2) The program is intended for #HCPs & is supported by an independent educational grant from Bayer. Statement of accreditation and faculty disclosures at https://t.co/gvXca4G9Xm. Follow this 🧵for 1⃣ FULL HOUR OF 🆓 CE/#CME credit–all delivered right here on X!
— cardio-met (@cardiomet_CE) May 20, 2024
3b) Which is TRUE:
— cardio-met (@cardiomet_CE) May 20, 2024
A. SGLT2i initiation/use doesn't necessitate altering freq of CKD monitoring
B. If eGFR ⬇️on start of SGLT2i,➡️hold or d/c tx.
C. After starting SGLT2i, it's reasonable to cont SGLT2i even if KRT is initiated.
D. SGLT2i is rec'd for pts w/T1D+CKD+eGFR< 15 ml
4) So let's GO! @edgarvlermamd will review the @goKDIGO Clinical Practice guideline on the Eval and Mgmt of CKD, particularly as it pertains to “Early, Optimal Management of #CKD & #Cardiorenal Disease to Prevent Disease Progression & Improve Outcomes”
— cardio-met (@cardiomet_CE) May 20, 2024
🔓 https://t.co/ctJubPmWFG pic.twitter.com/W912rIxZwo
6a) @goKDIGO 2.3 Prediction of #CV risk in ppl w/CKD
— cardio-met (@cardiomet_CE) May 20, 2024
Practice Point 2.3.1: For CV risk prediction to guide preventive therapies in people with CKD, use externally validated models that are either developed within #CKD populations or that incorporate #eGFR and #albuminuria
6c) … that include #eGFR & #albuminuria should be used to predict CV events in ppl w/CKD.
— cardio-met (@cardiomet_CE) May 20, 2024
👉QRISK https://t.co/DbZkfz3jHo
👉CKD Prognosis Consortium Risk Models https://t.co/vgWfK1Y5cC pic.twitter.com/YhjwZqUNvc
7b) In the @goKDIGO Guideline, the term “CKD treatment and risk modification” is used to encompass the aim of CKD treatment, which is to impart meaningful beneficial effects on “CKD manifestations” and on “CKD outcomes”https://t.co/QZVjaGXnSp pic.twitter.com/hZECha278l
— cardio-met (@cardiomet_CE) May 20, 2024
8b) Referral to providers/programs (psychologists, renal dietitians or accredited nutritionists, pharmacists, physical & occupational tx, 🚭programs) should be offered where indicated & available#VisualGraphic by @Dilushiwijayhttps://t.co/D0KKrI7Dmbhttps://t.co/iiOPq6y964 pic.twitter.com/XelUHEdPdW
— cardio-met (@cardiomet_CE) May 20, 2024
10) @goKDIGO 3.2.2 Physical activity & optimum weight
— cardio-met (@cardiomet_CE) May 20, 2024
Rec 3.2.2.1: We rec ppl w/#CKD be advised ➡️ moderate-intensity physical activity for a cumulative duration of at least 150 min/wk, or to a level compatible with their CV & physical tolerance (1D)https://t.co/D0KKrI7Dmb pic.twitter.com/lXiYsbfPVi
11b) In 119 countries (88.3% of the world’s adult population), the national intake of sodium exceeded this amount by > 1 gram per dayhttps://t.co/0wFGM1S5Fr pic.twitter.com/Slo2EeRVTn
— cardio-met (@cardiomet_CE) May 20, 2024
12a) @goKDIGO 3.4 Blood pressure control
— cardio-met (@cardiomet_CE) May 20, 2024
Recommendation 3.4.1: Adults with high BP & CKD should be treated with a target systolic blood pressure (#SBP) of < 120 mm Hg, when tolerated, using standardized office BP measurement (2B)#VisualGraphic from @Dilushiwijay @NephJC #NephJC pic.twitter.com/bXpHLDwzpt
12c) … reduces cardiovascular events and mortality in patients with CKD by 25%–30%#VisualGraphic from @Dilushiwijay@NephJC #Nephpearls
— cardio-met (@cardiomet_CE) May 20, 2024
🔓 https://t.co/vhdbitaILK pic.twitter.com/i1N1MtWo4n
13b) Out-of-office #BP measurements (ambulatory or home BP monitoring) are rec'd to complement standardized office BP readings for management of #htn.
— cardio-met (@cardiomet_CE) May 20, 2024
14) @goKDIGO 3.6 Renin-angiotensin system inhibitors
— cardio-met (@cardiomet_CE) May 20, 2024
Recommendation 3.6.1: We rec starting renin-angiotensin-system inhibitors (#RASi) (#ACEi or ARB) for people with #CKD and severely increased #albuminuria(G1–G4, A3) without #diabetes (1B) pic.twitter.com/j2dsNvgWa5
16) @goKDIGO Recommendation 3.6.3:
— cardio-met (@cardiomet_CE) May 20, 2024
KDIGO recommends starting #RASi (ACEi or #ARB) for people with #CKD and moderately-to severely increased #albuminuria (G1–G4, A2 and A3) with diabetes (1B)#VisualGraphic from @Dilushiwijay@NephJC #Nephpearls
🔓 https://t.co/iiOPq6yGVC pic.twitter.com/39cCOQ8rd9
18) @goKDIGO Practice Point 3.6.1:#RASi (ACEi or ARB) should be administered using the highest approved dose that is tolerated to achieve the benefits described; proven benefits were achieved in trials using these doseshttps://t.co/FA3FQtHP3X
— cardio-met (@cardiomet_CE) May 20, 2024
20) @goKDIGO Practice Point 3.6.3#Hyperkalemia associated with use of #RASi can often be managed by measures to ⬇️ the serum K+ levels rather than ⬇️the dose or 🛑RASi
— cardio-met (@cardiomet_CE) May 20, 2024
🔓 https://t.co/q4XN4Qi3gL
🔓 https://t.co/FA3FQtImTv pic.twitter.com/uzoa5LJRK8
22) @goKDIGO Practice Point 3.6.5
— cardio-met (@cardiomet_CE) May 20, 2024
Consider reducing the dose or discontinuing #ACEi or #ARB in the setting of either symptomatic hypotension or uncontrolled hyperK+ despite medical treatment, or to reduce uremic symptoms while treating kidney failure (eGFR <15 mL/min/1.73 m2)
24a) @goKIDIGO 3.7 Sodium-glucose cotransporter-2 inhibitors (#SGLT2i)
— cardio-met (@cardiomet_CE) May 20, 2024
Some of the trials that support the use of SGLT2i in this population are:#CREDENCE
🔓https://t.co/pVRv1UXg7V#DAPA_CKD
🔓https://t.co/Nn8rApirlp#EMPA_KIDNEY
🔓https://t.co/IhWpGXExAz
25) @goKDIGO Recommendation 3.7.1
— cardio-met (@cardiomet_CE) May 20, 2024
KDIGO recommends treating patients with #T2D, #CKD, and an #eGFR ≥20 ml/ min per 1.73 m2 with an #SGLT2i (1A) pic.twitter.com/FtwAxGElfI
27) @goKDIGO Practice Point 3.7.2
— cardio-met (@cardiomet_CE) May 20, 2024
It is reasonable to withhold #SGLT2i during times of prolonged fasting, surgery, or critical medical illness (when people may be at greater risk for ketosis)
🔓 https://t.co/twF3hPFigF
🔓 https://t.co/01wAjjSvbg pic.twitter.com/IOeU1leioh
29) @goKDIGO Recommendation 3.7.3
— cardio-met (@cardiomet_CE) May 20, 2024
KDIGO suggests treating adults with #eGFR 20 to 45 ml/min per 1.73 m2 with urine #ACR <200 mg/g (<20 mg/mmol) with an #SGLT2i (2B) pic.twitter.com/RrKfFoba1O
31) @KDIGO Recommendation 3.8 Mineralocorticoid receptor antagonists (MRA)
— cardio-met (@cardiomet_CE) May 20, 2024
Two trials that support the use of #MRA in this population are:#FIDELIO_DKD
🔓 https://t.co/a43k4YN4Ei#FIGARO_DKD
🔓 https://t.co/lAh0sIzzt5#VisualAbstract by @whatsthegfr #Nephpearls pic.twitter.com/M7Zr6bS4zh
33) @goKDIGO Practice Point 3.8.1
— cardio-met (@cardiomet_CE) May 20, 2024
Nonsteroidal #MRA best for adults w/ #T2D at ⬆️ risk of #CKD progression & #CV events, as demo'd by persistent #albuminuria despite other SOC tx.
3.8.2: A nonsteroidal #MRA may be added to a #RASi and an #SGLT2i for tx of T2D & CKD in adults
35) @goKDIGO Practice Point 3.8.4
— cardio-met (@cardiomet_CE) May 20, 2024
The choice of a #nonsteroidal #MRA should prioritize agents with documented #kidney or #cardiovascular benefits
See 🔓 https://t.co/9wybH9fHKD pic.twitter.com/6aHSLwrBar
37) @goKDIGO 3.15 Cardiovascular disease (#CVD) and additional specific interventions to modify risk
— cardio-met (@cardiomet_CE) May 20, 2024
3.15.1 Lipid management
Artwork by @medcomic pic.twitter.com/VHHL3y8Ly7
39) @goKDIGO Recommendation 3.15.1.2
— cardio-met (@cardiomet_CE) May 20, 2024
In adults aged ≥50 years with CKD and #eGFR ≥60 ml/min per 1.73 m2 (GFR categories G1–G2), KDIGO recommends treatment with a #statin (1B)
41) @goKDIGO Practice Point 3.15.1.1
— cardio-met (@cardiomet_CE) May 20, 2024
Estimate 10-year #cardiovascular risk using a validated risk tool. See 🔓 https://t.co/w917xE7wgS for reference
43) @goKDIGO Practice Point 3.15.1.3
— cardio-met (@cardiomet_CE) May 20, 2024
In adults with #CKD aged 18–49, a lower (i.e., <10% estimated 10-year incidence of #coronary death or nonfatal #MI may also be appropriate thresholds for initiation of #statin-based therapy
45) Dietary approaches: @goKDIGO Practice Point 3.15.1.5
— cardio-met (@cardiomet_CE) May 20, 2024
Consider a plant-based “Mediterranean-style” diet in addition to #lipid-modifying therapy to reduce #cardiovascular risk
🔓 https://t.co/mRK0VByAcs pic.twitter.com/BfGV1TC0YD
47) @goKDIGO Practice Point 3.15.2.1
— cardio-met (@cardiomet_CE) May 20, 2024
Consider other antiplatelet therapy (e.g., #P2Y12 inhibitors) when there is #aspirin intolerance.
49) @goKDIGO Practice Point 3.15.3.1
— cardio-met (@cardiomet_CE) May 20, 2024
Initial mgmt w/invasive strategy may still be better for ppl w/ CKD with acute/unstable #CAD, unacceptable #angina sx, #LVsystolic dysfunction due to ischemia, or left main disease#VisualAbstract from @agrawalkri @NephJC #Nephpearls pic.twitter.com/BKfwWvJi8o
51) Recommendation 3.16.1
— cardio-met (@cardiomet_CE) May 20, 2024
KDIGO recommends use of non–vitamin K antagonist oral anticoagulants (#NOACs or #DOACs) in preference to vitamin K antagonists #VKA (e.g., #warfarin) for #thromboprophylaxis in #Afib in people with #CKD G1–G4 (1C) pic.twitter.com/EQSeKcm0L3
54a) Whew! What a trip!! Summary points:
— cardio-met (@cardiomet_CE) May 20, 2024
👉#Cardiovascular morbidity & mortality disproportionately affect people with #CKD
👉Treat ppl w/#CKD w/a comprehensive tx strategy to ⬇️risks of CKD progression & its assoc'd complications.
👉encourage lifestyle modifications in CKD
54c) 👉aggressive management of #hyperlipidemia will help reduce #CV risk
— cardio-met (@cardiomet_CE) May 20, 2024
👉 as per prior #tweetorial from @edgarvlermamd at https://t.co/uwlVlKvcHH, following #albuminuria is an effective way of tracking #CKD progression.
55b) Recap #SGLT2i: @goKDIGO recommends treating patients with #T2D, #CKD, & #eGFR >/= 20 with an SGLT2i, & continue even if the eGFR falls < 20, unless it is not tolerated or #KRT is initiated.
— cardio-met (@cardiomet_CE) May 20, 2024
55d) Re #MRA: Nonsteroidal #MRA are most appropriate for adults w/#T2D at high risk of #CKD progression & #CV events, as demo'd by persistent #albuminuria despite other standard-of-care tx. Nonsteroidal MRA can be added to #RASi & #SGLT2i for treatment of T2D & CKD in adults.
— cardio-met (@cardiomet_CE) May 20, 2024
56) And that's it! You just earned 1⃣ hour 🆓 CE/#CME credit! Claim your certificate at https://t.co/rxocZPcGA2 and FOLLOW US for more #MedEd delivered wholly on X. Thanks as always to our faculty @edgarvlermamd !! And THANK YOU for joining us.
— cardio-met (@cardiomet_CE) May 20, 2024