2) This #accredited #tweetorial series on #kidneydisease #DKD through the lens of #T2D is supported by an independent educational grant from the Boehringer Ingelheim/Lilly Alliance and is intended for healthcare providers. Faculty disclosures are at https://t.co/PHlIppl6Yw.
β @CKD_ce (@ckd_ce) December 13, 2022
4) We must view the optimal approach to #DKD in the context of #DM as a global health crisis, affecting
β @CKD_ce (@ckd_ce) December 13, 2022
~27-31 million ppl (8.2% of US population)
~400 million ppl worldwide
πhttps://t.co/Y0C4IPkTgJ pic.twitter.com/wLpxyKdKON
6) Based on a study in 2015, the world use of kidney replacement therapy #KRT is projected to double by 2030, highlighting the #CKD disease burden and global challenges ahead. https://t.co/PtIzstKs6u pic.twitter.com/qHYuFjdhwq
β @CKD_ce (@ckd_ce) December 13, 2022
8) The combination #DM+#CKD β‘οΈindependent & additive effect on #CV risk & mortality.
β @CKD_ce (@ckd_ce) December 13, 2022
For every halving of #eGFR, CV incidence is 2x higher.
For every 10x β¬οΈin baseline urine albumin, CV event incidence is 2.5x higher.
πhttps://t.co/MQaUMeWRZR
πhttps://t.co/7qe4BJcnwi pic.twitter.com/6pIHJRfcxy
10) To get ahead of & reduce the impact #T2D and #DKD, coordinated efforts for early ID & intervention are necessary to slow disease progression. Gaps & barriers at the patient, physician, & system levels remainhttps://t.co/1V4XXC9iDo pic.twitter.com/mXwV5e26Vr
β @CKD_ce (@ckd_ce) December 13, 2022
12) An estimated 90% of patients with #DKD are undiagnosed & 40% with severe #DKD go undiagnosedhttps://t.co/1V4XXC9iDo
β @CKD_ce (@ckd_ce) December 13, 2022
14) However, CKD awareness does not by itself lead to healthy, risk reduction behaviors ie. tobacco/NSAID avoidance, exercise, ACEi/ARB use; suggesting barriers at the patient & provider levelhttps://t.co/mW43vFEwo0 https://t.co/Ea6kuODvQG pic.twitter.com/FX0uiblQPm
β @CKD_ce (@ckd_ce) December 13, 2022
16) Physicians still underprescribe proven #renoprotective meds, and overprescribe potentially harmful drugs. Below is unadjusted prevalence of prescription drugs #SGLT2i, #ACEi, #ARB, #PPI, #NSAID in CKD 3a-5
β @CKD_ce (@ckd_ce) December 13, 2022
π https://t.co/HcvVMtuhox pic.twitter.com/B93Ns502KS
18) Fortunately, there are existing and emerging, evidence-based therapies that provide new hope in management of #T2D and #DKD and possibilities an improved #DKD global trajectory pic.twitter.com/2fzeNaitqn
β @CKD_ce (@ckd_ce) December 13, 2022
20) Mark your best answer and return tomorrow for a continuation of this programβwe will focus on TEAM management! @NWiegley @kkalra_22 @ghobby @priti899 @JohnRMontford @NamrataYParikh @CharlieTomson @DiMiRenalMD @KIDNEYcon @GlomCon @MedTweetorials #FOAMed @aakashshingada
β @CKD_ce (@ckd_ce) December 13, 2022
22) The goal of #DKD treatment is three-fold:
β @CKD_ce (@ckd_ce) December 14, 2022
I. reduce concurrent or continued injury by addressing modifiable risk factors
–Glycemic control (goal A1c <7)
–Weight loss
–Smoking cessation
–BP control (goal <130/80)
–Low salt diet
πhttps://t.co/a9Npmfu71y pic.twitter.com/uxeI3HcuoU
24) The most familiar renoprotective agents in #DKD that alter glomerular hemodynamics are #RAASi agents (#ACEi & #ARBs) & #SGLT2i (& there’s ur answer for theβ in tweet 19). See https://t.co/jBnJwtNdhm & for more CE/#CME on DKD tx, spend some time at https://t.co/I1LleFSyzy. pic.twitter.com/DoJveH8cP4
β @CKD_ce (@ckd_ce) December 14, 2022
26) The emergence of #SGLT2i, #GLP-1 agonists and steroidal #MRAs have transformed the landscape of #DKD treatment, offering new therapy options and new hope.
β @CKD_ce (@ckd_ce) December 14, 2022
28) #SGLT2i are perhaps the best understood with the most diverse indications for use with some of the strongest supporting clinical data.https://t.co/765Av9PO3C
β @CKD_ce (@ckd_ce) December 14, 2022
See also (still available for CE/#CME credit) https://t.co/7Q90SSXQ8X from @willkidney pic.twitter.com/MBbtKHxi8j
30) The GLP-1 agonist #CV outcome studies summarized below revealed mixed kidney outcome results but strongly trend towards renoprotective activity through reduction in albuminuria and/OR better secondary composite kidney outcomeshttps://t.co/qi2F8od9yP pic.twitter.com/zcKp5Sqwhp
β @CKD_ce (@ckd_ce) December 14, 2022
32) Below are summaries of current and future clinical trials and evidence of albuminuria reduction vs GFR loss for #SGLT2i, #GLP-1 agonists (and #DPP4i).
β @CKD_ce (@ckd_ce) December 14, 2022
See πhttps://t.co/Eqjiw7HB5A
π https://t.co/QItZmus6m5 https://t.co/rUdAYSunRx pic.twitter.com/3YZYN9yc64
34) Letβs turn our attention to the antihypertensive therapy of mineralocorticoid receptor antagonists #MRAs pic.twitter.com/DAVkERu26M
β @CKD_ce (@ckd_ce) December 14, 2022
36) Preclinical models suggest more effective anti-inflammatory and antifibrotic activity w/nonsteroidal MRAs
β @CKD_ce (@ckd_ce) December 14, 2022
&
The anti-androgenic & progestogenic adverse effects w/steroidal #MRAs, however less apparent with eplerenone, are suboptimal . . . andhttps://t.co/eJC6CNjEv1
38) #FIDELIO-DKD, #RCT of finerenone vs placebo in CKD outcomes in #T2D vs placebo. Primary outcome: kidney failure, sustained eGFR decrease > 40% or death from any renal cause, N = 5674, favored finerenone, 17.8% event rate vs 21.1% w/placebo
β @CKD_ce (@ckd_ce) December 14, 2022
πhttps://t.co/UgvkaqDdBy pic.twitter.com/YrzkgYeWq7
40) How to reconcile gaps in #DKD care w/the promising renoprotective medications emergence?
β @CKD_ce (@ckd_ce) December 14, 2022
Through coordinated, #multidisciplinary & #interprofessional approach for early dx & tx. @katherinetuttl8 @joshuaNeumiller & Dr. Alicic have outlined strategies
πhttps://t.co/1V4XXC9iDo pic.twitter.com/jbHpG3vQk6
42) Welcome back! You’re in the home stretch as we talk about TEAM-based management of #DKD. I am @sophia_kidney reminding you there is no “I” in TEAM but there is a “T”: for education by TWEETORIAL! @ValleAlfonso @ArgaizR @DrRaymondHsu @GrahamAbra @Dilushiwijay @jaykoyner
β @CKD_ce (@ckd_ce) December 15, 2022
44) We can start by empowering providers to improve #CKD screening, recognition & management and provide resources like NKFβs CKD Change Package that provides process improvements and educational resources
β @CKD_ce (@ckd_ce) December 15, 2022
π https://t.co/pE5LgpO2Jk
46) American Society of Nephrology @ASNKidney developed the Diabetic Kidney Disease Collaborative (DKD-C), a conference where nephrologists and primary care physicians collaborate to implement new #DKD therapies
β @CKD_ce (@ckd_ce) December 15, 2022
π https://t.co/bptr7PE1PQ
48) With the significant overlap of care with #PCPs, #pharmacists, #cardiologists, #nephrologists & #endocrinologists, the stay-in-your-lane mentalities should be challenged. pic.twitter.com/zehcX8XmkW
β @CKD_ce (@ckd_ce) December 15, 2022
50) As nephrologists, we often see patients more frequently than they see their PCPs. We should begin to feel comfortable adjusting or replacing diabetes medications. pic.twitter.com/o5BiFJRtCW
β @CKD_ce (@ckd_ce) December 15, 2022
52) In one meta-analysis, multidisciplinary models lowered all-cause mortality of patients with CKD, temporary catheterization rate, hospitalization rate and slowed eGFR decline See πhttps://t.co/JPKvQVCoPf pic.twitter.com/TLfmQK3XfD
β @CKD_ce (@ckd_ce) December 15, 2022
54a) @goKDIGO compiled a βtop 10 takeawaysβ for providers summarizing the KDIGO 2020 Clinical Practice Guideline for Diabetes Management in #CKD
β @CKD_ce (@ckd_ce) December 15, 2022
πhttps://t.co/LHku5yz1Tt pic.twitter.com/xBDffVCGPf
55) Next, offering diabetes self-management programs #DSMP facilitated by health-care professionals tailored to patients with diabetes is neededhttps://t.co/DdkD1PcvN4 pic.twitter.com/szwk6KgGT7
β @CKD_ce (@ckd_ce) December 15, 2022
57) Diabetes self-management programs uptake: in the National Diabetes Audit 2013-2014 and 2014-2015, only 6.8% of privately health-insured people with #T2D attended #DSMP.
β @CKD_ce (@ckd_ce) December 15, 2022
π https://t.co/iIrgKMACfp
59) Access to #DSMP varies globally and reasons individuals do not participate are complex. https://t.co/g7JgRLbehn pic.twitter.com/MQ8WsYqmbr
β @CKD_ce (@ckd_ce) December 15, 2022
61) While barriers to #DKD management exist, they are not insurmountable. New therapies slowing progression of #DKD have given the healthcare community new hope. pic.twitter.com/K5dWkKM48c
β @CKD_ce (@ckd_ce) December 15, 2022
63) And that is IT! You made it! Go to https://t.co/uThWrIuHJy and claim your 0.75h πCE/#CME credit! And FOLLOW US here on @ckd_ce (and don't miss @cardiomet_ce) for more education by tweetorial! I am @sophia_kidney #nephtwitter #cardiotwitter #FOAMed #endotwitter
— @CKD_ce (@ckd_ce) December 15, 2022