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) March 14, 2023
4) In this #tweetorial, we will be highlighting the current evidence for a multi-disciplinary approach in slowing #CKD progression in patients with #T2D (G3aA1 – G4A3). pic.twitter.com/2crJ3uWSMg
— cardio-met (@cardiomet_CE) March 14, 2023
6) #CKD Stage 3-4 patients have ⬆️risk of #CV and all-cause mortality, especially at lower eGFR and higher albuminuria levels. Thus, present guidelines highlight therapeutic options that slow down GFR decline and decrease albuminuria.
— cardio-met (@cardiomet_CE) March 14, 2023
🔒 https://t.co/OGvqJushRM pic.twitter.com/dxxaDNJ1lW
8) The right answer is A/B! RAAS inhibition with either an ACEi or ARB is the cornerstone in the management of albuminuria in patients w/ #DM and #HTN. #RENAAL showed that losartan ⬇️risk of doubling of creatinine and ESRD.
— cardio-met (@cardiomet_CE) March 14, 2023
🔓https://t.co/r8zPLJYvip pic.twitter.com/doAevEqYbQ
10) How about ACE-inhibitors #ACEi? In the #ONTARGET study, there was no difference in renal outcomes between telmisartan and ramipril and this was consistent in all subgroups. Therefore, either drug class can be used
— cardio-met (@cardiomet_CE) March 14, 2023
🔒https://t.co/QRY2Z80h9W pic.twitter.com/iPmVQA3nnb
12) You start your patient above on telmisartan. Remember that he had #T2D with a #UACR of 1200 mg/d. What systolic BP do you target?
— cardio-met (@cardiomet_CE) March 14, 2023
14) Do note that #SPRINT excluded patients with #T2D and #proteinuria ≥1 g/day. Intensive treatment ⬇️ #CV outcomes but had little effect on #kidney outcomes.
— cardio-met (@cardiomet_CE) March 14, 2023
🔓https://t.co/QRasLpsGqb pic.twitter.com/WLDQBXzb2X
16) @goKDIGO admits that the benefits of intensive #BP lowering are less certain in patients w/ #T2D and #CKD. Renoprotection is mostly seen in proteinuric subgroups.
— cardio-met (@cardiomet_CE) March 14, 2023
(open circle – lower BP target
shaded circle – usual BP target)
🔓https://t.co/rVNmf8sVGg pic.twitter.com/FsGPKfDi3w
18) A ⬆️in serum #creatinine should not cause an immediate cessation of #ACEi or #ARBs. It is important to review other causes of #AKI and concomitant drugs that can ⬆️creatinine. Reduce dose or stop if mitigation strategies are ineffective. pic.twitter.com/DT7FncxjJ4
— cardio-met (@cardiomet_CE) March 14, 2023
19b) BONUS! For more education on this topic, see https://t.co/GbhudEBEVh. pic.twitter.com/0XwRP40qao
— cardio-met (@cardiomet_CE) March 14, 2023
21) Welcome back to our #accredited #tweetorial risk-guided, staged/sequential management of patients with Stage 3-4 #CKD in the context of #DM, by the interprofessional team. I am Carlo Trinidad MD, @hellokidneyMD, from Villaflor Memorial Hospital 🇵🇭. #Nephtwitter #Medtwitter
— cardio-met (@cardiomet_CE) March 15, 2023
23) The correct answer is D! The @goKDIGO and @AmDiabetesAssn consensus guidelines recommend early initiation with metformin + SGLT2i in most patients with T2D and CKD.
— cardio-met (@cardiomet_CE) March 15, 2023
🔓https://t.co/o15CL9faIA pic.twitter.com/9B2DHW4NaM
25) #SGLT2i’s are recommended in patients with #T2D and #CKD with an #eGFR of ≥20 mL/min regardless of #HbA1c.
— cardio-met (@cardiomet_CE) March 15, 2023
In #CREDENCE, #canagliflozin reduced primary & renal-specific composite outcomes & was consistent across subgroups.
🔓https://t.co/ALyOG1H1zY pic.twitter.com/5mbYMHymXX
27) #EMPA_KIDNEY included patients with eGFR as low as 20 mL/min with no #UACR cutoff. 46% had #T2D. #Empagliflozin ⬇️progression of kidney disease or #CV death and was also consistent across subgroups.
— cardio-met (@cardiomet_CE) March 15, 2023
🔒https://t.co/RYOmhIDQeD pic.twitter.com/RNbpHuxiXT
29) @goKDIGO does not recommend initiation of #SGLT2i in patients with #eGFR below 20 mL/min but once initiated, it can be continued even until dialysis for #CV benefit. pic.twitter.com/V4RPzuUg01
— cardio-met (@cardiomet_CE) March 15, 2023
31) Next . . . a 40/F with #T2D comes in for her routine follow-up. She is on #metformin 500 mg BID and empagliflozin 20 mg OD. Her latest #eGFR is 50 mL/min, #HbA1c is 8.5% and #UACR of 400 mg/g. What is her optimal HbA1c target?
— cardio-met (@cardiomet_CE) March 15, 2023
33) Going back to the above patient (CKD G3a) with #HbA1c of 8.5% and UACR of 400 mg/g. What is the best drug class to add to her regimen to achieve her HbA1c target?
— cardio-met (@cardiomet_CE) March 15, 2023
35) A meta-analysis of 8 trials showed that #GLP1_RAs
— cardio-met (@cardiomet_CE) March 15, 2023
⬇️MACE by 14%
⬇️all-cause mortality by 12%
⬇️composite kidney outcome by 21%
🔒https://t.co/aypqrzd7ki pic.twitter.com/y1ZkNHoUbt
37) A new kid on the block is #finerenone, a #nonsteroidal and selective #MRA. Data from #FIDELIO-DKD showed that it:
— cardio-met (@cardiomet_CE) March 15, 2023
-⬇️primary composite renal outcomes
-⬇️sustained decrease in eGFR
-⬇️secondary composite CV outcomes
🔓https://t.co/noQS28AnbZ pic.twitter.com/iVK0MD7MZO
39) Finally, we shouldn’t forget supportive & lifestyle interventions, including:
— cardio-met (@cardiomet_CE) March 15, 2023
✅Na bicarbonate
✅Dietary Na <2 g/day
✅⬆️Physical activity
✅Smoking cessation
The role of dietary protein restriction in diabetes is unclear & data are conflicting on its effect in slowing CKD.
40) And that's it! You can now go to https://t.co/G4mCr5IVKD and claim your 🆓0.5h CE/#CME credit, and FOLLOW US here at @cardiomet_ce (and on @ckd_ce) for the best in #renal and #cardiometabolic education delivered wholly on Twitter!
— cardio-met (@cardiomet_CE) March 15, 2023
I am @hellokidneyMD. 🙏for joining!