Cleveland Clinic Journal of Medicine2023 Update in Ambulatory General Internal Medicine

Pioneering Advancements in Outpatient Medicine: Key Insights from 2022-2023 Studies

This comprehensive article examines five pivotal studies published in 2022 and 2023, marking significant advancements in outpatient medicine. These studies address critical areas including chronic kidney disease, cardiovascular health, obesity management, and cholesterol regulation. The insights drawn from these studies not only refine current practices but also pave the way for new treatment paradigms in outpatient settings.

Key Points:

1. Empagliflozin in Chronic Kidney Disease: Empagliflozin slows chronic kidney disease progression, particularly in patients with significant albuminuria. The EMPA-KIDNEY trial showed a reduction in disease progression with empagliflozin, though benefits in patients without albuminuria are less clear.
2. Mediterranean Diet for Cardiovascular Disease: A Mediterranean diet surpasses a low-fat diet in preventing secondary cardiovascular events. The study indicated a 25% reduction in major cardiovascular events with the Mediterranean diet.
3. Hydrochlorothiazide for Kidney Stones: Hydrochlorothiazide does not effectively prevent symptomatic or radiologic recurrence of calcium-containing kidney stones, challenging previous assumptions about its efficacy in kidney stone prevention.
4. Tirzepatide for Weight Loss: Tirzepatide has shown effectiveness in weight loss among obese or overweight patients with weight-related complications. This provides a new therapeutic option for managing obesity beyond lifestyle changes.
5. Ezetimibe and Statin Therapy: Adding ezetimibe to lower-intensity statin therapy is noninferior to high-intensity statin therapy alone in preventing major adverse cardiovascular events. This combination may benefit patients intolerant to high-intensity statins.
6. Clinical Utilization of SGLT-2 Inhibitors: Despite the proven benefits of SGLT-2 inhibitors in chronic kidney disease, their clinical utilization remains low, indicating a gap between evidence and practice.
7. Dietary Interventions in Cardiovascular Disease: The effectiveness of dietary interventions, like the Mediterranean diet, in secondary prevention of cardiovascular events highlights the need for integrating dietary advice in clinical practice.
8. Strategies for Preventing Recurrent Kidney Stones: The lack of efficacy of hydrochlorothiazide in preventing recurrent kidney stones suggests a need to explore alternative preventive strategies.
9. Pharmacotherapy in Obesity Management: The success of tirzepatide in clinical trials underscores the importance of pharmacotherapy as a complement to lifestyle management in obesity.
10. Lipid Management with Ezetimibe and Statins: The study on ezetimibe and statin therapy suggests a shift towards combination therapy in lipid management, mirroring approaches in hypertension management.

According to the CDC, more than 1 in 7 US adults – about 35.5 million people, or 14% – are estimated to have CKD. As many as 9 in 10 adults with CKD do not know they have it.

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