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. Follow this 🧵for 1⃣FULL HOUR OF 🆓 CE/#CME credit–all delivered right here on X!
— @CKD_ce (@ckd_ce) May 7, 2024
3b) Which is TRUE:
— @CKD_ce (@ckd_ce) May 7, 2024
A. SGLT2i initiation/use doesn't necessitate altering freq of CKD monitoring
B. If eGFR ⬇️on start of SGLT2i,➡️hold or d/c tx.
C. After starting SGLT2i, it's reasonable to cont SGLT2i even if KRT is initiated.
D. SGLT2i is rec'd for pts w/T1D+CKD+eGFR< 15 ml
4) So let's GO! @edgarvlermamd will review the @goKDIGOClinical Practice guideline on the Eval and Mgmt of CKD, particularly as it pertains to “Early, Optimal Management of #CKD & #Cardiorenal Disease to Prevent Disease Progression & Improve Outcomes”
— @CKD_ce (@ckd_ce) May 7, 2024
🔓 https://t.co/mk4wUPYDyi pic.twitter.com/FqClbCzBFZ
6a) @goKDIGO 2.3 Prediction of #CV risk in people w/CKD
— @CKD_ce (@ckd_ce) May 7, 2024
Practice Point 2.3.1: For CV risk prediction to guide preventive therapies in people with CKD, use externally validated models that are either developed within #CKD populations or that incorporate #eGFR and #albuminuria
6c) … that include #eGFR & #albuminuria should be used to predict CV events in people w/CKD.
— @CKD_ce (@ckd_ce) May 7, 2024
👉QRISK https://t.co/YPHSpPBrEM
👉CKD Prognosis Consortium Risk Models https://t.co/KlUbqtkS4L pic.twitter.com/AalFrB0tRy
7b) In the @goKDIGO Guideline, the term “CKD treatment and risk modification” is used to encompass the aim of CKD treatment, which is to impart meaningful beneficial effects on “CKD manifestations” and on “CKD outcomes”https://t.co/0xqphqF1A9 pic.twitter.com/5aIq3zN1AU
— @CKD_ce (@ckd_ce) May 7, 2024
8b) Referral to providers/programs (psychologists, renal dietitians or accredited nutritionists, pharmacists, physical & occupational tx, 🚭programs) should be offered where indicated & available#VisualGraphic by @Dilushiwijayhttps://t.co/tyOXwKWfm5https://t.co/BnrmRE2WMB pic.twitter.com/hV2Y4SIrwN
— @CKD_ce (@ckd_ce) May 7, 2024
10) @goKDIGO 3.2.2 Physical activity & optimum weight
— @CKD_ce (@ckd_ce) May 7, 2024
Rec 3.2.2.1: We rec ppl w/#CKD be advised ➡️ moderate-intensity physical activity for a cumulative duration of at least 150 min/wk, or to a level compatible with their CV & physical tolerance (1D)https://t.co/tyOXwKWfm5 pic.twitter.com/T62H245X4a
11b) In 119 countries (88.3% of the world’s adult population), the national intake of sodium exceeded this amount by > 1 gram per dayhttps://t.co/mMvXVizKwn pic.twitter.com/ccW0nw4C6c
— @CKD_ce (@ckd_ce) May 7, 2024
12a) @goKDIGO 3.4 Blood pressure control
— @CKD_ce (@ckd_ce) May 7, 2024
Recommendation 3.4.1: Adults with high BP & CKD should be treated with a target systolic blood pressure (#SBP) of < 120 mm Hg, when tolerated, using standardized office BP measurement (2B)#VisualGraphic from @Dilushiwijay @NephJC #NephJC pic.twitter.com/9K1S8Zi4s1
12c) … reduces cardiovascular events and mortality in patients with CKD by 25%–30%#VisualGraphic from @Dilushiwijay@NephJC #Nephpearls
— @CKD_ce (@ckd_ce) May 7, 2024
🔓 https://t.co/7w1jE6zpZ6 pic.twitter.com/MfwD6ssPKS
13b) Out-of-office #BP measurements (ambulatory or home BP monitoring) are rec'd to complement standardized office BP readings for mgmt of #htn.
— @CKD_ce (@ckd_ce) May 7, 2024
14) @goKDIGO 3.6 Renin-angiotensin system inhibitors
— @CKD_ce (@ckd_ce) May 7, 2024
Recommendation 3.6.1: We rec starting renin-angiotensin-system inhibitors (#RASi) (#ACEi or ARB) for people with #CKD and severely increased #albuminuria (G1–G4, A3) without #diabetes (1B) pic.twitter.com/4kVnHt92zG
16) @goKDIGO Recommendation 3.6.3:
— @CKD_ce (@ckd_ce) May 7, 2024
KDIGO recommends starting #RASi (ACEi or #ARB) for people with #CKD and moderately-to severely increased #albuminuria (G1–G4, A2 and A3) with diabetes (1B)#VisualGraphic from @Dilushiwijay@NephJC #Nephpearls
🔓 https://t.co/BnrmRE2WMB pic.twitter.com/JlhnKFT6IV
18) @goKDIGO Practice Point 3.6.1:#RASi (ACEi or ARB) should be administered using the highest approved dose that is tolerated to achieve the benefits described; proven benefits were achieved in trials using these doseshttps://t.co/OQr27tJaHe
— @CKD_ce (@ckd_ce) May 7, 2024
20) @goKDIGO Practice Point 3.6.3#Hyperkalemia associated with use of #RASi can often be managed by measures to ⬇️ the serum K+ levels rather than ⬇️the dose or 🛑RASi
— @CKD_ce (@ckd_ce) May 7, 2024
🔓 https://t.co/7YuNqL8VjZ
🔓 https://t.co/OQr27tJaHe pic.twitter.com/jdjVo3Z9yk
22) @goKDIGO Practice Point 3.6.5
— @CKD_ce (@ckd_ce) May 7, 2024
Consider reducing the dose or discontinuing #ACEi or #ARB in the setting of either symptomatic hypotension or uncontrolled hyperK+ despite medical treatment, or to reduce uremic symptoms while treating kidney failure (eGFR <15 mL/min/1.73 m2)
24a) @goKIDIGO 3.7 Sodium-glucose cotransporter-2 inhibitors (#SGLT2i)
— @CKD_ce (@ckd_ce) May 7, 2024
Some of the trials that support the use of SGLT2i in this population are:#CREDENCE
🔓https://t.co/T8y8ERXbrJ#DAPA_CKD
🔓https://t.co/XS7XmyrYmi#EMPA_KIDNEY
🔓https://t.co/giaP2yFpxJ
25) @goKDIGO Recommendation 3.7.1
— @CKD_ce (@ckd_ce) May 7, 2024
KDIGO recommends treating patients with #T2D, #CKD, and an #eGFR ≥20 ml/ min per 1.73 m2 with an #SGLT2i (1A) pic.twitter.com/HBJIBWPHcj
27) @goKDIGO Practice Point 3.7.2
— @CKD_ce (@ckd_ce) May 7, 2024
It is reasonable to withhold #SGLT2i during times of prolonged fasting, surgery, or critical medical illness (when people may be at greater risk for ketosis)
🔓 https://t.co/Ayz8CewwGX
🔓 https://t.co/Eqjiw7I8V8 pic.twitter.com/whNeDcZkrm
29) @goKDIGO Recommendation 3.7.3
— @CKD_ce (@ckd_ce) May 7, 2024
KDIGO suggests treating adults with #eGFR 20 to 45 ml/min per 1.73 m2 with urine #ACR <200 mg/g (<20 mg/mmol) with an #SGLT2i (2B) pic.twitter.com/30ihz7hICq
31) @KDIGO Recommendation 3.8 Mineralocorticoid receptor antagonists (MRA)
— @CKD_ce (@ckd_ce) May 7, 2024
Two trials that support the use of #MRA in this population are:#FIDELIO_DKD
🔓 https://t.co/hpuUIH51cM#FIGARO_DKD
🔓 https://t.co/fZrVUNMEKq#VisualAbstract by @whatsthegfr #Nephpearls pic.twitter.com/kH6wDxQ3tw
33) @goKDIGO Practice Point 3.8.1
— @CKD_ce (@ckd_ce) May 7, 2024
Nonsteroidal #MRA best for adults w/ #T2D at ⬆️ risk of #CKD progression & #CV events, as demo'd by persistent #albuminuria despite other SOC tx.
3.8.2: A nonsteroidal #MRA may be added to a #RASi and an #SGLT2i for tx of T2D & CKD in adults
35) @goKDIGO Practice Point 3.8.4
— @CKD_ce (@ckd_ce) May 7, 2024
The choice of a #nonsteroidal #MRA should prioritize agents with documented #kidney or #cardiovascular benefits
See 🔓 https://t.co/VpgdH4J1y9 pic.twitter.com/TdpFyeiZHU
37) @go KDIGO 3.15 Cardiovascular disease (#CVD) and additional specific interventions to modify risk
— @CKD_ce (@ckd_ce) May 7, 2024
3.15.1 Lipid management
Artwork by @medcomic pic.twitter.com/x87zKuVvcd
39) @goKDIGO Recommendation 3.15.1.2
— @CKD_ce (@ckd_ce) May 7, 2024
In adults aged ≥50 years with CKD and #eGFR ≥60 ml/min per 1.73 m2 (GFR categories G1–G2), KDIGO recommends treatment with a #statin (1B)
41) @goKDIGO Practice Point 3.15.1.1
— @CKD_ce (@ckd_ce) May 7, 2024
Estimate 10-year #cardiovascular risk using a validated risk tool. See 🔓 https://t.co/uxLqMuQiQF for reference
43) @goKDIGO Practice Point 3.15.1.3
— @CKD_ce (@ckd_ce) May 7, 2024
In adults with #CKD aged 18–49, a lower (i.e., <10% estimated 10-year incidence of #coronary death or nonfatal #MI may also be appropriate thresholds for initiation of #statin-based therapy
45) Dietary approaches: @goKDIGO Practice Point 3.15.1.5
— @CKD_ce (@ckd_ce) May 7, 2024
Consider a plant-based “Mediterranean-style” diet in addition to #lipid-modifying therapy to reduce #cardiovascular risk
🔓 https://t.co/IcR85YyVY2 pic.twitter.com/jAiZFQz0ZO
47) @goKDIGO Practice Point 3.15.2.1
— @CKD_ce (@ckd_ce) May 7, 2024
Consider other antiplatelet therapy (e.g., #P2Y12 inhibitors) when there is #aspirin intolerance.
49) @goKDIGO Practice Point 3.15.3.1
— @CKD_ce (@ckd_ce) May 7, 2024
Initial mgmt w/invasive strategy may still be better for ppl w/ CKD with acute/unstable #CAD, unacceptable #angina sx, #LVsystolic dysfunction due to ischemia, or left main disease#VisualAbstract from @agrawalkri @NephJC #Nephpearls pic.twitter.com/pj3aa4cUsx
51) Recommendation 3.16.1
— @CKD_ce (@ckd_ce) May 7, 2024
KDIGO recommends use of non–vitamin K antagonist oral anticoagulants (#NOACs or #DOACs) in preference to vitamin K antagonists #VKA (e.g., #warfarin) for #thromboprophylaxis in #Afib in people with #CKD G1–G4 (1C)
53) @goKDIGO Practice Point 3.16.3
— @CKD_ce (@ckd_ce) May 7, 2024
Duration of #NOAC discontinuation before elective procedures needs to consider procedural bleeding risk, NOAC prescribed, and level of #GFR
🔓 https://t.co/0xqphqF1A9 pic.twitter.com/FwnScn8grP
54b) 👉target #SBP to <120 mm Hg
— @CKD_ce (@ckd_ce) May 7, 2024
👉 #RASi important to initiate early
👉 #SGLT2i therapy is supported in #CKD
👉 #nonsteroidal #MRA preferred over steroidal, & may be added to a #RASi and an #SGLT2i for tx of T2D & CKD in adults
55a) So we have just one remaining order of business . . . remember those questions back ⤴️ in posts 3b and 3c? So here's what you have learned. BE PROUD. pic.twitter.com/JZ5RqxJFNi
— @CKD_ce (@ckd_ce) May 7, 2024
55c) #SGLT2i initiation or use does not necessitate alteration of frequency of CKD monitoring and the reversible decrease in eGFR on initiation is generally not an indication to discontinue therapy.
— @CKD_ce (@ckd_ce) May 7, 2024
55e) To mitigate risk of #hyperkalemia, select people with consistently normal serum potassium concentration and monitor serum potassium regularly after initiation of a #nonsteroidal #MRA
— @CKD_ce (@ckd_ce) May 7, 2024
56) And that's it! You just earned 1⃣ hour 🆓 CE/#CME credit! Claim your certificate at https://t.co/9vEQnbKrXO and FOLLOW US for more #MedEd delivered wholly on X. Thanks as always to our faculty @edgarvlermamd !! And THANK YOU for joining us.
— @CKD_ce (@ckd_ce) May 7, 2024