2) This #accredited #tweetorial on #kidneydisease #CKD 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) January 10, 2023
4) In this #tweetorial, we will be highlighting the current evidence for a multi-disciplinary approach in slowing #CKD progression in patients with #T2D (G3aA1 – G4A3). pic.twitter.com/VlmMWoU0CO
— @CKD_ce (@ckd_ce) January 10, 2023
6) #CKD Stage 3-4 patients have ⬆️risk of #CV and all-cause mortality, especially at lower eGFR and higher albuminuria levels. Thus, present guidelines highlight therapeutic options that slow down GFR decline and decrease albuminuria.
— @CKD_ce (@ckd_ce) January 10, 2023
🔒 https://t.co/rfss5YMtEg pic.twitter.com/dL8PxsrIcj
8) The right answer is A/B! RAAS inhibition with either an ACEi or ARB is the cornerstone in the management of albuminuria in patients w/ #DM and #HTN. #RENAAL showed that losartan ⬇️risk of doubling of creatinine and ESRD.
— @CKD_ce (@ckd_ce) January 10, 2023
🔓https://t.co/MMjgBhLvFn pic.twitter.com/mbSmzmg15Q
10) How about ACE-inhibitors #ACEi? In the #ONTARGET study, there was no difference in renal outcomes between telmisartan and ramipril and this was consistent in all subgroups. Therefore, either drug class can be used
— @CKD_ce (@ckd_ce) January 10, 2023
🔒https://t.co/tYVyID2Ltj pic.twitter.com/gAuwsBg81b
12) You start your patient above on telmisartan. Remember that he had #T2D with a #UACR of 1200 mg/d. What systolic BP do you target?
— @CKD_ce (@ckd_ce) January 10, 2023
14) Do note that #SPRINT excluded patients with #T2D and #proteinuria ≥1 g/day. Intensive treatment ⬇️ #CV outcomes but had little effect on #kidney outcomes.
— @CKD_ce (@ckd_ce) January 10, 2023
🔓https://t.co/bp7SmLytW2 pic.twitter.com/JBcNyLeQ9T
16) @goKDIGO admits that the benefits of intensive #BP lowering are less certain in patients w/ #T2D and #CKD. Renoprotection is mostly seen in proteinuric subgroups.
— @CKD_ce (@ckd_ce) January 10, 2023
(open circle – lower BP target
shaded circle – usual BP target)
🔓https://t.co/WYol71hD1m pic.twitter.com/MHV5Sp0z6T
18) A ⬆️in serum #creatinine should not cause an immediate cessation of #ACEi or #ARBs. It is important to review other causes of #AKI and concomitant drugs that can ⬆️creatinine. Reduce dose or stop if mitigation strategies are ineffective. pic.twitter.com/sWRhSz92mr
— @CKD_ce (@ckd_ce) January 10, 2023
20) That’s all for part 1. Be sure to come back TOMORROW for part 2 and the rest of our discussion on #renoprotection in patients with #CKD Stage 3-4.
— @CKD_ce (@ckd_ce) January 10, 2023
👏 @brian_rifkin @AgarwalRajivMD @nephronus @edgarvlermamd @sophia_kidney @ChristosArgyrop @medtweetorials @nephondemand
22) You diagnose #T2D in a different #CKD patient with an #eGFR of 50 mL/min. His latest #HbA1c is 8.0%. What #hypoglycemic agent will you initiate?
— @CKD_ce (@ckd_ce) January 11, 2023
24) #Metformin is safe and effective for glycemic control. The overall risk for lactic acidosis is low and can safely be used for patients with an eGFR of ≥30 mL/min. A reduction in dosing to 1000 mg/daily is indicated if eGFR falls <45 mL/min. pic.twitter.com/lfST4tIbHj
— @CKD_ce (@ckd_ce) January 11, 2023
26) In #DAPA_CKD where ⅔ of patients had #T2D & had an #eGFR of 25-75 mL/min & median #UACR of 950 mg/g, #dapagliflozin reduced primary composite outcome (#ESKD, ⬇️eGFR at least 50%, CV/renal death) across all subgroups.
— @CKD_ce (@ckd_ce) January 11, 2023
🔓https://t.co/BkDuLoRsTX pic.twitter.com/ajSaqjqK1u
28) The 3 aforementioned trials combined included patients with a broad range of eGFR and UACR. In a meta-analysis of trials which enrolled T2D & CKD, #SGLT2i ⬇️kidney disease progression by 37%
— @CKD_ce (@ckd_ce) January 11, 2023
🔓https://t.co/ioHtaTRp0Z pic.twitter.com/i3nZPkR6r2
30) It is important to observe the “sick day protocol” by temporarily withholding #SGLT2i when
— @CKD_ce (@ckd_ce) January 11, 2023
⚠️In prolonged fasting
⚠️During critical illness
⚠️Prior to surgery
🔓https://t.co/1xM1RXfKq3 pic.twitter.com/X4l8XExvo8
32) Patient has #CKD G3, is relatively young w/ has severe albuminuria. Best answer is B. @goKDIGO gives a range of #HbA1c (<6.5% – <8.0%) w/ strong evidence of ⬇️CV outcomes, ⬇️progression of albuminuria &⬇️microvascular complications. The keywords are “individualized targets” pic.twitter.com/BHjzb0RjE4
— @CKD_ce (@ckd_ce) January 11, 2023
34) The right answer is D. @goKDIGO and @AmDiabetesAssn recommend #GLP1_RA as add-on therapy if individualized glycemic target is not achieved with use of metformin and #SGLT2i, or if the patient is unable to tolerate the latter two drugs. pic.twitter.com/Kjy3T5PUHo
— @CKD_ce (@ckd_ce) January 11, 2023
36) #GLP1_RA is preferred in patients with #ASCVD and metabolic risk factors. #SGLT2i on the other hand has stronger evidence on delaying #CKD progression and reducing hospitalization from HF #HHF.
— @CKD_ce (@ckd_ce) January 11, 2023
🔓https://t.co/BRoiDTDDCn pic.twitter.com/JSGIwzIhUM
38) Based on #FIDELIO_DKD and #FIGARO_DKD findings, @goKDIGO recommends #finerenone for patients with #T2D and:
— @CKD_ce (@ckd_ce) January 11, 2023
✅ eGFR ≥25 mL/min
✅ ACR ≥30 mg/g
✅ Serum K ≤4.8 mEq/L pic.twitter.com/mknBsAuTRn
40) And that's it! You can now go to https://t.co/klFYpu7h4D and claim your 🆓0.5h CE/#CME credit, and FOLLOW US here at @ckd_ce (and on @cardiomet_ce) for the best in #renal and #cardiometabolic education delivered wholly on Twitter!
— @CKD_ce (@ckd_ce) January 11, 2023
I am @hellokidneyMD. 🙏for joining! pic.twitter.com/JW38LCbTh2