2) This program is #accredited for CE/#CME #physicians #physicianassociates #nurses #pharmacists #nursepractitioners & is supported by an educational grant from the Boehringer Ingelheim Pharmaceuticals Inc and Eli Lilly Company. It is intended for healthcare professionals.
— @CKD_ce (@ckd_ce) October 18, 2022
4) A case to start: 50βοΈ with underlying type 2 diabetes (#T2D) and hypertension (#HTN) comes to your office for #CKD F/U. He has been diabetic for 20+ years and has #retinopathy and #neuropathy.
— @CKD_ce (@ckd_ce) October 18, 2022
He is on amlodipine, chlorthalidone, glipizide, insulin, losartan, metformin.
6) According to the @AmDiabetesAssn and @goKDIGO consensus, #SGLT2i are recommended in most patients with #T2D and #CKD with eGFR >/= 20 mL/min/1.73 m2 independent of HbA1c or the need for additional glucose lowering
— @CKD_ce (@ckd_ce) October 18, 2022
π πhttps://t.co/EGCNVK3Ej4 pic.twitter.com/JsymPSWtAX
8) These trials enrolled pts w/ #albuminuria:#CREDENCE: ACR >/=300 mg/g#DAPA_CKD: ACR >/=200 mg/g
— @CKD_ce (@ckd_ce) October 18, 2022
& showed significant benefit for composite outcomes/EPs:
π Substantial eGFR β¬οΈ
π Kidney failure
π Mortality
CREDENCE https://t.co/T8y8ERFA39
DAPA-CKD https://t.co/XS7XmyamXI
10) There is evidence from combined major #SGLT2i trials, however, suggesting that kidney and #CV benefits are consistent "irrespective of baseline #albuminuria"
— @CKD_ce (@ckd_ce) October 18, 2022
ππ https://t.co/119eoJLW0v
ππ https://t.co/Ines621Si4 pic.twitter.com/r37CkpAsDk
12) The lower limit of #eGFR for which initiation of #SGLT2i is recommended has changed over time as new data have rapidly become available pic.twitter.com/1fHfdJHo6b
— @CKD_ce (@ckd_ce) October 18, 2022
14) The @AmDiabetesAssn has also updated this threshold to >/= 20 in its living Standards of Care (from >/= 25 in the initial issue of the 2022 Standards of Care)
— @CKD_ce (@ckd_ce) October 18, 2022
ππ https://t.co/EGCNVJLv4W
16) #Empagliflozin Outcome Trials in Patients w/ Chronic HF (EMPEROR) provided clear evidence of efficacy & safety for empa in patients w/ #eGFR >/= 20 & HF#VisualAbstract by @whatsthegfr #EMPEROR_Preserved πhttps://t.co/sei2rrHpgM #EMPEROR_Reduced πhttps://t.co/w7kuOSHH4H pic.twitter.com/ApF41t5W11
— @CKD_ce (@ckd_ce) October 18, 2022
18) Evidence supporting initiation of an #SGLT2i for patients with #T2D and #eGFR 20β29 mL/min/1.73 m2 is strongest for patients with concomitant #albuminuria or #HF
— @CKD_ce (@ckd_ce) October 18, 2022
π πhttps://t.co/YB3anZ5bNV
π πhttps://t.co/GPCw41l3ay
π πhttps://t.co/119eoJLW0v pic.twitter.com/kVeDJMp6ab
20) See the areas of overlap for clinical trials with #SGLT2i in patients with #CKD
— @CKD_ce (@ckd_ce) October 18, 2022
π πhttps://t.co/hNDrpjaldo pic.twitter.com/GBnfkkI7y3
22) In the much anticipated EMPA-KIDNEY trial (The Study of Heart & Kidney Protection w/Empagliflozin), entry criteria were expanded to include nonalbuminuric CKD with an eGFR initiation threshold >/= 20 among >6,600 participants +/- T2D
— @CKD_ce (@ckd_ce) October 18, 2022
π @NDTsocial πhttps://t.co/LwfQisvHKd pic.twitter.com/PFSZzMpP21
24a) So let's pause here for a knowledge check, knowing that @nephondemand @ChristosArgyrop @Sglt2inhibitorL @HecmagsMD @sophia_kidney all know the answer . . . #FOAMed #NephTwitter @MedTweetorials
— @CKD_ce (@ckd_ce) October 18, 2022
25) Mark your response and RETURN TOMORROW for the correct answer and the remainder of this #tweetorial so that you can grab your 0.5hr πCE/#CME! See you then!!
— @CKD_ce (@ckd_ce) October 18, 2022
27) The correct answer is D–both #albuminuria & #HF. Look back up to tweet 18 for supporting references.
— @CKD_ce (@ckd_ce) October 19, 2022
And now . . . ONWARD!
Might one actually get into trouble initiating #SGLTi in pts with #T2D and #CKD?
29) Notably, protocols for both #CREDENCE & #DAPA_CKD specified continuation of study drug when eGFR fell below initiation thresholds
— @CKD_ce (@ckd_ce) October 19, 2022
π It is reasonable to continue tx if eGFR falls below initiation thresholds unless the patient is not tolerating treatment or #KRT is initiated pic.twitter.com/dkY1U3NOm8
31) Here is a practical approach to initiating #SGLT21 in patients with #T2D and #CKD
— @CKD_ce (@ckd_ce) October 19, 2022
π @CJASN πhttps://t.co/copKib4kd1 pic.twitter.com/TkQUe6pG0C
33) It is important to maintain at least low-dose #insulin & consider pausing #SGLT2i treatment during periods of acute illness
— @CKD_ce (@ckd_ce) October 19, 2022
35) Here is a nice table listing the different strategies to mitigate the adverse effects of #SGLT2i
— @CKD_ce (@ckd_ce) October 19, 2022
π πhttps://t.co/Ayz8CewwGX pic.twitter.com/TaFp5AGoDW
37) Recapping, based on strong evidence, the @AmDiabetesAssn and @goKDIGO consensus highlights that initiation of #SGLT2i is first line therapy in patients with #T2D and #CKD
— @CKD_ce (@ckd_ce) October 19, 2022
π https://t.co/EGCNVK3Ej4 pic.twitter.com/9lcwuHvU8F
39) πresource: Diabetes Management in CKD: A Consensus Report by @AmDiabetesAssn & @goKDIGO @DiabetesCareADA ca. 2022 #Nephpearls
— @CKD_ce (@ckd_ce) October 19, 2022
H/T @deboerih @gbakris @KatherineTuttl8 @P_Rossing @sylviaerosas @JoshuaNeumiller @ConnieMRhee @kamleshkhunti
ππ https://t.co/mK5rxI92tI pic.twitter.com/XokZ4tX6ud
41) It's C. Congratulations, you are ready to claim your CE/#CME certificate! Just go to https://t.co/ulYCJSmexO and don't forget to FOLLOW @ckd_ce for more #accredited #tweetorials by expert authors! It's that easy. I am @edgarvlermamd. Thank you for joining me! pic.twitter.com/rUFMDAQl0S
— @CKD_ce (@ckd_ce) October 19, 2022