2) This #tweetorial is supported by an unrestricted educational grant from Bayer and is intended for healthcare providers.
— @CKD_ce (@ckd_ce) April 11, 2023
4) How do we know which pts with #T2D are at risk for #CKD? @AmDiabetesAssn & @goKDIGO recently released consensus screening guidelines. Unfortunately, <50% of those with #T2D are screened for albuminuria annually.
— @CKD_ce (@ckd_ce) April 11, 2023
🔓https://t.co/mK5rxI8uEa pic.twitter.com/IQLW0IbW1z
6) Recently, Oliva-Damaso et al proposed an age-based risk strat tool for patients with #CKD. By these criteria, patients <40 should be referred to nephrology at #eGFR <60, while those ≥65 without increased #UAE may not need referral until eGFR <30.
— @CKD_ce (@ckd_ce) April 11, 2023
🔓 https://t.co/4e2o9RWOQS pic.twitter.com/BHA5yC28VV
8) Altho #ACEI/#ARB are 1st line for #HTN in #T2D, they could worsen #hyperkalemia. Carvedilol & nifedipine would also be effective but could worsen bradycardia & proteinuria, respectively. Chlorthalidone or other #thiazide is a cornerstone of tx in HTN & would be best choice.
— @CKD_ce (@ckd_ce) April 11, 2023
10) In the absence of contraindications, #ACEI OR #ARB is indicated for patients with #T2D and #CKD who also have #HTN and #proteinuria. (#IDNT #RENAAL, below)…
— @CKD_ce (@ckd_ce) April 11, 2023
🔓https://t.co/qJsCgfbbR6 pic.twitter.com/nGP1DRNYCY
12) #Hyperglycemia is the other major risk factor for #CKD progression in #T2D. The #ADA recommends a #hemoglobin A1c (#HbA1c) target of <7% for most persons with #diabetes, although <8% may be appropriate for those with life-limiting comorbidities. pic.twitter.com/qesnYtaWpc
— @CKD_ce (@ckd_ce) April 11, 2023
14) Case #2: 61♀️ with #T2D & CKD stage G3a/A2 presents with #HbA1c 7.6%. Which of the following would be the BEST initial therapy for #hyperglycemia? 🤔
— @CKD_ce (@ckd_ce) April 11, 2023
16) #SGLT2i also 1st line for glycemic control (2nd line for proteinuria) w/eGFR >20. Many clinical trials have shown improved kidney & #CV outcomes (#DAPA_CKD #EMPA_REG_OUTCOME #EMPA_KIDNEY #CANVAS #CREDENCE, below), some even in pts w/o diabetes.
— @CKD_ce (@ckd_ce) April 11, 2023
🔓https://t.co/T8y8ERXbrJ pic.twitter.com/9zuAFepLm3
18) …#SGLT2 inhibitors increase urinary glucose excretion, so may not be tolerated in patients with frequent #UTI or #yeast infection. A previous safety signal in patients with peripheral vascular disease #PVD (#CANVAS) has not been replicated.
— @CKD_ce (@ckd_ce) April 11, 2023
20) #GLP-1 agonists improve #CV outcomes such #MACE, #HF hospitalization, and #all_cause mortality; as well as kidney outcomes (mostly decreased #UAE).
— @CKD_ce (@ckd_ce) April 11, 2023
🔓 https://t.co/UtNcwbMsyh pic.twitter.com/yOgR15lKhp
22) #Finerenone, a #nonsteroidal #mineralocorticoid antagonist #MRA, improves outcomes in pts w/#T2D & #CKD (eGFR >25) & should be considered after #ACEI/ARB & #SGLT2i if #UACR >30 & K is normal (#FIGARO #FIDELIO_DKD, below).
— @CKD_ce (@ckd_ce) April 11, 2023
🔓 https://t.co/hpuUIH51cM pic.twitter.com/pLcGDiDU21
24) #Statins provide #CV benefit in #CKD stage 3-5 (#SHARP, below) but not #ESRD (#4D #AURORA).
— @CKD_ce (@ckd_ce) April 11, 2023
🔓 https://t.co/SBhJHw6V1A pic.twitter.com/NShQyMGkNG
26) All patients with #T2D and #CKD should have a comprehensive lifestyle assessment that emphasizes stopping #smoking, #exercising regularly, eating a healthy diet, and maintaining an appropriate #weight. pic.twitter.com/Tj00jUwWoq
— @CKD_ce (@ckd_ce) April 11, 2023
28) Despite our best efforts to control #hypertension, #hyperglycemia, and #proteinuria with #ACEI/#ARB, #SGLT2 inhibitors, #nonsteroidal #MRA, and the other agents above, #CKD frequently progresses. pic.twitter.com/McC19y7IwQ
— @CKD_ce (@ckd_ce) April 11, 2023
30) I hope you found this #accredited #tweetorial useful & have learned more about individualized strategies to risk-stratify, manage, & educate pts with advancing #CKD in the setting of #T2D!
— @CKD_ce (@ckd_ce) April 11, 2023
31) Now please claim your CE/#CME at https://t.co/z05npQDEv9 & FOLLOW US to learn more about this and other topics!
— @CKD_ce (@ckd_ce) April 11, 2023
🙏 I am James Novak MD PhD @JamesNovakNeph from @HenryFordHealth.@HFHNephFellow @HFHIntMedRes #Nephtwitter #Medtwitter #Medtweetorials #FOAMed