Education Health Medical Medical Education Chronic Kidney Disease (CKD)
cardio-met
cardio-met

@cardiomet_CE

21 Tweets Mar 14, 2023
Twitter
1) Welcome 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 #FOAMed
1) Welcome to our #accredited #tweetorial risk-guided, staged/sequential management of patients with...
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 cardiometabolic-ce.com
cardiometabolic-ce.com
3) This activity is accredited for #physicians #physicianassociates #nurses #NPs #pharmacists. Prior programs in this series, still eligible for CE/#CME, can be accessed at cardiometabolic-ce.com. Please FOLLOW US for ongoing #accredited education, delivered wholly on Twitter!
cardiometabolic-ce.com
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).
4) In this #tweetorial, we will be highlighting the current evidence for a multi-disciplinary approa...
5) Patients with #T2D & #CKD should be treated with a broad approach as seen in @goKDIGO’s care pyramid, which consists of lifestyle management & drug therapies that:
⚡Control hyperglycemia
⚡Give renoprotection
⚡Address other risk factors
🔓 kdigo.org
5) Patients with #T2D & #CKD should be treated with a broad approach as seen in @goKDIGO’s care...
kdigo.org
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.
🔒 doi.org
6) #CKD Stage 3-4 patients have ⬆️risk of #CV and all-cause mortality, especially at lower eGFR and...
doi.org
7) You saw a 47/F with T2D in the clinic with BPs ranging from 140-160/80-100. Her #UACR was at 1200 mg/g. You would start which medication to control her BP?
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.
🔓nejm.org
8) The right answer is A/B! RAAS inhibition with either an ACEi or ARB is the cornerstone in the man...
www.nejm.org
9) Another landmark trial, #IDNT showed that irbesartan (vs amlodipine and placebo) ⬇️risk of creatinine doubling and #ESRD among patients with #T2D & CKD. This was independent of its +BP lowering effects.
🔓nejm.org
9) Another landmark trial, #IDNT showed that irbesartan (vs amlodipine and placebo) ⬇️risk of creati...
www.nejm.org
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
🔒doi.org
10) How about ACE-inhibitors #ACEi? In the #ONTARGET study, there was no difference in renal outcome...
doi.org
11) There is clear evidence of the benefit of #ACEi/#ARB in #DKD & #HTN w/ moderate to severely increased albuminuria. But what about in other situations?
➕albuminuria / normal BP - may be beneficial
➖ albuminuria / ⬆️BP - ⬇️CV risk
➖ albuminuria / normal BP - ⛔
11) There is clear evidence of the benefit of #ACEi/#ARB in #DKD & #HTN w/ moderate to severely...
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?
13) The right answer is C. @goKDIGO updated its guidelines in 2021 w/ a new target of SBP <120 mmHg, regardless of #proteinuria status (2B). This is based on data from #SPRINT, which showed ⬇️CV outcomes w/ intensive treatment.
🔓kdigo.org
13) The right answer is C. @goKDIGO updated its guidelines in 2021 w/ a new target of SBP &lt;120 mm...
kdigo.org
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.
🔓nejm.org
14) Do note that #SPRINT excluded patients with #T2D and #proteinuria ≥1 g/day. Intensive treatment...
www.nejm.org
15) The #ACCORD trial enrolled exclusively patients with #T2D but excluded those with #creatinine of >1.5 mg/dL. It showed that targeting an #SBP of <120 mmHg did not reduce primary composite #CV events but it reduced #stroke.
🔓nejm.org
15) The #ACCORD trial enrolled exclusively patients with #T2D but excluded those with #creatinine of...
www.nejm.org
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.
(open circle - lower BP target
shaded circle - usual BP target)
🔓nejm.org
16) @goKDIGO admits that the benefits of intensive #BP lowering are less certain in patients w/ #T2D...
www.nejm.org
17) The current recommendation of @goKDIGO of <120 mmHg SBP comes from the combination analysis of both #SPRINT and #ACCORD data.
✅ Recommended for T2D and CKD
⛔ No evidence for #renoprotection
⬇️ #CV outcomes
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.
18) A ⬆️in serum #creatinine should not cause an immediate cessation of #ACEi or #ARBs. It is import...
19a) #Hyperkalemia is a known effect of #RAS blockade with ACEi or ARB. Stopping these drugs can ⬆️ CV events, so mitigation of hyperK is important. Strategies include:
✅moderation of K intake
✅avoid drugs that ⬆️K
✅use diuretics
✅use sodium bicarbonate
✅use K binders
19b) BONUS! For more education on this topic, see cardiometabolic-ce.com.
Video thumbnail
cardiometabolic-ce.com
20) That’s all for part 1. Be sure to come back TOMORROW for part 2 and the rest of our discussion on #renoprotection in patients with #CKD Stage 3-4.
👏 @brian_rifkin @AgarwalRajivMD @nephronus @edgarvlermamd @sophia_kidney @ChristosArgyrop @medtweetorials @nephondemand

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Education Health Medical Medical Education Chronic Kidney Disease (CKD)

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