Enhancing Cardiovascular Health in End-Stage Kidney Disease, with Maya N. Clark-Cutaia, PhD, RN

In an interview with HCPLive, Maya N. Clark-Cutaia, PhD, ACNP-BC, RN, Evelyn Lauder associate dean of Nurse Practitioner Programs and Professor, highlights key methods to enhance cardiovascular disease (CVD)-related outcomes in patients with end-stage kidney disease (ESKD). These strategies, presented at the National Kidney Foundation (NKF) 2024 Spring Clinical Meeting, include a multidisciplinary approach, developing personalized treatment plans, and encouraging self-management using lifestyle modifications.

HCPLive: What are some of the key challenges in improving these outcomes among this patient population?

Maya N. Clark-Cutaia, PhD, ACNP-BC, RN: Major challenges to improving CVD-related outcomes in ESKD are the complexity of the disease process and multimorbidity, poor understanding of treatment modalities specific to the ESKD population, and the intersectionality among these factors and the social determinants determinants of health of the individuals we seek to care for. CVD and ESKD have complex relationship—each an etiology for and increases the likelihood of disease progression, adverse outcomes for the other disease process. Unfortunately, we know very little about how the treatment modalities available might perform in this patient population because they are often excluded from trials due to the complexity of their disease and frailty. Even if ESKD patients are eligible, they are less likely to participate in and complete trials. Last, but certainly not least, health inequities and disparities in outcomes have persisted despite allocation of resources to ameliorate them, and much of this can be attributed to social determinants of health.

HCPLive: How does CVD impact the prognosis and quality of life of patients with ESKD?

Clark-Cutaia: Unfortunately, CVD is the leading case of morbidity and mortality in both children and adults with ESKD. It is estimated that over 70% of dialysis patients have CVD and 40-50% of deaths in the same are related to CVD. Depending on the CVD diagnosis, and the most common are heart failure, coronary artery disease and peripheral artery disease can be quite limiting, have significant symptom and self-management burden. This translates into reductions in quality of life.

HCPLive: What are some of the common risk factors for CVD in patients with ESKD?

Clark-Cutaia: Ironically, having ESKD is a major risk factor for CVD and vice versa. Others include obesity, diabetes, metabolic syndrome, chronic inflammation, and genetic predisposition.

HCPLive: What strategies or interventions have shown promise in improving CVD-related outcomes for these patients?

Clark-Cutaia: The strategies that I discuss in my talk are taking a multidisciplinary approach, developing personalized treatment plans and within that precision medicine encouraging self-management through lifestyle modifications that are attainable and sustainable. Easier said than done, but necessary is optimization with medication, and lastly continuous and consistent monitoring and education to allow for disease prevention and early intervention whenever possible.

HCPLive: Are there any emerging technologies or treatments that hold potential for improving CVD outcomes in this population?

Clark-Cutaia: I am not aware of any as yet, but I am hopeful there will be some on the horizon given the advances we are seeing in kidney transplantation, genetics, and other chronic disease management.

HCPLive: How does the management of CVD differ in patients with ESKD compared with the general population?

Clark-Cutaia: As discussed, the evidence for treatment modalities in dialysis patients is scarce and therefore, complicating the management for ESKD patients. Additionally, the interconnectedness of the CVD diagnosis with CKD diagnosis increases the complexity of management. Guidelines are for the “average” or “normal” individual with a disease process, but ESKD individuals are unique and as such may require greater precision and individualization with management.

HCPLive: Is there anything else you would like our audience to know?

Clark-Cutaia: I would like to encourage everyone to know their patient population and CVD risk. Educate themselves about CVD and ESKD to prevent progression of either disease in the patients they care for. Make sure that humility training is a part of that education so that we are ensuring to account for social determinants of health (SDoH) when providing guidance to patients. Meeting patients where they are is imperative.