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Chronic Kidney Disease Learning Zone

Congress highlights

Read time: 20 mins
Last updated:30th Jun 2022
Published:24th May 2022

ERA 2022 congress highlights

Keep up to date with the latest in chronic kidney disease (CKD) research with our coverage of the 2022 European Renal Association (ERA) Congress held in Paris, France. Watch as professional in the field of CKD, Professor Navdeep Tangri discusses the most relevant updates to existing clinical trials and provides expert summaries of the latest research. Follow along with our written coverage of the daily congress highlights to keep your CKD clinical knowledge and practice current. Learn more about: 

  • Latest updates to large cohort CKD clinical trials such as DAPA-CKD and REVEAL-CKD 
  • Newest evidence supporting the use of sodium–glucose co-transporter 2 (SGLT2) inhibitors and mineralocorticoid receptor antagonists (MRAs) for people with diabetic and non-diabetic kidney disease
  • Data demonstrating overlap between cardiovascular disease and type 2 diabetes in people with CKD

Congress highlights with Professor Navdeep Tangri

Watch our expert Professor Navdeep Tangri discuss research highlights from the 2022 ERA Congress. Professor Tangri focuses on the latest updates to ongoing CKD clinical trials (such as DAPA-CKD and REVEAL-CKD), the status of SGLT2 inhibitors and MRAs, as well as new research on the overlap between cardiovascular disease and type 2 diabetes in patients with CKD.

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Day One Highlights – CKD diagnosis and treatment from the mini-oral sessions

By Ben Gallarda

Key chronic kidney disease developments from the mini-oral sessions

The European Renal Association (ERA) 2022 Congress began with a good number of virtual mini-oral sessions and abstracts, discussing a wide range of topics in brief online presentations. In this article, we bring you some of the key developments in chronic kidney disease (CKD) from these mini-oral sessions.

Diagnosing CKD

In a mini-oral session on lab methods, glomerular filtration rate (GFR) measurement and urine proteomics, a good part of the discussion focused on detecting CKD earlier, particularly with albuminuria testing. Antonio Garreta Rufas presented the results of a systematic review examining barriers that may prevent adherence to Kidney Disease Improving Global Outcomes (KDIGO) guidelines for albuminuria testing1. One of the main identified barriers was physicians’ perception that test results would not materially impact patient care. Dr Rufas concluded his presentation noting that “testing of albuminuria rates are low, and we need to improve,” along with suggestions for several ways to achieve this. These results were supported by a separate modelling study, which showed that regular urine albumin-to-creatinine ratio (UACR) testing is both cost-effective and likely to prevent more severe outcomes of CKD, including late stage disease, dialysis, and cardiovascular disease (CVD)-related deaths2.

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Day Two Highlights – From late-breaking trials to CKD classification

By Anita Reid

Late-breaking clinical trials

Several late-breaking clinical summaries were revealed on the second day of the European Renal Association (ERA) 2022 Congress.

Patrick Rossignol reported that “all endpoints were statistically and convincingly” met in the DIAMOND Trial12 investigating patiromer, a novel K+ binder, in patients with comorbid heart failure (HF) with reduced ejection fraction and chronic kidney disease (CKD), and in whom hyperkalaemia leads to compromised treatment with renin-angiotensin-aldosterone system inhibitors (RAASi)13. Patiromer maintained lower serum K+ levels vs placebo across all CKD subgroups and resulted in a lower incidence of hyperkalaemic events, as well as a greater proportion of patients being maintained on a mineralocorticoid receptor antagonist (MRA) at target doses vs placebo across all CKD groups.

K+ binder, patiromer, reduces incidence of hyperkalaemic events in CKD with HF

The tubular stress biomarker, urinary dickkopf-3 (uDKK3), is a predictor of acute kidney injury (AKI) risk and chronic kidney disease (CKD) progression in adults14-16. According to Franz Schaefer and colleagues’ post-hoc analysis of the 4CS17 and ESCAPE trials18, higher levels of uDKK3 were associated with faster loss of estimated glomerular filtration rate (eGFR) in paediatric CKD. This was independent of underlying disease, age, baseline eGFR, proteinuria, hypertension and obesity. It was only in patients with high uDKK3 levels that RAAS inhibition and intensified blood pressure control were associated with reduced eGFR loss. “UDKK3 is a promising new biomarker that may be useful in predicting responsiveness to nephroprotective therapies and designing risk-adapted personalised medicine,” said Dr Schaefer.

Classification of CKD

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Patient experience during COVID

A patient association presented for the first time at a European Renal Association Congress.

Yvanie Caillé, founder of the French patient association, ‘Renaloo’, and eminent sociologist and vice-chair of Renaloo, Christian Baudelot, met virtually with prominent nephrologist, Raymond Vanholder, chair of the Brussel-based European Kidney Health Alliance. Patient associations were praised for their activity during the COVID-19 crisis.

The time has come to place a higher value on the role of patients’ associations. Increasingly, these associations are supporting patients and provide valuable insight.
Christian Baudelot

From the results of Renaloo’s latest patient survey, Yvanie Caillé highlighted poor vaccine coverage with 57% of dialysis patients and 54.7% kidney transplant recipients receiving their first booster vs 82% in the eligible population, and severe underuse of COVID-19-prophylactic, monoclonal antibody therapy, tixagevimab/cilgavimab (Evusheld).

57% of dialysis patients and 54.7% of kidney transplant patients have had their first booster vs 82% of the eligible population

Professor Vanholder, called for urgent action in the ‘Decade of the Kidney’ (2020-30). Although chronic kidney disease (CKD) affects nearly 100 million Europeans, kidney disease is absent from the list of European Union (EU) key health research areas, and many people with kidney disease are diagnosed late35.

Treatment for chronic kidney disease

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Day Four Highlights – The pillars of therapy to reduce cardio renal risk

By Anita Reid

During the last day of the ERA 2022 conference, there was a thorough discussion of the FIDELITY study in patients with CKD and type 2 diabetes, which called for a holistic approach to treatment.

Clinicians now have the benefit of add-on treatment with a new class of non-steroidal mineralocorticoid receptor antagonists

Individuals with type 2 diabetes (T2D) have a strong residual risk of chronic kidney disease (CKD) progression, despite being treated with current therapies, i.e., angiotensin-converting enzyme inhibitors (ACEi), angiotensin-receptor blockers (ARBs) and the sodium-glucose cotransporter 2 inhibitors (SGLT2i)52.

However, clinicians now have the benefit of add-on treatment with a new class of non-steroidal mineralocorticoid receptor antagonists (MRA), specifically finerenone, which has been the most extensively studied agent within the class to date, with pending results from glucagon-like peptide 1 receptor agonists (GLP1-RA) also showing promising results as add-on treatment.

Katherine Tuttle emphasised the importance of precise phenotyping, even based on the patient’s clinical picture, to improve the selection of therapies and how to apply them for therapeutic safety and efficacy.

George Bakris reviewed the results of FIDELITY, a large, pooled analysis of individual patient data (N=13171) taken from FIDELIO-DKD and FIGARO-DKD53,54. Both trials investigated the effect of finerenone on kidney and cardiovascular (CV) outcomes in patients with CKD and T2D.

FIDELITY showed that, on top of standard care (ACEIs/ARBs), finerenone reduced the risk of clinically meaningful CV and kidney outcomes in patients with T2D over a broad spectrum of CKD:

  • endpoint CV composite: 14% (HR 0.86; 95% CI, 0.78–0.95; P=0.0018)
  • hospitalisation for heart failure (HHF): 22% (HR 0.78; 95% CI, 0.66–0.92; P=0.0030)
  • kidney composite: 23% (HR 0.77; 95% CI, 0.77–0.88; P=0.0002)
  • dialysis: 20% (HR 0.80; 0.64–0.99; P=0.040) In addition to standard care, finerenone demonstrated CV benefits and preservation of kidney function in patients with T2D, regardless of the baseline estimated glomerular filtration rate (eGFR) or urinary albumin:creatinine ratio (UACR) and the use of SGLT2s or GLP-1RAs, with benefit primarily driven by reduction in HHF. Finerenone showed modest effects on systolic blood pressure and no sexual side-effects. Although hyperkalaemia increased with finerenone, the clinical impact was low; interestingly, for yet unknown reasons, hyperkalaemia risk is decreased in the presence of SGLT2is53
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References

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