Getting to the Heart of Kidney Disease session moderated by @jenniejlin and @RupalMehtaMD first up: Medication Landscape in Cardio-Renal Disease Robert Lee Page Pharm D #NKFClinicals
Starts off with the pearl the heart pumps blood top the kidney. Now on to new heart failure guidelines using all the l pillars and you get 73% reduction in mortality #NKFClinicals
Level of evidence in CKD is pretty much absent. #NKFClinicals
Saying blocking the bradykinin is really helpful. He says the cough sucks but it really helps. #NKFClinicals
ATLAS Trial randomized High or Low dose ACEi. No I difference in mortality benefit. ahajournals.org/doi/full/10.11… #NKFClinicals
He is pushing lower doses of ACEi/ARB to increase tolerability. #NKFClinicals
Pushing ARNI, no longer need to start with ACEi/ARB prior to adding ARNI. Remember to washout any ACEi before starting secubitril to avoid terrible angioedema.

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More from @kidney_boy

Apr 9
Tim @Maximal_Change Yau talking about Bridging the Generation Gap:Undertanding the Millennial and GenZ mind to optimize Med Ed. #NKFClinicals
Boomer 1946 to 1964. They have a landline. They read a newspaper. #NKFClinicals
Gen X 1965-1980 Saw the transition from traditional to digital media #NKFClinicals
Read 18 tweets
Apr 9
Nayan @captainchloride Aurora calls his own number to speak on stopping RASi. #NKFClinicals
The debate comes from worrying about EGFR decline, hyperkalemia vs CV health, mortality benefit, kidney benefit #NKFClinicals
In CRIC in propensity matched evaluation of RASi users vs no RASI in CKD 4/5. No difference in outcomes, Kidney Medicine 2020 Aurora. #NKFClinicals
Read 8 tweets
Apr 9
Next up Implications of lower BP thresholds in patients with advanced CKD by Paul Drawz. Starts with a question
Effects of intensive BP lowering in patients with advanced CKD likely include:
A) Prevention of ESRD
B) Increased risk of AKI
C) Increased fall risk
D) Increased risk of infection
Low BP targets and renal outcomes #NKFClinicals
Read 8 tweets
Apr 9
Slipped into the Optimizing antihypertensives medications selection in hemodialysis patients with Jennifer Flythe. #NKFClinicals
Audience response question.

The people chose fosinopril. #NKFClinicals
Treating blood pressure in HD reduces outcomes (just barely) #NKFClinicals
Read 16 tweets
Apr 9
Next up fellow Channeler, @AnnaGaddy to talk about urine Chemistries to Predict and Monitor Response to Diuretics. She’s an Assistant Professor of Medicine. #NKFClinicals
Interesting topics #NKFClinicals
Heart failure is a disease of inadequate sodium homeostasis. #NKFClinicals

Diuretics try to bring down ECF while in the long term patient returns to Na in = Na out (sodium intake is the dotted line)
Read 9 tweets
Apr 9
Next up is Dr. Uribarri to savage the urinary anion gap. Sorry @Dan_Batlle.
The urine anion gap is not real, but allows you to see what is not measured. There is no gap. Cations must equal anions.
Since 24 urine Na, K, Cl equal their dietary intake, then the urine anion gap must reflect relative dietary intake not ammonia in the urine. #NKFClinicals
Read 7 tweets

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