“The extension of the reimbursement of dapagliflozin for patients with chronic heart failure is a further step forward for a class of drugs”, the Sglt2i, “that has demonstrated cardiorenal protection because early treatment leads to a reduction in the progression of heart damage organ, both cardiac and renal”. This was stated by Loreto Gesualdo, professor of Nephrology at the University of Bari and president of Fism, the Italian Federation of medical-scientific societies, speaking this morning in Milan in a meeting with the press organized by AstraZeneca on the occasion of the AIFA green light for the reimbursement of dapagliflozin , the first and only selective inhibitor of the renal sodium and glucose co-transporter to be available in Italy also for the treatment of type 2 diabetes mellitus and chronic kidney disease.
“It is truly a revolution – underlines Gesualdo – not only in the field of heart failure, but also in all these chronic-degenerative pathologies which, let us remember, in 2040 will represent, if we do not intervene today, the 7 main causes of death. Heart failure , diabetes and chronic kidney disease are among the pathologies that most frequently lead to hospitalization, which goes hand in hand with an increase in mortality. So take action today and have a drug available that prevents the onset of chronic kidney disease , is an investment in the medium and long term. Those who do healthcare planning must understand that investing in prevention today, because we are talking not only about treatment – he specifies – but we are talking about prevention of complications, also means making the national healthcare system more sustainable” .
The class of Sgl2i is “innovative – remarks Gesualdo – and is changing the natural history of patients suffering from chronic kidney disease and heart failure”. These drugs have in fact been shown to have “different pharmacological effects: they act not only as mild diuretics, but they modulate the mechanism of hyperfiltration at the renal level, with beneficial effects on the kidney which then also have repercussions on the heart. Furthermore, they are able to correct hemoglobin levels and therefore anemia.”
Chronic kidney disease, just like diabetes – continues the nephrologist – is a multiplier of cardiovascular damage and, together with diabetes, leads to heart failure”. With dapagliflozin “we have the classic example of a single prescription capable of treating patients with diabetes, without diabetes, with chronic kidney disease and decompensation”. An “example of the digital ecosystem launched with Fism of the single prescription”, because it can be prescribed “both in the diabetic and non-diabetic setting. These are very high numbers – Gesualdo points out – we are talking about 10% of the population worldwide. In Italy, if we take the range between 35 and 80 years old, we are talking about 7% of the population, therefore 3 million Italians affected, potentially affected by renal failure, who don't know they have it because it needs to be looked for”.
Kidney disease, continues the specialist, is “one of the important complications of diabetes. In recent years the way in which kidney damage occurs in diabetes has changed. Previously, protein loss was prevalent, what we call micro or macroalbuminuria. Nowadays, however, a loss of renal function is increasingly frequent, the function of the kidney is reduced regardless of the loss of proteins. And this is linked somewhat to the change in the pathology of type 2 diabetes which, in addition to increasing in frequency, is always more frequent in older people. We increase the lifespan of people with diabetes, so they are more likely to develop kidney damage.” Diabetes is associated with other risk factors for kidney damage, obesity, hypertension, alteration of lipids, cholesterol, triglycerides. “These – warns Gesualdo – are all the risk factors for developing kidney damage. Until recently we did not have glycemic control of hypertension and lipids available to prevent kidney damage. Now we have a weapon which is precisely this class of drugs and dapagliflozin to prevent the development of kidney damage and, once kidney damage has developed, we have the opportunity to cure it. This is the great advantage of this molecule that acts across the entire spectrum of kidney disease in diabetes both in terms of prevention and in terms of treatment”.
In particular, “since we started using these drugs in an increasingly important way – concludes the Fism president – we have been able to reduce kidney damage by 10-15% in less than 2 years. Therefore, in terms of prevention, even when kidney damage developed, we were able to prevent the person from ending up on dialysis or undergoing a transplant. Used early, they are able to allow the person with diabetes to return to what is a risk of harm to those who do not have diabetes”.
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