Jeffrey Feldman, MD, describes the treatment goals for patients with CKD.
Ryan Haumschild, PharmD, MS, MBA: What are some of the treatment goals for patients with CKD [chronic kidney disease]? How do goals change with disease progression? If you could hit on that briefly before we head into some of the specific treatments, that would be helpful to square up the conversation.
Jeffrey Feldman, MD: Several years ago, we looked at weight. We tried to get people to lose weight, which was a very difficult process. We asked them to quit smoking. In New Jersey, our smoking rate is only about 12%, which is much lower than the national average. With A1C [glycated hemoglobin], it depends if you’re an endocrinologist. I was just at a meeting with Dr DeFranzo, and he likes his A1Cs at 6%. If you could keep people’s A1C with glycemic control, they would never develop kidney disease.
I go for blood pressure less than 130/80 mmHg. I’d actually like systolic a little lower. The other goal is that the most accurate way to get blood pressure readings is home blood pressure monitoring. It eliminates white-coat syndrome. We now have white-coat syndrome with hypertension, so you can have white-coat syndrome but still have hypertension. I found that to be a nice addition. The LDL [low-density lipoprotein] goal keeps drifting down. I’m a lipid specialist, so I like high-risk patients, particularly those with diabetes, to be less than 70 mg/dL, but with people with coronary disease, we use the European guidelines, which is less than 40 mg/dL.
Basically, the residual risk is looking at triglycerides. I’m very glad to see the cardiology community has made CKD a risk enhancer. High triglycerides and diabetes are risk enhancers. We’re getting more sophisticated. There are plenty of articles that show you the goals and the risk enhancers that we need to address. One other thing that needs to be mentioned is smoking. We need to get our patients to quit smoking. The new additive is decent sleep. Adults should get 7 to 8 hours of uninterrupted sleep. If you think there are issues with sleep disturbance, do a sleep study. Most people can now do it at home.
Transcript edited for clarity.