More Top Research From Kidney Week 2020

The American Society of Nephrology’s virtual Kidney Week featured a slew of research advancements and options for the treatment of chronic kidney disease (CKD). Some of the new findings presented included the investigational anti-mineralocorticoid agent finerenone for the slowing of CKD, new insights into dapagliflozin’s (Farxiga) renoprotective and cardioprotective benefits, and the best course of treatment for primary membranous nephropathy.

Below are highlights of several other noteworthy studies from the meeting.

Novel Anemia Treatment

In a pre-specified regional analysis of the PRO₂TECT program, Akebia’s investigational agent vadadustat for the treatment of anemia in patients with CKD not on dialysis showed no increased cardiovascular risk compared with darbepoetin alfa.

Previous phase III findings showed that the oral, hypoxia-inducible factor prolyl hydroxylase inhibitor was non-inferior to darbepoetin alfa in the average change in hemoglobin levels over a 52-week follow-up period. However, in this original trial vadadustat failed to meet the primary safety endpoint, with a quicker time to first occurrence of a major adverse cardiovascular event (MACE) versus darbepoetin alfa.

But the pre-specified analysis presented at Kidney Week found no increased cardiovascular risk associated with vadadustat across the U.S. patients treated to a target hemoglobin range of 10-11 g/dL.

“The newly presented analysis showed that there were regional differences with respect to MACE, expanded MACE, and all-cause mortality, consistent with well-known, differing regional hemoglobin treatment target guidelines,” said Glenn Chertow, MD, MPH, of Stanford University in California, in a statement.

Glomerular Diseases & Heart Risk

Both before and after the onset of end-stage kidney disease, people with glomerular disease carry an increased risk of cardiovascular disease.

Looking at a centralized kidney pathology registry of Canadian patients with various glomerular diseases, patients with nearly all types saw a relatively high rate of cardiovascular events. Specifically, cardiovascular risk was about 2.5-fold higher among those with glomerular diseases versus the general population (standardized incidence ratio 2.5, 95% CI 2.1-2.8).

When the results were broken down by type of disease, people with membranous nephropathy (HR 2.6, 95% CI 1.7-3.9) and focal segmental glomerulosclerosis (HR 3.7, 95% CI 2.6-5.3) had a significantly higher risk for a cardiovascular event compared with immunoglobulin (Ig) A nephropathy. However, those with minimal change disease saw a similar rate of cardiovascular events compared with IgA nephropathy (HR 1.3, 95% CI 0.8-2.4).

“Consideration of glomerular disease-specific factors can help improve cardiovascular risk prediction. Failure to take these novel factors into account will lead to underestimation of cardiovascular risk and underutilization of cardiovascular primary prevention strategies,” the study’s lead author, Heather Gunning, MBChB, of the University of British Columbia in Canada, explained in a statement.

“Further research is ongoing into the impact of glomerular disease activity and therapy over time on cardiovascular risk. This will allow better understanding of the impact of glomerular disease on cardiovascular risk and whether treatment may modify this,” she added.

Racial Disparities in Kidney Failure

Black and Hispanic patients had a more rapid decline in kidney function after new-onset CKD compared with white patients.

In a large study of over 830,000 U.S. veterans, Black and Hispanic patients saw significantly higher rates of progression to end-stage kidney disease over a 10-year follow-up period. Specifically, Black patients had as high as a 2.9-fold higher risk for developing end-stage kidney disease compared with white patients in the 56-65 age group (cause-specific hazard ratio 2.90, 95% CI 2.79-3.01).

In this same age group, Hispanic patients had a nearly similar elevated risk for end-stage kidney disease versus white patients (HR 2.67, 95% CI 2.50-2.85).

“[T]his was truly driven by a greater risk of kidney failure due to faster decline in kidney function after CKD onset, rather than because of lower risks of death prior to kidney failure,” the study’s lead author, Guofen Yan, PhD, of the University of Virginia in Charlottesville, pointed out in a statement. “Delineation and elimination of the causes of faster kidney function declines in Blacks and Hispanics are therefore the appropriate strategies to improve clinical outcomes in Blacks and Hispanics with CKD.”

“Slowing the faster progression in Blacks and Hispanics with CKD should be a major focus in research, practice, and healthcare policy to achieve the goal of reducing the disparities in CKD,” she concluded.