Diabetes and Kidney Disease
Feb 9, 2016, 11:02 AM
I
finally had a chance to enroll in another AADE15 Session on Demand. If you were not able to attend the live meeting in New Orleans, you can get on-demand access through My Learning on the AADE website. There are so many sessions to choose from—ways to apply information to our patients with diabetes or help build our clinical practice and diabetes service.
In November, I decided to enroll in a presentation titled How Sweet Is Your Heart? Cardiovascular Effects of Diabetes Drugs. This time, I listened to Diabetic Kidney Disease presented by Edward Barnes, MD, FACP. This presentation was a fantastic review on kidney disease, since diabetes is the primary reason for end-stage renal disease.
It is essential to be aggressive with glycemic control among newly diagnosed patients.
This presentation emphasized the importance of checking for albuminuria, as it is an early indicator of end-stage renal disease. If albuminuria is detected early, then we can adequately treat the patient to prevent a further decrease in glomerular filtration rate, leading to end-stage renal disease over the next 15 to 30 years. As learned from the Diabetes Complications and Control Trial, it is essential to be aggressive with glycemic control among newly diagnosed patients. Aggressive glycemic control can prevent microvascular complications, including nephropathy. Dr. Barnes emphasized the importance of treating comorbid conditions (i.e. hyperlipidemia, coronary artery disease, hypertension), but we have great medications to prevent and treat a diabetic kidney.
Angiotensin-converting-enzyme (ACE) inhibitors are useful and there are several agents on the market—benazapril, captopril, cilazapril, enalapril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, and trandolapril. Some of these agents are combined with other anti-hypertensive medications to decrease pill burden. Patients on ACE-inhibitors should be counseled about monitoring serum creatinine and potassium levels, as well as the possibility of a dry cough. Angiotensin II receptor blockers (ARBs) are another class of medications effective in treating a diabetic kidney. Several agents are available and include azilsartan, candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan, and valsartan. Similar to ACE-inhibitors, these agents are available in combination with other anti-hypertensives and monitoring is required (i.e. serum creatinine, potassium). As a reminder, certain ACE-inhibitors and ARBs may be used for other disease states based on other evidence, outside nephropathy (e.g. candesartan for heart failure).
In the concluding portion of the presentation, Dr. Barnes explained emerging evidence and new research in the arena of nephrology, as there will be new treatment options and strategies in managing patients with kidney disease.
If you were not able to attend his session or have not listened to this specific presentation from AADE15, I would encourage you to take an hour of your time and do so!
About the Author
Jennifer Clements received her Doctorate of Pharmacy from Campbell University in 2006 and completed a primary care residency at a Veterans Affairs Medical Center in 2007. She is also a certified diabetes educator and board certified in pharmacotherapy. Currently, she is the Interim Chair and Associate Professor in the Department of Pharmacy Practice at Presbyterian College School of Pharmacy.