Spotlight: Chronic Kidney Disease, Cardiovascular Disease, and Diabetes
The Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for managing chronic kidney disease (CKD) was updated in April 2024. Highlights include:
- Use an SGLT2i to treat:
- Patients with type 2 diabetes (T2D), CKD, and an eGFR ≥ 20 ml/min
- Adults with CKD and: eGFR ≥ 20 ml/min with urine ACR ≥ 200 mg/g, or heart failure
- Adults with eGFR 20 to 45 ml/min with urine ACR < 200 mg/g
- Use a long-acting GLP-1 RA to treat adults with T2D and CKD who have not reached their glycemic targets with the use of metformin and SGLT2i treatments (or if unable to use the aforementioned medications).
The Chronic Kidney Disease module (August 2020) also recommended the use of SGLT2i for patients with CKD and T2D meeting certain conditions.
Preventing Recurrence of Bacterial Vaginosis
The New England Journal of Medicine recently published the results of a study which recruited women with bacterial vaginosis and in a monogamous relationship with a male partner, to evaluate the effects of concurrent partner treatment on the recurrence of bacterial vaginosis within 12 weeks. The women were given first-line recommended antimicrobial treatment, while for those in the partner-treatment group, their male partners received both oral (400 mg metronidazole tablets) and topical (2% clindamycin cream applied to penile skin) antimicrobial agents twice daily for one week. In the control group the women received treatment but not their male partner. All couples were advised to avoid sexual contact while receiving treatment. The partner-treatment group included 69 couples, and the control group had 68 couples.
Findings
- Recurrence occurred in 35% of women in the partner-treatment couples and 63% of the control group.
- The mean time to recurrence in the partner-treatment group was 73.9 days while it was 54.5 days in the control group.
Risk of Stroke and Myocardial Infarction with Hormonal Contraception Use
A nationwide prospective cohort study in Denmark published in the BMJ, used national registry data (n= > 2 million) to study the association between hormonal contraception and the risk of stroke and myocardial infarction. Participants selected were aged 15 to 49 years and were screened for conditions used for exclusion, including: history of arterial or venous thrombosis, hormone therapy use, infertility treatment, endometriosis, and hysterectomy.
Summary of key results
| Type of Hormonal Contraception | Standardized incidence rate per 100,000 person years: Ischaemic stroke | Standardized incident rate per 100,000 person years: Myocardial infarction |
|---|---|---|
| No use | 18 | 8 |
| Combined oral contraception | 39 | 18 |
| Combined vaginal ring | 46 | 49 |
| Combined hormonal patch | 17 | – |
| Progestin-only pills | 33 | 13 |
| Subcutaneous progestin-only implant | 28 | – |
| Progestin-only injection | 24 | – |
| Progestin-only intrauterine device | 23 | 11 |
The Contraception Update module (August 2023) also included information about the increased risk of ischemic stroke and myocardial infarction with combined oral contraceptives use. Absolute risk levels were listed as lower than those reported in this study and were based on an earlier Danish cohort study on hormonal contraception (Table 4).
Positive Airway Pressure (PAP) Therapy for OSA and Mortality Risk
The Lancet Respiratory Medicine journal recently published a systematic review and meta-analysis of 10 RCTs and 20 confounder-adjusted non-RCTs (n= > 1.1 million). The risk of cardiovascular mortality (HR 0.45) and all-cause mortality (HR 0.63) was significantly lower in participants using PAP than those not.
The study was funded by ResMed (a company producing sleep apnea treatment products), and 4 authors are listed as employees of ResMed with others having received funding from them. The fact that data from non-RCTs, but not those from RCTs, reached significance for differences between PAP and no-PAP groups was proposed by the authors as being due to the lack of statistical power in the RCTs.
The Obstructive Sleep Apnea in Adults module (November 2023) also discusses the health risks of untreated OSA, including cardiovascular mortality (Info points 7,8) and includes details of a study on reduced cardiovascular mortality risk with CPAP adherence ≥ 4 hours daily (Info point 22).