Treatments for Diabetic Kidney Disease
Ankit Patel, MD, PhD. Nephrology Specialist at AristaMD
The most common form of chronic kidney disease that we see is diabetic kidney disease. Diabetic kidney disease really refers to any kidney disease that occurs in the presence of diabetes. Now, what that means is it’s not always the diabetes in itself that is causing the kidney disease. There could be other reasons, and it’s not always diabetes that’s causing proteinuria. So diabetes can cause kidney disease in, say, two broad buckets. One, it can cause the glomerulus for the filtering components of the kidney to become damaged and cause lead to proteinuria and a lot of sequelae that lead to chronic kidney disease. Another is that diabetes can significantly impact vasculature, the blood vessels that feed the kidney. When they get damaged, the kidney also suffers, and the kidney function goes down over time.
And so from big studies, large studies from well before 2000, or well before 1990, you know that blood pressure control of less than 130/80 in diabetic kidney disease patients slows the rate of kidney disease. An A1C that’s less than seven is particularly helpful in slowing the rate of kidney disease. You know, that’s not always possible in all our patients, but really just understanding that that target is the one that we have particular data about, in inflection point. In terms of that risk of disease progression in the mid-nineties and around 2000, we had a few big trials for the first time that showed certain medications that were helpful in diabetic kidney disease with proteinuria. These were the ACE inhibitors in angiotensin receptor blockers. We know that, particularly in patients with proteinuria, they can slow their rate of progression.
But in more recent years, and I’d say in the last six years, seven years, there’s been a whole host of trials and a lot of excitement because there’s a whole new set of medications that have been found to slow the rate of kidney disease in, in patients with diabetes, particularly the SGLT two inhibitors, which is a non-steroidal mineral corticoid receptor antagonist. This is similar to spironolactone. Though the studies were never done particularly with Spironolactone, with this medication called canone and the more recent data with the GLP one agonist, these medications that have gained a lot of popularity in relation to obesity treatment, there was a trial looking at the impact of these medications on the rate of CKD progression. That was recently, it was called the flow trial with semaglutide, which was recently stopped early, and it actually was stopped early because of efficacy.
Now, we don’t have the data as of yet in terms of the impact it has, but there are other studies that show that it reduces that, that this class of drugs reduces proteinuria. We should have the data soon to really make it a bonafide treatment recommendation in patients with diabetic kidney disease. And so now we have an arsenal of medications that we can use at our disposal, and we can find out which ones are the right combination, or maybe in some patients, all of them could be useful in mitigating the risk of disease, kidney disease specifically.
Five Ways eConsults Support Value-Based Care
Combine your referral management platform with an eConsult solution to reduce patient wait times and the cost of care. Learn five ways our eConsults support value-based care by allowing primary care physicians, nurse practitioners or PAs to submit electronic requests for patient advice to our team of specialists to manage low-acuity patients.
#1 Help Patients Avoid Unnecessary Face-to-Face Specialty Visits
About 70% of eConsults can address what physicians typically send for a face-to-face specialty visit. As a web-based physician-to-physician consultation, there is no need for any particular technology or integration — the PCP orders the referral the same way they would traditionally order one. Or suppose the patient was to go face-to-face for a specialty consult with the provider using our referral nurse coordination, RNN service, and nurse navigators. In that case, our nurse will curate the eConsults by grabbing all of the data needed for the patient from the chart. Private health information is then sent to our specialist, who reviews the data and provides an evidence-based response on that patient’s best practice and management. Within four to six hours, the primary care provider receives a notification and can view the eConsult specialist’s recommendations.
The bottom line — for every specialty visit where we serve the patient using an eConsult and address issues through the primary care provider, we can fend off the need for three face-to-face visits. Also, once you gain specific knowledge from a specialist on a particular condition, you have the answer to the same question when it comes up again.
Ankit Patel, MD, PhD
Nephrology Specialist at AristaMD
Ankit B. Patel, MD, PhD is a board-certified nephrologist who completed his MD at Weill Cornell Medical College and PhD at Weill Cornell Graduate School of Biomedical Sciences. He completed his internal medicine residency at Brigham and Women’s Hospital in Boston and his Nephrology fellowship at the combined Brigham and Women’s/Massachusetts General Hospital Fellowship. His clinical interests remain broad in adult nephrology and include acid-base and electrolyte disorders.