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Challenges of Cardio-Kidney Composite Outcomes in Large-Scale Clinical Trials
Ravi B Patel1, Jozine M Ter Maaten2, João Pedro Ferreira3
1Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (R.B.P., S.J.S.).
Circulation
|January 7, 2021
Summary
Novel treatments like SGLT2 inhibitors and sacubitril-valsartan show benefits for both heart and kidney health. Future trials may use combined cardio-kidney outcomes, but challenges need addressing.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Cardiovascular and kidney diseases frequently coexist, worsening patient outcomes.
- Clinical presentation of heart failure and kidney dysfunction can overlap, complicating diagnosis.
- Existing treatments may offer dual benefits for cardiac and kidney health.
Purpose of the Study:
- To review the impact of novel therapies on cardio-kidney outcomes.
- To discuss the potential and challenges of using composite cardio-kidney endpoints in clinical trials.
Main Methods:
- Review of recent clinical trial data and post hoc analyses.
- Examination of evidence for Sodium-glucose cotransporter-2 (SGLT2) inhibitors and sacubitril-valsartan.
- Analysis of the rationale and challenges for composite cardio-kidney outcome measures.
Main Results:
- SGLT2 inhibitors demonstrate benefits in chronic kidney disease, cardiovascular disease, and heart failure.
- Sacubitril-valsartan improves cardiovascular outcomes and shows favorable kidney effects in heart failure.
- Evidence suggests concordant cardio-kidney benefits from these novel agents.
Conclusions:
- Novel therapies offer promising dual benefits for cardiovascular and kidney health.
- Composite cardio-kidney outcomes are being considered for future trials.
- Careful consideration of challenges is needed before implementing composite cardio-kidney endpoints.
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