2) We welcome returning faculty Dilushi Wijayaratne @Dilushiwijay, Consultant #Nephrologist & Lecturer, & @ISNEducation #SoMe team member Colombo 🇱🇰.#FOAMed #KidneyDisease #nephtwitter
— @CKD_ce (@ckd_ce) July 9, 2024
This program received NO industry support. Faculty disclosures at https://t.co/PHlIpplEO4. pic.twitter.com/Uhxeg2Rhej
4a) Which of the following would NOT be considered one of the 4 “pillars” of optimal prevention of disease progression in #DKD?
— @CKD_ce (@ckd_ce) July 9, 2024
a. #GLP-1RA
b. #SGLT2i
c. #nonsteroidal #MRA
d. loop #diuretics
5) Let's take a closer look at #GLP1RA and their effects on the #kidney. VA by @nephromythri pic.twitter.com/Sy4R4aNQ8t
— @CKD_ce (@ckd_ce) July 9, 2024
7) The last few years have been a fascinating period for #nephrology. Lately, several agents have been proven to be effective in reducing hard #renal endpoints in #DKD (and even non-DKD).https://t.co/lDY6wUM6xF pic.twitter.com/V3U7E8uuax
— @CKD_ce (@ckd_ce) July 9, 2024
9) #GLP1RAs were developed as anti-diabetes meds. GLP & GLP-1 are released by the gut after glucose or fatty meals. GLP-1 then acts on its receptors in the beta cells of the pancreas to release insulin & inhibit glucagon release. There are many varied effects in the body. pic.twitter.com/7RETClwVuL
— @CKD_ce (@ckd_ce) July 9, 2024
11) There are many #GLP1RAs on the market. Here are the pharmacokinetic properties of some of these drugs. #Semaglutide is now available as an oral preparation.https://t.co/GZTKsvFgx9 pic.twitter.com/XKvZ0VLIRF
— @CKD_ce (@ckd_ce) July 9, 2024
13) However, most of the data on renal outcomes was exploratory data from CV outcome trials of #GLP1RA.
— @CKD_ce (@ckd_ce) July 9, 2024
Check out the trials of GLP-1 receptor agonists pic.twitter.com/SreG8RxnCa
15) Overall the renal outcomes seemed to be favorable with #GLP1RA but these results were largely driven by albuminuria outcomes and not hard clinical end-points. Here is a closer look at the renal outcomes.https://t.co/m6tcLkEWpY pic.twitter.com/fejgmISMvf
— @CKD_ce (@ckd_ce) July 9, 2024
16b) Population
— @CKD_ce (@ckd_ce) July 9, 2024
🌟T2D
🌟CKD
(ie. #eGFR 50-75 with UACR >300 -<5000 OR eGFR 25 – <50 with UACR >100 – <5000)
n= 3533
3876 sites, 28 countries
I & E, schema shown below pic.twitter.com/I6ib235zlp
17b) Key secondary outcomes (formal hierarchical testing strategy)
— @CKD_ce (@ckd_ce) July 9, 2024
● total eGFR slope (i.e., the annual rate of change in eGFR from rand to the end of the trial)
● major CV events (a composite of nonfatal MI, nonfatal stroke, or death from CV causes)
● death from any cause
19) Results
— @CKD_ce (@ckd_ce) July 9, 2024
👉Baseline characteristics
Mean age 66.6 y
Female 30%
mean #BMI ~ 32 kg/m²
Mean eGFR 47 ml/min/1.73m2
UACR 567 mg/g
21) The primary outcome was consistent across all pre-specified subgroups
— @CKD_ce (@ckd_ce) July 9, 2024
Including #eGFR category and #UACR category pic.twitter.com/q7OkaB15Q2
23) Effect on eGFR slope
— @CKD_ce (@ckd_ce) July 9, 2024
✅Difference in annual slope- 1.16ml/min/1.73m2 preserved in #semaglutide arm
✅Similar estimates using Serum cystatin C-based assessment- 3.39 ml/min/1.73m2 preserved at 104 weeks pic.twitter.com/Nip5EQSVVw
25) ⚠️Safety outcomes
— @CKD_ce (@ckd_ce) July 9, 2024
✅Fewer #AEs in the #semaglutide arm, dominated by fewer COVID-19-related events & CV events.
❌13% vs 11.9% AEs ➡️permanent drug d/c in semaglutide arm- mainly due to GI side effects
❌6.8 vs 5.9% higher malignant tumours in semaglutide
Adherence 89% pic.twitter.com/Xm037xTydD
27)🔑From evidence to implementation
— @CKD_ce (@ckd_ce) July 9, 2024
We can now modify disease course of pts w/#T2D at high risk of progression to ESKD w/4 “pillars of therapy," but the key to better pt outcomes is implementation. We need to ensure
🌟Education
🌟Adherence
🌟Accesshttps://t.co/wthuioNdeA pic.twitter.com/ZujZBdtWHJ
28b) (cont)
— @CKD_ce (@ckd_ce) July 9, 2024
❓Efficacy in non-albuminuric diabetic kidney disease- not included
❓Efficacy in lower BMI categories mean BMI was relatively high in this study
❓Are the effects of the 4 pillars incremental?
29) And you just earned 0.5hr 🆓 CE/#CME! Claim your certificate at https://t.co/gDElTGQjf0.
— @CKD_ce (@ckd_ce) July 9, 2024
Many thanks to @Dilushiwijay & @ISNEducation! Pick up credit from prior #nephrology-focused tweetorials at https://t.co/KmHXCtvHyb!