Melanie Cole, MS (Host): Welcome to UAB Med Cast. I'm Melanie Cole, and joining me today is Dr. Claretha Lyas. She's a Nephrologist and Assistant Professor at UAB Medicine, and she's here to highlight chronic kidney disease for us today. Dr. Lyas, it's a pleasure to have you back with us. Tell us a little bit about chronic kidney disease. What do you see happening in the trends? How prevalent is this? What's going on?

Claretha Lyas, MD: So great to be with you today here on this podcast. And yes, we here at UAB and within my specialty specifically, we see a lot of chronic kidney disease. Chronic kidney disease is pretty fairly prevalent here in the US, as well as in Alabama. About 15% of people within the US have some form of chronic kidney disease.

The numbers that we see here at UAB certainly represent that. The most common reason why people often get sent to us is because they have a longstanding history of diabetes, as well as hypertension. And then we, they come to see us in clinic because they, in addition to those chronic illnesses, have a history of chronic kidney disease. So we see it pretty often here in Alabama and especially here at UAB.

Melanie Cole, MS (Host): We are updating a previous podcast, Dr. Lyas. Tell us a little bit about what's changed, as far as management and screening for chronic kidney disease.

Claretha Lyas, MD: Yes, absolutely. So we are very excited in the nephrology community about some of the newer treatment options that have become available for patients with chronic kidney disease. The disease itself, is I guess pretty consistent with where we were when we last spoke, but for the past couple years, there are newer treatments that are available.

So previously when someone had chronic kidney disease, we could obviously treat the underlying cause of the disease, but also add additional agents, particularly ACE inhibitors or angiotensin receptor blockers. And that was pretty much it in terms of other specific therapies that we had for chronic kidney disease.

Now, within the past two years, there's a whole new class of medicines that's very exciting called, sodium glucose code transporters or SGLT-2 inhibitors, that we now use as sort of the mainstay of therapy on top of either an ACE inhibitor or an angiotensin receptor blocker. Those really have really revolutionized our management of chronic kidney disease here in the past couple of years. So for most patients who come to see us, they have either albuminuria or proteinuria. We often add a SGLT-2 inhibitor to their hopefully ACE inhibitor or angiotensin receptor blocker. And then for those patients who have type 2 diabetes, there's another class of drugs now that we are excited about adding as well.

The class is called a mineralocorticoid receptor antagonist. And the agent that we are using most often is called finerenone, trade named KERENDIA. With the addition of these two classes of medicines, we are really hoping to see some decrease in progression of chronic kidney disease. So certainly very exciting times for us.

Host: Is there anything new as far as comorbid conditions that can go along with and or contribute to chronic kidney disease, as you're seeing patients and we're looking at the link between high blood pressure and you mentioned diabetes and some of these factors, what are we doing for them so that it is not just the kidney we're treating, but the whole person.

Claretha Lyas, MD: Right. So certainly here in Alabama, I would say the main reason why a lot of people develop chronic kidney disease is from a longstanding history of type 2 diabetes. Having their diabetes under control is certainly the thing that we want to make sure that we work with either primary care or endocrinology to do, but also making sure their blood pressure is well controlled and then having them on these two classes of medicines if they are able to, which is the SGLT-2 inhibitors and then a mineralocorticoid receptor antagonist. I will say though that as we are sort of emerging out of the pandemic, we did see some people develop kidney dysfunction as it relates to COVID. So some people have been following us within nephrology because they now have chronic kidney disease related to their sickness or hospitalization related to COVID.

So that would be the only, I guess sort of newer disease process that can be a cause of chronic kidney disease. But outside of that, as I would say, certainly here in Alabama, diabetes is probably the most common reason why people develop CKD.

Host: As we're speaking to other providers, Dr. Lyas, give us some indications for referrals to the experts at UAB Medicine. Tell us a little bit about what you'd like those community physicians and other providers to know about when you feel it's important they refer.

Claretha Lyas, MD: Certainly chronic kidney disease is a condition that we would like to treat early enough so that we can slow the progression of disease. For patients who have chronic kidney disease stage 3 and higher, we would like for them to be referred. And so just to sort of back up a moment, chronic kidney disease is divided into five stages, with 1 being sort of the more mild stage and stage 5 being kidney failure or preparing or nearing dialysis. Most patients are in stage 3, sort of the mild to moderate stage and at this point, we would hope that physicians would be able to refer us to nephrologists, in stage 3, or higher.

And if they have worsening albuminuria or proteinuria. So certainly, for diabetics or any other patient with chronic kidney disease, having albuminuria or proteinuria more than 500 milligrams, as well as at least stage 3, we would love for them to come see us in nephrology, so that we can make sure that we're doing all we can to slow their progression of disease.

Host: What's exciting on the horizon as far as kidney disease and or transplant treatment, anything you'd like to speak to other providers about.

Claretha Lyas, MD: I think there are a couple of things that are exciting. So one is the newer therapies that I alluded to. So we have more tools in the toolkit to treat patients with chronic kidney disease. And then two, I think on the horizon is that we hopefully will be able to get more of our patients who may progress to dialysis, opportunities for transplantation.

So UAB is sort of on the, the cutting edge of xenotransplantation. So that still has a long ways to go, but it, it's exciting to know that with the therapies that we have available to slow progression, then hopefully within a next several years we can increase our number of people who get transplanted. Then we really will be able to make a significant difference in the way that we manage chronic kidney disease.

Host: And if you could impart one bit of your best advice for other providers and really across the healthcare spectrum, because chronic kidney disease is a real multidisciplinary situation, so there's nutritionists, dieticians involved, there's nurse managers, there's Nephrologists, like yourself. Can you please speak to all of these providers about what you feel are some of the most important aspects of chronic kidney disease and why that multidisciplinary approach is so important?

Claretha Lyas, MD: Yes. So I am certainly glad that you brought up the multidisciplinary aspect of managing chronic kidney disease because, it is exactly that. We want to make sure that patients for one, are educated on their disease, know what it means, know risk factors for progression, and know the reason why they develop chronic kidney disease.

Two, we do want them to be able to have proper nutrition that supports their disease process. So having a dietician available, is certainly important. Understanding their medications. So we in our clinic have the benefit and the luxury of having a pharmacist with us. So understanding medications, how other medications may interact with one another. And making sure that medications are dosed appropriately are all very important aspects of managing patients with chronic kidney disease. And then last, having sort of a nephrologist there to be sort of an advocate, not only in managing the disease, but making sure that patients, when time is appropriate can be transitioned to transplant evaluation services to help patients get transplanted because obviously, we know that transplants are better in terms of morbidity and mortality compared to dialysis. So we want to make sure that patients who are eligible, can get speedy access to transplant evaluation. So all those pieces, that you just mentioned are very important as we manage patients with chronic kidney disease.

Melanie Cole, MS (Host): Thank you so much Dr. Lyas for joining us, and I hope you'll come back and update us as more things exciting in this world of kidney disease are happening at UAB Medicine. And for more information, please visit our website at uabmedicine.org/physician. That concludes this episode of UAB Med Cast. I'm Melanie Cole.

Thanks so much for joining us today.