Translating Clinical Trial Data into Real-World Practice: Examining CKD Screening and Three Patient Case Profiles

Overview

Regular screening of UACR and adding finerenone to SGLT2 inhibitors can greatly impact T2D at risk for CKD. Join faculty as they discuss three patient cases.

Learning Objectives

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

  • Assess best practices in screening for CKD and challenges in implementation of appropriate guideline-based recommendations for CKD screening and risk assessment
  • Explain the real-world use of therapies to protect patients from CKD progression in the context of novel mechanisms 
  • Summarize the rationale and best practices for combination therapy with mineralocorticoid receptor antagonists and other renoprotective agents, such as SGLT2 inhibitors

Target Audience

Nephrologists, cardiologists, endocrinologists, and primary care physicians  

Program Description

One in 10 Americans have type 2 diabetes (T2D), and 40% of patients with T2D have chronic kidney disease (CKD), which significantly increases the risk for cardiovascular disease in this patient population. In today’s treatment landscape for the reduction of renal and cardiovascular risk in patients with T2D at risk for progressive kidney disease, clinicians have a number of therapeutic agents to choose from. Those include sodium-glucose Cotransporter 2 (SGLT2) inhibitors, acetyl-CoA Carboxylase (ACC) inhibitors, Glucagon-like peptide-1 (GLP-1) receptor agonists, and mineralocorticoid receptor antagonists (MRAs). The latest drug to join the armamentarium is finerenone, an MRA which has been shown 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. However, clinicians have been slow to implement guidelines in screening for CKD in patients with T2D, and clinicians need to know when and how to sequence these therapies in real-world practice. In this webinar Drs Erin Michos, MD, MHS, associate director of preventive cardiology at Johns Hopkins University School of Medicine, and Joel Topf, MD, FACP, assistant clinical professor of medicine at Oakland University, William Beaumont School of Medicine, discuss guideline-based recommendations for screening to evaluate CKD risk in patients with T2D, as well as real-world use of therapies that protect patients from CKD progression, including combination therapy with MRAs and other renoprotective agents, such as SGLT2 inhibitors. Finally, the two experts weigh in on three patient cases as a way of translating this knowledge into real-world practice.

 

Activity summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation
Activity opens: 
12/14/2022
Activity expires: 
12/31/2023
Cost:
$0.00

Support Statement

Supported by an educational grant from Bayer HealthCare Pharmaceuticals.

Learning Objectives

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

  • Assess best practices in screening for CKD and challenges in implementation of appropriate guideline-based recommendations for CKD screening and risk assessment
  • Explain the real-world use of therapies to protect patients from CKD progression in the context of novel mechanisms 
  • Summarize the rationale and best practices for combination therapy with mineralocorticoid receptor antagonists and other renoprotective agents, such as SGLT2 inhibitors

Release, Review, and Expiration Dates

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

Statement of Need and Purpose

Few clinicians have implemented recent screening guidelines, with one large practice-based analysis finding that only 37% of patients with T2DM are receiving recommended screening. A 30% reduction in UACR has been identified as a marker of a 53% reduction in the risk of progression to end-stage kidney disease. Conversely, a 30% increase in UACR more than doubled the risk of progression to end-stage kidney disease in one large analysis of 1417 patients with albuminuria over a median follow-up of 2 years. Abundant clinical evidence now supports the use of finerenone in the management of patients with T2DM at risk for CKD, as well as the use of SGLT2 inhibitors. Reviewing key clinical data with these therapy important to understand, but there is also a need to understand when and how to use this information in real-world practice. Credible evidence exists supporting the importance of UACR reduction in patients with T2DM who are at risk for CKD with the addition of finerenone therapy to baseline therapy, whether added before an SGLT2 inhibitor, or after. Given these challenges and the advent of new data, the CME Institute is proposing an initiative to address these gaps with didactic material and three case-based discussions to translate clinical data into real-world practice.

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. 

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 Affiliation

Erin Michos, MD, MHS
Associate Professor of Medicine
Johns Hopkins School of Medicine
Baltimore, MD

 

Joel Topf, MD, FACP
Medical Director
Beaumont Hospital
Grosse Pointe, MI

 

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 Michos has served on the speakers/advisory boards for Astra Zeneca, Bayer, Boehringer Ingelheim, and Novartis. 

Dr Topf has received grant/research support from Natera; has received honoraria for speaking/teaching from AstraZeneca; has served on advisory boards for Tricida, Vifor, Cara, Bayer and AstraZeneca.

____

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.

Susan B. Nicholas, MD, MPH, PhD 
Peer Review 
Professor of Medicine, Divisions of Nephrology; Endocrinology, Diabetes and Metabolism 
UCLA 
Los Angeles, CA 

Dr. Nicholas has received consulting fees from Bayer AG, Boehringer Ingelheim/Lilly; received grant/research support from Bayer AG, Goldfinch Bio, Travere and Terasaki Institute of Biomedical Innovation; received honoraria for speaking/teaching from AstraZeneca, Bayer AG, Boehringer Ingelheim/Lilly; and received advisory board fees from Bayer AG, Gilead, NovoNordisk, Boehrigner Ingelheim/Lilly. 

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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