Discover and read the best of Twitter Threads about #credence

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The big picture of #DKD worldwide
Meda Pavkov @CDCgov

Long term improvements for diabetes and ESKD stalled after 2010

@nkf workshop SGLT2 in glucose homeostasis & kidney disease
Prevention & Treatment of #DKD

Health in All Policies (HiAP)
Systematically considering the health effects of all policies.

Big problems need big solutions.

SGLT2i are a part of the solution that we need 5 lenses:

Changing Landscape: Advances in Understanding DKD Pathophysiology
Kathy Tuttle
Dual specialist who sees more people with diabetes in the nephrology clinic than in the endocrine clinic!

SGLT2i of course &
GLP1 receptor antagonists kidney outcomes data reviewed
Read 8 tweets
@NephroGuy @GlassockJ @hswapnil @cdchu Need clinical context +/- biomarkers? I can't even fathom the amount of "harm" by physicians and patients overreacting to small changes in creatinine instead of continuing the meds needed for their CV and Kidney Protection.

Examples of why we need to split and not lump:

@NephroGuy @GlassockJ @hswapnil @cdchu In ADHF from ESCAPE:
@NephroGuy @GlassockJ @hswapnil @cdchu Data from Italy: Decongestion with WRF--> Excellent survival
Read 12 tweets
The #CREDENCE Trial was discussed @NephJC last night. We were fortunate to have the lead author of the paper @VladoPerkovic join in. He took questions from the participants. Here is the summary of his responses 👇🏽
Q1: Why was the 100 mg dose of Canagliflozin used in #CREDENCE and not the 300 mg dose?
VP: We were anxious about the toxicity as seen in some previous trials, & we wanted to minimize that risk
Q2: Why did centers from Germany have a lower HbA1C cut off for inclusion in the study compared to the centers from other parts of the world - 10.5% vs. 12%?
VP: That was a regulatory request from Germany 🇩🇪
Read 24 tweets
💥How do SGLT2 Inhibitors work?
💥How does an anti-diabetic drug improve Renal & Cardiovascular outcomes?
💥To understand this let’s first review:
⚡️Renal handling of glucose
💥Renal handling of glucose:
⚡️180 g of glucose is filtered thru the glomeruli every day
(180 L x 100mg/dL)
⚡️But all the glucose is completely reabsorbed
⚡️Renal reabsorption of glucose occurs thru transporters in the proximal tubule called SGLT
💥Sodium-Glucose Co-transporters (SGLT)
⚡️There are many 👇🏽
⚡️Not all of them are located in the kidney👇🏽
Read 24 tweets
💥Why is the #CREDENCE Trial such a big deal for the Nephrologists?
⚡️It is the first ‘positive’ trial in CKD DM pts. in two decades!
The last positive RCTs in CKD-T2DM were RENAAL & IDNT & those were published in 2001....19 years ago!

💥RENAAL Trial: Losartan ⬇️ CKD progression & ⬇️ risk of ESRD by 28% compared to placebo, but it did not lower CV mortality
💥IDNT Trial: Irbesartan ⬇️ CKD progression & risk of ESRD by 23% compared to the Amlodipine and Placebo, but it did not lower CV mortality
Read 17 tweets

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