2) @ERAkidney #ERA22 is a primary international scientific symposium for interaction and exchange among basic scientists and clinicians working in #Nephrology. It was held in May. Our expert author is Dr. Sheila Bermejo (@shbermejo) from @vallhebron in Barcelona, Spain. pic.twitter.com/Fh0LaSQH9l
— cardio-met (@cardiomet_CE) August 9, 2022
4) So let’s start with a quick knowledge ✔️. What is the recommended first line drug therapy for #diabetes_mellitus and chronic kidney disease (#CKD)?
— cardio-met (@cardiomet_CE) August 9, 2022
a. #Metformin
b. Metformin + #RAASB
c. Metformin + #SGLT2i
d. Metformin + SGLT2i + RAASB
6) This is regardless of whether patients do or do not have #diabetes, according to the results of the #DAPA-CKD clinical trial (🔓https://t.co/Nn8rApirlp) pic.twitter.com/uzDUjr9juH
— cardio-met (@cardiomet_CE) August 9, 2022
8a) Patients with #diabetes experience an ⬆️in the reabsorption of glucose & sodium by the SGLT2 channels located in the renal tubule. This causes a ⬇️in the arrival of sodium concentration at the macula densa, which is interpreted as low renal plasmatic flux. pic.twitter.com/Rcrcqb2EzL
— cardio-met (@cardiomet_CE) August 9, 2022
9) If SGLT2 blockade occurs, natriuresis increases, bringing a higher concentration of sodium to the macula densa ➡️producing a vasoconstriction of the afferent arteriole and subsequently a restoration of the #GFR, as you can see here pic.twitter.com/NidvJ6KY35
— cardio-met (@cardiomet_CE) August 9, 2022
11) In addition, a few studies have evidenced hemoconcentration in patients treated with #SGLT2i. One plausible hypothesis is that the increase in intratubular volume that occurs in the macula densa ➡️ hypoxia and a subsequent increase in #EPO production.
— cardio-met (@cardiomet_CE) August 9, 2022
13a) In summary, there are numerous pathways through which #SGLT2i are involved with potential #cardiovascular benefit, although they are poorly understood:
— cardio-met (@cardiomet_CE) August 9, 2022
👉modulation of CV risk factors
👉hemoconcentration
👉⬆️ oxygen carrying capacity
👉altered cardiac substrate metabolism
13c)
— cardio-met (@cardiomet_CE) August 9, 2022
👉alteration in intracellular sodium stores
👉⬇️uric acid
👉#RAAS modulation
Is there any doubt why “flozinating” has become so popular?!? pic.twitter.com/HS3kkYNEyg
15) In European guidelines @goKDIGO, the use of SGLT2i is already first-line drug therapy in #T2D. pic.twitter.com/ZKr2pomqPv
— cardio-met (@cardiomet_CE) August 9, 2022
17) And we must take into account the upcoming #EMPA_KIDNEY trial results because this study enrolled a #CKD population with a broad range of #eGFR, with and without albuminuria. We are waiting for these results!! pic.twitter.com/Z8CvFpwdve
— cardio-met (@cardiomet_CE) August 9, 2022
18b)
— cardio-met (@cardiomet_CE) August 9, 2022
1⃣Management of patients with #DKD & normoalbuminuria
2⃣ #SGLT2i in kidney transplant patients
3⃣Management of patients with DKD and #T1D
⌛️Time will tell . . . pic.twitter.com/6xdLeJHE4m
20) Mark your best response and RETURN TOMORROW for the correct answer and more #ERA22 data on #SGLT2i and #DKD, along with a link to your 🆓CE/#CME.
— cardio-met (@cardiomet_CE) August 9, 2022
👏@ClaraGCarro @PepaSolerR @SENefrologia @JonathanNefro @nefrocat @jlgorriz @EdoardoMelilli @SVNefro @CKJsocial @torra_roser
22) Yesterday’s quiz (tweet 19)? The correct answer is C. As per tweet 12 ⤴️, natriuresis probably isn’t as critical to the mechanism of action of #SGLT2i‘s benefits on #cardiovascular & #cardiorenal outcomes as once thought. pic.twitter.com/w5KYL6kOuN
— cardio-met (@cardiomet_CE) August 10, 2022
23b) We are going to highlight here the most interesting new evidence on #SGLT2i provided at #ERA22 in different scenarios, starting with the use of SGLT2i in #CKD patients with and without #diabetes_mellitus.
— cardio-met (@cardiomet_CE) August 10, 2022
25a) Dr. Jelakovic (MO411) 🇭🇷in a cohort of patients with and without #DM (n=49) evidenced that the use of #SGLT2i was associated with a ⬇️in BP, as well as proteinuria (NS), a slight ⬆️ in creatinine & an improvement of glycemic control. pic.twitter.com/k6V8wHFtRH
— cardio-met (@cardiomet_CE) August 10, 2022
26) Now to #HF… Dr. Abdullaev (MO634) 🇺🇿 in a multicenter study (n=225) with patients with #HFrEF & #HFpEF were randomized to the use of #dapagliflozin vs. placebo. After 1yr of follow-up, risk of worsening HF or CV death was lower in the group treated with dapagliflozin. pic.twitter.com/V4BDc3y5Vw
— cardio-met (@cardiomet_CE) August 10, 2022
27b) Of these, 21.6% were older than 75 years. But the news is reassuring! The use of #SGLT2i in this group of patients were safe: there was no evidence of a higher incidence of side effects. pic.twitter.com/iXsFpyl4R9
— cardio-met (@cardiomet_CE) August 10, 2022
27d) In the treatment group, women non-adherent to #SHBPP had a higher % of #UTIs than adherent women. In the control group, adherent & non-adherent, UTIs had similar %.
— cardio-met (@cardiomet_CE) August 10, 2022
28a) #ERA22 also featured updates on the the basic science of #SGLT2i.
— cardio-met (@cardiomet_CE) August 10, 2022
Dr. Vergara @AnderVerg (FC121) and colleagues 🇪🇸compared the use of triple therapy with #SGLT2 + #ERA + #ramipril vs ramipril alone in mice. pic.twitter.com/1cOYun4Ogb
29a) Further, Dr. Navarro (MO 640) et al 🇪🇸showed in a cohort of patients with #diabetes (n=57) that the use of #SGLT2i in 45 (vs 12 with #DPP4i) ➡️⬆️increase in urinary levels of #KLOTHO (an anti-aging single-pass membrane protein predominantly produced in the kidney) . . . pic.twitter.com/mFclTlJZ5w
— cardio-met (@cardiomet_CE) August 10, 2022
30) In summary, multiple presentations at #ERA22 supported the conviction that use of #SGLT2i has a promising present and future, with increasing evidence in favor of its use in the daily clinical practice in patients with and without #diabetes and #CKD.
— cardio-met (@cardiomet_CE) August 10, 2022
31) And that's it! Now go and claim your 🆓CE/#CME at https://t.co/rkpfn6moRF and FOLLOW US for more #accredited #tweetorials in the #cardiorenal & #cardiometabolic spaces. I am @shbermejo. Be sure to join my colleague @ClaraGCarro next week for Part 2 of this #ERA22 update!
— cardio-met (@cardiomet_CE) August 10, 2022