Thread by @aishaikh

💥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!
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@RenalFellowNtwk
@VladoPerkovic
@georgeinstitute
#NephJC
#Nephpearls

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
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💥IDNT Trial: Irbesartan ⬇️ CKD progression & risk of ESRD by 23% compared to the Amlodipine and Placebo, but it did not lower CV mortality
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Since 2001 there have been a slew of ‘negative trials’ which has been frustrating for the Nephrology community - because the Rx of traditional CV risk factors did not result in the same benefits in CKD pts. as it does in the general population 👇🏽
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💥Let’s review these ‘negative’ RCTs in CKD patients since 2001:
⚡️Normalization of Hemoglobin
⚡️Use of Statins
⚡️Rx of Bone Mineral Disease
⚡️Lowering of homocysteine
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💥Normalization of Hb with ESA in CKD patients - RCTs 👇🏽
⚡️CHOIR - Erythropoietin caused ⬆️ CV events & death
⚡️CREATE - Erythropoietin did not ⬇️ CV events or improve QoL
⚡️TREAT - Darbepoetin causes ⬆️ risk of stroke
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💥Statins in CKD - RCTs 👇🏽
⚡️4D - Atorvastatin did not ⬇️ CV events or death in ESRD pts.
⚡️AURORA - Rosuvastatin did not ⬇️ CV events or death in ESRD pts.
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💥Agents targeting Bone Mineral Metabolism in ESRD pts. - RCTs 👇🏽
⚡️EVOLVE - Cinacalcet did not ⬇️ risk of CV events or death in pts. with secondary hyperparathyroidism
⚡️DCOR - Sevalemer vs. Calcium-based phosp. binders - no difference in mortality
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💥Agents targeting Bone Mineral Metabolism in CKD - RCTs 👇🏽
⚡️PRIMO - Paricalcitol did not improve LV index or diastolic function 9/

💥Lowering of Homocysteine in CKD - RCTs 👇🏽
⚡️ASFAST - Rx with folic acid did not ⬇️ CV events or death
⚡️HOST - Rx with folic acid and B vitamins (B6 & B12) did not ⬇️ CV events or death
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💥So you get the picture - Nephrologists were slowly becoming this 👇🏽
“An Internist who knows everything but does nothing”
Then came #CREDENCE...
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This is why the #CREDENCE trial is such a big deal!
💥💥💥We finally have a drug that not only ⬇️ CKD progression in diabetic patients but also ⬇️ CV events💥💥💥
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💥 To understand the magnitude of the problem take a 👀 at 👇🏽
⚡️Global DM prevalence: 422 million in 2014 (WHO)
⚡️Global DM prevalence expected to ⬆️ to 640 million by 2040 (ADA)
⚡️Current prevalence of DM in USA: 30.3 million (ADA)
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💥Number of Patients w/ ESRD in USA: 726,331 (USRDS)
⚡️DM is the leading cause of ESRD
⚡️Annual Medicare spending for ESRD care in USA: $31 billion (2013)
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⚡️We now have SGLT2 Inhibitors that can slow the progression of CKD in diabetic pts. and lower the risk of CV events
💥💥This is why the #Credence trial should be celebrated by everyone and not just by Nephrologists! 💥💥
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💥This tweetorial was intended to highlight the negative trials in which Rx of traditional CV risk factors did not improve outcomes in CKD pts. But due to the attention this tweetorial is getting I feel compelled to add the following negative CKD/DM Trials 👇🏽

💥Other Negative trials in CKD-DM
⚡️VA NEPHRON D - ACE inh + ARB ⬆️ risk of adverse events
⚡️ALTITUDE- Aliskirin + ACE inh or ARB ⬆️ risk of adverse events
⚡️BEACON - Bardoxolone methyl did not ⬇️ risk of ESRD and ⬆️ risk of CV events