2) The program is intended for #HCPs & is supported by an independent educational grant from Bayer. Statement of accreditation and faculty disclosures at https://t.co/PHlIppl6Yw.
— @CKD_ce (@ckd_ce) April 3, 2024
Follow this π§΅for 0.75hr π CE/#CME credit–all delivered right here on X!
4) Let us extend this metaphor into #cardiorenal physiology and disease by looking at the cross talk between the heart and the kidneys
— @CKD_ce (@ckd_ce) April 3, 2024
π https://t.co/TTY6SuZiRs pic.twitter.com/ttjom9u5it
5b) He further postulated that the final composition of the urine is the result of resorption processes taking place in the renal tubuli located downstream of the renal glomeruli
— @CKD_ce (@ckd_ce) April 3, 2024
5d) His work was published at a time when the physiological role of the kidneys was still being debated
— @CKD_ce (@ckd_ce) April 3, 2024
At that time, a natural force (rather than #bloodpressure) was thought to be the driving force for urine production
π https://t.co/ugw4B6ivmP pic.twitter.com/0LqPSRFmKq
6b) Likewise, as a result of less glomerular filtration, the ensuing hypervolemia may lead to acute heart failure or aggravate a chronic heart failure (#CHF) condition
— @CKD_ce (@ckd_ce) April 3, 2024
Thus, the heart and kidneys are both functionally dependent on each other
π https://t.co/ugw4B6hXxh
7b) Guyton contributed physiological research on the role of the peripheral circulation to blood pressure regulation, which, in turn, affects kidney function
— @CKD_ce (@ckd_ce) April 3, 2024
π https://t.co/TXH3wYKmct pic.twitter.com/LPAM0QZgWk
7d) Thus, Carl Ludwigβs work laid the basis for further research on the autonomic control of circulation
— @CKD_ce (@ckd_ce) April 3, 2024
π https://t.co/ugw4B6hXxh pic.twitter.com/8csbVJh5qa
8b) And our understanding of the bi-directional links between cardiac and kidney function has expanded significantly since then pic.twitter.com/VxtHMHFsYZ
— @CKD_ce (@ckd_ce) April 3, 2024
9b) Although this classification has been of great value for awareness for researchers & clinicians, as well as the ID of pts, it is based largely on expert opinion. Data to support the distinction based on pathophys, tx, & prognosis are limited.
— @CKD_ce (@ckd_ce) April 3, 2024
π https://t.co/OxVR0bdBQj
10a) Since the early 2000s, the definition of #cardiorenal syndrome #CRS has evolvedhttps://t.co/DPHmnU1aJD pic.twitter.com/vXwbOjitz4
— @CKD_ce (@ckd_ce) April 3, 2024
10c) #Kidney dysfunction in heart failure is now also thought to develop as a result of reduced cardiac output, which results in increased cardiac congestion, increased right atrial pressure, and increased central venous pressure
— @CKD_ce (@ckd_ce) April 3, 2024
11a) The regulation of cardiac and kidney function involves a complex interplay between (neuro)hormones, sympathetic nervous activity, and filling statushttps://t.co/qbJ5FMk4dA
— @CKD_ce (@ckd_ce) April 3, 2024
11c) Increased sympathetic nervous activity can further enhance #RAAS-mediated fluid overload and increase systemic vasoconstriction#VisualArt by @medcomic pic.twitter.com/MB3rcUECzD
— @CKD_ce (@ckd_ce) April 3, 2024
12b) Cardiac and kidney dysfunction can be further accelerated by the presence of cardio-renal #anemia, which can be triggered by reductions in hemoglobin, iron, #fetuin A and renal erythropoietin (#EPO), . . .
— @CKD_ce (@ckd_ce) April 3, 2024
12d) In a set of complex dynamic control systems, hyperphosphatemia can result in both the increased production of parathyroid hormone (#PTH) and/or fibroblast growth factor 23 (#FGF_23)
— @CKD_ce (@ckd_ce) April 3, 2024
13) Going back to our canary in the coal mine metaphor, what can we use as our canary to warn us of danger ahead?
— @CKD_ce (@ckd_ce) April 3, 2024
This table shows the associations of #albuminuria with #cardiovascular disease #Nephpearls #Cardiorenal
π https://t.co/vkyazZNbKq pic.twitter.com/oHVu7Ze294
14b) The physiologic role of albumin is to maintain plasma oncotic pressure & to transport various endogenous & exogenous ligands through the bloodstream to target cells
— @CKD_ce (@ckd_ce) April 3, 2024
14d) Albuminuria involves structural damage in the glomerulus, which is associated with an increased risk for undesirable cardiovascular and kidney outcomes
— @CKD_ce (@ckd_ce) April 3, 2024
π https://t.co/vkyazZNbKq pic.twitter.com/ibssD1cXtl
15b) . . . because of the shared pathological processes with #CKD and because of compensatory mechanisms in chronic #cardiovascular disease #Nephpearls #Cardiorenal
— @CKD_ce (@ckd_ce) April 3, 2024
π https://t.co/vkyazZNbKq pic.twitter.com/Mv4etS2KDC
16b) In the @goKDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of #CKD, clinical terminology was changed to focus on #albuminuria rather than #proteinuria as albumin is the principal component of urinary protein in most kidney diseases
— @CKD_ce (@ckd_ce) April 3, 2024
16d) In addition, assays to measure #albumin are more precise & sensitive than those used to measure urine protein
— @CKD_ce (@ckd_ce) April 3, 2024
π https://t.co/ew2fSY7DMq#VisualAbstract by @AnnaGaddy pic.twitter.com/3g5rjafyEE
17b) It is also important to recognize that there are factors causing biological variation in urine albumin or urine protein, thereby significantly affecting the interpretation of these tests in certain circumstances #Nephpearls #Cardiorenal
— @CKD_ce (@ckd_ce) April 3, 2024
π https://t.co/0xqphqF1A9 pic.twitter.com/QeeCA95Dx8
18b) There are several methods to detect albuminuria in daily clinical practice
— @CKD_ce (@ckd_ce) April 3, 2024
Studies examining the diagnostic accuracy of tests to quantify urine #albumin and other proteins usually compare tests with laboratory quantification from 24-hour urine collections
18d) Because #creatinine excretion in the urine is fairly constant throughout the 24 hour period, the measurement of ACR (or PCR) allows correction for variations in urinary concentration
— @CKD_ce (@ckd_ce) April 3, 2024
ACR is a suitable alternative to timed measurement of urine albumin loss
18f) The numeric equivalence of #ACR in mg/g (mg/mmol) to approximately g/d is based on the simple assumption that creatinine excretion rate (CER) approximates 1 gram/d (10 mmol/d)
— @CKD_ce (@ckd_ce) April 3, 2024
18h) Use of urinary albumin measurement as the preferred test for proteinuria detection will improve the sensitivity, quality, and consistency of approach to the early detection and management of kidney disease
— @CKD_ce (@ckd_ce) April 3, 2024
19a) Elevated levels of urine albumin are one of the earliest signs of #CKD and damage of the kidney microvasculature
— @CKD_ce (@ckd_ce) April 3, 2024
19c) Several guidelines recommend screening for #albuminuria @goKDIGO @ACCinTouch @American_Heart @ISHBP @AmDiabetesAssn #Nephpearls #Cardiorenal
— @CKD_ce (@ckd_ce) April 3, 2024
π https://t.co/vkyazZNbKq pic.twitter.com/XzTvD58gsx
20) Despite this however, there are factors that have been identified that contribute to low albuminuria testing rates
— @CKD_ce (@ckd_ce) April 3, 2024
π https://t.co/vkyazZNbKq pic.twitter.com/dtfjk9TQ5D
22a) There is significant emphasis on the importance of detecting CKD, and considerations for the optimal methods for staging of CKD, and how to establish chronicity and etiology
— @CKD_ce (@ckd_ce) April 3, 2024
π https://t.co/0xqphqF1A9 pic.twitter.com/pTqH83zE9q
22c) Early detection of any chronic disease, including #CKD, provides greater opportunities to reduce morbidity as treatments can be initiated earlier in the disease course
— @CKD_ce (@ckd_ce) April 3, 2024
23a) Practice Point 1.1.1.2 from @goKDIGO: Following incidental detection of elevated urinary albumin-to-creatinine ratio (#ACR), #hematuria, or low estimated GFR (#eGFR), repeat tests to confirm presence of CKD
— @CKD_ce (@ckd_ce) April 3, 2024
π https://t.co/0xqphqF1A9
23c) Monitoring #CKD through the surveillance of #albuminuria and #GFR serves to update staging for prognosis, identify timing of intervention strategies, and assess the effectiveness of specific treatments
— @CKD_ce (@ckd_ce) April 3, 2024
24a) Practice Point 2.1.2 from @goKDIGO: Assess #albuminuria and #GFR more often for individuals at higher risk of #CKD progression when measurement will impact therapeutic decisions
— @CKD_ce (@ckd_ce) April 3, 2024
24c In addition, progression risk may vary by the etiology of CKD within a specific stage based on GFR and albuminuria or proteinuria
— @CKD_ce (@ckd_ce) April 3, 2024
π https://t.co/0xqphqF1A9 pic.twitter.com/dMJPR5QzW7
25b) Small fluctuations in #albuminuria or #proteinuria levels may not indicate disease progression
— @CKD_ce (@ckd_ce) April 3, 2024
Appreciation of factors that impact albuminuria and changes in the measure is also important for healthcare providers
π https://t.co/0xqphqF1A9 pic.twitter.com/E2aGmgvHqx
26b) However, changes in albuminuria within an individual have substantial variability, with large fluctuations expected given that the 95% CI around repeat ACR testing is approximately 50%
— @CKD_ce (@ckd_ce) April 3, 2024
26d) Conversely, reductions of the ACR by up to 50% are also consistent with random fluctuation
— @CKD_ce (@ckd_ce) April 3, 2024
π https://t.co/0xqphqF1A9 pic.twitter.com/S0R7LP7m9z
27b)
— @CKD_ce (@ckd_ce) April 3, 2024
π It is well established that there is a strong as sociation of albuminuria with several manifestations of CVD and CVD mortality
π Despite this knowledge, rates of albuminuria screening in high-risk patients, such as those with diabetes or hypertension, are low
27d)
— @CKD_ce (@ckd_ce) April 3, 2024
π Albuminuria diagnosis supports the identification of patients at risk of #CVD and #CKD and presents a crucial early opportunity to intervene with cardiorenal-protective therapy to slow disease progression and improve patient outcomes
π https://t.co/vkyazZNbKq pic.twitter.com/bhZ8JqEUzx
28a) So, what have we learned? Elevated levels of WHAT are one of the earliest signs of CKD and damage of the kidney microvasculature?
— @CKD_ce (@ckd_ce) April 3, 2024
A. Urine Albumin
B. Serum Creatinine
C. Urine pH
D. Estimated GFR (calculated by CKD-EPI equation)
28d) The following can βfalsely increaseβ albumin and protein in the urine, EXCEPT
— @CKD_ce (@ckd_ce) April 3, 2024
A. Hematuria
B. Menstruation
C. Exercise
D. None of the above
28e) Assess albuminuria in adults, or albuminuria/ proteinuria in children, & GFR at least annually in ppl with #CKD. This serves to update staging for prognosis, identify timing of intervention strategies, & assess the effectiveness of specific tx's.
— @CKD_ce (@ckd_ce) April 3, 2024
π https://t.co/0xqphqF1A9
29) So you just earned 0.75hr π CE/#CME. Claim it NOW at https://t.co/Qw7f6O2s4R and FOLLOW US so that you don't miss the next #tweetorial from @edgarvlermamd on Early, Optimal Management of #CKD and #Cardiorenal Disease to Prevent Disease Progression and Improve Outcomes! pic.twitter.com/oA1LAb0bSw
— @CKD_ce (@ckd_ce) April 3, 2024