The Kidney in Cardiometabolic Disease | Recording-The Kidney in Cardiometabolic Disease

Video Transcription

Video Summary

This webinar, moderated by Dr. Rich Pratley, explores the intricate relationship between kidney and heart health, particularly in the context of diabetes. Dr. Lance Sloan, a triple-boarded expert in endocrinology, nephrology, and internal medicine, presents an in-depth overview of how metabolic diseases like diabetes impact kidney function and, consequently, cardiovascular health.<br /><br />Dr. Sloan explains that diabetes is not merely a disorder of high blood sugar but significantly involves increased total body sodium, which elevates intravascular volume and burdens the heart, leading to heart failure. The kidney plays a central role by regulating sodium, glucose, and other nutrients via complex mechanisms involving transporters such as SGLT-2 and SGLT-1 in the proximal tubule. Diabetes enhances sodium and glucose reabsorption, escalating the workload on the kidney and heart.<br /><br />He describes the pathophysiology involving intrarenal renin-angiotensin systems, mitochondrial dysfunction, and reactive oxygen species leading to increased sodium retention. This creates a feedback loop amplifying kidney damage and cardiac stress. SGLT2 inhibitors emerge as crucial therapeutic agents that disrupt this cycle by reducing sodium and glucose reabsorption, modulating the renin-angiotensin system and sympathetic nervous activity, thus protecting both the kidney and the heart.<br /><br />Dr. Sloan also highlights differences in kidney disease manifestations, noting both albuminuric and non-albuminuric pathways, with advanced glycosylation end products contributing to fibrosis and chronic damage. GLP-1 receptor agonists also play a role by decreasing sodium uptake and offering weight loss benefits that indirectly support kidney and heart function.<br /><br />In the Q&A, Dr. Sloan emphasizes that all SGLT2 inhibitors have similar effects, encouraging early use to prevent kidney function decline. He also addresses the considerations for their use in type 1 diabetes and the impact of obesity on kidney and heart disease.<br /><br />Overall, the webinar underscores the intertwined nature of kidney and heart disease in diabetes, showing that targeted therapies improving kidney sodium and glucose handling can significantly reduce cardiovascular and renal morbidity and mortality.

Keywords

kidney health

heart health

diabetes

SGLT2 inhibitors

sodium reabsorption

renal physiology

cardiovascular disease

metabolic disease

GLP-1 receptor agonists

renal and cardiac interplay