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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Let's hear The Evidence For and Against Combination #Thyroid Hormone therapy by Dr. Bianco #AACE2022#Endotwitter. This conversation is controversial here are some of the main slides
Patient's on Lt4 reporting a lot of residual symptoms in energy, cognition
Normal physiology the majority of thyroid hormone production is T4 (16:1 T4:T3) and gets converted peripherally to T3 (5mcg made in thyroid, 25mcg made peripherally)
Now to talk about Phosphatonins and #phosphorus metabolism/bone disease by Dr. Kumar moderated by @sfeirjad...I'm ready to learn since admittedly I know little of this #AACE2022#Endotwitter#bone
Why bother about phosphorus? Well it plays many roles in cellular signaling and maintenance of membrane structure of #bone. Low concentrations associated with rhabdo, decreased cardiac function and bone dysfunction (#osteomalacia, #rickets). low and high phos causes bone disease
High Phos Concentrations are Associated with CV Disease and Excess Mortality in CRF and decreasing levels reduces CV mortality
Look how far we have come in #diabetes technology and there is still a lot more to go #AACE2022. #CGM technology has been a game changer and the accuracy continues to improve with each generation
So what's new in the pipeline for #diabetes technology? Let me tell you starting with #dexcom G7. It will be smaller with a better MARD, better warm up and ALL-IN-ONE applicator and transmitter! Just pending FDA review #AACE2022#endotwitter#medtwitter
#NAFLD has effects on other conditions including DM, CVD, CKD etc due to increased hyperinsulinemia, insulin resistance, proinflammatory factors etc
How do we screen for #NAFLD and find the ones with fibrosis? A lot will be missed if just checking transaminases. FIB-4 and NFS is a better screening tool