🆕 Management of diabetes in CKD

🆒Changes from previous KDIGO

✅SGLT2i can be started with GFR>20 (earlier 30)

2️⃣Suggested adding non steroidal MRA in pts with UACR>30mg/g and GfR>25 on max RASi(l (normal K)

3️⃣GLP1 RA may be used in pts with DM/CKD and obesity to promote

#era24
FLOW included people with T2D at high risk of CKD progression and
CV events

HbAt 7.8%

TD2 duration 15 years: 56.8%

Median UACR: 567.6 mg/g

eGFR: 47.0 ml/min/1.73 mª

BP: 139/76 mmHg

Prior MI or stroke: 22.9%

CHF : 19.2%

RAAS blocker: 95.3%

SGLT2 inhibitor: 15.6%

Important updates with deployment of the full PREVENT risk model. Inclusion of SDI starts to incorporate SDOH that drive disparities. When indicated, UACR and HbA1c further characterize CKM risk and enhance/personalize prediction.

#UACR at #kidneywk

Excited for the deployment of the PREVENT prediction model, which incorporates CKM components, includes heart failure and total CVD as outcomes, and provides assessments of 10y and 30y risk. Add-on models with UACR, HbA1c and place-based SDOH coming soon!

💥Kidney Involvement in Transthyretin Cardiac Amyloidosis
👉Role of UACR
#Editorial : onlinelibrary.wiley.com/doi/10.1002/ej…
Original Article: onlinelibrary.wiley.com/doi/10.1002/ej…
#nephrology #CardioEd #cardiology #Cardiotwitter #meded #nephropearl

The most exciting session of #AHA23 . PREVENT risk calculator that estimates 10-year and 30-year total CVD, ASCVD and HF risk, incorporating eGFR and with special add-ons that include UACR, A1c and zip code! Circulation

BREAKING!! The University of Arizona CRs University of Arizona College Republicans have decided to disaffiliate with CRU and have instead chartered with CRA. UACR has a club over 150 members and we are very excited they will be joining the team!

#SELECT Kidney Outcomes now out in Nature Medicine with #ERA24 !

Sema 2.4mg ow
✅ 22% ⬇️ 5-point kidney composite outcome, driven by UACR reduction
✅ 0.75mL/min slowing in eGFR decline

Kidney protection evident even in lower risk pts without DM or CKD!

nature.com/articles/s4159…

Hypothetical 50y.o. with diabetic nephropathy (no RAS) losing 5ml/min/yr.

eGFR 46, uACR 400mg/mmol (3500 mg/g), no ‘4 pillar’ meds.

You add max RASi, flozin, nsMRA, GLP1RA.

4 month review - BP good, uACR down >90%. The lowest eGFR you’ll ’tolerate’ without stopping a med is:

#Rituximab in #membranous #nephropathy , by L Beck.
👉🏻Take home messages :
📍Efficacy depends on UACR, alb and antiPLA2R level
📍High-dose initial rx and 2nd course often required
📍Initial combination with CNI as an option
📍CYC can still be considered in severe pts
#KidneyWk

Dr BiykemBozkurt delivered an incredible talk on the 🫀- renal axis at #HeartFailure2024 :

📍 #Albuminuria predicts HF risk➡️Annual screening of #eGFR & #UACR in #Type2DM with/without #CKD
📍 #Finerenone is recommended to ⬇️ CV & kidney failure, prevent HF in #CKD & #DM

In this subanalysis of the Finerenone in #CKD and #T2DM ,

📌N= 13 026 participants (avg age 64.8yrs, 69.8% male) shows lower eGFR & higher #albuminuria = higher CV events.

📌 #Finerenone ⬇️ CV risk (HR 0.86, p=0.002) across eGFR & UACR. 1yr finerenone treatment could prevent

🚨 NICE published final draft guidance on empagliflozin #ChronicKidneyDisease 🚨

🔸Gone with data from EMPA-Kidney

🔹eGFR 20-44 no requirement for raised urine albumin

🔸eGFR 45-90 uACR > 22.6mg/mol (>200mg/g)

⚠️ DRAFT only - appeal period ends 1st December

👉 Great to

Balcinrenone plus dapagliflozin in patients with heart failure and chronic kidney disease: Results from the phase 2b MIRACLE trial

not see significant reduction UACR in balcinrenone plus dapagliflozin compared with dapagliflozin

onlinelibrary.wiley.com/doi/full/10.10…
Muthu Vaduganathan

Change in eGFR and UACR in #Flow
#ERA24

🚫Urine Albumin-to-Creatinine Ratio (UACR)**: is a specific test that measures the ratio of albumin to creatinine in the urine. It is used to detect and monitor the presence of albuminuria, which is an early sign of kidney damage in individuals with diabetes or hypertension.

🔥Out now in #JCF ! This brief report shows that in the ongoing FINEARTS-HF trial, incorporating UACR reclassified kidney risk in 1/3 trial pts and US adults with HF, emphasizing the importance of albuminuria as part of comprehensive risk assessment.

🔗bit.ly/3UTfys8

アストラゼネカ社は、慢性腎臓病(CKD)および蛋白尿を持つ患者において、ETA受容体拮抗薬ジボテンタンとSGLT2iダパグリフロジンの併用が、アルブミン尿の有意な減少を示したと発表👏

ベースラインと比較した尿中アルブミン・クレアチニン比（UACR）
✅高用量52.5％↓
✅低用量47.7％↓