2a) @ERAkidney #ERA22 is a primary international scientific symposium for interaction and exchange among basic scientists and clinicians working in #Nephrology. Our expert author is Dr. Clara García Carro (@ClaraGCarro) from San Carlos Clinical Hospital (Madrid, Spain). pic.twitter.com/igBJpVnNDD
— @CKD_ce (@ckd_ce) August 3, 2022
3) This program is #accredited for CE/#CME & is supported by an independent educational grant from the Boehringer Ingelheim/Lilly Alliance. It is not intended for US- or UK-based based HCPs. Accreditation statement & faculty disclosures at https://t.co/PHlIppl6Yw.
— @CKD_ce (@ckd_ce) August 3, 2022
5) As you know, #canagliflozin was associated, in the #CANVAS program, to a higher risk of lower-extremity #amputation, so … are #SGLT2i as effective in terms of #CV #morbidity and #mortality in patients with #CKD and #PVD as in CKD patients without PVD? pic.twitter.com/2rj9gJocaE
— @CKD_ce (@ckd_ce) August 3, 2022
7) 3514 patients with #CKD and without #PVD and 1156 had CKD + PVD were submitted to propensity-score matched #canagliflozin and placebo to balance differences between groups.
— @CKD_ce (@ckd_ce) August 3, 2022
9) Beneficial effects of #canagliflozin on CV and kidney outcomes are consistent and can be seen in patients regardless of these comorbidities. pic.twitter.com/QEKcj7mrtZ
— @CKD_ce (@ckd_ce) August 3, 2022
10b) Here is the Nephrology team from Clinico San Carlos Hospital that produced this work on #SGLT2i and #kidneytransplant recipients! pic.twitter.com/tZNkTk3TMI
— @CKD_ce (@ckd_ce) August 3, 2022
12) We also saw ⬇️ uric acid & cholesterol levels, & ⬆️ magnesium levels. 48 patients presented #UTI at 12 months and only one lost the graft. Incidence of UTI was higher in patients with previous episodes. There were no other major adverse events. pic.twitter.com/cm4gvDJ0OB
— @CKD_ce (@ckd_ce) August 3, 2022
14) The hypothesis is that the renal injury is due to #pinocytosis with uptake into lysosomes. Two very interesting papers about #osmotic #nephrosis after #SGLT2i were reviewed:
— @CKD_ce (@ckd_ce) August 3, 2022
🔓https://t.co/G1evXzyoRa
🔓https://t.co/y1wyKMUYW8
(see photo) pic.twitter.com/HqyFodmIqc
15b)
— @CKD_ce (@ckd_ce) August 3, 2022
👉diuretics – dose adjustment, close renal function and volume status follow up
👉 NSAIDs, cyclosporine, mannitol, amphotericin – avoid use together with #SGLT2i
👉 radiocontrast agents- stop SGLT2i before radiocontrast studies
👉 advanced age warrants close follow-up
17) Patients with #CKD with or without #T2D were randomized to dapagliflozin or placebo. Included subjects were treated with target or stable dose of #ACEi/ARBs. Primary composite outcome: sustained ≥50% #eGFR decline, #ESKD, or ☠️from a kidney/CV cause.
— @CKD_ce (@ckd_ce) August 3, 2022
19) However, the benefit of dapagliflozin on the primary outcome was consistent regardless of use or non-use of the target dose of ACEi/ARBs, as shown in this figure. This benefit was also present for a secondary composite #cardiovascular outcome. pic.twitter.com/itqk7AEiFr
— @CKD_ce (@ckd_ce) August 3, 2022
In which clinical scenarios are SGLT2i beneficial in terms of cardiorenal protection?
— @CKD_ce (@ckd_ce) August 3, 2022
A) no use of ACEi/ARBs
B) kidney transplant
C) concomitant use of diuretics
D) in all of them, but if they are used together with diuretics we should evaluate carefully volume status
21) Mark your best response and return tomorrow for the correct answer & MORE from #ERA22, & then a link to your 🆓CE/#CME!
— @CKD_ce (@ckd_ce) August 3, 2022
👏@shbermejo @PepaSolerR @JonathanNefro @edgarvlermamd @nephondemand @HecmagsMD @ChristosArgyrop @torra_roser @EmiliSanAlv @jlgorriz #FOAMed @MedTweetorials
22b) As to yesterday's poll (tweet #20). If you didn't yet answer, please scroll up and COMMIT!
— @CKD_ce (@ckd_ce) August 4, 2022
waiting
waiting
waiting
The correct answer is D. While on #SGLT2i therapy, hypovolemia should be avoided & diuretic use must be monitored.
24) #FLOW is an ongoing trial; 3535 patients were included. Patients baseline characteristics were presented at the congress: mean eGFR 47.0 mL/min/1.73 m2 (79.6% < 60) and mean UACR 567 mg/g (68.5% > 300 mg/g), mean #BMI was 32 kg/m2 and 95.8% were on #RAAS inhibition.
— @CKD_ce (@ckd_ce) August 4, 2022
26) Real world data about #semaglutide in patients with #DKD were presented by Gottfried Rudofsky 🇨🇭 in a pooled post hoc analysis of #SURE studies (all of them ~30 weeks’ duration) according to eGFR. pic.twitter.com/WQ2vN4ACf0
— @CKD_ce (@ckd_ce) August 4, 2022
28) Another interesting work was presented by Hon-Yen Wu 🇹🇼 comparing the effectiveness of #DPP4 inhibitors versus sulfonylureas in addition to metformin in a population-based cohort study of 37,317 patients in Taiwan with a mean follow-up of 2.1 years. pic.twitter.com/THMeIiLNjs
— @CKD_ce (@ckd_ce) August 4, 2022
30) Matrix metalloproteinase 10 (#MMP10) is known to be implicated in diabetic #microvascular complications and its levels increase progressively from early stages of #DKD.
— @CKD_ce (@ckd_ce) August 4, 2022
32) Albuminuria as a risk factor for dementia presented by Gaye Hafez 🇹🇷 was a very motivating talk. Prof Hafez linked albuminuria and dementia, being risk factors for both entities the same (hypertension, diabetes…). pic.twitter.com/IA3qPcf5TL
— @CKD_ce (@ckd_ce) August 4, 2022
34) Finally, what about #finerenone? #MRA were reviewed in a specific session at the #ERA22 congress on Sunday! First of all, a image to remember cardiorenal benefits of MRA by J Barrera-Chimal @barrera_lab 🇨🇦, https://t.co/t1Nd8LTV1j pic.twitter.com/SAEnJkSam2
— @CKD_ce (@ckd_ce) August 4, 2022
36) Prof George Bakris @BakrisGeorge 🇺🇸 reviewed #FIDELITY-DKD data, a pooled analysis of #FIGARO_DKD & #FIDELIO_DKD ➡️ 13171 #T2D pts randomized to finerenone (10 or 20 mg) or placebo, with a median follow up of 3 years. Mean #eGFR was 57 ml/min/1.73m2 and mean #UACR 515 mg/g. pic.twitter.com/GoPXxdfaF1
— @CKD_ce (@ckd_ce) August 4, 2022
38) In this pooled analysis, finerenone reduced by 23% the risk of the renal composite outcome, and reduced all the components of this kidney composite outcome. Only 1.7% patients required drug discontinuation while 14% presented any grade of hyperkalemia. pic.twitter.com/JZcLV1lrUV
— @CKD_ce (@ckd_ce) August 4, 2022
40a) Finally, Prof @KatherineTuttl8 🇺🇸 presented a terrific talk about how to start using #finerenone in everyday clinical practice. Main limitation: hyperkalemia. Clue points to start finerenone use:
— @CKD_ce (@ckd_ce) August 4, 2022
41) In summary, presentations at #ERA22 supported the conviction that use of combined treatment with RAAS blockade, SGLT2i, GLP1-RA and NS-MRA is the way we should follow in our clinical practice to stop progression in CKD patients with T2D.
— @CKD_ce (@ckd_ce) August 4, 2022
42) And that's it! Now go and claim your 🆓CE/#CME at https://t.co/2bL4NtRLr4 and FOLLOW US for more #accredited #tweetorials in the #cardiorenal & #cardiometabolic spaces. I am @ClaraGCarro. Thanks for joining us!
— @CKD_ce (@ckd_ce) August 4, 2022