2) Dr. Mohsen is also Ambassador for Africa in Tele-Cardiology Working group (ISfTeH) and is author of the book, Tips and Tricks in Cardiology. This program is accredited for 0.75 h credit for #physicians #physicianassociates #nursepractitioners #nurses #pharmacists.
— @CKD_ce (@ckd_ce) May 25, 2022
4) #Cardiovascular disease in patients with #CKD is more frequent, more severe, & has different manifestations compared w/ the non-CKD population➡️high economic & societal burden. pic.twitter.com/MM2cCmNIzQ
— @CKD_ce (@ckd_ce) May 25, 2022
6) … sudden cardiac death, cardiac valve disease, arterial calcification, and hemorrhagic stroke. Either ischemic or non-ischemic cardiac diseases present in CKD patients are characterized by evolving to chronic congestive heart failure (HF) (i.e., cardiorenal syndrome type 4). pic.twitter.com/xBkYmhwbcw
— @CKD_ce (@ckd_ce) May 25, 2022
8) No doubt, combo of CKD & HF is a growing health, economical & societal problem as the aging population ➡️⬆️numbers of affected ppl. Pts w/both #CKD & and #HF experience unacceptably high rates of symptom load, hospitalization, & mortality. pic.twitter.com/u86agOhqCi
— @CKD_ce (@ckd_ce) May 25, 2022
10) So now let’s establish some definitions so that we are all speaking in the same terms. First, #heartfailure, from 🔓https://t.co/mga5W5ts4Z: pic.twitter.com/Any6Q1Vxa3
— @CKD_ce (@ckd_ce) May 25, 2022
12) The latter markers include albuminuria, urine sediment abnormalities, histological, or structural abnormalities.
— @CKD_ce (@ckd_ce) May 25, 2022
And #CKD is graded in stages, allowing us to know that we are comparing 🍎to 🍎: pic.twitter.com/nM5XWiwhsb
14) Different databases tell us different numbers, but the best answer is ~ 30-60 percent. In a systematic review of 16 studies of > 80,000 hosp and non-hosp pts with HF, moderate to severe kidney impairment (eGFR < 53 mL/min, serum creat > 1.5 mg/dL+, or … pic.twitter.com/yL6ripm49u
— @CKD_ce (@ckd_ce) May 25, 2022
16) In ADHERE, mean eGFR was 55 mL/min per m2, & only 9% had normal eGFR (defined as at least 90 mL/min per 1.73 m2). In addition to these baseline observations, pts under tx for acute or chronic #HF frequently develop⬆️serum creat, fulfilling criteria for type 1 or type 2 #CRS. pic.twitter.com/AGp9IzUdqk
— @CKD_ce (@ckd_ce) May 25, 2022
18) It’s d, prior history of HF or diabetes & uncontrolled #hypertension, and also an admission serum creatinine of 1.5 mg/dL or higher. The⬆️in serum creat usually occurs in the first 3-5 days of hospitalization. It is known that 1/2 – 2/3 of pts w/HF present with eGFR < 60, …
— @CKD_ce (@ckd_ce) May 25, 2022
20) Per the US Renal Data System (🔓https://t.co/FzeMI6TsM7), in 2016, the prevalence of #HF in #CKD pts aged 65 and older was 26%, compared to only 6% among pts without CKD.
— @CKD_ce (@ckd_ce) May 25, 2022
22) So we have been drinking from the firehose here . . . let’s take a break. PLEASE RETURN TOMORROW for more education on the looming dual epidemics of #CKD and #HF! Nods to @ValleAlfonso @GoggleDocs @mvaduganathan @SantosGallegoMD @gcfmd @BiykemB @kevin_damman @P_Rossing pic.twitter.com/Im1ugYPxwN
— @CKD_ce (@ckd_ce) May 25, 2022
24) Whereas the worldwide incidence of de novo #HF in the general population does not exceed 1%, the incidence in known #CKD is ~ 17% – 21%. Bad things go together!
— @CKD_ce (@ckd_ce) May 26, 2022
🔓https://t.co/Q0W74MPO0i
🔓https://t.co/f4nDWuvxlQ pic.twitter.com/ZOWxxNbEl1
26) In addition, through its effect as a left-to-right extracardiac shunt, the arteriovenous fistula can increase cardiac workload substantially, & in some pts ➡️high-output state & resultant HF over time.
— @CKD_ce (@ckd_ce) May 26, 2022
🔓https://t.co/TonSFnw7aAhttps://t.co/eg9Zb4DqC9https://t.co/zNx3iRyoSA pic.twitter.com/HX7JWG594s
28) Over 2y, pts w/ both CKD+HF had adjusted survival probability of 77.8%, vs 90.2% for those with CKD alone, & 93.7% for those without or CKD. 🔓https://t.co/FzeMI6TsM7. For which was #CKD more strongly associated with mortality & more prognostic discrimination?
— @CKD_ce (@ckd_ce) May 26, 2022
30) So what about diagnosing structural 🫀disease (such as #LVH) in pts w/ #CKD? Structural heart disease is highly prevalent in patients with CKD, the prevalence increasing progressively with the loss of renal function and thus is present in > 80% of patients with ESRD. pic.twitter.com/fhZ4Bi6AvS
— @CKD_ce (@ckd_ce) May 26, 2022
32) So that's #echo. What about lab values? How do we interpret #Natriuretic_Peptide (NP) levels in pts w/ #CKD?
— @CKD_ce (@ckd_ce) May 26, 2022
CKD is one among the numerous causes of elevated NPs that may weaken their diagnostic utility in HF. See 🔓https://t.co/pFgQYPx5HB.
34) Indeed, 2 recent studies➡️pts w/advanced #CKD + #HF w/⬆️#BNP have very low #neprilysin activity & postulated that BNP is a potent endogenous neprilysin inhibitor. See 🔓https://t.co/KRyexutmr8 & 🔓https://t.co/HCiaLBzSyu. pic.twitter.com/7eUdQn6sfn
— @CKD_ce (@ckd_ce) May 26, 2022
36) For BNP, effect of renal dysfunction overall is smaller, & ⬆️the rule-out cut-off to 200 pg/mL rather than 100 pg/mL seems sufficient. Due to incomplete data, NP testing for #HF should be discouraged in pts on dialysis.
— @CKD_ce (@ckd_ce) May 26, 2022
🔓https://t.co/H72LNIvBdm
🔓https://t.co/dVyEsHYj36
38) Now let's wind down this #tweetorial–and get to your CE/#CME credit grab, with a review of best management of #heartfailure in patients with #CKD.
— @CKD_ce (@ckd_ce) May 26, 2022
🔓https://t.co/gggEQWRW2F; https://t.co/2FHzbF9Kh3; https://t.co/gbgEpFyWbF pic.twitter.com/M4kjxyVZua
40) Re Angiotensin receptor and neprilysin inhibitor (#ARNI), mineralocorticoid receptor antagonists (BONUS: for more CE/CME, go to https://t.co/5bNr9FNSZL), beta blockers, & #ivabradine: pic.twitter.com/v0BMJx0MES
— @CKD_ce (@ckd_ce) May 26, 2022
42) Finally, re diuretics in pts with #HF and #CKD: pic.twitter.com/9xutiO8fY6
— @CKD_ce (@ckd_ce) May 26, 2022
43) And so, you MADE IT! You're READY for the coming epidemics of #HF & #CKD! Go to https://t.co/zasnZ9RmTL & claim your credit: #physicians #physicianassociates #pharmacists #nurses #nursepractitioners. I am @drahmedmohsen85. FOLLOW US for more expert-led CE/#CME programs! pic.twitter.com/5Fl8O0TzVS
— @CKD_ce (@ckd_ce) May 26, 2022