Quality of care for people with chronic kidney disease: a systematic review and meta-analysis.

Objectives: Guideline-based strategies to prevent chronic kidney disease (CKD) progression and complications are available, yet their implementation in clinical practice is uncertain. We aimed to synthesise the available evidence on the concordance of CKD care with clinical guidelines to identify gaps and inform future CKD care.

Design: Systematic review and meta-analysis.

Decline in glomerular filtration rate as an endpoint in heart failure clinical trials: challenges and solutions.

Chronic kidney disease (CKD) and cardiovascular disease are tightly interconnected, with common mechanisms that underlie the development and progression of both diseases, recently articulated into the framework of the cardiovascular-kidney-metabolic syndrome. CKD and heart failure commonly coexist in the same individual, with increasing evidence for common therapies in both disease states. It is valuable for patients, clinicians, and regulatory agencies to understand how to best assess CKD progression in patients with heart failure for evaluation of individual patients and as part of an endpoint for outcome trials.

Natriuretic Peptides, Body Mass Index, and Clinical Outcomes in Heart Failure with Mildly Reduced or Preserved Ejection Fraction.

Background: Natriuretic peptides are the primary biomarkers recommended in heart failure (HF) guidelines to risk stratify patients in clinical practice and serve as key eligibility criteria in contemporary clinical trials. However, threshold levels typically do not account for measures of adiposity, such as body mass index (BMI).

Objective: To evaluate the association between N-terminal pro-B-type natriuretic peptide (NT-proBNP) with clinical outcomes in individuals with HF and mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), stratified according to BMI.

Cardiovascular, kidney, and metabolic health: an actionable vision for heart failure prevention.

The substantial and growing prevalence of heart failure, which remains the leading cause of preventable hospitalisation worldwide, has brought heart failure prevention into sharp focus. Although this condition has historically been characterised by impaired cardiac function, mounting evidence has underscored its complex and multisystem pathobiology. Epidemiological studies have indicated that other forms of cardiovascular disease, along with kidney and metabolic dysfunction, frequently and increasingly contribute to heart failure onset.

Association of Volume Status Assessed by Bioimpedance with Blood Pressure in CKD.

Background: Hypertension is common among patients with CKD and is a risk factor for cardiovascular events and mortality. Though hypervolemia is a contributor to hypertension, the association of blood pressure with biomarkers of volume among patients with CKD is unclear.

Methods: Using data from 5,384 patients in the Chronic Renal Insufficiency Cohort (CRIC), we fit linear regression models to examine the association of vector length (bioimpedance proxy of volume) with systolic and diastolic blood pressure (BP).

Prevalence of SGLT2 inhibitor and GLP1 receptor agonist prescriptions in type 2 diabetes patients with and without chronic kidney disease: Analysis of an Australian primary care dataset.

Aims: Sodium-glucose co-transporter 2 inhibitors (SGLT2 inhibitors) and glucagon-like peptide-1 receptor agonists (GLP1-RA) have cardio-kidney-metabolic benefit. This study aimed to understand the prevalence of prescription of SGLT2 inhibitors and GLP1-RA among patients with T2DM with and without chronic kidney disease (CKD) in Australian primary care.

Materials And Methods: We conducted a retrospective, cohort study of adults with T2DM who attended primary care practices participating in MedicineInsight.

SGLT2 Inhibition and Hospitalizations in Patients with CKD: A Meta-Analysis of Kidney Outcome Trials.

Background: Unplanned hospitalization, irrespective of cause, is a meaningful outcome for patients, caregivers, clinicians and health systems. The effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors on all-cause hospitalization in patients with chronic kidney disease (CKD) has not been systematically evaluated.

Methods: We conducted a post-hoc analysis of the Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) trial to evaluate the effect of canagliflozin on non-elective all-cause hospitalization using Cox proportional hazards models, with recurrent events analysis to assess effects on first and subsequent hospitalizations.

Corticosteroid Effects in IgA Nephropathy by Baseline Proteinuria and Estimated GFR.

Introduction: Higher proteinuria and lower estimated glomerular filtration rate (eGFR) are predictors of kidney failure in IgA nephropathy (IgAN); however, it is uncertain whether these markers modify response to corticosteroids. This analysis of the TESTING trial assessed the effects of methylprednisolone on kidney and safety outcomes by baseline proteinuria and eGFR.

Methods: A total of 503 participants with IgAN and proteinuria ≥ 1 g/d were randomized to oral methylprednisolone (full-dose 0.

Variation in uptake of sodium glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor analogues in adults with type 2 diabetes at high cardiovascular risk.

Purpose: We quantified variation in the uptake of sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor analogues (GLP-1RA) across sociodemographic, behavioural and clinical characteristics of people with type 2 diabetes (T2D) at high cardiovascular risk.

Methods: We used the 45 and Up Study survey data (2018-2020) linked to dispensing and service claims for 10,171 people with T2D (56% male, median age of 72 years, median diabetes duration of 11 years). We calculated the prevalence of GLP-1RA and SGLT2i use within 1 year and used logistic regressions to assess associations with each participant characteristic.

Obesity and Risk of Kidney Outcomes in Heart Failure With Preserved Ejection Fraction: A Participant-Level Pooled Analysis of 4 Contemporary Trials.

Background: Obesity is prevalent among patients with heart failure with preserved ejection fraction (HFpEF).

Objectives: This study aims to evaluate whether anthropometrics including body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) are associated with kidney outcomes in patients with HFpEF.

Methods: In this participant-level pooled analysis of DELIVER, PARAGON-HF, TOPCAT Americas, and I-PRESERVE, we evaluated the impact of adiposity-related anthropometrics on risk of kidney outcomes (sustained eGFR reduction of ≥50%, end-stage kidney disease, or kidney-related death).

Trends in use of sodium-glucose cotransporter 2 inhibitors among people with type 2 diabetes following hospitalisation with heart failure: A population-based study.

Aims: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are a pillar of therapy among people with both type 2 diabetes (T2D) and heart failure (HF). Despite being a population at high-risk of cardio-renal events, little is known on SGLT2i uptake following hospitalisation, a key opportunity for prescribing.

Methods: Using linked administrative data, we identified adults with T2D hospitalised with HF from January 2014 to June 2021, New South Wales, Australia.

Systematic Review of the Effects of Iron on Cardiovascular, Kidney, and Safety Outcomes in Patients With CKD.

Introduction: Heart failure and chronic kidney disease (CKD) are closely associated, and iron deficiency is highly prevalent in both conditions. However, major cardiovascular and nephrology guidelines offer contrasting recommendations for iron use. We evaluated the effects of iron versus usual care or placebo on the clinical outcomes in patients with CKD.

Assessing patterns of chronic kidney disease care in Australian primary care: a retrospective cohort study of a national general practice dataset.

Background: Chronic kidney disease (CKD) monitoring and cardiovascular risk management are essential in reducing disease progression and cardiovascular events. This study aimed to understand CKD monitoring and management practices in Australian primary care.

Methods: We conducted a retrospective, population-based cohort study of adults who attended general practices participating in MedicineInsight between 1 January 2011 and 30 June 2020 and met diagnostic criteria for CKD.

Clinical Implications of Slope of GFR in Clinical Trials of CKD Progression.

Key Points: Acute effects impact the clinical endpoint independently of treatment effects on the chronic slope. Our findings support the 3-year total slope as the primary slope-based outcome in randomized trials.

Background: Slope of the GFR is considered a validated surrogate endpoint for CKD trials.

Effects of anti-inflammatory agents on clinical outcomes in people with chronic kidney disease: a systematic review and meta-analysis of randomized control trials.

Background: Chronic kidney disease (CKD) is characterized by chronic inflammation, which is strongly linked to risk of cardiovascular disease. Anti-inflammatory agents present a novel strategy to reduce the burden of cardiovascular disease in people with CKD, but their effects on clinical outcomes are uncertain.

Methods: A systematic review and meta-analysis was performed to assess the efficacy and safety of anti-inflammatory agents in CKD (PROSPERO CRD42021238755).

Effects of SGLT2 inhibition on insulin use in CKD and type 2 diabetes: insights from the CREDENCE trial.

Background: Insulin is a mainstay treatment for diabetes, but its use is associated with weight gain and hypoglycaemia. Data on the effects of sodium-glucose co-transporter 2 (SGLT2) inhibitors on insulin use in people with chronic kidney disease (CKD) are limited.

Methods: We conducted a post hoc analysis of the Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation trial.

Combination therapy as a new standard of care in diabetic and non-diabetic chronic kidney disease.

Unlabelled: Combination therapy, involving the use of multiple medications together, is becoming a new standard of care for chronic kidney disease (CKD). For people with CKD, combination therapy offers the promise of preventing kidney failure and reducing the risk of heart problems. This approach is appealing because different drugs target distinct mechanisms involved in CKD progression.

Risk-directed management of chronic kidney disease.

The timely and rational institution of therapy is a key step towards reducing the global burden of chronic kidney disease (CKD). CKD is a heterogeneous entity with varied aetiologies and diverse trajectories, which include risk of kidney failure but also cardiovascular events and death. Developments in the past decade include substantial progress in CKD risk prediction, driven in part by the accumulation of electronic health records data.

Canagliflozin reduces oral loop diuretic intensification in patients with type 2 diabetes: A participant-level pooled analysis of the CANVAS and CREDENCE trials.

Aims: The sodium-glucose cotransporter 2 inhibitor canagliflozin reduces the risk of heart failure (HF) hospitalization or cardiovascular death and chronic kidney disease (CKD) progression among patients with type 2 diabetes at high cardiovascular risk or with CKD. Patients with type 2 diabetes commonly have coexisting HF or CKD that require treatment with loop diuretics; however, the prognostic implications of oral loop diuretic intensification are not well characterized.

Methods And Results: In this participant-level pooled analysis of the CREDENCE and CANVAS trials (not including CANVAS-R), 1454/8731 (16.

Cardiovascular, kidney and safety outcomes with canagliflozin in older adults: A combined analysis from the CANVAS Program and CREDENCE trial.

Aim: SGLT2 inhibitors may be underused in older adults with type 2 diabetes due to concerns about safety and tolerability. This pooled analysis of the CANVAS Program and CREDENCE trial examined the efficacy and safety of canagliflozin according to age.

Methods: Pooled individual participant data from the CANVAS Program (n = 10 142) and CREDENCE trial (n = 4401) were analysed by baseline age (<65 years, 65 to <75 years, and ≥75 years).