Thread by @jronenMD

Day 3/Lecture 1: CKD
1. Cr and cystatin C: Cr has a diet source, cystat C does not (nor muscular influence). Musc young pt w/o RF and neg UA with an inc Cr has just that, not AKI!
2. Indications for Nephrology Referral in patient's with CKD (see photo). #IM2023 @ACPIMPhysicians

4. SGLT2i + Finerinone (non-steroid MRA) attenuates CKD progress and HF hospitalization (not Semaglutide except w/CAD pts) even w/o hx of DM. + effect after max RASi on board.
5. Tx pts w/ DM+CKD with GFR > or = 30 cc/min w/ SGLT2i (Empa, Dapa, Canag).

#IM2023 @ACPIMPhysicians

6. SGLT2i not rec in DM1 pts (risk of DKA) and ADPCKD
7. Spiro/eplerenone with more data in HFrEF, Finerenone with more data in CKD.
8. Q of which to start first - SGLT2i or MRA, still remains.
9. Per KDIGO, sCr increase of 0.3 mg/dL in 48h = AKI.

#IM2023 @ACPIMPhysicians

10. Lower incidence of CA-AKI with routinely hypo- or iso-osmolar iodinated contrast modalities (min vol). Hydrate patients with CKD4 or worse with NS 3 cc/kg/h before and after such studies including cor angio.

#IM2023 @ACPIMPhysicians

11. With Group 2 Gad-based contrast media, harms of delaying or witholding GBCM for an MRI in a patient with AKI or eGFR<30 is likely to outweigh risk in most clinical situations.

#IM2023 @ACPIMPhysicians

12. Note: When initiating SGLT2i/MRA expect <30% rise in serum Cr and/or 30% drop d/t hemodynamic modulation. Consider dropping diuretic dosages in CKD patients.
13. Maximize RASi in patients with HTN and albuminuria.
14. Do we add finerenone after RASi or SGLT2i? Trial underway.

@ACPIMPhysicians Saving for cystatin C content: journals.lww.com/kidney360/page…