Session 10. Cardio reno-metabolic discourse - CKD in Primary Care

The kidney and diabetes: the Primary Care approach


  Per-henrik Groop
  Professor of Internal Medicine at the University of Helsinki

Professor Per-Henrik Groop, MD, DMSc, FRCPE graduated from the University of Helsinki in 1982. It was here where he defended his thesis on ‘The relationship between GIP and beta-cell function in man’ in 1989. Following post-doctoral studies at Guy’s Hospital, University of London, under Professor Giancarlo Viberti, Professor Groop returned to Helsinki as Consultant of Nephrology. He served as Professor of Nephrology (Chair) 2010-2015 and is currently Professor of Internal Medicine (Chair) at the University of Helsinki. He is also Chief Physician at the Department of Nephrology, University of Helsinki and Helsinki University Hospital and Principal Investigator of the Finnish Diabetic Nephropathy (FinnDiane) Study at the Folkhälsan Research Center in Helsinki, Finland. He is Adjunct Professor at the Department of Diabetes, Monash University, Melbourne, Australia.

His research is focused on the dissection of the pathogenesis of diabetic complications withspecial emphasis on diabetic nephropathy. In order to provide a unique set of clinical resources with high power to identify genes and genetic variants associated with diabetic complications, Professor Groop initiated the large, nationwide FinnDiane Study in 1997. To date, this landmark study comprises 9000 patients with Type 1 Diabetes and their family members recruited via a comprehensive network of 92 hospitals and healthcare centres throughout Finland. His FinnDiane Research Group represents an inter-disciplinary team of 45 scientists, post-graduate students and personnel.

Diabetes is increasing with epidemic proportions, from 30 million people affected by diabetes in 1985 to 537 million in 2021. Screening individuals with diabetes for the presence of chronic kidney disease (CKD) by urinary albumin excretion rate (i.e., albuminuria) and estimated glomerular filtration rate (eGFR) shows that CKD is common and is detected in more than every second individual screened. Early detection of CKD is important, because CKD increases the risk of early death, cardiovascular events like myocardial infarction and stroke, hospitalization for heart failure, and need for kidney replacement therapy (dialysis, transplantation). It goes without saying that detection of CKD is not only a test result it is a “call for action”. Optimal standard of care (“five-finger-rule”) and additional novel organ-protective medications have shown dramatic improvements in the prognosis of individuals with CKD and diabetes. Since most individuals with diabetes are seen by primary care physicians, it is important that screening for early signs of CKD and immediate initiation of optimal standard of care and organ-protective medication is the responsibility of the primary care physician. This presentation will focus on the prevalence and consequences of CKD in diabetes as well as how the risk of complications can be reduced in individuals with CKD and diabetes.

Learning objectives:

1. How should I screen for the presence of CKD in diabetes?

2. What is optimal standard of care – “five-finger-rule”?

3. How can I improve the prognosis of individuals with CKD and diabetes by prescribing the novel organ-protective medications?




The heart and diabetes


  Francesco Cosentino
  Professor of Cardiology

Prof. Francesco Cosentino is professor of Cardiology and chair of Cardiovascular Medicine at the Karolinska Institute and Karolinska University Hospital in Stockholm, Sweden.

He obtained his MD degree and postgraduate training in Internal Medicine andCardiovascular Disease at the University of Rome, Italy. In 1991 he moved to Mayo Clinic & Foundation, Rochester, MN, USA for a Cardiovascular Fellowship. During his stay at the Mayo Clinic & Foundation he fulfilled all the requirements for a PhD in Biomedical Sciences - Cardiovascular Pharmacology. In 1995, he joined the Cardiovascular Division at the University Hospital of Bern, Switzerland. Two years later, Prof. Cosentino moved to the Division of Cardiology of Zurich University Hospital as “lecturer” and then “titular professor” of Cardiology.

In 2006, he was appointed associate professor of Cardiology at the University“Sapienza” of Rome. Since 2013, he is full professor of Cardiology at the Karolinska Institutet and Karolinska University Hospital in Stockholm. Prof. Cosentino is the recipient of grants and prizes from national and international institutions, research councils and private foundations. He is the leading author of more than 250 original articles published in top-ranking, peer-reviewed journals.

Prof. Cosentino is member of the European Society of Cardiology Board and chair of ESC Advocacy Committee. He is Deputy Editor of the European Heart Journal and Consulting Editor of Cardiovascular Research Journal. He has been chairman of the 2019 ESC Guidelines on diabetes, pre-diabetes and cardiovascular disease and in 2020-2022 vice president of the European Society of Cardiology. Currently, he chairs the ESC Advocacy Committee and ESC board member.

The cardiovascular disease continuum begins with risk factors such as diabetes mellitus, progresses to vascular disease and myocardial dysfunction, and finally ends with cardiovascular death. Patients with type 2 diabetes (T2D) are at high risk for heart failure (HF). Moreover, HF patients with T2D have a worse prognosis than those without. The lifetime adjusted cumulative hazard for incident HF in patients with T2D, hypertension and obesity with an index age of 55 years reaches 60%. Moreover, patients with T2D represent a substantial proportion of patients hospitalized for HF. In a large global registry, patients with history of atherothrombosis and T2DM had a 30% greater risk of hospitalization for HF (HHF) than patients with atherothrombosis but without T2D. Results from clinical outcome trials with glucose-lowering therapies have yielded mixed results with regard to effects on HF risk, with some increasing, many neutral, and some decreasing risk. Six clinical outcome trials with 4 different sodium-glucose co-transporter 2 (SGLT2) inhibitors in patients with T2DM (EMPA-REG OUTCOME, CANVAS Programme [two trials], DECLARE-TIMI, CREDENCE, VERTIS CV) have demonstrated consistent reduction in risk for first HHF (with hazard ratios (HRs) ranging from 0.61 to 0.73 in the overall population) across a range of patients with and without atherosclerotic cardiovascular disease, as well as in populations with T2D with moderate or worse chronic kidney disease (CREDENCE and SCORED) or with and without diabetes (DAPA-CKD and EMPA KIDNEY). In these patients at high risk for HF, a consistent risk reduction of CV death or HF hospitalization was observed. Accordingly, the American Diabetes Association, the European Society of Cardiology with the European Association for the Study of Diabetes, the American Heart Association recommend the use of SGLT2 inhibitors in patients with T2D to reduce the risk of HHF events.