Dr. Staton discussing some therapies for #CKD and another point of view for SGLT2i benefit or risk #AACE2022 #Endotwitter #diabetes 
One study found that Ppl who had the largest eGFR reduction after starting ACE/ARB the slower rate of decline overall. Other study said that >10% decline had worse outcomes
Stopping the ACE-I/ARB was associated with decreased survival and higher MACE... so if pt is doing well on the med don't stop it.
GLP1RA and CKD progression. LIraglutide decreased urine albumin level but no change in eGFR. Dulaglutide did both...but maybe only in macroalbuminuria? No unique benefit in DPP4i
Now on to SGLT2i. There is an expected increase in eGFR after initiation likely from decreased glomerular hyperfiltration from TB feedback --- studies show slowed decline in eGFR and improved albuminuria
Dr. Staton with concern for longterm effects of #sglt2i and the advanced glycation end products as a consequence of increased glucosuria. Another worry is that it is causing hyperfiltration over time #AACE2022
Reminder that HTN and BG management are the only proven preventions for #CKD
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