Kidney in Cardiometabolic Disease - Annual Meeting 2025-The Kidney in Cardiometabolic Disease

Video Transcription

Video Summary

Dr. Lance Sloan, an expert in endocrinology and nephrology, presented on the kidney's role in endocrine disorders, particularly diabetes and its impact on kidney and heart function. Diabetes, especially type 2, is the leading cause of chronic kidney disease (CKD), which in turn increases the risk of cardiovascular death, primarily from heart failure rather than just atherosclerotic events. The kidney maintains the body's extracellular environment by regulating fluid, electrolytes, nutrients, and oxygen delivery, communicating with the central nervous system via the macula densa.<br /><br />In diabetes, increased glucose reabsorption by kidney transporters (SGLT-1 and SGLT-2) raises sodium retention, activating the renin-angiotensin system (RAS) and sodium proton exchangers. This chain reaction increases intravascular volume and blood pressure, placing stress on the heart and leading to remodeling and heart failure. SGLT2 inhibitors reduce sodium-glucose reabsorption, mitigate RAS activity, and improve kidney and cardiovascular outcomes by lowering glomerular pressure, oxidative stress, and inflammation.<br /><br />Dr. Sloan also discussed distal tubule mechanisms, including flow-sensing flagella that regulate sodium and potassium channels, explaining drug effects like SGLT2 inhibitors’ role in preventing hyperkalemia. Insulin resistance further exacerbates sodium retention and gluconeogenesis in the kidney. Importantly, SGLT2 inhibitors improve hemoglobin levels not just by EPO but also by reducing inflammation-related hepcidin, enhancing red blood cell production.<br /><br />In summary, diabetes intensifies kidney and heart burden through increased sodium retention and RAS activation, leading to heart failure. SGLT2 inhibitors and GLP-1 receptor agonists, via distinct but complementary mechanisms, offer promising protection for kidney and cardiovascular health.

Keywords

Endocrinology

Nephrology

Diabetes Mellitus

Chronic Kidney Disease

SGLT2 Inhibitors

Renin-Angiotensin System

Heart Failure

GLP-1 Receptor Agonists