CRS 2017: CKD and Cardiometabolic Risk: A Q&A With Dr. James Matera

October 22, 2017 at 11:55am

Cardiometabolic risk reduction is at the core of nearly every clinician’s practice, given the prevalence of these conditions—hypertension, diabetes, dyslipidemia, and obesity—among the US population. Nearly 10% of American adults have diabetes, nearly 30% have high blood pressure, and nearly 35% are obese, meaning that helping patients manage their cardiometabolic health likely is one of the most common components of daily practice.

Consultant360 recently spoke with James Matera, DO, FACOI, who is a nephrologist at the Nephrology Hypertension Associates of Central NJ and co-director of physician integration at CentraState Medical Center in Freehold, NJ, about how to manage patients with cardiometabolic risk and kidney disease.

Consultant360: What key issues contribute to the growth of the cardiometabolic disease epidemic in the United States?

James Matera: I think the primary factors in this epidemic revolve around the issues we face regarding obesity, progressive diabetic disease, hypertension, and the larger numbers of chronic kidney disease patients. All of these disease states are risk factors and when additive, can be profound in the cardiovascular spectrum.

C360: What is the biggest misconception about cardiometabolic disease?

JM: A common misconception that I see is the lack of action when overt signs and symptoms are present. We need to be preventive instead of reactionary to this syndrome. Once disease states are established, the outcomes decline and the morbidities increase.

C360: Why are primary care clinicians critical in the management of patients with cardiometabolic risk factors?

JM: Primary care doctors are the gatekeepers and will be increasingly responsible (financially and medically) for improving patient experiences and outcomes, all while maximizing resources and containing costs. This gives them a unique role in being the patient advocate and implementing appropriate prevention and treatment protocols.

C360: What cardiometabolic risks do patients with chronic kidney disease (CKD) face?

JM: CKD incidence is escalating in the United States and is responsible for a significant proportion of the annual medicare costs. Cardiovascular disease remains the number one issue facing CKD patients, and the impact starts well before CKD might be evident. It becomes very important to identify CKD and lessen the cardiac risks these patients will ultimately face.

C360: What are some recent pharmacologic or nonpharmacologic developments in the clinical approach to, or our understanding of, chronic kidney disease?

JM: Two come to mind in particular: (1) Better understanding of the staging of CKD and where we can expect the risk factors to increase and (2) Recognition of the electrolyte issues, such as hyperphosphatemia, that directly impact cardiovascular risks. We are seeing improvement in treatment of these conditions, and data is showing improvement in cardiovascular outcomes.

C360: What do you feel is the greatest challenge for primary care clinicians in the treatment of CKD?

JM: The difficulty in assessing risk factors and the actual meaning of CKD staging; also the controversies surrounding early vs late nephrology referral and outcomes that can be associated with that. I strongly feel the nephrologist should be proactive in giving the primary doctor the tools and guidelines for determining when interventions are needed in CKD.

C360: If you could give primary care providers one piece of practical advice to improve the management of CKD and cardiometabolic risk in daily practice, what would it be?

JM: Recognize the problem and develop a strong collaborative initiative with the nephrologist to lessen the cardiovascular burden of disease.