Implementing personalized medicine in diabetic kidney disease: Stakeholders' perspectives

Vries, Jeroen K. de; Levin, Adeera; Loud, Fiona; Adler, Amanda I; Mayer, Gert; Pena, Michelle J

doi:10.1111/dom.13412

Cited by 12 publications

(9 citation statements)

References 26 publications

(29 reference statements)

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“…Diabetes management following a uniform treatment algorithm is often associated with progressive treatment failure and development of diabetic complications [82]. Importantly, a better risk stratification and more precise options for treatment need to be developed and included in clinical practice guidelines [83]. The growing T2DM patient numbers discussed earlier in this paper, suggest that the only way forward is to follow innovative approaches to curb the pandemic we are facing.…”

Section: Resultsmentioning

confidence: 99%

Inflammatory cytokines in type 2 diabetes mellitus as facilitators of hypercoagulation and abnormal clot formation

Randeria

Thomson

Nell

et al. 2019

Cardiovasc Diabetol

125

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Background: The global burden of type 2 diabetes mellitus (T2DM), together with the presence of cardiovascular risk in this population, is reaching pandemic levels. A prominent feature of T2DM is chronic and systemic inflammation, with the accompanying presence of circulating and dysregulated inflammatory biomarkers; which in turn is associated with abnormal clot formation. Methods:Here, we investigate the correlation between abnormal blood clotting, using thromboelastography (TEG), clot ultrastructure using scanning electron microscopy (SEM) and the presence of a dysregulated inflammatory cytokine profile, by examining various circulating biomarkers. Results:Our results show that many biomarkers, across TEG, cytokine and lipid groups, were greatly dysregulated in the T2DM sample. Furthermore, our T2DM sample's coagulation profiles were significantly more hypercoagulable when compared to our heathy sample, and ultrastructural analysis confirmed a matted and denser clot structure in the T2DM sample. Conclusions:We suggest that dysregulated circulating molecules may in part be responsible for a hypercoagulable state and vascular dysfunction in the T2DM sample. We propose further that a personalized approach could be of great value when planning treatment and tracking the patient health status after embarking on a treatment regimes, and that looking to novel inflammatory and vascular biomarkers might be crucial.

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Section: Resultsmentioning

confidence: 99%

Inflammatory cytokines in type 2 diabetes mellitus as facilitators of hypercoagulation and abnormal clot formation

Randeria

Thomson

Nell

et al. 2019

Cardiovasc Diabetol

125

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show abstract

“…In the first step, in a more traditional symposium, various speakers outlined their perspectives on precision medicine in DKD. The topics discussed during this symposium were elaborated on in a series of articles published in a special issue on precision medicine in DKD ( de Vries et al, 2018 ; Heerspink and de Zeeuw, 2018 ; Heerspink et al, 2018 ; Mol et al, 2018 ; Mulder et al, 2018 ).…”

Section: Methodsmentioning

confidence: 99%

“…Renal and CV disease are often not driven by one single underlying mechanism, and patients also have different causes determining individual risk. Current evidence-based guidelines are based on results from large interventional trials, and although these have been key to the improvement of overall quality of care of DKD patients, they do not take into account the heterogeneity of the response in patients ( de Vries et al, 2018 ; de Zeeuw and Heerspink, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Perspectives on a Way Forward to Implementation of Precision Medicine in Patients With Diabetic Kidney Disease; Results of a Stakeholder Consensus-Building Meeting

et al. 2021

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Aim: This study aimed to identify from different stakeholders the benefits and obstacles of implementing precision medicine in diabetic kidney disease (DKD) and to build consensus about a way forward in order to treat, prevent, or even reverse this disease.Methods: As part of an ongoing effort of moving implementation of precision medicine in DKD forward, a two-day consensus-building meeting was organized with different stakeholders involved in drug development and patient care in DKD, including patients, patient representatives, pharmaceutical industry, regulatory agencies representatives, health technology assessors, healthcare professionals, basic scientists, and clinical academic researchers. The meeting consisted of plenary presentations and discussions, and small group break-out sessions. Discussion topics were based on a symposium, focus groups and literature search. Benefits, obstacles and potential solutions toward implementing precision medicine were discussed. Results from the break-out sessions were presented in plenary and formed the basis of a broad consensus discussion to reach final conclusions. Throughout the meeting, participants answered several statement and open-ended questions on their mobile device, using a real-time online survey tool. Answers to the statement questions were analyzed descriptively. Results of the open-ended survey questions, the break-out sessions and the consensus discussion were analyzed qualitatively.Results and conclusion: Seventy-one participants from 26 countries attended the consensus-building meeting in Amsterdam, April 2019. During the opening plenary on the first day, the participants agreed with the statement that precision medicine is the way forward in DKD (n = 57, median 90, IQR [75–100]). Lack of efficient tools for implementation in practice and generating robust data were identified as significant obstacles. The identified benefits, e.g., improvement of the benefit-risk ratio of treatment, offer substantive incentives to find solutions for the identified obstacles. Earlier and increased multi-stakeholder collaboration and specific training may provide solutions to alter clinical and regulatory guidelines that lie at the basis of both obstacles and solutions. At the end of the second day, the opinion of the participants toward precision medicine in DKD was somewhat more nuanced (n = 45, median 83, IQR [70–92]) and they concluded that precision medicine is an important way forward in improving the treatment of patients with DKD.

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“…Precision nephrology is a branch of medicine that came forward with the noble aim of providing information and methodological tools that allow redefinition of CKD in terms of pathogenesis, prevention, prognosis, and treatment besides and beyond clinical intuition [14]. Precision nephrology includes many areas, including better phenotyping, improved elucidation of disease mechanisms, customization of medical decisions, and better risk stratification [15]. The major challenge for nephrologists and researchers, regarding precision nephrology, is ameliorating the knowledge of the mechanisms underlying the large variability of CKD.…”

Section: The Complexity Of Ckdmentioning

confidence: 99%

Precision Nephrology Is a Non-Negligible State of Mind in Clinical Research: Remember the Past to Face the Future

Provenzano

Nicola

Pena

et al. 2020

Nephron

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CKD is a major public health problem. It is characterized by a multitude of risk factors that, when aggregated, can strongly modify outcome. While major risk factors, namely, albuminuria and low estimated glomerular filtration rate (eGFR) have been well analyzed, a large variability in disease progression still remains. This happens because (1) the weight of each risk factor varies between populations (general population or CKD cohort), countries, and single individuals and (2) response to nephroprotective drugs is so heterogeneous that a non-negligible part of patients maintains a high cardiorenal risk despite optimal treatment. Precision nephrology aims at individualizing cardiorenal prognosis and therapy. The purpose of this review is to focus on the risk stratification in different areas, such as clinical practice, population research, and interventional trials, and to describe the strategies used in observational or experimental studies to afford individual-level evidence. The future of precision nephrology is also addressed. Observational studies can in fact provide more adequate findings by collecting more information on risk factors and building risk prediction models that can be applied to each individual in a reliable fashion. Similarly, new clinical trial designs can reduce the individual variability in response to treatment and improve individual outcomes.

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Implementing personalized medicine in diabetic kidney disease: Stakeholders' perspectives

Cited by 12 publications

References 26 publications

Inflammatory cytokines in type 2 diabetes mellitus as facilitators of hypercoagulation and abnormal clot formation

Inflammatory cytokines in type 2 diabetes mellitus as facilitators of hypercoagulation and abnormal clot formation

Perspectives on a Way Forward to Implementation of Precision Medicine in Patients With Diabetic Kidney Disease; Results of a Stakeholder Consensus-Building Meeting

Precision Nephrology Is a Non-Negligible State of Mind in Clinical Research: Remember the Past to Face the Future

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