1b) Check out our other #ADA2022 recap #tweetorial by new @GoggleDocs family member @Ines_Vfonseca who focused on the cardiac data presented: https://t.co/vMR5y2EQmb
— @CKD_ce (@ckd_ce) August 23, 2022
3) Faculty disclosures and statement of accreditation are provided at https://t.co/PHlIppl6Yw. Please FOLLOW @ckd_ce and @cardiomet_ce so you don’t miss any of our unique #accredited #serialized #tweetorials, always 🆓, always from expert authors!
— @CKD_ce (@ckd_ce) August 23, 2022
5) 🌟Highlight for us was the presentation of the New Joint Statement from ADA-KDIGO on the Management of #Diabetes & #CKD@ADA_DiabetesPro @goKDIGO
— @CKD_ce (@ckd_ce) August 23, 2022
Available in draft from
👉 🔓https://t.co/1o9DY8t9KO 👈 pic.twitter.com/lZG7gTkw8Q
7) 👉Today we are going to focus purely on the utility and application of SGLT2i in the consensus statement.
— @CKD_ce (@ckd_ce) August 23, 2022
📍If you want to read more check out this 🧵: https://t.co/a4k8FXuhFS
8b) More detail at
— @CKD_ce (@ckd_ce) August 23, 2022
👉🔓https://t.co/1o9DY8t9KO
and from @BakrisGeorge himself at https://t.co/7vhK0b3o7B
10) 👉What’s more than this is that #SGLT2i may delay the progression to dialysis by nearly 13 years❗️(based on data from the #CREDENCE trial)
— @CKD_ce (@ckd_ce) August 23, 2022
🔓https://t.co/FPNzM8eYlA pic.twitter.com/ApR42WZTlL
12) So ideal treatments should also ⤵️ adverse cardiovascular events as well as ⤵️ adverse kidney outcomes pic.twitter.com/xAZmxzyVk3
— @CKD_ce (@ckd_ce) August 23, 2022
14) Perhaps the major change in the ADA-KDIGO joint statement is the inclusion of mineralocorticoid antagonists (#MRA)
— @CKD_ce (@ckd_ce) August 23, 2022
📍steroidal MRA (e.g. #spironolactone) for hypertension
or
📍non-steroidal MRA (e.g. #finerenone) for persistent albuminuria despite RAS blockade and #SGLT2i pic.twitter.com/rW5yXdk4Wx
16) So we now do have three pillars of slowing #DKD progression & reducing adverse cardiovascular outcomes:
— @CKD_ce (@ckd_ce) August 23, 2022
1️⃣Renin-Angiotensin Blockade
2️⃣ SGLT2 Inhibition
3️⃣non-steroidal MRA@BakrisGeorge at #ADA2022: https://t.co/7vhK0b3o7B pic.twitter.com/0n5UByQbIS
17b) See 🔓https://t.co/8xVrDnq1Sl
— @CKD_ce (@ckd_ce) August 23, 2022
&
🔓https://t.co/xptXYtwNjb pic.twitter.com/LfLs6mbEO1
19a) ⚠️Use of #RASi + #MRAs brings with it an ⤴️risk of #hyperkalaemia.
— @CKD_ce (@ckd_ce) August 23, 2022
📍Although ns-MRA, like #finerenone, have a much lower risk of hyperkalaemia than steroidal MRA’s
📍Finerenone was assoc. with ⤴️ discontinuation due to hyperkalaemia in the FIDELIO-DKD trial (2.3 vs 0.9%)
20a) Can #SGLT2i ⤵️ #hyperkalaemia risk❓
— @CKD_ce (@ckd_ce) August 23, 2022
📍SGLT2i ⤴️ distal 🧂 & water delivery, ⤴️ electronegative charge in the tubular lumen that regulates potassium excretion in the distal nephron
📍glycosuria may also ⤴️ potassium excretion
📍SGLT2i ⤴️ aldosterone so ⤵️ serum potassium
22) And more #ADA2022:
— @CKD_ce (@ckd_ce) August 23, 2022
👉Post hoc safety analysis by @brendonneuen #CREDENCE trial found #canagliflozin
⤵️ risk of composite of investigator-reported #hyperkalaemia events or initiation of K+ binders
⤵️ initiation of K+ binders 😊
⤵️ risk of K+>6mmol
🔓https://t.co/uHWAEi3ohG pic.twitter.com/LImhmB9H2M
24) So #SGLT2i may be excellent agents to help prevent #hyperkalaemia in people treated with
— @CKD_ce (@ckd_ce) August 23, 2022
📍RAS blockade ✅
and/or
📍MRA ✅
…although don’t forget you may still need to consider potassium binders‼️ pic.twitter.com/Xt090HG1Vz
26) So how are we doing here? Drinking from the firehose? Let’s make sure you’re keeping up!
— @CKD_ce (@ckd_ce) August 23, 2022
The @ADA_DiabetesPro – @goKDIGO consensus document recommends #SGLT2i are initiated above what eGFR threshold for the treatment of CKD?
Mark your best answer!
28) WELCOME BACK! We are reviewing key highlights of #ADA2022 with @drpatrickholmes of @GoggleDocs, who is focusing on new data re non-🫀 effects of #SGLT2i.
— @CKD_ce (@ckd_ce) August 24, 2022
Did you answer yesterday's quizzes (tweets 26-7)?
The correct answer for BOTH is C.
Did you score 💯 ??
Now, ONWARD!
30) Furthermore, the more you screen, the more #CKD you will find.
— @CKD_ce (@ckd_ce) August 24, 2022
Because #CKD is not only associated with risk of progressing to renal replacement therapy #RRT, but also ⬆️risk of adverse #CV events like #HeartFailure, we need a population health approach pic.twitter.com/hb5NTiRQFI
32) Are the right people prescribing #SGLT2i?
— @CKD_ce (@ckd_ce) August 24, 2022
📍SGLT2i initiation has shifted from endocrinology to us in primary care ☺️. This has to be a good thing when thinking of population health❗️
📍Initiation by cardiologists and in particular #nephrologists has to improve pic.twitter.com/jCB0uKvflx
34) At #ADA2022 @christinelimont presented more recent prescribing data on prescribing in people with #T2DM & eGFR ≥30 from #NHANES data 🇺🇸
— @CKD_ce (@ckd_ce) August 24, 2022
📍only 5.6% were taking a #SGLT2i
📍SGLT2i use didn't differ across high risk groups (CV or CKD)
📍⤵️ use in uninsured & ethnic groups 😡 pic.twitter.com/z2DEEcDpaS
36) So which of these appears NOT to be a barrier for someone being initiated on a SGLT2i?
— @CKD_ce (@ckd_ce) August 24, 2022
a. Being over 75 years of age
b. High out-of-pocket costs
c. Being of white European descent
d. Being of black African descent
Answer before you scroll ⤵️
38) Q. Can #SGLT2i help reduce the risk of Kidney stones?
— @CKD_ce (@ckd_ce) August 24, 2022
A. Could do, per poster presentation at #ADA2022‼️#CaReMe
👉SGLT2i ⤵️ kidney stones when compared to:
📍DPP4i
📍GLP-1RA
In a propensity matched cohort study: pic.twitter.com/dcLWAmbMlu
40a) Moving on to another area of growing importance in #type2diabetes, namely Non-alcoholic Liver disease (#NAFLD: for more info/credit, see https://t.co/iXHHdNl9nJ by @mcharltonmd).
— @CKD_ce (@ckd_ce) August 24, 2022
Can #SGLT2i help with this condition?
41) #SGLT2i may prevent the development of #NAFLD in #T2DM
— @CKD_ce (@ckd_ce) August 24, 2022
📍best evidence comes from a large population study in 🇬🇧
👉Compared to users of #DPP4i, SGLT2i use was assoc with a relative reduction in risk of developing NAFLD of 22%
🔓https://t.co/aIfKPKisyM pic.twitter.com/2a7GeH8YH7
43) More #ADA2022:👉#SGLT2i as a tx for #NAFLD
— @CKD_ce (@ckd_ce) August 24, 2022
📍long-term data from #EMPA_REG_OUTCOME study#Empgagliflozin assoc. with
⤵️ALT 2.22u/L at 28 wks
⤵️ALT 1.26u/L at 164 wks
⤵️greatest is highest ALT quartile
👉 ALT⤵️ independent of changes in weight/HbA1c
🔓https://t.co/iNfHshkS5Y pic.twitter.com/fH9cgHUtxv
45) So how does SGLT2i ⤵️ Liver Fat❓
— @CKD_ce (@ckd_ce) August 24, 2022
📍multiple mechanisms:
👉 Glycosuria➡️Insulin⤵️
👉⤴️ Glucagon/Insulin ratio ➡️ Ketogenesis
👉 ⤴️ Hypothalamic insulin sensitivity ➡️ Vagal nerve tone⤴️
🔓https://t.co/YzTWfRuGE4
— @CKD_ce (@ckd_ce) August 24, 2022
48) Randomised, double-blind, placebo controlled, cross-over trial
— @CKD_ce (@ckd_ce) August 24, 2022
📍Primary outcome effect on empa+ramipril on GFR vs placebo+ramipril treatment
📍each phase measured:
-GFR
-Tubular Na handling
-Arterial stiffness
-HR variability
-Cardiac output
-plasma & urine biochem pic.twitter.com/0IkmaSGKn1
50) 👉Conclusion
— @CKD_ce (@ckd_ce) August 24, 2022
David Cherney was right all along: #RAS blockade & #SGLT2i work together to restore tubuloglomerular feedback 👏👏👏
✅Consistent with protective ⤵️ intraglomerular pressure
⚠️ mechanistic study
⚠️ DKA risk with SGLT2i in #T1D high, but may ⤵️ cardiorenal risk
52) Oh yeah, you got this . . . it's D, all of the above. And with that triumph, you can go and claim your 🆓0.75h CE/#CME #physicians #physicianassociate #nurses #nursepractitioners #pharmacists pic.twitter.com/5pLImaRgsi
— @CKD_ce (@ckd_ce) August 24, 2022
53) So go to https://t.co/5JjsQJCaJ5 and claim what is yours! And FOLLOW @ckd_ce and @GoggleDocs for the latest in #cardiorenal and #cardiometabolic education! I am @drpatrickholmes, and I thank you for joining us! pic.twitter.com/lwD96QdPNt
— @CKD_ce (@ckd_ce) August 24, 2022