Medical Pulse Interview | talk about the new STRATEGY of T2D related CKD management, and take multiple measures to help win-win results

Guide

Epidemiological studies have shown that with the significant increase in the prevalence of diabetes, the prevalence of type 2 diabetes mellitus (T2D)-related chronic kidney disease (CKD) has also increased proportionally, and has now become the primary cause of end-stage renal disease (ESRD)¹, which is also the primary hospitalization cause of CKD patients in China, with a heavy disease ^burden2

T2D-related CKD onset is hidden, disease awareness rate is low, disease progression is rapid, treatment drug options are limited, and actively exploring and improving the patient-centered multidisciplinary comprehensive management model is an effective means

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Epidemiology and management status analysis of T2D-related CKD,

Multidisciplinary diagnosis and treatment paves the way for health

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CKD refers to decreased glomerular filtration rate (GFR) and/or increased urinary albumin excretion for at least 3 months, commonly seen in patients with ^diabetes3

Returning to the clinic, it has been reported that about 20% to 40% of patients with diabetes will develop T2D-related CKD, and if there is no timely intervention, it will eventually progress to ESRD that requires dialysis or transplantation, and early screening, early diagnosis, and early treatment are the key to improving the prognosis ^of

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Pioneering and innovative,

Nonelidone promotes the upgrading of T2D-related CKD treatment strategies

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In the multidisciplinary diagnosis and management of patients with T2D-related CKD, the choice of clinical treatment drugs has also attracted widespread attention

Aldosterone is a mineralocorticoid that is an important component of the RAAS system and can be maintained by binding to MR

Figure 1 Pro-inflammatory and fibrotic effects caused by MR overactivation are key to the progression of T2D-associated CKD disease

Mineralocorticoid receptor antagonists (MRA) are mainly divided into steroidal and nonsteroidal categories, steroidal MRA includes spironolactone and eplerenone, the above two drugs not only can not achieve binding and selective balance, and the concentration distributed in the kidneys is much higher than the heart, resulting in some patients prone to hyperkalemia and sex hormone-related adverse reactions after medication, resulting in its failure to be widely used in the ^clinic9
.

Non-nelidone is a naphthalene derivative based on the structure of dihydropyridine DHP-1, with a unique nonsteroidal highly selective innovative structure, is the first nonsteroidal MRA with clear evidence of renal cardiac benefit, has a high selectivity and high affinity for MR, can be evenly distributed in the kidney and heart tissue, can effectively inhibit the inflammation and fibrosis of target organs such as the kidney heart, at the same time, high potassium side effects are lower, no adverse reactions related to sex hormones are found, and both efficacy and safety are taken into ^account10 (Figure 2)
。

Fig.
2 Nonelidone innovates nonsteroidal highly selective molecular structures with both efficacy and safety

The FIDELITY ^study11, a key clinical trial, also confirmed that non-nerolidone significantly reduced the risk of renal compound endpoints by up to 23%, cardiovascular composite endpoints by up to 14%, and serum potassium levels were stable during treatment (Figure 3) on the basis of maximizing RAS inhibitor therapy and patients had achieved blood pressure and blood glucose standards
.
3

Fig.
3 On the basis of maximized RASi treatment, noneligilone can still significantly reduce the renal and cardiovascular composite endpoints

Referring to nonelidone, Professor He Qiang believes that "as a new MRA, this drug can better protect the kidney and heart function of patients with T2D-related CKD, delay the progression of the disease, and have fewer side effects than traditional MRA, which can promote the implementation of T2D-related CKD management.
"

Recognizing the listing of nonelidone from the aldosterone system, Professor Lu Chen pointed out: "This journey is a trilogy of human understanding of diseases, understanding diseases, and developing drugs, and hopes that non-necroidones can shine in T2D-related CKD treatment.
"

In addition, Professor Wang Rong also placed great expectations on the advent of nonelidone, saying: "Nonelidone has achieved good clinical benefits
in the global clinical studies that have been completed in the early stages, and in the large-scale clinical studies that are currently underway.

It is expected that after the listing, more evidence can be accumulated for clinical use, so that patients can achieve better treatment results on the basis of existing standard treatment.
"

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Take multiple measures together,

Explore new models of disease management

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The rapid development of information technology such as 5G, big data, metacosmity, and artificial intelligence, as well as the rapid popularization of mobile Internet, have had a profound impact on
the medical field.

On July 6, 2022, the "Digital Construction Summit Forum" of Zhejiang Provincial Hospital of Traditional Chinese Medicine was successfully held, and through the signing of strategic cooperation agreements with digital construction enterprises, it promoted the digital transformation of the innovative development of traditional Chinese medicine, and was committed to building a highland
of digital transformation in Zhejiang Province.

Professor He Qiang said: "Under the current normal situation of the epidemic, with the help of digital means, patients can identify kidney disease early and pay attention to changes in the condition in
time.

Promote the construction of "trinity" smart hospitals and information standardization of electronic medical records, smart services and smart management, which can provide patients with full-process and full-cycle TCM health smart services
.
"

As an important organizational model of the medical federation, the specialty alliance is conducive to promoting hierarchical diagnosis and treatment, scientifically implementing two-way referral, and improving the ability to solve major diseases of the specialty
.

At the end of July, the Shandong Provincial Hospital Nephrology Professional Alliance Conference initiated by Professor Wang Rong was held in Weifang, for the background and goal of the alliance, Professor Wang Rong said: "Multi-center cooperation is crucial in the management of chronic diseases, the original intention of creating the Nephrology Professional Alliance is to use the advantages of disciplines to integrate the nephrology health resources of existing medical institutions in the province, promote the complementary advantages of the alliances, and promote projects and activities related to the standardized diagnosis and treatment of kidney diseases.
Improve the technical level and service capacity of primary nephrology"
.

Nowadays, the vigorous development of the field of kidney disease in China is inseparable from the joint efforts
of several generations of nephrology experts.

For decades of practicing medicine, Professor Lu Chen and his team have been working hard in the field of nephrology, focusing on the clinical pathology and molecular biology series of IgA nephropathy, membranous nephropathy, diabetic nephropathy, and epidemiological investigation of chronic kidney disease
.

Over the years, the team has made many achievements, including the Xinjiang Autonomous Region Science and Technology Outstanding Contribution Award, the First Prize and the Huaxia Medical Award, which provide new ideas and methods
for the prevention and management of chronic kidney disease.

Professor Lu Chen continues to pay attention to the progress of clinical drugs in the field, he said that "the approval of nonelidone provides a new way for the clinical treatment of T2D-related CKD, and it is hoped that more patients will benefit from it in the near future.
"

Conclusion

China's T2D related CKD burden is increasing, clinical should strengthen multidisciplinary communication and cooperation, the establishment of T2D related CKD joint outpatient and specialized disease diagnosis and treatment units, the establishment of nephrology as the mainstay, by the endocrinology, cardiology, neurology and ophthalmology and other disciplines of experts composed of multidisciplinary diagnosis and treatment collaborative group, in order to improve the comprehensive management of diseases, improve the quality of life of patients, reduce the patient's case fatality rate
.

While actively promoting digital construction and exploring new models of integrated disease management, we should strengthen basic disease research and clinical research and accelerate the research and development
of innovative drugs.

The successful approval of nonelidone provides a new treatment option for T2D-related CKD patients in China, and it is expected that the drug can become a "sharp weapon" for kidney-heart risk management and prevention of T2D-related CKD patients in China!

Expert Profiles

Rankings are in no particular order

He Qiang

Zhejiang Provincial Hospital of Traditional Chinese Medicine

Professor, Chief Physician, Doctoral Supervisor, Deputy Secretary, Vice Dean

Former deputy director of the Nephrology Center of the First Affiliated Hospital of Zhejiang University School of Medicine

Former leader of the Department of Nephrology, Zhejiang Provincial People's Hospital

Standing Committee Member of Nephrologist Branch of Chinese Medical Doctor Association

Member of organ transplant physician branch of Chinese Medical Doctor Association

Vice Chairman of the Nephrology Rehabilitation Professional Committee of the Chinese Rehabilitation Society

Young Vice Chairman of the Nephrology Professional Committee of the Chinese Association of Integrative Traditional and Western Medicine

Chairman of the Medical Law and Medical Service Branch of Zhejiang Medical Association

Chairman of the Renal Disease Rehabilitation Professional Committee of Zhejiang Rehabilitation Society

Vice Chairman of Nephrology Branch of Zhejiang Medical Association

Vice Chairman of The Nephrologist Branch of Zhejiang Medical Doctor Association

Lu Chen

The First Affiliated Hospital of Xinjiang Medical University

Doctor of Medicine, Professor, Researcher, Chief Physician, Doctoral Supervisor, Dean

Winner of the Chinese Physician Award, outstanding returnee from Xinjiang

Member of the Nephrology Branch of the Chinese Medical Association

Member of the Nephrologist Branch of the Chinese Medical Doctor Association

Member of the Standing Committee of the Pathophysiology Committee of Chinese Nephropathy

Member of the Nephrology Group of the Geriatrics Branch of the Chinese Medical Association

Youth Committee Member of Internal Medicine Branch of Chinese Medical Association

Chairman of the Nephrology Professional Committee of Xinjiang Medical Association

Wang Rong

Shandong Provincial Hospital

Vice President of Shandong Provincial Hospital, Director of Nephrology

Professor of Shandong University, doctoral supervisor, Taishan scholar

Chairman of the Nephrology Professional Committee of Shandong Medical Association

Member of the National Health Commission's Renal Disease Quality Control Expert Group

Vice President of the Nephrologist Branch of the Chinese Medical Doctor Association

Vice President of the Nephrologists Branch of the World Association of Chinese Physicians

He is the chief editor and co-editor of several monographs on nephrology

He has won many awards such as Shandong Provincial Science and Technology Progress Award and Shandong Medical Science and Technology Award

He is good at the diagnosis and treatment of glomerular diseases, systemic diseases of kidney damage, acute and chronic kidney injury, renal hypertension, complex water and electrolyte disorders, difficult and rare kidney diseases, dialysis-related complications, etc.
, and has rich clinical experience

References

1.
Zhang L, Wang F, Wang L, et al.
Prevalence of chronic kidney disease in China: a cross-sectional survey[J].
Lancet.
2012,379(9818):815-822.

2.
LI Hang.
A New Breakthrough in the Treatment of Type 2 Diabetes Mellitus complicated with Chronic Kidney Disease: Nonsteroidal Highly Selective Mineralocorticoid Receptor Antagonists[J].
Chin J Internal Medicine,2021,60(1):5-8.

3.
Expert Consensus Collaboration Group on Diabetic Nephrology, Department of Medicine, Peking University.
Expert consensus on the diagnosis and treatment of diabetic nephrology[J].
Chinese Medical Journal,2020,100(4):247-260.

4.
Wang Weiqing.
Chinese Expert Consensus on oral hypoglycemic drug therapy for patients with type 2 diabetes mellitus complicated with chronic kidney disease (2019 update)[J].
Chinese Journal of Endocrinology and Metabolism, 2019,35(6):447-454

5.
Zhang Luxia,Zhao Minghui.
Focusing on the disease spectrum change and population management strategy of chronic kidney disease in China[J].
Chinese Journal of Internal Medicine,2017,56(3):161-162.

6.
Microvascular Complications Group of Diabetes Branch of Chinese Medical Association.
Clinical guidelines for the prevention and treatment of diabetic kidney disease in China[J].
Chinese Journal of Diabetes,2019,11(1):15-28.

7.
Bomback AS, Klemmer PJ.
The incidence and implications of aldosterone breakthrough[J].
Nat Clin Pract Nephrol.
2007 Sep; 3(9):486-92.

8.
Gao X, Yamazaki Y, Tezuka Y,et al.
Pathology of Aldosterone Biosynthesis and its Action[J].
Tohoku J Exp Med.
2021 May; 254(1):1-15.

9.
Cheng Kuan.
New advances in the research and application of nonelidone[J].
Chinese Journal of Clinical Pharmacology and Therapeutics,2022,27(4):450-456.

10.
Yang P, Huang T, Xu G.
The novel mineralocorticoid receptor antagonist finerenone in diabetic kidney disease: Progress and challenges[J].
Metabolism.
2016, 65(9):1342-1349.

11.
Agarwal R, Filippatos G, Pitt B, et al.
Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis[J].
Eur Heart J.
2022 ,43(6):474-484.

For academic communication by healthcare professionals only

Approval code: PP-KER-CN-0179-1