Are you looking forward to the presentation of the CREDENCE trial at @ISNWCN? Check out our new meta-analysis, led by @VladoPerkovic, summarising data on the effects of SGLT2 inhibitors on CV renal & safety outcomes in CKD #ISNWCN #VisualAbstract Tweet added by Brendon Neuen @brendonneuen

Brendon Neuen

5 years

Are you looking forward to the presentation of the CREDENCE trial at @ISNWCN ? Check out our new meta-analysis, led by @VladoPerkovic , summarising data on the effects of SGLT2 inhibitors on CV renal & safety outcomes in CKD #ISNWCN #VisualAbstract

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Brendon Neuen

@brendonneuen

5 years

@ISNWCN @VladoPerkovic @georgeinstitute @hswapnil @arvindcanchi @drjjw @kidney_boy @vjha126 @cpcannon @edgarvlermamd @AnastasiaSMihai @CristobMorales We pooled data from trials & regulatory submissions reporting effects of SGLT2 inhibitors in T2DM & eGFR <60 It includes >50 individual RCTs & up to: - 6,589 ppl for biomarkers - 7,363 ppl for CV/mortality outcomes - 5,863 ppl for renal outcomes - 6,160 ppl for safety outcomes

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Brendon Neuen

@brendonneuen

5 years

@ISNWCN @VladoPerkovic @georgeinstitute @hswapnil @arvindcanchi @drjjw @kidney_boy @vjha126 @cpcannon @edgarvlermamd @AnastasiaSMihai @CristobMorales We found only small & variable effects on HbA1c, but BP lowering similar to what has been reported in ppl with normal kidney function i.e. the glucose-mediated effects (HbA1c +/- weight) appear to dissociate from natriuretic effects (BP & albuminuria) in the setting of CKD

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Brendon Neuen

@brendonneuen

5 years

@ISNWCN @VladoPerkovic @georgeinstitute @hswapnil @arvindcanchi @drjjw @kidney_boy @vjha126 @cpcannon @edgarvlermamd @AnastasiaSMihai @CristobMorales Despite relative small/inconsistent effects on HbA1c, SGLT2 inhibitors reduce the risk of major adverse cardiovascular events & hospitalization for heart failure in ppl with eGFR <60, without a clear effect on all-cause mortality

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Brendon Neuen

@brendonneuen

5 years

@ISNWCN @VladoPerkovic @georgeinstitute @hswapnil @arvindcanchi @drjjw @kidney_boy @vjha126 @cpcannon @edgarvlermamd @AnastasiaSMihai @CristobMorales In ppl with eGFR <60, SGLT2 inhibitors slow the annual loss of kidney function & reduce the risk of worsening kidney function/EKSD/renal death, with no increased risk of renal AEs or AKI. But there were few renal events, so less certainty (at least compared to CV outcomes)

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Brendon Neuen

@brendonneuen

5 years

@ISNWCN @VladoPerkovic @georgeinstitute @hswapnil @arvindcanchi @drjjw @kidney_boy @vjha126 @cpcannon @edgarvlermamd @AnastasiaSMihai @CristobMorales There were no additional safety concerns in ppl with eGFR <60 beyond what we already know for the class. We did however find differences in risks across individual agents for several outcomes. Much uncertainty here, underscoring the importance of upcoming CKD trials

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Brendon Neuen

@brendonneuen

5 years

@ISNWCN @VladoPerkovic @georgeinstitute @hswapnil @arvindcanchi @drjjw @kidney_boy @vjha126 @cpcannon @edgarvlermamd @AnastasiaSMihai @CristobMorales I know CREDENCE will soon superseded this paper, but I still hope it provides a useful & comprehensive summary of the totality of evidence going into 2019, until we have more definitive data in the CKD population (from trials including DAPA-CKD, EMPA-KIDNEY, SCORED)

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Brendon Neuen

@brendonneuen

5 years

@ISNWCN @VladoPerkovic @georgeinstitute @hswapnil @arvindcanchi @drjjw @kidney_boy @vjha126 @cpcannon @edgarvlermamd @AnastasiaSMihai @CristobMorales For a more in depth discussion of the limitations of this data, strength of evidence for various outcomes, and other aspects, check out the full-text (unfortunately behind pay wall for now, DM me if you can’t get access)

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Brendon Neuen

@brendonneuen

5 years

@ISNWCN @VladoPerkovic @georgeinstitute @hswapnil @arvindcanchi @drjjw @kidney_boy @vjha126 @cpcannon @edgarvlermamd @AnastasiaSMihai @CristobMorales Ping @JulieALovshin @gemtreee @doreen_rabi @DanielJDrucker @AliceYYCheng @ValleAlfonso @raj_mehta @JeremySussman @mmamas1973 @mvaduganathan @JJheart_doc @sandeep @swiviott @ZelnikerThomas @DLBHATTMD @kamleshkhunti @profmjdavies @willcefalu @_brendan_ @lamcardio @TheMahaf

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Brendon Neuen

@brendonneuen

5 years

@ISNWCN @VladoPerkovic @georgeinstitute @hswapnil @arvindcanchi @drjjw @kidney_boy @vjha126 @cpcannon @edgarvlermamd @AnastasiaSMihai @CristobMorales @JulieALovshin @gemtreee @doreen_rabi @DanielJDrucker @AliceYYCheng @ValleAlfonso @raj_mehta @JeremySussman @mmamas1973 @mvaduganathan @JJheart_doc @Sandeep @swiviott @ZelnikerThomas @DLBHATTMD @kamleshkhunti @profmjdavies @willcefalu and @drpaddymark @DrDanMO @kidneydoc101 @NavTangri @ChristosArgyrop @EdoardoMelilli @scoca1 @alexchangmd @taraichang @lp7777777 @jenniejlin @willkidney @Kidneys1st @xaviervel @kidney_doctor @poyanmehr @Msood99M @methodsmanmd @shilpa_jes @pecoitsfilho

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Anil Rajani

@anil_rajani

5 years

@brendonneuen @ISNWCN @VladoPerkovic @georgeinstitute @hswapnil @arvindcanchi @drjjw @kidney_boy @vjha126 @cpcannon @edgarvlermamd @AnastasiaSMihai @CristobMorales Nice informative article. Can you suggest a good article exploring or explaining preserved effects of sglt2i on BP and weight even in CKD? This aspect of this class is really intriguing.

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Brendon Neuen

@brendonneuen

5 years

@anil_rajani @VladoPerkovic @hswapnil @drjjw @kidney_boy @cpcannon @edgarvlermamd @AnastasiaSMihai @CristobMorales BP & albuminuria more so than weight. Some key theories: - Ppl with CKD might be more “salt sensitive” - Persistence of tubuloglomerular feedback at lower eGFR - Augmented natriuresis with other diuretics - Ppl with CKD had higher BP at baseline

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Brendon Neuen

@brendonneuen

5 years