Canada
Canada
Canada has had a hard road to the FIFA World Cup. Never ranking higher than 38th in the world (2022), the team has made it to the dance only one other time (1986) (Video 1). We know that will change in 2026; as a host nation they will automatically qualify for that Tournament. For now, though, this year's berth into the World Cup was a hard-won achievement and one that is sure to excite Canadian football fans!
Things look good for the Canadian team in this year's NephroWorldCup as well. Canadian researchers have struck gold with a study that looks at the intersection of Cardiology, Nephrology, and Endocrinology -- a new "triple threat" in modern medicine.
Video 1: Canada's journey to qualify for the 2022 World Cup
CaReMe: Cardiology, Renal, and Metabolic diseases | A/K/A CVRM | The new triple threat in modern medicine
Video 2: Kidney benefits of GLP1RA | Courtesy of Drs. Kevin Fernando and Patrick Holmes
We all know the breadth and depth of disease burden that diabetic patients face. This one singular diagnosis portends poor prognoses in cardiovascular and kidney health. The model that these Canadian researchers propose is that of a dedicated and unique multi-specialty clinic. Known as as a C.a.R.E. clinic (Cardiac and Renal Endocrine clinic), this retrospective cohort study evaluated 74 patients to determine the feasibility, strengths and challenges of this specific healthcare delivery model. Researchers noted an improvement in LDL-cholesterol, hemoglobin A1C, increase uptake in use of statins and GLP1 receptor agonists (Video 2).
Of note, the study subjects already had a high level of use of renin-angiotensin-aldosterone inhibition.
Indeed care coordination within specialties was well integrated that the researchers proposed the C.a.R.E. clinic as a potential avenue by which SGLT2 inhibitor use could increase (Figure 1). The adoption of this class of medications was low at the start (4.1%) and improved to 35.1%.
Figure 1: Prescription rate of SGLT2i by specialty | Courtesy of Dr. Harish Seethapathy | Zoom in for details
Interestingly, the multi-specialty clinic is not new and yet we haven't seen widespread adoption of it. Perhaps its rarity was more a consequence of the lack of effective treatment options than anything else. With the increasing availability of GLP1RAs, SGLT2i's and a new appreciation of metformin in diabetic kidney/cardiac disease, the C.a.R.E. clinic may be coming to an outpatient facility near you (Carousel 1 and Video 3).
Carousel 1: the CaReMe UK initiative and characteristics of a successful multi-specialty clinic | Presented at the 2021 Virtual CKD meeting | Courtesy of Dr. Smeeta Sinha
Video 3: Metformin is back! | Courtesy of Drs. Kevin Fernando and Patrick Holmes
So where does the C.a.R.E. clinic and, CaReMe in general, put Canada in the NephroWorldCup? Given so many obstacles facing physicians when considering cross-disciplinary diabetic therapies (i.e., GLP1RAs and/or SGLT2 inhibitors), perhaps it is time to serious consider a new specialty dedicated to the integration of best practices in cardiac, kidney, and diabetic care (Figure 2).
Figure 2: Key clinical trials in diabetic kidney/cardiac diseases | Courtesy of Dr. Lovy Gaur | Zoom in for details