2) This #accredited #tweetorial series on #kidneydisease #CKD 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/gvXca4G9Xm
— cardio-met (@cardiomet_CE) February 14, 2023
4) Today we are specifically going to look at the evidence for a multi-disciplinary approach to protection of the patient with #diabetes and #CKD (G1A1-G2A3), but first a quiz! pic.twitter.com/v598vbfocF
— cardio-met (@cardiomet_CE) February 14, 2023
6) Doing studies in pts with an #eGFR > 60 is difficult. It might take decades to get the number of events to prove benefit in renal/cardiac/mortality endpoints. Some recommendations are therefore extrapolated from studies of more severe #CKD, with an eye on risks/benefits. pic.twitter.com/UeYiaeVpHK
— cardio-met (@cardiomet_CE) February 14, 2023
8) For the 1st half of this tweetorial we are going to focus on lifestyle and monitoring of patients with #diabetes and early CKD (G1-2). In the 2nd half we will examine the benefits of specific medication classes. pic.twitter.com/hEp5mRoCIm
— cardio-met (@cardiomet_CE) February 14, 2023
10a) Physical Activity
— cardio-met (@cardiomet_CE) February 14, 2023
Recommend light to moderate intensity as tolerated.
Few studies in #DM & #CKD, recommendations derived from general population studies. pic.twitter.com/JoJAcSGWug
11) Education Programs
— cardio-met (@cardiomet_CE) February 14, 2023
Systematic review supported the efficacy of a well-structured self-management program.
Improves surrogate outcomes including #BP and glucose control.
Should be individualized, and is generally considered cost-effective. pic.twitter.com/B2qdtEpcqL
12b) Protein source: plant (base) vs animal (acid) has shown benefits in large cohort studies.
— cardio-met (@cardiomet_CE) February 14, 2023
Dietary education should start in diabetics with CKD 1-2.
See 🔓https://t.co/jXDY9DDA27
14) Glycemic Target#HbA1c, glycated albumin, #fructosamine correlation w/ plasma glucose ⬇️with advanced #CKD.
— cardio-met (@cardiomet_CE) February 14, 2023
Glycated albumin & fructosamine influenced by low albumin. HbA1c influenced by #anemia.#CGM (continuous glucose monitoring) isn’t known to be influenced by CKD level. pic.twitter.com/EqNbi7wc69
16) Poll: Which one of the following is accurate regarding a systolic BP < 120 versus < 140 mmHg?
— cardio-met (@cardiomet_CE) February 14, 2023
a. All cause mortality ↓
b. #CKD slowed with ↓ BP
c. More #ESKD in ↓ BP
17b) Of note in SPRINT, pts with eGFR > 90 had 3.5 X greater risk of ↓ in eGFR to < 60 with intensive control. Might just represent hemodynamic change.
— cardio-met (@cardiomet_CE) February 14, 2023
See 🔓https://t.co/K7kRbiGjD9
19) Hyperlipidemia
— cardio-met (@cardiomet_CE) February 14, 2023
Given ↑ morbidity & mortality associated w/#CV disease in #DM & #CKD, lipid lowering therapy is often recommended in #nondialysis CKD.
Statins alone or in combo with #ezetimibe.
Small studies suggest ↓ #albuminuria and slower decline in #eGFR with statins. pic.twitter.com/iwYfm9PgS7
21) Welcome back to our #accredited #tweetorial on emerging data for treatment of Diabetes and CKD #DM in #CKD. Today we are going to look at medication classes. I am Brian Rifkin MD, @brian_rifkin, from the Hattiesburg Clinic. #Nephtwitter #Medtwitter #CardioTwitter #FOAMed
— cardio-met (@cardiomet_CE) February 15, 2023
23a) Renin-Angiotensin System Blockade (#RASI)
— cardio-met (@cardiomet_CE) February 15, 2023
Recommended to titrate to max tolerated dose.
Goal to reduce #proteinuria by at least 30%. pic.twitter.com/ummvF2j868
24) Evidence for preservation of #eGFR in pts w/ #CKD 1-2 is limited.#ACEi/#ARB in pts with eGFR < 60 & HTN WITHOUT ALBUMINURIA showed min benefit > other meds.@goKDIGO/@AmDiabetesAssn discourage #RASi in normoalbuminuric, normotensive patients with DM. Answer for tweet 22: C. pic.twitter.com/khbeAbuE1n
— cardio-met (@cardiomet_CE) February 15, 2023
26a) RAS Blockade#MRAs are used in resistant #HTN & are shown to ↓ #proteinuria in CKD 1-4 in pts on ACEi/ARB.
— cardio-met (@cardiomet_CE) February 15, 2023
Lack of long-term trials demonstrating cardiac/renal outcomes.
27) #Metformin
— cardio-met (@cardiomet_CE) February 15, 2023
Low cost, safe and has CV & CKD progression benefits.
Use may also be associated with weight loss.
No risk of #hypoglycemia as a single agent.
Can be considered as first-line therapy, minimal risk of lactic acidosis and no dosage adjustment needed CKD 1-2. pic.twitter.com/OaF3kbkXaw
29) SGLT2 Inhibitor
— cardio-met (@cardiomet_CE) February 15, 2023
EMPA-KIDNEY: showed benefits in pts eGFR < 90 ml/min, but less so in the group with < 300 mg/g proteinuria at 2-years.
May be appropriate first-line for CKD 1-2 with #UACR > 1000 mg/g and high risk of rapid declining eGFR.
See 🔓https://t.co/IhWpGXExAz pic.twitter.com/WljZTIHNYA
31) GLP1 Receptor Agonist #GLP1_RA
— cardio-met (@cardiomet_CE) February 15, 2023
Use if glucose > goal on metformin & SGLT2i.
CV benefits, but not a universal class effect.
No proven preservation of eGFR except w/ dulaglutide.
No hypoglycemia, may promote weight loss.
Side effects: GI irritation & injection site reaction. pic.twitter.com/STGJMjj9zV
33) Summary
— cardio-met (@cardiomet_CE) February 15, 2023
Preventing #ESKD and #dialysis are critical to patients’ longevity and quality of life.
Early screening and treatment may have significant effects on the trajectory of CKD.
Focusing on #CV health often also benefits kidney health.
35) Summary#SGLT2i and #metformin are appropriate 1st line meds in #DM & #CKD 1-2.#RAS inhibitors should be used cautiously in early CKD without #proteinuria.
— cardio-met (@cardiomet_CE) February 15, 2023
Treatment w/ RASi/SGLT2i/statins may be indicated in CKD pts with & without DM, but w/ other #CV disease risk factors.
36) This has been @brian_rifkin with another educational #tweetorial from @cardiomet_ce. Claim your 🆓CE/#CME at https://t.co/IZfQHfKFOx. FOLLOW US!
— cardio-met (@cardiomet_CE) February 15, 2023
👏@sophia_kidney @hellokidneyMD @ChristosArgyrop @edgarvlermamd @NephRodby @kidneymo @kdjhaveri @VelezNephHepato