2) This work was presented by Will Herrington @willkidney, @The_MRC @Kidney_Research UK funded AssocProf @Oxford_NDPH and representing the contributions of 241 participating sites from 8 countries 🌎🌍. EMPA-KIDNEY was funded and sponsored by Boehringer Ingelheim.
— cardio-met (@cardiomet_CE) December 28, 2022
4a) In this program we cover the findings of a meta-analysis (see highlights at https://t.co/6B5mZcl6mn), put into context by #AHA22 discussant PROFESSOR NAVEED SATTAR Professor of Metabolic Medicine at the School of Cardiovascular and Metabolic Health at @UofGSCMH @UofGlasgow pic.twitter.com/5bypnlF88E
— cardio-met (@cardiomet_CE) December 28, 2022
5) Followers of @cardiomet_ce (if you aren't one, BECOME ONE!) will know from programs (available for 🆓CE/#CME credit at https://t.co/XFPs2Ca0jj) on our feed that the renoprotective signals from #SGLT2i use have been promising, but #EMPA_KIDNEY is the one we've been awaiting.
— cardio-met (@cardiomet_CE) December 28, 2022
6b) The most consistent advice from guidelines has been use of #RASi. In 🇺🇸 data 2006-17, what % of eligible pts with CKD received appropriate RASi therapy?
— cardio-met (@cardiomet_CE) December 28, 2022
7) Sodium glucose co-transporter-2 (#SGLT2) inhibitors were developed as a therapy to ⬆️ #glucosuria in #T2D. The findings that #SGLT2i might improve #cardiovascular and #cardiorenal outcomes was largely serendipitous. pic.twitter.com/SM8rqg8YlT
— cardio-met (@cardiomet_CE) December 28, 2022
9) A multitude of benefits emerged over time, with new trial evidence ➡️ new indications for various #SGLT2i's in #T2D, #T2D+#ASCVD, #HF (inclusive of both #HFrEF & #HFpEF) with and without #T2D, and #CKD in the setting of #T2D, or #DKD. pic.twitter.com/tki1Dpccmx
— cardio-met (@cardiomet_CE) December 28, 2022
11) This is why we have so eagerly awaiting the results of #EMPA_KIDNEY. @willkidney provided those details on 4 November in Orlando. A manuscript was simultaneously published in @NEJM at 🔓https://t.co/RYOmhIDQeD. pic.twitter.com/xvnCvKBg7S
— cardio-met (@cardiomet_CE) December 28, 2022
13a) To be enrolled, background tx w/ #RASi as appropriate was required. Intervention then was 1:1 randomization to #empagliflozin 10mg QD or placebo. Sample size: event-driven towards min 1070 primary #outcomes, defined as composite of #CV death or #CKD progression
— cardio-met (@cardiomet_CE) December 28, 2022
14)
— cardio-met (@cardiomet_CE) December 28, 2022
👉6609 patients were enrolled and were well-matched. Mean age ~ 64 years, 1/3 ♀️, 54% no #DM at baseline. Mean #eGFR=37, median urinary #ACR ~ 330mg/g.
👉"Broad range" enrollment target met, as 31% of #CKD attributable to #DKD and 25% to #glomerular disease. pic.twitter.com/uAhhddf1tA
16) Further details about #outcomes in #EMPA_KIDNEY are discussed (and remain available for CE/#CME credit) at https://t.co/EsU0HK3ZpG and https://t.co/6B5mZcl6mn.
— cardio-met (@cardiomet_CE) December 28, 2022
18) Here's a look at the aggregate population & CV outcomes. There is no real impact of outcomes considering +DM or -DM, except for #CKD; the pts without diabetes with CKD still have limited data from a CV perspective (though there is clear benefit on kidney disease progression): pic.twitter.com/UJFLAeR00g
— cardio-met (@cardiomet_CE) December 28, 2022
20) Back ⤴️in tweet 10, we hoped for guidance on persons with specific subtypes of #CKD. With the addition of data from #EMPA_KIDNEY, we now have much more data (most notably #IgAN, but lacking #PCKD): pic.twitter.com/37PPyyQlXt
— cardio-met (@cardiomet_CE) December 28, 2022
22) And re #SGLT2i and risk of euglycemic #DKA & rates of lower limb #amputations. The meta-analysis data here speak for themselves: there is clearly ⬆️ risk of #DKA in patients with #diabetes, but absolute rates in type 2 diabetes are low. pic.twitter.com/LKMHaPu7pS
— cardio-met (@cardiomet_CE) December 28, 2022
24) #DAPA_CKD data extended those findings to address less severe (A2) #albuminuria (https://t.co/3oadbrR7Vs): pic.twitter.com/POTYMVuMQF
— cardio-met (@cardiomet_CE) December 28, 2022
26a) . . . which gives us robust, comprehensive data to support updating #guidelines to make #SGLT2i foundational therapy in #CKD, regardless of #T2D status: pic.twitter.com/rqJCjVSRrx
— cardio-met (@cardiomet_CE) December 28, 2022
27) The take-home message from the meta-analysis, per Prof Sattar and @drpaddymark: think #SGLT2i = #FOUNDATIONAL THERAPY in #CKD: pic.twitter.com/0N25g1yu80
— cardio-met (@cardiomet_CE) December 28, 2022
28b) . . . #SGLT2i can play an important role in slowing disease progression and improving #cardiovascular and #cardiorenal outcomes: pic.twitter.com/eRPQQl0eis
— cardio-met (@cardiomet_CE) December 28, 2022
29a) Re #EMPA_KIDNEY + the large meta-analysis: what conclusion would be INCORRECT to draw regarding #SGLT2i therapy in pts with #CKD? (CONT)
— cardio-met (@cardiomet_CE) December 28, 2022
30) c is incorrect and therefore is the right answer. Larger numbers as in #EMPA_KIDNEY confirm the effectiveness of #SGLT2i in CKD regardless of diabetes status.
— cardio-met (@cardiomet_CE) December 28, 2022
31) Now proceed to https://t.co/C1CNrzjFTB & collect your 0.5hr CE/#CME. Follow us for more expert-led #accredited renal education! Thank you for joining us!
— cardio-met (@cardiomet_CE) December 28, 2022