Emperor's syndrome in the COVID-19 era: Time for patient-centered nephrology?

Area of Science:

• Nephrology
• Public Health
• Infectious Diseases

Background:

• Chronic kidney disease (CKD) is a significant risk multiplier, particularly for patients with diabetes and hypertension.
• These conditions are also major risk factors for severe COVID-19 infection and adverse outcomes.
• The field of nephrology has faced stagnation in managing CKD, leading to high morbidity and mortality.

Purpose of the Study:

• To highlight the stagnation in nephrology care for chronic kidney disease patients.
• To identify the impact of the COVID-19 pandemic on health policies and practices in nephrology.
• To discuss the potential of sodium-glucose cotransporter 2 inhibitors (SGLT2i) as a promising therapeutic intervention.

Main Methods:

• Review of existing literature on CKD management and COVID-19 impact.
• Analysis of clinical practice patterns and evidence base in nephrology.
• Evaluation of emerging treatments like SGLT2 inhibitors for cardiovascular and renal outcomes.

Main Results:

• Nephrology clinical practice often relies on weak evidence, termed the 'Emperor's syndrome'.
• Despite high risks, CKD patient outcomes remain poor.
• Sodium-glucose cotransporter 2 inhibitors demonstrate potential for improving cardiovascular and kidney outcomes.

Conclusions:

• The COVID-19 pandemic underscores the urgent need for advancements in CKD management.
• There is a critical need for robust clinical trials to guide evidence-based practice in nephrology.
• A shift towards patient-centered care, potentially boosted by treatments like SGLT2 inhibitors, could positively transform nephrology.