Tiffany Archibald [00:00:24]:
I have the pleasure of introducing our amazing speaker today. Doctor Roberto Collazo joined Dallas Nephrology Associates in 1999. He just celebrated 25 years being with DNA and he is board certified in internal medicine and nephrology. He currently sees patients at our Methodist Pavilion location. Doctor Collazo, we are so happy and honored to have you today.
Dr. Robero Collazo [00:00:52]:
Thank you for having me.
Tiffany Archibald [00:00:53]:
We’re going to get right into the questions because this is a very robust topic. It’s very important. So what types of treatment have there been in the past for patients with chronic kidney disease?
Dr. Robero Collazo [00:01:05]:
So that’s a very important question. In the past, very few treatments have been shown to slow the progression of kidney disease. As an example, I finished med school in 1993, back in the nineties, we show that the use of medications that we call ACE (Angiotensin-converting enzyme) inhibitors have been able to slow the progression of kidney disease. But it was not until the early two thousands where the new class of medications called angiotensin receptor blockers showed that in patients with diabetes, you can slow the progression of kidney disease. Most recently, we have new medications that have been shown to slow the progression of kidney disease. So we’re living very exciting times in the field of nephrology.
Tiffany Archibald [00:01:51]:
So what are the new types of treatments that are out?
Dr. Robero Collazo [00:01:54]:
So, like I said, in the nineties we only have ACE inhibitors, and in the two thousands we show the effectiveness of using Angiotensin receptor blockers (ARBs). In the last 5 to 10 years, we have collected data in more than 4,000 patients on multiple trials that show that the use of what we call SGLT-2 inhibitors, medications that inhibit the absorption of glucose in the kidneys and actually make your urinate glucose, have been surprisingly effective, that slow the progression of kidney disease also have some benefits on patients with congestive heart failure. They’re also effective decreasing proteinuria, decreasing blood pressure, and other potential benefits like decreasing inflammation and fibrosis. So we’re very excited about this new class of medications that are commonly called flozins or glilflozins, like canagliflozin, empagliflozin and dapagliflozin.
Tiffany Archibald [00:02:57]:
Let’s get into the research part. We know that you lecture, you educate, and so what research has been completed regarding the benefits and treatment of other conditions that are related to kidney disease.
Dr. Robero Collazo [00:03:10]:
So there is a link between the heart problems and the kidney problems. And most recently, the American Heart Association came up with new statements about recognizing a new syndrome called the cardio-kidney-metabolic (CKM) syndrome. So not only patients with kidney disease suffer from other conditions, but particularly they suffer from heart conditions. And patients from heart conditions suffer from kidney conditions. So now we have medications like the one that we discussed, the SGLT-2 inhibitors, or inhibitors, of the sodium glucose cotransporters that have been shown not only improving kidney outcomes, but also heart outcomes, increasing the survival of patients with kidney disease, increasing the survival of our patients with heart disease. So the way that we, as a nephrologist, will look at this is that we don’t only treat the kidney condition, but we also treat the heart condition. And we tell our patients that we care as much as we care about the kidneys, we care about their hearts. So there is a new medication that blocked the mineralocorticoid receptor called finerenone, that it’s not only good to decrease the blood pressure, decreasing proteinuria, but slowing the progression of kidney disease. And they may have some anti-inflammatory, anti-fibrotic medications, anti-fibrotic effects on the heart and the kidneys. There is also a new class of medications that have been now popular because they’ve been recognized, like the weight loss drugs. That class of medications are called GLP-1 (Glucagon-like peptide-1) agonists. And those medications are also being found to be not only beneficial for the heart, but also beneficial for the kidneys, slowing the progression of kidney disease, particularly in patients with diabetes. But to summarize, we’re going to have four potential medications.
Tiffany Archibald [00:05:14]:
Okay, what’s the first one?
Dr. Robero Collazo [00:05:16]:
The first one is going to be the ACE (Angiotensin-converting enzyme) inhibitors, or angiotensin receptor blockers (ARBs).
Tiffany Archibald [00:05:19]:
Okay. Second one.
Dr. Robero Collazo [00:05:21]:
The second one is going to be the SGLT-2 inhibitors, or the medications that make you urinate more glucose.
Tiffany Archibald [00:05:28]:
Okay.
Dr. Robero Collazo [00:05:28]:
The third medication is going to be the non-steroidal mineralocorticoid receptor antagonist, the blockers of this important hormone called aldosterone. And then the last medication is the GLP-1 agonist. Medications that are not only good for weight loss, but also to improve cardiac and kidney outcomes in patients with diabetes.
Tiffany Archibald [00:05:50]:
All right? And I know that we have touched on this on other podcasts, but just talk about the effects of diabetes on the kidneys and why that last medication, I think also the second one you discussed is so important.
Dr. Robero Collazo [00:06:06]:
So we know that one out of seven Americans are suffering from chronic kidney disease, and the majority of patients suffer from diabetes. So for the nephrologists the majority of patients that come to our office is because they suffer from diabetes. And we know that diabetes is a systemic disease that affect multiple organs, particularly the kidneys and the heart. So any medications that can help slowing the progression of the kidney disease, decreasing the protein excretion in the urine, lowering the blood pressure, decreasing fibrosis, decreasing inflammation, and also have the potential effect to help the heart, is going to help our patients live longer, have a better quality of life.
Tiffany Archibald [00:06:53]:
So we have patients listening, and so are you able to provide me with an example of a patient that has benefited from some of these new therapies that are out there?
Dr. Robero Collazo [00:07:06]:
Absolutely. We recently had a patient that was referred to us for swelling of the lower extremities, a lot of edema, poorly controlled hypertension and worsening of the kidney disease. When I examined the patient, the patient was quite hypertensive. He was also obese.
Tiffany Archibald [00:07:23]:
When you say quite hypertensive, give an example of that blood pressure.
Dr. Robero Collazo [00:07:27]:
Yeah.
Dr. Robero Collazo [00:07:27]:
The blood pressure was higher than 140 over 90. And the heart doctor diagnosed him with congestive heart failure. But also the heart doctor was able to measure how much albumin he was excreting in the urine, because we found now that the albumin excretion in the urine is an important risk factor for cardiovascular disease. So he was sent to us by the cardiologist. So the patient was very swollen with a very elevated high blood pressure. He was having persistent shortness of breath, tiredness, fatigue. His kidney function was slowly getting worse. We quantified the amount of protein in the urine, and he had quite a bit of protein in the urine. So the patient was already taking angiotensin receptor blockers. So on top of that, we added the use of medications called SGLT-2 inhibitors that increases the glucose excretion in the urine. And we also added the non-steroidal mineral cortical receptor antagonist to help the other medications. And with that triple therapy, the patient was able to lose 20 pounds.
Tiffany Archibald [00:08:44]:
Wow.
Dr. Robero Collazo [00:08:45]:
His blood pressure came down to less than 130 over 80. He was producing quite a bit of urine, more than two liters per day. He started feeling a lot better. And then because of the issues with the obesity, then we added the fourth medication, which is a class of medications that are being used for weight loss that are becoming very popular. So we added the use of semaglutide, and he lost about 20 more pounds after adding the medication. So after being on the four drugs for about three months, the patient is doing a lot better.
Tiffany Archibald [00:09:27]:
Oh, wow, 90 days.
Dr. Robero Collazo [00:09:29]:
His blood pressure is improved.
Tiffany Archibald [00:09:31]:
Wow.
Dr. Robero Collazo [00:09:32]:
His kidney function is improving. His heart condition also show evidence of improvement. And this is what the data have been showing that kidney doctors should do in our office, offering these patients the most updated guideline directed medical therapy to help our patients with kidney disease and heart disease.
Tiffany Archibald [00:09:58]:
Let’s talk about how kidney patients can get involved. I think you can sit here and you can tell us about all the new therapies and all the research and the 4,000 patients that have been part of the study that got us this data and got us to this point. But we need patients and family members and caregivers that are listening to get patients involved. So take the floor and tell us how more patients can get involved.
Dr. Robero Collazo [00:10:24]:
So referral to the nephrologist is really important. For the nephrologists, we have the challenge that we have to be updated with the new data coming out. So we have to offer the patients the scientifically proven data that’s being shown to be beneficial. So nephrologists, we have to update ourselves. Very important when you are seeing patients, that you gain the trust of the patients. The patients will not take that medications if they don’t trust you. And trusting a doctor takes time. So this is important that the patients feel comfortable with the doctor, that the doctors spends time with patients, that we can discuss what are the benefits, but also the potential side effects. Once a patient is in agreement of taking the medicines, then the big challenge that we have is can the patients can afford these therapies because we’re talking about adding medications, and that’s a challenge that we have. Some of the insurance companies and payers are not covering for these agents. So even if the patient wants to be on it, the doctor wants to prescribe it. We have the obstacle from insurance companies that they don’t want to pay for this medication. So we need to make an effort to make these medications affordable for our patients. I think that’s a big challenge that we have. Since we’re now discussing four potential drugs, the patients always look at me and say, Dr. Robero Collazo, do you think I can afford those four medications? Initially, we can help the patients by providing some of the samples that we get from the office, but we need to make those medications affordable so patients can take it.
Tiffany Archibald [00:12:14]:
Okay. All right. So patients that are listening, you have to establish that relationship, the comfortability with the physician. You know, I myself, as a CKD patient and transplant recipient, I know sometimes if I’m being told it’s a possibility for another medication, I just, I get a little anxious. I get a little defensive. So it’s definitely important to have that open line of communication and that trust that nephrologists aren’t just throwing these medications out there. We have the data and the statistics to show the benefits. So very good for our patients to know that they’re in great hands because.
Dr. Robero Collazo [00:12:55]:
Absolutely.
Tiffany Archibald [00:12:56]:
Exactly. Exactly. I can go on and on about this topic. Okay, so thank you, Doctor Collazo, so much for coming today, educating us on the new therapies, the therapies that have been used in the past, and why patients need to be active and engaged in their treatment. Do you have any closing remarks before we wrap up?
Dr. Robero Collazo [00:13:21]:
The way that we practice medicine these days, 2024 is completely different, the way that we practice nephrology even five years ago. So this is a field that is evolving. We have new medications for our patients. So I want the patients to be as excited as I am to be able to offer new therapies. We don’t want to see patients going into dialysis. We want to try our best to avoid patients to require transplantation or dialysis. So we will continue with our efforts to provide the patients with the best and updated therapy available.
Tiffany Archibald [00:14:03]:
All right, again, thank you for sharing these promising opportunities that have the potential to improve kidney disease and patient outcomes now and in the future. So I want to thank everyone for joining us today. To learn more, you can give us a call at Dallas Nephrology. Our number is 214-358-2300 and we can provide you with more information or if you want a consultation. Thank you so much.
Dr. Robero Collazo [00:14:31]:
You’re very welcome. Thank you for having me.
Tiffany Archibald [00:14:33]:
Thank you for joining us today. For information about Dallas Nephrology associates, please visit our website@dneph.com, if you found our information helpful, feel free to share it with others who may also be affected by chronic kidney disease.
Tiffany Archibald [00:14:51]:
Dallas Nephrology Associates DNA Podcast series, Let’s Talk About Kidneys is provided for general information purposes only and does not replace the need to talk with a healthcare professional about your unique situation, care, and options. Our goal is to provide you with as much information as possible so you can be as informed as possible. Reference to any specific product, service, entity, or organization does not constitute an endorsement or recommendation by DNA. The views expressed by guests of their own and their appearance on the program does not imply an endorsement of them or any entity or organization they represent. The views and opinions expressed by DNA employees, contractors, or guests are their own and do not necessarily reflect the views of DNA or any of its representatives. Some of the resources identified in the podcast are links to other websites. These other websites may have differing privacy policies from those of DNA. Please be aware that the Internet sites available through these links and the material that you may find there are not under the control of DNA. DNA shall have no responsibility for the accuracy, legality, or content of the external site or subsequent links. Contact the external site for answers to questions regarding its content. The resources included or referenced in the podcasts and on the website are provided simply as a service. DNA does not recommend, approve, or endorse any of the content on the linked sites. The content provided on this website and in the podcast is not medical advice and should not be used to evaluate, diagnose, treat, or correct any medical condition. The content is solely intended to educate users regarding chronic kidney disease, end stage renal disease, end stage kidney disease, ESKD and related conditions, and ESRD ESKD treatment options. None of the information provided on this website or referenced in the podcast is substitute for contacting a healthcare professional.