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Medicine Matters diabetes

We heard about this new panel of biomarker, the CKD273, today. It's certainly a very interesting marker which has, I believe, the potential of predicting those patients who will progress towards kidney disease earlier than albuminuria. If we are able to identify those patients that progress for kidney disease, we can intervene earlier and preserve their renal function or delay the progression of renal function decline and prevent dialysis. Which is an end point where we don't want to arrive.



The CKD273 might have the potential to pick up earlier patient. Probably need further development in the future. Biotechnology to make the measurement of this or other marker accessible to primary care physician, for example, at a reasonable price. And so that's a challenge. But we've moved so far with other technologies in diabetes. I'm sure, in the future, there will be a possibility to have techniques and tools to measure this marker, this pool of markers and others in a quick and reasonably cheap way. So we can use them in clinic every day.



I think the study was asking two questions. And certainly, we have the impression that the CKD273 predicts occurrence of marker albuminuria. The addition of Losartan on top of RAAS inhibition-- because 80% of the patients were treated with RAAS inhibitors-- possibly has muddied the water a little bit. Two questions in one study might have complicated the readout of the other questions. And I'm sure future studies will definitely confirm the role of this new marker.



Personally, I would not add two inhibitor of the RAAS cascade. And as we have seen in the study, there was an increase in hypokalemia, which we actually have to avoid. So safety is paramount.



But certainly, it's a good start. And it opens many questions and more studies. And certainly, to see a future for this new marker and new technologies for the future for earlier prevention in diabetes and kidney disease.



Is there now an argument for starting renoprotective medications at a much earlier stage of renal decline in people with type 2 diabetes?

You are asking that question of the moment, I think. We don't have the renal data, yet. But I believe what we've seen in CREDENCE for canagliflozin is probably a class effect across all of them.



And if we look at the new European Cardiology Association guidelines in conjunction with the EASD, we see that in patients at risk SGLT2 inhibitor or GLP-1 agonist are first-line before metformin. I would honestly put metformin together.



And so you see that cardiologists are really much more aggressive. And these drugs save lives. Forget the kidney. They save hearts in cardiovascular mortality.



And usually, we know the heart and kidney go together. So likely that as the initial data are showing positive for both heart and kidney. So really they are getting better, I would say.