Moving Beyond the Joint: The Interplay Between Gout and Kidney Disease

Nehad Soloman, MD, FACR; Andrew Sharobeem, DO, FACR, and Sunil Patel, MD, explore the nephrologist's vital role in gout diagnosis, treatment options for gout patients with chronic kidney disease, and strategies for managing refractory gout and its associated challenges.

Moving Beyond the Joint: The Interplay Between Gout and Kidney Disease 

Andrew Sharobeem, DO, FACR

Andrew Talal, MD, is a Professor of Medicine and Founder/Director of the Center for Research and Clinical Care in Liver Disease at the State University of New York at Buffalo - School of Medicine and Biomedical Sciences.

Experts Discuss Advances in Pathophysiology of Hepatitis B Virus for 2024

Advances in Pathophysiology of Hepatitis B Virus for 2024

In recognition of May 19 as World Hepatitis Testing Day and the month of May as Hepatitis Awareness Month, we are launching our latest 

, which spotlights a conversation between subject matter experts on updates and unmet needs in the management of 

Although not discussed with the same frequency and urgency as 

 within public health circles, HBV represents a significant impact to public health globally and within the US, where an estimated 2.4 million are chronically infected, because unlike with HCV, there is no cure for these chronically infected patients. However, like HCV, the ongoing opioid crisis in the US has contributed to ballooning rates of acute hepatitis B infection in recent years and only 25% of infected individuals receive a diagnosis, according to the Hepatitis B Foundation.

The first in our 6-part series, this segment opens with introductions from our 3 subject matter experts, which is followed by a discussion on updates in pathophysiology and how they have influenced current care strategies for HBV. In the conversation, Nancy Reau, MD, explains how recent advancements have clarified the virus's lifecycle, which has contributed to the development of new diagnostics that, while not yet fully available in clinical practice, are poised to significantly enhance treatment by identifying better therapeutic targets and monitoring treatment success. Andrew Talal, MD, adds to the discussion by highlighting the importance of the updated World Health Organization and US Centers for Disease Control and Prevention guidelines. Talal stresses the significance of expanded treatment eligibility, particularly for adolescents and adults, broader antiviral treatment options, and the role of enhanced diagnostics in improving patient outcomes.

This conversation sets the stage for a detailed exploration of the latest therapeutic strategies and the most pressing unmet needs in the fight against hepatitis B, providing valuable insights for clinicians and researchers committed to advancing care in this field.

In this 6-part discussion, our group of experts tackles the following topics:

Advances in Pathophysiology of Hepatitis B Virus

Implications of HBV DNA Integration on Care

Improving Hepatitis B Screening and Vaccination

Therapeutic Pipeline Updates in Hepatitis B Virus

Role of Advocacy, Patient Voice in Hepatitis B Virus

Nancy Reau, MD: Richard B. Capps Chair of Hepatology, Associate Director of Solid Organ Transplantation, and Section Chief of Hepatology at Rush University Medical Center.

Andrew Talal, MD: Professor of Medicine and Founder/Director of the Center for Research and Clinical Care in Liver Disease at the State University of New York at Buffalo - School of Medicine and Biomedical Sciences.

In this segment of our 6-part discussion on updates and unmet needs within the management of hepatitis B virus focuses on advances in the pathophysiology of hepatitis b virus for 2024.

Andrew Talal, MD

Exploring the Cardiovascular Benefits, Potential of Finerenone

Management of chronic kidney disease among patients with type 2 diabetes has undergone significant change in the last decade. Once handcuffed by a lack of safe and efficacious options, changing standards of care coming as the result of pharmacotherapeutic advancement have ushered in a new era of management for this patient population.

This change has been spearheaded by 2 particular classes—a familiar face in the form of SGLT2 inhibitors and the novel nonsteroidal mineralocorticoid receptor antagonist (nsMRA) finerenone (Kerendia), which received approval in July 2021 for reducing the risk of sustained eGFR decline, kidney failure, cardiovascular death, non-fatal myocardial infarction, and hospitalization for heart failure in adult patients with chronic kidney disease associated with type 2 diabetes.

Finerenone first captivated the attention of nephrologists, endocrinologists, and other providers managing patients with type 2 diabetes with the release of data from the FIDELIO-DKD and FIGARO-DKD trials. The number of specialists captivated by the agent and its potential benefit grew with the release of data surrounding the cardiovascular benefits among patients with heart failure observed within the FINEARTS-HF trial at the European Society of Cardiology Congress 2024.

In this segment, which is part 5 of a 5-part series, discussants Edgar Lerma, MD, a nephrologist, and Anuradha Lala-Trindade, MD, a cardiologist, dive into the cardiovascular benefits highlighted in the FINEARTS-HF trial with finerenone, specifically its impact on heart failure with preserved ejection fraction (HFpEF). Lala-Trindade elaborates on the historical challenges of treating HFpEF, noting that earlier trials with steroidal MRAs like spironolactone showed mixed results. However, finerenone demonstrated a significant reduction in cardiovascular death and heart failure hospitalizations, marking a substantial advancement for both heart and kidney health in HFpEF patients.

They discuss the paradigm shift in treatment approaches—favoring simultaneous, low-dose initiation of all four heart failure “pillars” rather than sequential dosing. Lala-Trindade points to finerenone’s unique, manageable side-effect profile, particularly its lower risk of hyperkalemia, as promising for broader applicability. They conclude with a look at the practical questions surrounding accessibility and cost, noting the need for more data on the value finerenone may add compared to traditional MRAs.

 a clinical professor of Medicine in the Section of Nephrology at the University of Illinois at Chicago and a nephrologist with Associates In Nephrology based in Chicago.

 the director of Heart Failure Research, program director of the Advanced Heart Failure and Transplant Fellowship, and associate professor of Medicine at The Mount Sinai Fuster Heart Hospital & Department of Population Health Science and Policy.

Relevant disclosures for Lerma include Akebia, Astra Zeneca, Bayer, Boehringer Ingelheim, Glaxo Smith Kline, Otsuka, Travere, Vifor, and Fresenius. Relevant disclosures for Lala-Trindade include Merck, AstraZeneca, Cytokinetics, and Novartis.

Campbell P. Finerenone (Kerendia) approved for chronic kidney disease associated with type 2 diabetes. HCP Live. July 9, 2021. Accessed October 23, 2024. https://www.hcplive.com/view/finerenone-kerendia-approved-chronic-kidney-disease-associated-with-type-2-diabetes.

Campbell P. FDA updates Finerenone label to reflect Cardiovascular Outcomes Data. HCP Live. September 8, 2022. Accessed October 23, 2024. https://www.hcplive.com/view/fda-updates-finerenone-label-to-reflect-cardiovascular-outcomes-data.

Solomon SD, McMurray JJV, Vaduganathan M, et al. Finerenone in Heart Failure with Mildly Reduced or Preserved Ejection Fraction. 

. Published online September 1, 2024. doi:10.1056/NEJMoa2407107

In the final part of this 5-part series, Lala-Trindade discusses the findings of the FINEARTS-HF trial and how it might inform use of finerenone. 

Anuradha Lala-Trindade, MD

Anti-VEGF for RVO: The Gold Standard

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John W Kitchens, MD, bookends the discussion by highlighting the landscape of branch vein occlusion (BRVO) treatment options. 

Anti-VEGF for RVO: The Gold Standard 

Carl D. Regillo, MD, FACS

Dhiren Patel, PharmD, CDCES, BC-ADM, BCACP

A pair of authors of a recent scientific statement and the president of the HFSA discuss cognitive impairment in heart failure. 

Role of Screening, Addressing Cognitive Impairment in Heart Failure Management

For some time, the heart failure community has warned of an impending storm brewing under the nose of public health despite their rallying cries and calls for a greater emphasis on management. With the aging US population as a backdrop, the prevalence of 

 is expected to grow in the coming years and, with heart failure fellowships going unfilled at an alarming rate, many in the field are concerned they are heading toward a perfect storm bent on wreaking havoc on public health.

The concern among filling fellowship slots aside, advanced heart failure and transplant specialists currently practicing have been confronting a growing concern associated with the aging population, but that could spell disaster for heart failure in particular: cognitive impairment. In their latest scientific statement, the Heart Failure Society of America has aimed at the issue and how it affects the management of heart failure.

Published on March 12, 2024, the 17-page document cites 142 references and is divided into 5 sections addressing the following subjects: risk factors for cognitive impairment, implications of cognitive impairment, management of cognitive impairment, integration of cognitive impairment into decision-making, and gaps in knowledge and challenges to implementation. In addition to calling attention to the prevalence of cognitive impairment in this patient population, the docuemnt also provides an overview of recommended screening tools and practices based on contemporary literature.

In this HCPLive peer-to-peer discussion, we spotlight perspectives on the subject from 3 subject matter experts in Eiran Gorodeski, MD, MPH, Parag Goyal, MD, MS, and James Fang, MD. In the conversation, Fang, who also serves as the president of the Heart Failure Society of America, acts as a moderator and guides Gorodeski and Goyal, who served as lead co-authors for the statement, through a discussion on the creation process, key takeaways, the complexities of heart failure management in patients with cognitive impairment, and the role of the Heart Failure Society of America and other professional organizations in aiding clinicians with incorporating changes and recommendations within these types of documents.

, director of the Advanced Heart Failure & Transplant Center at Harrington Heart & Vascular Institute in the University Hospitals Health System as well as section head of advanced heart failure in the Division of Cardiovascular Medicine and Professor of Medicine at Case Western Reserve University.

, statement co-author, associate professor of Medicine, the Founding Director of the Heart Failure with Preserved Ejection Fraction Program, and the director of the Cardiac Amyloidosis Program at Weill Cornell Medicine.

 president of the Heart Failure Society of America, chief of Cardiovascular Medicine at the University of Utah School of Medicine, and director of the Cardiovascular Service Line at University of Utah Health Care.

Relevant disclosures for Gorodeski include Dynamed Plus. Relevant disclosures for Goyal include Agepha, Axon, and Sensorum Health. Relevant disclosures for Fang include Amgen, AstraZeneca, Boehringer Ingelheim, Novartis, and 

Bozkurt B, Ahmad T, Alexander KM, et al. Heart Failure Epidemiology and Outcomes Statistics: A Report of the Heart Failure Society of America. 

. 2023;29(10):1412-1451. doi:10.1016/j.cardfail.2023.07.006

Goyal P, DiDomenico RJ, Pressler SJ, Allen LA, Gorodeski EZ. Cognitive Impairment in Heart Failure: A Heart Failure Society of America Scientific Statement. 

. Published online March 12, 2024. doi:10.1016/j.cardfail.2024.01.003

Eiran Gorodeski, MD, MPH, Parag Goyal, MD, MSc, and James Fang, MD, discuss the HFSA's recent scientific statement on the prevalence and impact of cognitive impairment on the management of heart failure. 

The Role of Screening, Addressing Cognitive Impairment in Heart Failure Management

Eiran Gorodeski, MD, MPH

Hersh Shroff, MD, MPA, is a transplant hepatologist and an assistant professor of medicine at the University of North Carolina School of Medicine

Discussion between 3 subject matter experts on the impact of stigmatization on delays in diagnosis of alcohol-related liver disease.

HCPLive Alcohol Stigma Discussion Part 1

Recent years have seen a drastic increase in alcohol use in the United States. Alongside this growing prevalence has come an influx of severe morbidity and mortality linked to 

, with the National Institute on Alcohol Abuse and Alcoholism citing alcohol’s involvement in nearly half of all liver disease deaths among people 12 years of age and older in 2022 and labeling alcohol as one of the leading causes of preventable death.

Many cases of ALD are rooted in underlying 

, a medical condition involving frequent or heavy alcohol consumption that often requires an individualized treatment approach with a combination of medication, behavioral interventions, and mutual support groups. According to the 2022 National Survey on Drug Use and Health, 29.5 million people ages 12 and older had AUD in the past year. Of this group, 2.2 million received alcohol use treatment.

Although it is a mental health disorder, AUD’s role in the development and progression of ALD underscores the importance of its treatment alongside medical intervention for the liver and other potential negative physical impacts of alcohol use. However, it tends to fall by the wayside due to a number of patient, clinician, and system barriers, many of which are linked to the stigma surrounding AUD and its negative impact on patients’ willingness to seek care as well as clinicians’ ability to provide adequate care.

In this HCPLive special report, our moderator, Hersh Shroff, MD, MPA, is joined by Jay Luther, MD, and Chris Kahler, PhD, to discuss the stigmatization of AUD. The first segment of their conversation focuses on defining stigma, both at the public and structural level, and outlining its role in delaying and hindering care for these patients.

Shroff introduces the topic and poses a question to Kahler about the different forms and definitions of stigma and how public perception of AUD may contribute to delays in seeking care. Kahler responds by describing stigma as a “complex construct,” explaining its manifestation at both social structural levels and individual levels as well as how the stigma surrounding AUD may lead patients to underreport their alcohol consumption, avoid discussing concerns with their clinician, and hesitate to seek care from a specialist.

Shroff expresses agreement with Kahler’s response and poses a similar question to Luther, this time inquiring about how structural stigma in the health care system perpetuates disparities for patients with ALD. Similar to Shroff, Luther notes he agrees with Kahler’s response and mentions how certain aspects of this individualized stigma are also present at a greater structural level.

He goes on to describe how the disease has been labeled, pointing to inherent problems with the terms alcoholic liver disease and alcoholic hepatitis and how the term “alcoholic” contributes to the ongoing stigma in ways clinicians may not even realize. Structurally, Luther notes that there has been little to no overlap between the treatment of liver disease and the treatment of alcohol addiction, forcing patients to see different specialists and potentially making them feel as though they are being judged or blamed for their alcohol use.

However, Luther goes on to explain how some institutions, including his own, are taking strides to combat this structural stigma by incorporating what he calls a “team approach” with combined efforts from a hepatologist, an addiction specialist, and a social worker whose shared goal is to “get you feeling better to get you healthier.”

Check out the second half of the discussion:

Addressing Stigma to Improve Outcomes in Alcohol-Related Liver Disease

 a transplant hepatologist and an assistant professor of medicine at the University of North Carolina School of Medicine

 an assistant professor of medicine at Harvard Medical School and director of the Massachusetts General Hospital Alcohol Liver Center

 a professor of behavioral and social sciences, a professor of psychiatry and human behavior, and the director of the Center for Alcohol and Addiction Studies at Brown University

Shroff, Luther, and Kahler have no relevant disclosures.

National Institute on Alcohol Abuse and Alcoholism. Alcohol Use in the United States: Age Groups and Demographic Characteristics. Alcohol’s Effects on Health. 2023. Accessed April 30, 2024. 

https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/alcohol-use-united-states-age-groups-and-demographic-characteristics

National Institute on Alcohol Abuse and Alcoholism. Alcohol and the Human Body. Alcohol’s Effects on Health. 2024. Accessed April 30, 2024. 

https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/alcohol-and-human-body

Cleveland Clinic. Alcohol Use Disorder. Diseases & Conditions. June 2, 2021. Accessed April 30, 2024. 

https://my.clevelandclinic.org/health/diseases/3909-alcoholism

National Institute on Alcohol Abuse and Alcoholism. Alcohol Use Disorder (AUD) in the United States: Age Groups and Demographic Characteristics. Alcohol’s Effects on Health. 2023. Accessed April 30, 2024. 

https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/alcohol-use-disorder-aud-united-states-age-groups-and-demographic-characteristics

In the first segment of this HCPLive special report, experts discuss the stigma surrounding alcohol use disorder and alcohol-associated liver disease.

Recognizing Stigma's Impact on Care for Alcohol-Related Liver Disease

Hersh Shroff, MD, MPA

Overview and Diagnosis of COPD

MeiLan K. Han, MD, MS

Dermatologists end their discussion on seborrheic dermatitis (SD), highlighting key takeaways for patients and clinicians on managing this condition.

Beyond Skin Deep: Validating and Transforming SD Patient Care

 As we kind of wrap things back around, we’ve all been in practice for a good amount of time. I think we all have kind of a unique perspective on treating patients with seborrheic dermatitis. I’m just wondering, based on the information that you’ve seen, based on your own clinical practice and any clinical trials, if you could think about some kind of a pearl that you would give to our viewers to take home, maybe to make us all a little bit better in our prescribing or our understanding the needs of a seborrheic dermatitis patient. Adelaide, I’m going to start with you, talking about children, is [there] some special way to communicate or [do] you know some special kernel of truth that you’ve learned in treating a seborrheic dermatitis pediatric patient?

 Well, I think one of the first things I do is I reassure them that it is a treatable problem and that we have tools that will be helpful. And we also have on the horizon some medicines which I’m always proud to say that I’ve had a small role in bringing forward hopefully to the market, and they’ll be coming soon, and I’ll update them as we go along. I think addressing it front and center as a medical problem for which we have treatments and hopefully, soon, better treatments is reassuring. The other thing I say is we take this seriously. I’ve had too many patients come in and say [that] the doctor barely looked then they left the room. “I got a prescription, but then what do I do?” They don’t feel that they’re really feeling validated, so [as] I do often with many disease states I say [that] we take this seriously, and they tell me how grateful they are to hear somebody say that.

 Adelaide, I think I’m taking that home. I want to tell my patients from now, “I take this very, very seriously,” because I think I want to be heard as a patient. I want you to hear what I’m saying and understand that this is important to me even if it doesn’t look like it’s so terrible; I want I want my physician to hear me and understand what I’m saying. James, thoughts on anything that you can give us to take home?

 Just to validate the patient’s concerns and the impact that it has on her life. [Telling them,] “Hey, it’s OK for you to feel this way about your condition. It’s not too trivial, and [I] take it very seriously.” I also thinking establishing that this is a condition that we’re going to be able to treat. It’s not a cure, but we’re going to treat this. We have really good treatments now on the horizon that could really help you get to the place you want to be.

 I think it’s important not to make judgments based on how their seborrheic dermatitis may appear. It’s important to ask patients about their symptoms. In particular, I really focus on asking about their itch. I’ve been surprised so many times. And I think seborrheic dermatitis is just one of those diseases where itch can be a significant burden. You should ask them about it. And now we have the emergence of [a] novel therapeutic that can reduce itch so quickly.

 It’s so interesting because I ask all of my atopic dermatitis patients, talk to me about your itch. That’s so easy because it’s so quick, and I can write it down. I don’t have to do a whole EASI [Eczema Area and Severity Index] score. I can ask them about their itch, do an overall IGA, or investigator’s global assessment. I’ve learned that itch is very important for my psoriasis patients. So now I try to ask my patients [about it]; not [that] everybody itches, but a significant number of psoriasis patients do itch. But I haven’t always asked my seborrheic dermatitis patients about their itching. I think that we could all kind of take that back, and maybe that will make us even better in terms of understanding their burden and being able to monitor it a little bit closer.

 I think all of you said it best, but I would take it a step further and just make them unravel it and remind them of the itch, the dryness, the epidermal changes of scale, the redness, and then bring it back to why are we treating with all these different components of cleansing, moisturizing, and the active ingredient. But also make them think about the marathon and not the sprint, not just making [it] go away quickly, but making things stay away and the safety of giving them things that will do that.

 I think these are all such critical points. What I’m hearing from all of you, who are some of the best clinicians out there, is validating that they have a real medical condition and that they deserve appropriate therapy, that we hear them, we have new options that are available, we can help to simplify the treatment regimen, we can give them something that’s safe, effective, [and] well tolerated, and we can help them in this journey. My goal always is to make them not think about their skin. If they want to think about it in a good way, that’s great, if they’re happy with their skin, that’s great. I want you to live your life and your skin goes with you, but your skin should not be the center of how you live your life, trying to hide the flake, trying to hide the redness, trying to not scratch. I think this is really, really critical. I’ve learned a lot from my colleagues and from talking to each one of you. I think we have some really interesting information. I want to thank each of you for participating today, I’d like to thank the audience for joining us. I hope that you’ve all been able to take home some kernels of truth, and I’d like to thank you all for watching this HCPLive 

Transcript was AI-generated and edited for clarity. 

Authors