Dr Joseph Vassalotti Discusses Upstream Interventions Based on CKD Risk Stratification

Implementing screening for chronic kidney disease (CKD) in the primary care setting can help identify patients who may benefit from upstream interventions and medications to reduce their risk of kidney failure, said Joseph Vassalotti, MD, clinical professor at Icahn School of Medicine at Mount Sinai and chief medical officer of the National Kidney Foundation.

What are the advantages of outlining CKD treatment recommendations according to patients’ disease class?
I think that because kidney disease is something that nephrologists have thought a lot about, that we focused a lot on the interventions being the nephrology consult, and that’s very important. That’s one of the benefits of this study is that we were able to allocate the nephrology consults according to the severity of the disease. But we also included upstream interventions that really occur in the primary care space before the patient transitions to nephrology for things like blood pressure control and diabetes control, pharmacy intervention, medical nutrition therapy—these are interventions that the primary care clinician can employ. And then now we have medication classes, like ACE [angiotensin-converting enzyme] inhibitors and angiotensin receptor blockers, for hypertension with high levels of albuminuria, that have strong evidence from randomized controlled trials that they attenuate the progression of kidney disease, that they reduce the onset of end-stage renal disease, and that they reduce cardiovascular events and mortality.

The opportunity to incorporate those therapies based on the risk stratification with the 2 tests is really important to emphasize. One aspect that we didn’t study is there is a new class of drugs called SGLT2 [sodium-glucose cotransporter-2] inhibitors for diabetes, because we designed the study really before some of the randomized trials came out. That is another opportunity, I think, for type 2 diabetes and population health and chronic kidney disease, is this class of medications reduces cardiovascular events, particularly heart failure, reduces the risk of cardiovascular death, and actually reduces the risk of kidney disease progression and kidney failure.
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