Prof David Wheeler

So my name is David Wheeler. I'm a nephrologist at University College London, and I'm here to talk about observational data in diabetic kidney disease.

How do real-world cardiovascular and renal outcomes compare to clinical trial results, and which data sources are giving us the best insights into DKD outcomes?

So looking at the observational data that we've got in diabetic kidney disease, it's striking that the conclusions you can draw from the observational studies are very similar to the conclusions you can draw from the clinical trials. So there's a very good correlation between the results of the observational studies and the interventional studies, particularly when it comes to therapeutic interventions.

What's the biggest gap between DKD guidelines and actual prescribing for cardiovascular and renal protection?

I think what we learned from the observational data is that we're not good at screening for CKD, we're not good at managing the basics such as blood pressure control and glycemic control, and we're not getting patients onto the evidence-based therapies.

So using the observational data, you can see where the gaps are in the delivery of healthcare. The trials of course, tell us what we should be doing in terms of the therapeutic interventions.

Can we optimise for both cardiovascular and renal protection simultaneously in DKD patients?

I think we're actually using the same drugs both for cardiovascular protection and for kidney protection. So the therapies that we're offering these patients, the ACE inhibitors, the angiotensin receptor blockers, the SGLT2 inhibitors, the mineralocorticoid receptor antagonists, are actually all providing benefits both from a cardiovascular and a kidney perspective.

So getting the patients onto these therapies hopefully both reduces the cardiovascular risk and reduces the risk of end-stage kidney disease and the need for dialysis.

What does real-world data tell us about sequencing therapies for optimal cardiovascular and renal outcomes?

So we've got a number of therapies now and the question is, what order do we use them in and how quickly do we start the next one? And we don't know from clinical trials exactly what sequence we should be prescribing in.

It's going to be easier to learn that from observational data sets looking at what happens to patients who start on these therapies in different sequences, but I haven't really seen a lot of observational data yet that has addressed that issue. I think there will be more coming very soon.

How should cardiology and nephrology collaborate differently based on current real-world cardiovascular and renal outcome data?

So cardiologists and nephrologists have historically been very focused on the organ that they are involved with looking after. And what we probably should do is think a little bit more broadly.

So nephrologists should think a little bit more about the heart and cardiologists should think a little bit more about the kidneys. And I think by doing this and by working out the optimal therapy for both the heart and the kidney, we can better improve the outcomes for our patients.