Thread by @scoca1

@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:

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@NephroGuy @GlassockJ @hswapnil @cdchu In ADHF from ESCAPE:

@NephroGuy @GlassockJ @hswapnil @cdchu Data from Italy: Decongestion with WRF--> Excellent survival

@NephroGuy @GlassockJ @hswapnil @cdchu Data from SOLVD: Early WRF was context dependent

@NephroGuy @GlassockJ @hswapnil @cdchu Data from RALES: WRF in the spironolactone group much different prognosis than WRF in placebo arm

@NephroGuy @GlassockJ @hswapnil @cdchu Data from SPRINT: Intensive BP arm lower eGFR but no evidence of kidney injury

@NephroGuy @GlassockJ @hswapnil @cdchu Data from VA NEPHRON-D: AKI in the Dual RAAS arm had much different prognosis than AKI in the monotherapy arm

@NephroGuy @GlassockJ @hswapnil @cdchu More data from SPRINT (@ucsdnephrology)

@NephroGuy @GlassockJ @hswapnil @cdchu @ucsdnephrology Not randomized, but how about this recent study from Brar et al. showing starting ACEi/ARB after an episode of AKI resulted in more recurrent AKI in the following year but lower mortality

@NephroGuy @GlassockJ @hswapnil @cdchu @ucsdnephrology And, all I can do is hope and pray that people do not treat the early reduction in eGFR upon initiation of SGLT2 inhibitors as "AKI" and inappropriately stop these CV/Kidney miracle agents.
#EmbraceTheReductionInIntraGlomerularPressure
@VladoPerkovic

@NephroGuy @GlassockJ @hswapnil @cdchu @ucsdnephrology @VladoPerkovic From the #CREDENCE methods paper by @jardine_meg et al.

"Patients experiencing a doubling of serum creatinine or nonfatal cardiovascular events are recommended to continue study treatment and complete assessments at all scheduled visits."

karger.com/Article/FullTe…

@NephroGuy @GlassockJ @hswapnil @cdchu @ucsdnephrology @VladoPerkovic @jardine_meg The greatest trick the devil played on the world was making everyone believe that it was imperative to try to achieve the lowest SCr/highest GFR at all times

#DontBeBlind
#seetheforestfromthetrees