Laura K Triantafylidis1,2, Chelsea E Hawley1,3,2, Christopher Fagbote1, Jiahua Li4, Nicole Genovese1, Julie M Paik3,4,5,6. 1. Pharmacy Department, VA Boston Healthcare System, Boston, MA, USA. 2. Both authors are co-first authors. 3. New England Geriatric Research, Education and Clinical Center, 20025VA Boston Healthcare System, Boston, MA, USA. 4. Renal Section, 20025VA Boston Healthcare System, Boston, MA, USA. 5. Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. 6. Harvard Medical School, Boston, MA, USA.
Abstract
BACKGROUND: The American Diabetes Association (ADA) recommends sodium-glucose cotransporter-2 (SGLT2) inhibitors as the second medication to be started, after metformin, for patients with chronic kidney disease (CKD). Sodium-glucose cotransporter-2 inhibitors may cause volume, blood pressure, and electrolyte disturbances; consequently, frequent monitoring and adjustments to other diabetes, blood pressure, and/or diuretic medications may be necessary. OBJECTIVE: To evaluate the safety and efficacy of an interprofessional clinic model partnering nephrologists and pharmacists for the initiation and monitoring of SGLT2 inhibitors. METHODS: A clinical pharmacist was embedded within the nephrology clinic to provide patient education, telephone follow-up, and to work collaboratively with the nephrologists. Diabetes, hypertension, and diuretic regimens were adjusted as needed after empagliflozin initiation. Diabetes regimens were adjusted to adhere to the 2019 ADA guidelines that promote agents with CKD and atherosclerotic cardiovascular disease benefit. RESULTS: Fourteen patients were initiated on empagliflozin during the study period. Urine albumin-to-creatinine ratio (UACR) improved (mean % change -12% ± 61%); the mean percentage change was greater in patients with a higher baseline UACR. The mean change in hemoglobin A1c was 0.3% ± 0.6%. Common adverse reactions were observed and improved over time; no serious adverse drug reactions occurred. Finally, empagliflozin initiation necessitated adjustments to diabetes, hypertension, and diuretic regimens in almost all patients (n = 13, 93%). CONCLUSION: The implementation of an innovative, interprofessional care model within a nephrology clinic for the initiation and monitoring of empagliflozin in patients with DKD demonstrated clinical benefit with minimal safety concerns.
BACKGROUND: The American Diabetes Association (ADA) recommends sodium-glucose cotransporter-2 (SGLT2) inhibitors as the second medication to be started, after metformin, for patients with chronic kidney disease (CKD). Sodium-glucose cotransporter-2 inhibitors may cause volume, blood pressure, and electrolyte disturbances; consequently, frequent monitoring and adjustments to other diabetes, blood pressure, and/or diuretic medications may be necessary. OBJECTIVE: To evaluate the safety and efficacy of an interprofessional clinic model partnering nephrologists and pharmacists for the initiation and monitoring of SGLT2 inhibitors. METHODS: A clinical pharmacist was embedded within the nephrology clinic to provide patient education, telephone follow-up, and to work collaboratively with the nephrologists. Diabetes, hypertension, and diuretic regimens were adjusted as needed after empagliflozin initiation. Diabetes regimens were adjusted to adhere to the 2019 ADA guidelines that promote agents with CKD and atherosclerotic cardiovascular disease benefit. RESULTS: Fourteen patients were initiated on empagliflozin during the study period. Urine albumin-to-creatinine ratio (UACR) improved (mean % change -12% ± 61%); the mean percentage change was greater in patients with a higher baseline UACR. The mean change in hemoglobin A1c was 0.3% ± 0.6%. Common adverse reactions were observed and improved over time; no serious adverse drug reactions occurred. Finally, empagliflozin initiation necessitated adjustments to diabetes, hypertension, and diuretic regimens in almost all patients (n = 13, 93%). CONCLUSION: The implementation of an innovative, interprofessional care model within a nephrology clinic for the initiation and monitoring of empagliflozin in patients with DKD demonstrated clinical benefit with minimal safety concerns.
Authors: Neil J Stone; Jennifer G Robinson; Alice H Lichtenstein; C Noel Bairey Merz; Conrad B Blum; Robert H Eckel; Anne C Goldberg; David Gordon; Daniel Levy; Donald M Lloyd-Jones; Patrick McBride; J Sanford Schwartz; Susan T Shero; Sidney C Smith; Karol Watson; Peter W F Wilson Journal: J Am Coll Cardiol Date: 2013-11-12 Impact factor: 24.094
Authors: Bruce Neal; Vlado Perkovic; Kenneth W Mahaffey; Dick de Zeeuw; Greg Fulcher; Ngozi Erondu; Wayne Shaw; Gordon Law; Mehul Desai; David R Matthews Journal: N Engl J Med Date: 2017-06-12 Impact factor: 91.245
Authors: Sergei Petrykiv; C David Sjöström; Peter J Greasley; John Xu; Frederik Persson; Hiddo J L Heerspink Journal: Clin J Am Soc Nephrol Date: 2017-03-16 Impact factor: 8.237
Authors: Christoph Wanner; Silvio E Inzucchi; John M Lachin; David Fitchett; Maximilian von Eynatten; Michaela Mattheus; Odd Erik Johansen; Hans J Woerle; Uli C Broedl; Bernard Zinman Journal: N Engl J Med Date: 2016-06-14 Impact factor: 91.245
Authors: Melanie J Davies; David A D'Alessio; Judith Fradkin; Walter N Kernan; Chantal Mathieu; Geltrude Mingrone; Peter Rossing; Apostolos Tsapas; Deborah J Wexler; John B Buse Journal: Diabetes Care Date: 2018-10-04 Impact factor: 19.112
Authors: Min Zhuo; Jiahua Li; Leo F Buckley; Sri Lekha Tummalapalli; David B Mount; David J R Steele; David J Lucier; Mallika L Mendu Journal: Kidney360 Date: 2022-01-19
Authors: Chelsea E Hawley; Nicole Genovese; Montgomery T Owsiany; Laura K Triantafylidis; Lauren R Moo; Amy M Linsky; Jennifer L Sullivan; Julie M Paik Journal: J Am Geriatr Soc Date: 2020-10-04 Impact factor: 7.538