2a) @ERAkidney #ERA22 is a primary international scientific symposium for interaction and exchange among basic scientists and clinicians working in #Nephrology. Our expert author is Dr. Clara García Carro (@ClaraGCarro) from San Carlos Clinical Hospital (Madrid, Spain). pic.twitter.com/P8pNG8nR62
— cardio-met (@cardiomet_CE) August 16, 2022
3) This program is #accredited for CE/#CME & is supported by an independent educational grant from the Boehringer Ingelheim/Lilly Alliance. It is not intended for US- or UK-based based HCPs. Accreditation statement & faculty disclosures at https://t.co/HgNk2ajJBC.
— cardio-met (@cardiomet_CE) August 16, 2022
5) As you know, #canagliflozin was associated, in the #CANVAS program, to a higher risk of lower-extremity #amputation, so … are #SGLT2i as effective in terms of #CV #morbidity and #mortality in patients with #CKD and #PVD as in CKD patients without PVD? pic.twitter.com/yN2FUmCwop
— cardio-met (@cardiomet_CE) August 16, 2022
7) 3514 patients with #CKD and without #PVD and 1156 had CKD + PVD were submitted to propensity-score matched #canagliflozin and placebo to balance differences between groups.
— cardio-met (@cardiomet_CE) August 16, 2022
9) Beneficial effects of #canagliflozin on CV and kidney outcomes are consistent and can be seen in patients regardless of these comorbidities. pic.twitter.com/JdeOihUtOY
— cardio-met (@cardiomet_CE) August 16, 2022
10b) Here is the Nephrology team from Clinica San Carlos Hospital that produced this work on #SGLT2i and #kidneytransplant recipients! pic.twitter.com/7ae72K5dLc
— cardio-met (@cardiomet_CE) August 16, 2022
12) We also saw ⬇️ uric acid & cholesterol levels, & ⬆️ magnesium levels. 48 patients presented #UTI at 12 months and only one lost the graft. Incidence of UTI was higher in patients with previous episodes. There were no other major adverse events. pic.twitter.com/NKIOSwCdTw
— cardio-met (@cardiomet_CE) August 16, 2022
14) The hypothesis is that the renal injury is due to #pinocytosis with uptake into lysosomes. Two very interesting papers about #osmotic #nephrosis after #SGLT2i were reviewed:
— cardio-met (@cardiomet_CE) August 16, 2022
🔓https://t.co/nMlqgbN8CN
🔓https://t.co/9lw8PlKtTB
(see photo) pic.twitter.com/YZKVq1rKME
15b) 👉diuretics – dose adjustment, close renal function and volume status follow up
— cardio-met (@cardiomet_CE) August 16, 2022
👉 NSAIDs, cyclosporine, mannitol, amphotericin – avoid use together with #SGLT2i
👉 radiocontrast agents- stop SGLT2i before radiocontrast studies
👉 advanced age warrants close f/u
17) Patients with #CKD with or without #T2D were randomized to dapagliflozin or placebo. Included subjects were treated with target or stable dose of #ACEi/ARBs. Primary composite outcome: sustained ≥50% #eGFR decline, #ESKD, or ☠️from a kidney/CV cause.
— cardio-met (@cardiomet_CE) August 16, 2022
19) However, the benefit of dapagliflozin on the primary outcome was consistent regardless of use or non-use of the target dose of ACEi/ARBs, as shown in this figure. This benefit was also present for a secondary composite #cardiovascular outcome. pic.twitter.com/HjgNQYVRHL
— cardio-met (@cardiomet_CE) August 16, 2022
20b) In which clinical scenarios are SGLT2i beneficial in terms of cardiorenal protection?
— cardio-met (@cardiomet_CE) August 16, 2022
A) no use of ACEi/ARBs
B) kidney transplant
C) concomitant use of diuretics
D) in all of them, but if they are used together with diuretics we should evaluate carefully volume status
22a) WELCOME BACK! I am @ClaraGCarro and we are discussing #DKD highlights from the recent #ERA22 congress. Yesterday (scroll ⤴️!) we discussed new data on #SGLT2i (as did my colleague @shbermejo last week–see https://t.co/rkpfn6moRF) & today we talk #GLPRA #DPP4i & #MRAs.
— cardio-met (@cardiomet_CE) August 17, 2022
23) Now we move to #GLP1_RA! GLP1-RA kidney-protective effects (⬇️in proteinuria, preservation of #eGFR) were observed in CV outcomes trials #CVOT. FLOW is the first trial specifically designed to evaluate the effect of #semaglutide on major renal outcomes in #DKD patients pic.twitter.com/pDsPlnuZNB
— cardio-met (@cardiomet_CE) August 17, 2022
25) Baseline characteristics of #FLOW study confirm that this study will in fact evaluate #semaglutide effect in kidney outcomes in patients at very high risk of renal progression. This study was presented by Vlado Perkovic @VladoPerkovic pic.twitter.com/Ql3L6yImqs
— cardio-met (@cardiomet_CE) August 17, 2022
27) This work included 913 patients on #semaglutide and other anti-hyperglycaemic drugs. Significant changes in #HbA1c and body weight were observed in eGFR>30 ml/min/m2. Rates of serious adverse reactions were low in all eGFR groups. Only 3.8% required drug discontinuation. pic.twitter.com/l3aHrsFmQQ
— cardio-met (@cardiomet_CE) August 17, 2022
29) This work showed that patients on #DDP4i were at low risk of #MACE, #cerebrovascular disease, & #hypoglycemia when compared with matched pairs on sulfonylureas. Use of #sitagliptin & #vildagliptin were also linked to a lower risk of #heartfailure. pic.twitter.com/X5ew3lLFZp
— cardio-met (@cardiomet_CE) August 17, 2022
31) @nrgarciaunaves1 🇪🇸 group presented a work based on data of 256 #T2D patients that showed serum MMP-10 levels were inversely associated to 25(OH)D3 levels, especially in patients with #CKD, suggesting that higher values of 25(OH)D3 should be targeted in patients with DKD. pic.twitter.com/VH46Q5Rjuv
— cardio-met (@cardiomet_CE) August 17, 2022
33) She also raised a very interesting question: in primary nephropathies, is the kidney damage responsible for endothelial dysfunction and that causes dementia? Or is it a primary endothelial problem that causes renal impairment and dementia? pic.twitter.com/JNasV1x3as
— cardio-met (@cardiomet_CE) August 17, 2022
35) When compared to steroidal MRAs, finerenone has:
— cardio-met (@cardiomet_CE) August 17, 2022
👉a similar potency to MR to spironolactone
👉a higher selectivity to MR than spironolactone/eplerenone
👉absence of CNS penetration
👉absence of sexual side effects
👉lower effect on BP than spironolactone/eplerenone
37) In this analysis, finerenone significantly reduced the risk of primary CV outcome by 14%, driven almost exclusively by #heartfailure protection. The benefits were consistent regardless baseline eGFR/UACR and the use of #SGLT2i or #GLP1RA. pic.twitter.com/yyQMQ6wR3l
— cardio-met (@cardiomet_CE) August 17, 2022
39) So, what are the three strategies to stop #CKD progression in our #DKD patients?
— cardio-met (@cardiomet_CE) August 17, 2022
👉ACEi/ARBs
👉SGLTi
👉Nonsteroidal MRAs
And it is necessary to use these three drugs together to an increased benefit!
40b) 👉 Hyperkalemia mitigating factors: concomitant use of diuretics and SGLT2i.
— cardio-met (@cardiomet_CE) August 17, 2022
👉 eGFR 60-25 ml/min/1.73m2 25 ml/min/1.73m3 prior to starting treatment: use 10 mg dose
👉 Do not start finerenone if eGFR <25 25 ml/min/1.73m2 and/or serum potassium > 4.5
42) And that's it! Now go and claim your 🆓CE/#CME at https://t.co/OfQX8Wcr7O and FOLLOW US for more #accredited #tweetorials in the #cardiorenal & #cardiometabolic spaces. I am @ClaraGCarro. Thanks for joining us! pic.twitter.com/fStJUMhGfe
— cardio-met (@cardiomet_CE) August 17, 2022