2) Our #accredited #tweetorial series on #ADPKD is supported by an independent educational grant from Otsuka Pharmaceuticals and is intended for healthcare providers.
— @CKD_ce (@ckd_ce) June 14, 2022
4a) So let's consider a hypothetical case. 42♂️ is referred to your office for evaluation for CKD.
— @CKD_ce (@ckd_ce) June 14, 2022
He reports intermittent gross hematuria accompanied by bilateral flank pains. pic.twitter.com/oPBmmCYYt2
4c) Vitals and w/u: BP 130/80, HR 70, RR 18
— @CKD_ce (@ckd_ce) June 14, 2022
PE is unremarkable
Labs: Na 135, K 4.0, BUN/ Creat 24/ 2.3, eGFR 35 mL/min/1.73 m2, Hgb 13.5
6) This basic universal management should be recommended to all patients with ADPKD
— @CKD_ce (@ckd_ce) June 14, 2022
🔓https://t.co/KwfHOGENzE pic.twitter.com/QfhrW8IU7J
8) Here's a nice visual representation of the Mayo Clinic classification diagram
— @CKD_ce (@ckd_ce) June 14, 2022
🔓https://t.co/KwfHOGENzE pic.twitter.com/Tnmg7aGc6H
10) Did you commit?!?
— @CKD_ce (@ckd_ce) June 14, 2022
The correct answer is C. This patient has the rapidly progressive variant of #ADPKD (for more on this–and more 🆓CE/#CME credit, see https://t.co/dOExSd1DYU by @fouadchebib. Disease-modifying therapy #DMT should be initiated.
12a) Based on the SPRINT trial, the @goKDIGO guidelines gave a Level 1B recommendation that adults with high #BP and #CKD be treated with a target systolic blood pressure (SBP) of <120 mm Hg, when tolerated, using standardized office BP measurement.
— @CKD_ce (@ckd_ce) June 14, 2022
🔓https://t.co/BnrmREkxE9 pic.twitter.com/6dy2lhKDhq
12c) . . . a slower ⬆️ in total kidney volume #TKV, no overall change in the estimated #GFR, a greater ⬇️in the left-ventricular-mass index, & greater ⬇️in urinary albumin excretion.
— @CKD_ce (@ckd_ce) June 14, 2022
🔓https://t.co/SgcFeuBfKO pic.twitter.com/hs2bYm0l20
14) Still considering optimal basic management. . . in the #CRISP study, average daily dietary sodium was approximately 4.3 g, remained constant over time despite dietary instructions, and was associated with TKV increasehttps://t.co/tN3UxsXulg pic.twitter.com/Pig019iWhc
— @CKD_ce (@ckd_ce) June 14, 2022
16a) Adequate hydration is also a big deal! Vasopressin is believed to play an important role not only in the development of cystic disease in ADPKD but also in the progression of CKD
— @CKD_ce (@ckd_ce) June 14, 2022
🔓https://t.co/EW1dhBTSek
17a) #Protein intake is also important to monitor in basic #management of #ADPKD. In the CRISP study, estimated protein intake was associated with steeper TKV increase (univariate analysis) during a period of observation of up to 6 years.
— @CKD_ce (@ckd_ce) June 14, 2022
🔓https://t.co/tN3UxsXulg
18a) Other recommendations for optimized management of adult pts with #ADPKD include:
— @CKD_ce (@ckd_ce) June 14, 2022
👉Moderate daily phosphate restriction (800 mg) along with moderate protein restriction to our patients
👉Treatment of metabolic acidosis maintaining a plasma bicarbonate level >/= 22 mmol/L
19) So, what have you learned? Which of the following is NOT a basic management measure for adults with #ADPKD?
— @CKD_ce (@ckd_ce) June 14, 2022
a. moderate phosphate restriction
b. maintain plasma bicarb at < 22 mmol/L
c. moderate protein restriction
d. moderation in calorie intake
21) Welcome back! I am #FOAMed advocate @edgarvlermamd and we are talking about case-base management of #ADPKD, the most common #inherited #kidneydisease. We discussed a case of #hematuria & #flankpain that turned out to be ADPKD.
— @CKD_ce (@ckd_ce) June 15, 2022
23) Does he have the #rapidly #progressive form of #ADPKD?
— @CKD_ce (@ckd_ce) June 15, 2022
For treatment, it's important to know!
Image source: https://t.co/EohqcuA2qk pic.twitter.com/Vh34JM88vY
25) Listed are some methodologies to determine which patients with #ADPKD are at higher risk for progressive disease
— @CKD_ce (@ckd_ce) June 15, 2022
(blog post) @AJKDonline: https://t.co/AAUCxQ45Jj
(article) https://t.co/Gfy9dt6jVu
(another @ckd_ce accredited tweetorial) https://t.co/GCce6vQOkO pic.twitter.com/an4SEHUo9G
26b) Published in 2016, the #PROPKD score accurately predicted renal outcomes in patients with ADPKD and may be helpful in the personalization of therapeutic management of #ADPKD.#VisualAbstract by @edgarvlermamd
— @CKD_ce (@ckd_ce) June 15, 2022
🔓https://t.co/qcFIo06Ihr pic.twitter.com/VWCaYNqOX9
27b) age and eGFR, as a prognostic biomarker for risk of GFR decline
— @CKD_ce (@ckd_ce) June 15, 2022
This study showed that the TKV was the most important prognostic term for 30% ⬇️in eGFR in #ADPKD patients with and without preserved baseline eGFR.#VisualAbstract by @edgarvlermamd
🔓https://t.co/2O5oN8QGVb pic.twitter.com/4ZTqJGmnIg
28b) . . . thereby qualifying #htTKV as a prognostic biomarker in ADPKD.#VisualAbstract by @edgarvlermamd
— @CKD_ce (@ckd_ce) June 15, 2022
🔓https://t.co/WteCTj4F49 pic.twitter.com/xjkJjMsYx8
30a) In summary, various factors (genetic, epigenetic, and environmental) affect disease severity in #ADPKD through cyst number, rate of growth, and vasopressin state.
— @CKD_ce (@ckd_ce) June 15, 2022
The prognostic factors that affect the various pathogenic processes in ADPKD . . .
31) Now that we have identified that our case is a rapid progressor, in addition to the basic optimized management, novel disease modifying therapies should be considered as they may potentially slow disease progression. pic.twitter.com/7YO8gb1R6a
— @CKD_ce (@ckd_ce) June 15, 2022
31) Now that we have identified that our case is a rapid progressor, in addition to the basic optimized management, novel disease modifying therapies should be considered as they may potentially slow disease progression. pic.twitter.com/7YO8gb1R6a
— @CKD_ce (@ckd_ce) June 15, 2022
33a) In the TEMPO 3:4 trial, #tolvaptan, as compared with placebo, slowed the increase in total kidney volume and the decline in kidney function over a 3-year period in patients with ADPKD 🔓https://t.co/cOzihQdUJn pic.twitter.com/mk0OVEyb00
— @CKD_ce (@ckd_ce) June 15, 2022
34a) In the Replicating Evidence of Preserved Renal function: an Investigation of Tolvaptan Safety and Efficacy (#REPRISE) trial, after 1 year of treatment, eGFR decreased by 2.34 and 3.61 ml/min per 1.73 m2 in the tolvaptan and placebo groups (p<0.001).
— @CKD_ce (@ckd_ce) June 15, 2022
35) The TEMPO 3:4 and REPRISE trials showed that tolvaptan slowed eGFR decline over a broad range of disease stages and could be used safely
— @CKD_ce (@ckd_ce) June 15, 2022
🔓https://t.co/YausSkqDFx @fouadchebib pic.twitter.com/ek7ofyQMMU
36b) This table shows the potential long-term benefit on kidney function on the basis of the rates of eGFR decline in tolvaptan-treated patients and controls observed in the TEMPO 3:4 and REPRISE clinical trials
— @CKD_ce (@ckd_ce) June 15, 2022
🔓https://t.co/YausSkqDFx https://t.co/7fEN9GkFh1 pic.twitter.com/4euJBHR59t
38) Results of this post hoc analysis ➡️tolvaptan slows eGFR ⬇️ in subjects with #ADPKD & CKD Gr 4, thereby suggesting that tolvaptan can be initiated or maintained in such pts once their eGFR drops < 25 #VisualAbstract by @krishnadoctor1
— @CKD_ce (@ckd_ce) June 15, 2022
🔓https://t.co/X5GYAWSsyQ pic.twitter.com/IhOxGzRNIC
40) One must weigh the potential benefits and harms when initiating tolvaptan https://t.co/YausSkrbv5 pic.twitter.com/FN8VFEnLCe
— @CKD_ce (@ckd_ce) June 15, 2022
42a) Other drugs may ultimately prove useful in #ADPKD. More stable synthetic peptides similar to #somatostatin (#octreotide, #lanreotide, and #pasireotide) have been developed for potential clinical use.
— @CKD_ce (@ckd_ce) June 15, 2022
42c) Participants in this study however, experienced higher frequency of adverse events (hyperglycemia and diabetes).#VisualAbstract by @whatsthegfr
— @CKD_ce (@ckd_ce) June 15, 2022
🔓https://t.co/zCcLtke7jO pic.twitter.com/LvYk4JDOIP
44) #Metformin in #ADPKD
— @CKD_ce (@ckd_ce) June 15, 2022
In this small trial of 97 patients with ADPKD, metformin was found to be safe and tolerable while slightly reducing estimated GFR decline but not to a significant degree.https://t.co/JZ1BC2bFpU pic.twitter.com/9a4naZQCNz
46) I also recommend this nice paper “Assessing Risk of rapid Progression in ADPKD and Special Considerations for Disease-Modifying Therapy” ca. 2021 published in @AJKDonline by @fouadchebib #Nephpearlshttps://t.co/6wYz8v9VL1 pic.twitter.com/DFLokZ81WR
— @CKD_ce (@ckd_ce) June 15, 2022
48) And that's it! You just earned 0.5h CE/#CME for #physicians #physicianassociates #nurses #nursepractitioners #pharmacists. Just go to https://t.co/J00knYGXQN and claim your certificate! I am @edgarvlermamd and I thank you for following @ckd_ce (and @cardiomet_ce)!
— @CKD_ce (@ckd_ce) June 15, 2022