kidney disease remain high with no beneficial impact on its accompanying burden of cardiovascular disease (CVD).

3. The advent of the newer classes of antihyperglycemic agents, including SGLT2 (sodium glucose cotransporter 2) inhibitors and GLP-1 (glucagon-like peptide-1) receptor agonists, has changed the landscape of therapeutic options for patients with CKD with T2D, with demonstration of significant reductions in cardiovascular adverse event rates and progression to end-stage renal disease (ESRD).

4. Several potential mechanisms exist through which these beneficial effects are achieved in both drug classes, which may be independent of their antihyperglycemic effects.

5. Given the well-proven CVD and CKD benefits from these drug classes in randomized controlled trials, there is an urgent need to incorporate multidisciplinary care in the identification of high-risk patients who may benefit from these agents.

6. This scientific statement summarizes the current literature on the cardiorenal protective effects with SGLT2 inhibitors and GLP-1 receptor agonists in patients with CKD and T2D. It reviews potential mechanistic pathways that may drive these benefits and summarizes the literature on adverse effects in patients with CKD and T2D at risk for or with established CVD.

7. It also provides practical guidance on a proposed collaborative care model bridging cardiologists, nephrologists, endocrinologists, and primary care physicians to facilitate the prompt and appropriate integration of these therapeutic classes in the management of patients with T2D and CKD.

8. In addition, legislative support should promote equitable access to these agents, especially for vulnerable and underrepresented patient populations who also carry the highest burden of CVD and CKD risk with T2D.

9. Achieving these targets aligns closely with the innovative Advancing American Kidney Health Executive Order by the US government, as outlined by the US Department of Health and Human Services, particularly with the important goal of reducing the burden of ESRD by 25% by the year 2030.

10. With multidisciplinary efforts from primary care physicians, cardiologists, nephrologists, endocrinologists, pharmacists, advanced practitioners, and other allied health professionals toward providing targeted therapies for CVD and CKD risk reduction in patients with T2D, there is opportunity to meaningfully reduce morbidity, mortality, and health care expenditures for this vulnerable patient population.

Source: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000920