ASN Kidney Week: American Society of Nephrology Kidney Week

Susan E. Quaggin, MD, FASN, president of the American Society of Nephrology (ASN) for the 2021-2022 term, discussed the major focuses and breakthroughs in nephrology to be presented at Kidney Week 2022, which include novel treatments for common and rare kidney diseases, as well as efforts to address disparities for transplant and care access.

Although their underlying mechanisms differ, finerenone reduces albuminuria to the same extent as SGLT2 inhibitors, said George Bakris, MD, professor of medicine and director of the American Heart Association Comprehensive Hypertension Center at the University of Chicago Medicine.

Can a population health framework focused on a certain set of patients with chronic disease (ie, chronic kidney disease [CKD]) improve care in the primary care setting?

With the impact of coronavirus disease 2019 (COVID-19) evident in patients with renal disease, a discussion at Kidney Week focused on ways to engage them in clinical trials.

Recognizing chronic kidney disease (CKD) can lead to earlier implementation of interventions among patients, ultimately reducing the risk of end stage renal disease, said Shweta Bansal, MD, FASN, associate professor of medicine in the nephrology division at the University of Texas Health Center at San Antonio.

Although renal replacement therapy is a clinically meaningful end point, trials must include numerous patients and follow them for long periods of time, said Kunihiro Matsushita, MD, an associate professor in the Department of Epidemiology and Division of Cardiology at Johns Hopkins University.

Understanding patients’ social determinants of health (SDOH), including their past experiences with discrimination and medical mistrust, can help improve patient-reported outcomes (PROs), according to new research.

During Kidney Week, various studies discussed not only the effect coronavirus disease 2019 (COVID-19) has on patients with end-stage renal disease (ESRD) but also new attacks of acute kidney injury (AKI) that can cause severe illness or even death.

The use of estimated glomerular filtration rate (eGFR) equations in assessing chronic kidney disease (CKD) for Black patients may lead to underdiagnosis and undertreatment, according to a nephrologist speaking at Kidney Week.

Several symptoms patients with chronic kidney disease (CKD) experience are approved indications for medical cannabis, said Joshua L Rein, DO, FASN, a nephrologist at Mt. Sinai Hospital in New York City.

In reviewing the previous literature on health disparities in kidney disease, there is not a lot described in patients with kidney pathologies outside of ESKD and dialysis, said Jill Krissberg, MD, a pediatric nephrology fellow at Stanford University School of Medicine.

After conducting further genome-wide association studies (GWAS), we will be able to inform communities about the potential implications of gene expression in their kidneys, said Adriana Hung, MD, MPH, associate professor of medicine at Vanderbilt University in an interview with Bryce Rowan, a statistical genetic analyst.

Additional studies about roxadustat, a drug in the new class of hypoxia-inducible factor stabilizers, were released during Kidney Week; one of them explored its role in lowering cholesterol in patients with chronic kidney disease (CKD) and anemia.

The decision to go on dialysis is often automatic, but using a shared decision-making process reduces the chance that a patient will regret it later.

People who experience acute kidney injuries (AKIs) in the hospital have higher rates of cardiac disease and death compared with those who have been discharged, said Benjamin Griffin, MD, a nephrologist and assistant professor of internal medicine at the University of Iowa.

Finerenone slowed chronic kidney disease (CKD) progression by 18% and cut cardiovascular (CV) events by 14%, according to phase 3 trial results.

High incidence of kidney failure in minority groups can be attributed to faster progression of kidney function decline in these populations, said Guofen Yan, PhD, associate professor of biostatistics in the department of public health sciences at the University of Virginia School of Medicine.

Vadadustat is an investigational drug belonging to a class known as hypoxia-inducible prolyl hydroxylase inhibitors (HIF-PHIs) for the treatment of anemia in chronic kidney disease.

The investigational drug finerenone met its primary endpoint in FIDELIO-DKD of slowing progression of chronic kidney disease (CKD) in patients with type 2 diabetes and CKD, said Rajiv Agarwal, MD, MS, FASN, a professor of medicine at Indiana University School of Medicine and a staff physician at the Veterans Affairs Medical Center in Indianapolis, Indiana.

Experts presenting the American Society of Nephrology’s Kidney Week session entitled “From Kids to Adults: Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) Across the Life Course,” outlined the detrimental effects of childhood CKD and other kidney diseases on long-term health.

In a session focused on sodium-glucose cotransporter 2 (SGLT2) inhibitors presented at the American Society of Nephrology’s (ASN) Kidney Week, experts highlighted the benefits of using this drug class in patients with kidney disease and outlined future steps for integration of care.

Many of the patients in our clinic system were not being screened for chronic kidney disease even though they exhibited risk factors, said Shweta Bansal, MD, FASN, associate professor of medicine in the nephrology division at the University of Texas Health Center at San Antonio.

Although many investigators have pushed the envelope in researching how patients with chronic kidney disease (CKD) experience disabilities, there is still a need for more knowledge on how those disabilities evolve over time, according to Cynthia Delgado, MD, associate professor of medicine at the San Francisco Veterans Affairs Medical Center and University of California San Francisco Medical Center.

Frailty significantly raises the risk of developing disabilities as a result of hemodialysis, so even patients who are intermediately frail should be monitored, said Cynthia Delgado, MD, associate professor of medicine at the San Francisco Veterans Affairs Medical Center and University of California San Francisco Medical Center.

Educating primary care clinicians on how to manage chronic kidney disease in the primary care setting can help avoid referrals for nephrology consults that aren’t needed, said Joseph Vassalotti, MD, clinical professor at Icahn School of Medicine at Mount Sinai and chief medical officer of the National Kidney Foundation.

Clinicians should be mindful of how their patients with disabilities function in their everyday lives, not just in the exam room, according to Cynthia Delgado, MD, associate professor of medicine at the San Francisco Veterans Affairs Medical Center and University of California San Francisco Medical Center.

CKDintercept, the primary care initiative of the National Kidney Foundation, involves multiple strategies aimed at improving the quality of kidney care, explained Joseph Vassalotti, MD, clinical professor at Icahn School of Medicine at Mount Sinai and chief medical officer of the National Kidney Foundation.

Physical disabilities may make it difficult for patients with chronic kidney disease to follow provider recommendations and achieve a good therapeutic alliance, which can lead to increased burden of illness, according to Cynthia Delgado, MD, associate professor of medicine at the San Francisco Veterans Affairs Medical Center and University of California San Francisco Medical Center.

Recent findings have shown that aerobic exercise improves microvascular function and coronary artery function in patients with kidney disease, but further research is needed on the relationship between exercise and kidney function, said Danielle Kirkman, PhD, assistant professor at Virginia Commonwealth University.

Future research should examine the effects of exercise on slowing the progression of kidney disease, among other important questions, according to Danielle Kirkman, PhD, assistant professor at Virginia Commonwealth University.