ASN Kidney Week 2024: Clinical Trials Highlight Advances in Kidney Disease Treatment
核心洞察
A trial showed targeted correction of hyponatremia (搜索) in hospitalized patients did not improve mortality and re-hospitalization rates.
Pegcetacoplan significantly reduced proteinuria in patients with complement 3 glomerulopathy (搜索) or primary immune complex-mediated membranoproliferative glomerulonephritis (搜索).
Semaglutide reduced major kidney outcomes, cardiovascular events, and death risks in type 2 diabetes (搜索) patients with chronic kidney disease (搜索), irrespective of CKD severity.
Several significant clinical trial results impacting kidney-related medical care were presented at ASN Kidney Week 2024, held October 23–27. These trials addressed various aspects of kidney disease, from electrolyte disorders to chronic kidney disease (搜索) progression and vascular access for hemodialysis.
Hyponatremia Correction
A trial involving 2,173 hospitalized patients across Europe investigated the impact of targeted correction of hyponatremia (搜索), a common electrolyte disorder, on patient outcomes. Patients were assigned to either targeted correction of blood salt levels or routine care. The primary outcome was the combined risk of death or rehospitalization within 30 days. While the targeted group achieved normal blood salt levels more frequently (60.4% vs. 46.2%), there was no significant difference in the combined event rate of death or rehospitalization (21.0% vs. 22.2%). According to Julie Refardt, MD, PhD, "Better correction of hyponatremia did not lead to an improvement in mortality and hospitalization rates. Therefore, in hospitalized patients, hyponatremia seems to be rather a marker of worse outcome instead of its cause."
Pegcetacoplan for Glomerulonephritis
The VALIANT trial assessed the efficacy and safety of pegcetacoplan, a complement inhibitor, in patients with complement 3 glomerulopathy (搜索) or primary immune complex–mediated membranoproliferative glomerulonephritis (搜索). The trial included 63 patients receiving pegcetacoplan and 61 receiving placebo for 6 months. Pegcetacoplan significantly reduced proteinuria by 68.3% compared to placebo. Carla M. Nester, MD, noted, "The results were consistent across patients with different characteristics. In addition, pegcetacoplan demonstrated favorable safety across native and post-transplant populations."
Semaglutide in Diabetic Kidney Disease
The FLOW trial examined the impact of semaglutide, a glucagon-like peptide 1 receptor agonist, on kidney outcomes in adults with type 2 diabetes (搜索) and chronic kidney disease (搜索) (CKD). An analysis of 3,533 participants revealed that semaglutide significantly reduced the risks of major kidney outcomes, cardiovascular events, and death from any cause. Katherine R. Tuttle, MD, stated, "We found that the benefit on kidney outcomes was consistent regardless of CKD severity at study entry. Ongoing studies are investigating the mechanisms of kidney protection by semaglutide, and whether semaglutide is also safe and efficacious for CKD in persons with type 1 diabetes or those without diabetes."
Pain Management in Hemodialysis
The HOPE Consortium Trial evaluated Pain Coping Skills Training, a non-pharmacologic cognitive behavioral therapy intervention, for chronic pain management in hemodialysis patients. The trial, involving 643 participants, demonstrated that the intervention improved pain interference, depression, anxiety, and quality of life. Laura M. Dember, MD, mentioned, "Future work will focus on how to best broadly implement this intervention in the dialysis setting."
Acellular Tissue Engineered Vessel for Hemodialysis Access
A trial of 242 patients undergoing surgical vascular access creation compared Humacyte's acellular tissue engineered vessel (ATEV) with traditional arteriovenous fistulas (AVFs). The ATEV group showed higher success rates in maintaining 6-month functional patency (81% versus 68%) and 12-month secondary patency (68% versus 62%), particularly in female, diabetic, and obese patients. Mohamad A. Hussain, MD, PhD, stated, "These findings suggest that ATEV could be a reliable option for vascular access for these subgroups with high risk of AVF failure, without compromising safety."
Dapagliflozin in Advanced CKD
The DAPA advKD trial investigated dapagliflozin, a sodium-glucose co-transporter 2 inhibitor, in patients with advanced CKD (stages 4 and 5). The trial randomized 180 patients to dapagliflozin plus integrated CKD care or integrated CKD care alone. Over a median of 1.62 years, the dapagliflozin group exhibited a slower reduction in kidney function and lower rates of kidney and cardiovascular outcomes. Yi-Wen Chiu, MD, explained, "Our study focused on patients with advanced chronic kidney disease (搜索) to test whether dapagliflozin can still benefit those with severely reduced kidney function. We found that this medication helped slow the decline in kidney function and reduced the need for dialysis or other advanced treatments."