Improving Standards of Care in Type 2 Diabetes with Chronic Kidney Disease: Integrating the Non-Steroidal Mineralocorticoid Antagonist Class in Cardiorenal Medicine

Overview

How to screen UACR and eGFR levels, implement selective non-steroidal MRA therapies, and mitigate the risk of hyperkalemia to prevent CKD disease progression. 

Learning Objectives

After completing this educational activity, you should be able to: 

  • Evaluate the underlying pathophysiology, mechanisms, and appropriate guideline-based screening practices in CKD to optimize outcomes 
  • Summarize the efficacy and safety of novel therapies for the management of T2D and CKD to reduce the risk of adverse renal and cardiovascular outcomes 
  • Review best practices for the sequencing of appropriate therapy in patients with T2D and CKD based on current screening best practices, guidelines, and clinical evidence 

Target Audience

Nephrologists, endocrinologists, cardiologists, and primary care physicians   

Program Description

Join Drs Martha Gulati and Christos Argyropoulos and Mr Viet Le in a roundtable discussion about screening for and treating chronic kidney disease (CKD) in patients with type 2 diabetes (T2D). Discover which patients are at risk for developing end-stage-renal disease, including patients with elevated albuminuria and low estimated glomerular filtration rate (eGFR), and therefore how to screen patients based upon urine albumin-creatinine ration (UACR) and eGFR levels. Novel non-steroidal mineralocorticoid receptor antagonists (MRAs) such as finerenone, which is indicated to reduce the risk of sustained eGFR decline, end-stage kidney disease, cardiovascular death, non-fatal myocardial infarction, and hospitalization for heart failure in adult patients with CKD, are now available to protect kidney function in patients with T2D. SGLT2 inhibitors including canagliflozin and dapagliflozin have shown robust reduction in composite renal primary outcomes, and the mechanisms of SGLT2 inhibitors, angiotensin-converting enzyme inhibitors (ACEis), and angiotensin II receptor blockers (ARBs) may act in a complementary way with the non-steroidal MRAs, potentially offering further clinical benefits. There is a risk of hyperkalemia when implementing MRA therapies for CKD in T2D, and it is necessary for clinicians to properly understand how to mitigate that risk through appropriate dietary counseling, and through the use of potassium-binding therapies, including patiromer and sodium zirconim cyclosilicate, which are indicated for reducing potassium levels, alongside other agents such as sodium polystyrene sulfonate. There is a need for clinicians to work as a multidisciplinary team while including the patient in the shared decision-making process to avoid disease progression and life-altering dialysis. 

Activity summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation
Activity opens: 
08/18/2022
Activity expires: 
08/31/2023
Cost:
$0.00

Support Statement

Supported by an educational grant from Bayer HealthCare Pharmaceuticals, Inc

Learning Objective

After completing this educational activity, you should be able to:

  • Evaluate the underlying pathophysiology, mechanisms, and appropriate guideline-based screening practices in CKD to optimize outcomes
  • Summarize the efficacy and safety of novel therapies for the management of T2D and CKD to reduce the risk of adverse renal and cardiovascular outcomes
  • Review best practices for the sequencing of appropriate therapy in patients with T2D and CKD based on current screening best practices, guidelines, and clinical evidence

Release, Review, and Expiration Dates

This CME activity was published in August 2022 and is eligible for AMA PRA Category 1 Credit™ through August 31, 2023.

Statement of Need and Purpose

An improved understanding of the underlying CKD pathophysiology, particularly MR activation leading to inflammation and fibrosis is an educational gap among physicians. Patients with elevated albuminuria and low eGFR are at risk of developing end-stage-renal disease is magnified, and there is a significant need to screen patients based upon UACR and eGFR levels. The addition of selective non-steroidal MRAs and new data has created a need for clinicians to understand the appropriate use of these therapies in preventing CKD disease progression. Since CKD in patients with T2D spans multiple specialties, there is a need for clinicians to work as a multidisciplinary team while including the patient in the shared decision-making process to avoid disease progression and life-altering dialysis. Last, there is a need for clinicians to properly understand how to mitigate the risk of hyperkalemia when implementing MRA therapies for CKD in T2D.  

Unlabeled and Investigational Usage

The faculty of this educational activity may include discussions of products or devices that are not currently labeled for use by the FDA. Faculty members have been advised to disclose to the audience any reference to an unlabeled or investigational use.

No endorsement of unapproved products or uses is made or implied by coverage of these products or uses.

Please refer to the official prescribing information for each product for discussion of approved indicators, contraindications and warnings.

Review Process

The faculty members agreed to provide a balanced and evidence-based presentation and discussed the topics and CME objectives during the planning sessions. The faculty’s submitted content was validated by CME Institute staff, and the activity was evaluated for accuracy, use of evidence, and fair balance by the Chair and a peer reviewer who is without conflict of interest.

The opinions expressed herein are those of the faculty and do not necessarily reflect the opinions of the CME provider and publisher or the commercial supporter

© Copyright 2022 Physicians Postgraduate Press, Inc.

Faculty 

Christos Argyropoulos, MD, MS, PhD, FASN
Division Chief of Nephrology
University of New Mexico School of Medicine
Albuquerque, New Mexico 

Martha Gulati, MD, MS, FACC, FAHA, FASPC, FESC 
Professor of Medicine, Director of CVD Prevention and Associate Director of the Barbra Streisand Women’s Heart Center
Cedars-Sinai Heart Institute 
Los Angeles, California

Viet Le, MPAS, PA-C, FACC, FAHA
Associate Professor of CV Research
Intermountain Heart Institute, Intermountain Healthcare
Salt Lake City, Utah 

 

Financial Disclosure

The CME Institute adheres to the Standards for Integrity and Independence in Accredited Continuing Education of the Accreditation Council for Continuing Medical Education (ACCME). Any individuals in a position to control the content of a continuing education activity, including faculty, content developers, reviewers, staff, and others, are required to disclose to learners the presence or absence of any relevant financial relationships with an ACCME-defined ineligible company within the preceding 24 months of the activity. The ACCME defines an “ineligible company” as one whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

The CME Institute has mitigated all relevant conflicts of interest prior to the commencement of the activity. None of the individuals involved in the content have relevant financial relationships with ineligible companies except the following:

Dr. Argyropoulos has served as a consultant for Bayer, Otsuka, and Baxter; received grant/research support from Alkahest; and has served on speakers/advisory boards for Bayer. 

Dr. Gulati has no disclosures. 

Mr. Le has no disclosures.

Accredited Provider Disclosure

Michael R. Page, PharmD, RPh
Independent Medical Director/Medical Writer
Plainsboro, New Jersey
Dr. Page is a consultant for BioCentric, Inc. and American Medical Communications, Inc.

None of the other planners, reviewers, and CME Institute staff for this educational activity have relevant financial relationships with ineligible companies to disclose. All relevant financial relationships have been mitigated.
 

Accreditation Statement

The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation

The CME Institute of Physicians Postgraduate Press, Inc., designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.

To obtain credit for this activity, study the material and complete the CME Posttest and Evaluation.

Available Credit

  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation

Price

Cost:
$0.00
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