Pulmonary Hypertension in Kidney Disease: An Expert Perspective
Pulmonary Hypertension in Kidney Disease: An Expert Perspective
Dr. Bakris: Very good. Let's summarize. I think we've designed a very good hypothesis here for a good clinical trial needing to be done because there really aren't any. That's clear. I think number two is, we really can't recommend anything because we don't really have solid evidence, for example, arguing that we should do annual echocardiography, other than doing it in a clinical trial for routine management. I guess we're back to volume removal, volume removal, volume removal to idealize this, and perhaps, in a formal way, study these patients with echocardiograph, maybe the morning after or whatever. Correlate that with ambulatory blood pressure in a subgroup as well to really get a nice flavor for the hemodynamics of this and reduce the risk for heart failure deaths in these patients. I'll give you the final comment on this.
Dr. Kawar: Absolutely, I think there's a lot of work to be done in this area. I think in terms of clinical management with the data that we have, and that's what I tried to show in the review, it's volume, volume, volume. We don't have any more data on any of those drugs used in pulmonary hypertension. But there's a lot of work to be done to trial those drugs and to try, in the first instance, to understand the natural history of the condition in a more controlled way and move on to clinical trials. But I think there is a lot of work to be done in this area.
Dr. Bakris: Thank you very much, Bisher, for talking with me this morning. I think it's really been enlightening. I think we've gotten some very exciting protocols that could be generated from this and a whole area that hasn't really been explored in dialysis patients that needs to be explored. Thanks again. Thank you to everybody for listening, and have a good day.
Summary
Dr. Bakris: Very good. Let's summarize. I think we've designed a very good hypothesis here for a good clinical trial needing to be done because there really aren't any. That's clear. I think number two is, we really can't recommend anything because we don't really have solid evidence, for example, arguing that we should do annual echocardiography, other than doing it in a clinical trial for routine management. I guess we're back to volume removal, volume removal, volume removal to idealize this, and perhaps, in a formal way, study these patients with echocardiograph, maybe the morning after or whatever. Correlate that with ambulatory blood pressure in a subgroup as well to really get a nice flavor for the hemodynamics of this and reduce the risk for heart failure deaths in these patients. I'll give you the final comment on this.
Dr. Kawar: Absolutely, I think there's a lot of work to be done in this area. I think in terms of clinical management with the data that we have, and that's what I tried to show in the review, it's volume, volume, volume. We don't have any more data on any of those drugs used in pulmonary hypertension. But there's a lot of work to be done to trial those drugs and to try, in the first instance, to understand the natural history of the condition in a more controlled way and move on to clinical trials. But I think there is a lot of work to be done in this area.
Dr. Bakris: Thank you very much, Bisher, for talking with me this morning. I think it's really been enlightening. I think we've gotten some very exciting protocols that could be generated from this and a whole area that hasn't really been explored in dialysis patients that needs to be explored. Thanks again. Thank you to everybody for listening, and have a good day.