Pam Harrison

November 09, 2016

CHICAGO — Results from the LEADER trial on renal outcomes in patients with diabetes treated with liraglutide, a long-acting glucagon-like peptide-1 receptor agonist, are among the highly anticipated findings that will be presented here at Kidney Week 2016.

"Diabetes is actually a subtheme of the meeting this year. It represents the biggest cause of end-stage renal disease, certainly in the Western world," said Roy Zent, MD, PhD, from the Vanderbilt University School of Medicine in Nashville, Tennessee, who is program chair for the meeting.

"We're really trying to concentrate on the disease and how it affects the kidney," he told Medscape Medical News.

To this end, emphasis on the genetic and metabolic pathways that contribute to diabetes and subsequent chronic kidney disease will be explored in state-of-the-art lectures on topics that range from the genetics of human obesity to the way enteroendocrine physiology informs drug design for diabetes and obesity.

Another major focus of the meeting — dialysis — will be addressed by the late-breaking SOLID trial, which looks at whether less sodium in dialysate can promote the regression of left ventricular mass in hemodialysis patients.

Attention will also be paid to the many novel ways in which nephrologists can preserve kidney function and free patients with end-stage renal disease from the burden of thrice-weekly dialysis.

"We've been victims of our own success, in that we've had a life-preserving and life-saving therapy for ESRD for a long time," said Raymond Harris, MD, from the Vanderbilt University School of Medicine, who is president of the American Society of Nephrology (ASN).

"But we really want to take that next step and get into ways to prevent patients from going on to need dialysis," Dr Harris told Medscape Medical News.

"One of the greatest things to happen in modern medicine is that we have a replacement for kidney function, which is a first," said Dr Zent.

"We're hoping that dialysis will be used less and less as we go on," he said. "Hopefully, in the next 50 years, we'll have better treatments and cures and we'll have a population that is not so dialysis-dependent."

In fact, during the recent White House Organ Summit, the ASN pledged the first $7 million toward the prize for a competition to incentivize investigators to develop alternatives to current dialysis procedures.

ASN Celebrates Fiftieth Anniversary

The ASN will celebrate its fiftieth anniversary by offering a spectacular line-up, according to meeting organizers.

"We've really concentrated on making the best content possible available at this year's Kidney Week," said Dr Harris.

A lot of the meeting is really directed at what most nephrologists see and do all the time, added Dr Zent. "I'm hoping that by concentrating on common diseases we all see in nephrology, we'll get really broad interest from nephrologists," he told Medscape Medical News.

As well as looking at ways to prevent dialysis, several presentations will look at ways to delay the progression of chronic kidney disease.

A presentation on results from a substudy of the China Stroke Primary Prevention Trial will show that the addition of folic acid to enalapril significantly delayed disease progression in adults with hypertension and mild to moderate chronic kidney disease.

And members of the same investigative team will report that enalapril plus folic acid prevents new-onset proteinuria in adults with diabetes at baseline, but not in adults without diabetes.

There will also be presentations on the impact of diet on the progression of kidney disease. In a meta-analysis of cohort studies, investigators extol the virtues of a Mediterranean diet, already known to lower the risk for cardiovascular disease in the general population, for patients with chronic kidney disease.

And the Jackson Heart Study will show that the decline in estimated glomerular filtration rate is greater with a high-protein diet than with a low-protein diet in a black population, especially patients with diabetes at baseline.

In another study, intradialytic protein supplementation with whey protein during each hemodialysis session appeared to attenuate the usual decline in bone mineral density seen in dialysis patients, at least those 60 years and older.

Several late-breaking studies will explore ways to improve allograft functioning after live-donor kidney transplantation, and whether different induction regimens can allow for rapid steroid withdrawal after receipt of a donor kidney.

Also presented will be details of a novel calcineurin inhibitor treatment for active lupus nephritis.

Delegates will hear about novel ways to correct metabolic acidosis with oral bicarbonate, which improves insulin resistance in patients with chronic kidney disease. The same investigators will also show that that low serum bicarbonate levels could be detrimental to cognition in patients with and without chronic kidney disease.

"Our theme this year — Reinventing Nephrology: From Molecule to Man — reflects our feeling that it's time to revitalize and reinvent what nephrology is and its purpose, both clinically and in research, Dr Harris explained. We need to "really understand some of the basic mechanisms of kidney function and, more important, kidney pathophysiology, so we can develop better therapeutics," he said.

Dr Harris and Dr Zent have disclosed no relevant financial relationships.


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