💥COVID-19 in Dialysis Patients
@ASNKidney #KidneyWk #COVID19

⚡️Limiting Spread of Infection in the HD unit by @KidneySW
Some key pearls 💎

⚡️The 1st patient to die due to COVID-19 in the United States was a Hemodialysis patient (died on 28th Feb, 2020)
⚡️How contagious is SARS-CoV-2 virus?
⚡️More contagious than Influenza but less contagious than Measles
⚡️Each SARS-CoV-2 positive person can infect 3 more people👇🏽
⚡️ESKD patients are 5x more likely to have COVID-19 than other Medicare beneficiaries

⚡️ESKD patients are 8x more likely to be hospitalized due to COVID-19 than other Medicare beneficiaries👇🏽
💥Based on a physician survey of over 5000 physicians, the Top US Specialties treating COVID-19 patients: Nephrologists ranked No: 2!
👇🏽
💥Three Guiding Principles for treatment of ESKD patients in a Hemodialysis Unit
💥Great quote by Mark Twain

“The right word may be effective, but no word was ever as effective as a rightly timed pause.”

We all have to live by this principle during this pandemic when each day poses a new challenge
💥”Whoever said one person can’t change the world never ate an undercooked bat”
#COVID19 #KidneyWk @ASNKidney

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More from @aishaikh

23 Oct
‼️Effect of Finerenone on CKD outcomes in T2DM

⚡️Finerenone decreased risk of CKD progression by 18%

⚡️Finerenone decreased CV morbidity & mortality by 14%

Published in @NEJM today

nejm.org/doi/full/10.10…

@ASNKidney #Kidneywk
💥How does Finerenone work?
(These Slides are from the ASN Kidney Week: High Impact Clinical Trial Session)
💥Trial eligibility criteria👇🏽
Read 17 tweets
14 Oct
⚡️Excited to share our work:

“Prolonged SARS-CoV-2 Viral RNA Shedding and IgG Antibody Response to SARS-CoV-2 in Patients on Hemodialysis” published in @CJASN Summary👇🏽

👉🏽 cjasn.asnjournals.org/content/clinja…

@aishaikh @ZeldisEtti @kirkcampbell @LilCh4n
1/
⚡️Background

❓Are patients on maintenance hemodialysis able to develop IgG antibodies to the SARS-CoV-2 virus after COVID-19 infection?

❓What is the duration of SARS-CoV-2 viral RNA shedding among HD patients following the diagnosis of COVID-19?

2/
💥Case Series of patients on maintenance hemodialysis (HD) at a single HD unit in NYC

⚡️Patients were tested for SARS-CoV-2 RNA (RT-PCR) if they had signs or symptoms suggestive of COVID-19, or the testing was performed as part of routine surveillance

3/
Read 16 tweets
14 Oct
💥New meta-analysis reports CV, Kidney & Mortality outcomes with SGLT2i use with & without Metformin
👉🏽 dom-pubs.onlinelibrary.wiley.com/doi/10.1111/do…

⚡️Before reviewing the meta-analysis check out this Tweetorial on Should Metformin be the 1st line therapy in T2DM patients?👇🏽
1/
⚡️In the meta-analysis, 6 SGLT2i vs Placebo RCTs were included:

-4 trials were CV outcome trials (EMPA-REG, CANVAS, DECLARE-TIMI, VERTIS-CV)

-1 trial was a Kidney outcome trial
(CREDENCE)

-1 trial was a Heart Failure trial
(DAPA-HF)
2/
💥Total number of participants from the 6 RCTs were 51,743

💥Baseline Metformin use varied across the trials as shown below:

⚡️21% in DAPA-HF
⚡️58% in CREDENCE
⚡️74%-82% in EMPA-REG, CANVAS,
DECLARE-TIMI, VERTIS-CV
3/
Read 6 tweets
8 Oct
❇️ Quiz for the “KDIGO 2020 Clinical Practice Guideline for Diabetes Management in CKD”

⚡️You can review the Tweetorial on the KDIGO Guideline before answering the quiz - see below👇🏽

@goKDIGO
#KDIGO
1/
❇️ Question 1
⚡️Prolonged use of Metformin (use for > than 4 years) can cause deficiency of this vitamin?

2/
❇️ Metformin interferes with the intestinal absorption of Vitamin B12

⚡️In NHANES Study, Vitamin B12 deficiency was noted in 5.8% patients with T2DM on metformin

⚡️Vitamin B12 monitoring should be considered in pts. on prolonged metformin Rx (> 4 yrs)
3/
Read 24 tweets
30 Sep
💥KDIGO 2020 Clinical Practice Guideline for Diabetes Management in CKD
Tweetorial

☄️Comprehensive Care in DM & CKD

☄️Glycemic Monitoring & Targets

☄️Lifestyle Interventions

☄️Anti-glycemic Rx

👉🏽 tinyurl.com/yyth59kn
1/
@goKDIGO @Kidney_Int
#KDIGO
💥Before reviewing the guidelines, note the difference between the:

⚡️Recommendations
⚡️Practice Points

💥Recommendations are based on strong evidence whereas for the Practice Points the evidence is insufficient or inconclusive👇🏽

2/
💥Comprehensive Care is needed for pts. with DM & CKD to ⬇️ risk of
CV disease & Kidney Disease progression👇🏽

✅ Glycemic Control
✅ BP Control
✅ Lipid Rx
✅ Nutrition
✅ Exercise
✅ Smoking Cessation

🌟RAS Blockade & SGLT2i👇🏽

🌟Anti-platelet Rx👇🏽

3/
Read 23 tweets
30 Aug
💥DPA-CKD Trial results announced

⚡️Dapagliflozin lowered the risk of kidney failure and lowered mortality in both diabetic & non-diabetic patients

⚡️No episodes of hypoglycemia in non-diabetic patients
#ESCCongress #DAPACKD
Here is the full presentation (in short clips)
Read 9 tweets

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