1b) Our topic for🆓CE/#CME : #Obesity and #CKD!#MedTwitter #nephtwitter @ISNkidneycare #FOAMed— @CKD_ce (@ckd_ce) November 15, 2023
Follow this 🧵 for 0.5hr 🆓CE/#CME, and follow @ckd_ce for your #MedEd needs in #nephrology–without ever having to leave X !
3) In 2010 #obesity was associated with 3.4 million deaths & accounted for 3.9% of years of life lost worldwide. This trend has only worsened, and currently, about 13% of adults worldwide are considered obese, with another 39% of adults categorized as overweight. pic.twitter.com/9qZjt6TEIz— @CKD_ce (@ckd_ce) November 15, 2023
6a) #CKD & #Obesity— @CKD_ce (@ckd_ce) November 15, 2023
⬆️ obesity rates result from the complex interplay of genetic, environmental, behavioral, & societal factors.
In #nephrology, understanding the intricate relationship between obesity & kidney health is a priority for disease management & patient well-being.
7) CKD & Obesity— @CKD_ce (@ckd_ce) November 15, 2023
Studies indicate a strong association between #obesity & the development and progression of #CKD.
⬆️ risk of incident CKD in individuals with a ⬆️ body mass index (#BMI).
Additionally, 1 of 3 cases of CKD in the US may be attributable to obesity.
9a) Which of the following patterns are associated with worse outcomes in patients with #CKD undergoing weight loss:— @CKD_ce (@ckd_ce) November 15, 2023
a. Steep BMI ⬇️
b. Early ⬇️ albumin
c. Late ⬆️BP
d. All of the above
10b) #Lifestyle— @CKD_ce (@ckd_ce) November 15, 2023
Without further intervention, lifestyle modification alone typically results in regaining 1/3 of lost weight in the following year, with continued weight gain thereafter.
Most report that maintaining weight loss is far less rewarding than losing weight.
12a) When prescribing exercise for patients with #CKD/#ESKD, you should recommend:— @CKD_ce (@ckd_ce) November 15, 2023
a. Perform 90 min rigorously daily
b. Never exercise at #HD
c. Build exercise into daily activity
d. Avoid weightlifting🏋️
14a) #Medications:— @CKD_ce (@ckd_ce) November 15, 2023
A meticulous approach is necessary, given the altered #pharmacokinetics, potential interactions, & safety profiles associated with #CKD.
A personalized approach is essential, considering individual comorbidities, concurrent medications, & CKD stage. pic.twitter.com/tJh1R1mZ4o
14c) #Incretins:— @CKD_ce (@ckd_ce) November 15, 2023
Glucagon-like peptide-1 receptor agonists (#GLP_1RA) & Gastric Inhibitory Peptide (#GIP) are part of a class of drugs known as #incretins.
When considering weight loss pharmacotx in pts with CKD, incretin-based medications can be considered first-line therapy.
14e) #Incretins— @CKD_ce (@ckd_ce) November 15, 2023
A meta-analysis of 8 trials found that GLP-1s ⬇️ MACE by 14% and a composite kidney outcome (including #albuminuria ≥ 300 mg/g) by 21%.
The beneficial effects on #MACE were similar among patients with and without #CKD.
15a) Surgery:— @CKD_ce (@ckd_ce) November 15, 2023
For patients with severe #obesity who have not responded to lifestyle modifications or medical therapy.
May ⬆️ the complexity of managing nutritional and electrolyte disorders in #CKD/#ESKD.
15b) Surgery:— @CKD_ce (@ckd_ce) November 15, 2023
Used extensively to get to a goal #BMI prior to #transplantation.
Observational cohort data suggests surgery resulted in significant improvements for up to 3 y in #eGFRs for patients with stage 3 & 4 #CKD.
The absolute rates of postoperative complications were low. pic.twitter.com/5yAH4xJs7W
17) You just earned 0.5hr 🆓CE/CME! Claim your certificate now at https://t.co/ntTproOpQs and share this #tweetorial with your followers and friends! Thanks to @brian_rifkin for authoring!#FOAMed #nephtwitter @ISNkidneycare @KIReports @goKDIGO @MedTeetorials— @CKD_ce (@ckd_ce) November 15, 2023