Updates from ASN 2021: Examining New Therapies & Healthcare Disparities

Announcer:
Welcome to the ASN Action Center on ReachMD. On this episode, we’re joined by Dr. Maureen Brogan, an Associate Professor of Medicine at Albert Einstein College of Medicine and the Clinical Director in the division of nephrology at Montefiore Medical Center. Dr. Brogan is here to share her insights on topics covered at the American Society of Nephrology Kidney Week 2021, including new drugs available and race disparities in research trials. Here’s Dr. Brogan now. 

Dr. Brogan: 
So I’m most excited about the most powerful drugs that have come out that will help us in kidney and heart protection. So these drugs are called Flozins or SGLT2 inhibitors. And they originally were discovered from apple bark in the 1800s. And they were not approved for use until 2012 to 2015, somewhere around there. And they're very mild medications to control diabetes. They only lower what's called the hemoglobin A1c by less than 1%. But what they do for the heart and the kidney is decrease progression of kidney disease in not just diabetics, but everyone with kidney disease. They lower protein in the urine, which can worsen the progression of kidney disease. They also may make you at less risk for even developing diabetes. For the heart, they decrease overall death from heart disease and decrease hospitalization for heart failure.

What's also great about these drugs is they were also studied in patients with more significant kidney disease, which a lot of drugs are not studied in patients with low glomerular filtration rates, or GFR. So you can use them in patients that only have a glomerular filtration rate of 25 mils per minute, or significant kidney disease. So we can start them in even those patients, and it will be helpful.

They also have diuretic action. So if you start a patient on these medications, you can lower the diuretics they're on. They also don't raise harmful hormones in the blood of these patients. So they're shown to be better.

So I'm really excited about these drugs.  I’m using these drugs in my patients. There's a risk to taking any medication. So there's a risk of urinary/genital infections. But we can advise patients to use prevention, like making sure they keep their areas dry because you're actually spilling glucose in the urine with these medications. So you want to make sure you're not getting an infection there.

And diabetics are at risk for developing diabetic ketoacidosis on these medicines, so patients could check their urine for ketones to see if they’re at risk for this. And if they're not feeling well, they can stop these medications.

But overall, these medications will prevent worsening kidney disease and heart disease and death. So I'm really excited about these drugs. And it's really nice to hear something so hopeful after what we went through with the COVID epidemic.

So there were several talks about healthcare disparities during the American Society of Nephrology meeting. We have recently changed our formula in most hospitals to remove race as part of the evaluation of kidney function. So we have something called the GFR formula, and race does not need to be part of that formula. We’re trying to have research cover patients from all diverse populations, so that you can apply the research to patients. We've learned that less minorities are on home dialysis modalities. And especially during COVID, patients on home treatments did better because they were not taking public transportation to dialysis units, sitting in waiting rooms, and being at an in-center dialysis unit three times a week, making them at more risk for acquiring COVID infection. So we would like to have more patients on home modalities and feel more in control of their disease process. So that's something that we learned.

Announcer:
That was Dr. Maureen Brogan sharing highlights from the American Society of Nephrology Kidney Week 2021 on new drugs available within nephrology disparities within research trials. To access this and other episodes in our series, visit ReachMD.com/ASN, where you can Be Part of the Knowledge. Thanks for listening.