This document summarizes a presentation on the benefits of SGLT2 inhibitors (SGLT2i) for patients with diabetes and kidney disease. It discusses how SGLT2i lower intraglomerular pressure and protect the kidneys by reducing hyperfiltration. Clinical trials show SGLT2i slow the progression of kidney disease and reduce cardiovascular risks compared to other treatments like ACE inhibitors or ARBs alone. The document concludes SGLT2i provide renal and cardiovascular benefits and are an important new treatment for preserving kidney function in patients with diabetes.
DKD is a leading cause of ESRD in the US, affecting 30-40% of those with diabetes. Poor glycemic control and hypertension are major risk factors for developing and progressing DKD. Clinical trials have shown that intensive control of blood glucose and blood pressure can delay and prevent kidney disease. New drugs targeting the kidney are showing promise in reducing albuminuria and slowing kidney function decline in DKD patients.
This document proposes revisions to ICD-9-CM codes for classifying chronic kidney disease (CKD). It outlines stages of CKD based on glomerular filtration rate and proteinuria levels. The current codes do not distinguish CKD from end-stage renal disease (ESRD) or capture disease severity. The proposed changes would add codes to classify CKD stages 1-5, indicate presence of proteinuria, and code for underlying etiologies. This enhanced classification system could help determine patient risk, guide treatment, and assess quality of care for CKD.
This document discusses the role of glyptins (DPP-4 inhibitors) in the management of type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). It notes that T2DM is a leading cause of CKD globally and that strict glycemic control is important for treating diabetic nephropathy. However, patients with CKD are at higher risk of hypoglycemia from antidiabetic medications. The document examines whether glyptins may be renoprotective and safer to use in CKD patients compared to other drugs due to their low risk of hypoglycemia. It reviews studies on the use of sitagliptin and other glyptins in T2
1. Chronic kidney disease (CKD) is a major public health problem affecting millions of Americans. Early detection and treatment can help slow progression of the disease and prevent complications.
2. Screening high-risk groups such as those with diabetes or hypertension can help identify CKD earlier. Estimating glomerular filtration rate (GFR) using the MDRD equation is recommended for detection and staging of CKD.
3. A three-pronged initiative is needed to screen for CKD risk factors, develop early detection processes, and establish collaborative disease management between primary care and nephrology. This can help address issues of underdiagnosis and late referral currently associated with CKD.
This document discusses the challenges of treating diabetes in patients with chronic kidney disease (CKD). It notes that diabetes is a leading cause of CKD and end-stage renal disease. While good glycemic control can prevent CKD progression, it is difficult to achieve in CKD patients due to changes in insulin metabolism and increased risk of hypoglycemia. The document reviews various classes of anti-diabetic medications and their safety in different stages of CKD. It concludes that treatment options are limited for patients with more advanced CKD and emphasizes individualizing therapy based on renal function.
Ngal ,cystatin c versus creatinine clearence asMoustafa Rezk
This document discusses biomarkers for acute kidney injury (AKI), specifically NGAL and cystatin C. It provides background on the definition and classification of AKI, limitations of creatinine as a biomarker, and the need for earlier detection. It summarizes studies showing NGAL and cystatin C can increase within hours after cardiac surgery or injury, earlier than rises in creatinine. These biomarkers may allow for earlier diagnosis and intervention to prevent further kidney damage.
DKD is a leading cause of ESRD in the US, affecting 30-40% of those with diabetes. Poor glycemic control and hypertension are major risk factors for developing and progressing DKD. Clinical trials have shown that intensive control of blood glucose and blood pressure can delay and prevent kidney disease. New drugs targeting the kidney are showing promise in reducing albuminuria and slowing kidney function decline in DKD patients.
This document proposes revisions to ICD-9-CM codes for classifying chronic kidney disease (CKD). It outlines stages of CKD based on glomerular filtration rate and proteinuria levels. The current codes do not distinguish CKD from end-stage renal disease (ESRD) or capture disease severity. The proposed changes would add codes to classify CKD stages 1-5, indicate presence of proteinuria, and code for underlying etiologies. This enhanced classification system could help determine patient risk, guide treatment, and assess quality of care for CKD.
This document discusses the role of glyptins (DPP-4 inhibitors) in the management of type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). It notes that T2DM is a leading cause of CKD globally and that strict glycemic control is important for treating diabetic nephropathy. However, patients with CKD are at higher risk of hypoglycemia from antidiabetic medications. The document examines whether glyptins may be renoprotective and safer to use in CKD patients compared to other drugs due to their low risk of hypoglycemia. It reviews studies on the use of sitagliptin and other glyptins in T2
1. Chronic kidney disease (CKD) is a major public health problem affecting millions of Americans. Early detection and treatment can help slow progression of the disease and prevent complications.
2. Screening high-risk groups such as those with diabetes or hypertension can help identify CKD earlier. Estimating glomerular filtration rate (GFR) using the MDRD equation is recommended for detection and staging of CKD.
3. A three-pronged initiative is needed to screen for CKD risk factors, develop early detection processes, and establish collaborative disease management between primary care and nephrology. This can help address issues of underdiagnosis and late referral currently associated with CKD.
This document discusses the challenges of treating diabetes in patients with chronic kidney disease (CKD). It notes that diabetes is a leading cause of CKD and end-stage renal disease. While good glycemic control can prevent CKD progression, it is difficult to achieve in CKD patients due to changes in insulin metabolism and increased risk of hypoglycemia. The document reviews various classes of anti-diabetic medications and their safety in different stages of CKD. It concludes that treatment options are limited for patients with more advanced CKD and emphasizes individualizing therapy based on renal function.
Ngal ,cystatin c versus creatinine clearence asMoustafa Rezk
This document discusses biomarkers for acute kidney injury (AKI), specifically NGAL and cystatin C. It provides background on the definition and classification of AKI, limitations of creatinine as a biomarker, and the need for earlier detection. It summarizes studies showing NGAL and cystatin C can increase within hours after cardiac surgery or injury, earlier than rises in creatinine. These biomarkers may allow for earlier diagnosis and intervention to prevent further kidney damage.
This document provides an overview of chronic kidney disease (CKD), including definitions, stages, methods for measuring glomerular filtration rate and proteinuria, risk factors for progression, complications, and management strategies. Key points covered include defining and staging CKD, estimating GFR using creatinine clearance and the MDRD equation, screening for and treating anemia, hypertension, hyperlipidemia, renal osteodystrophy, and acidosis, and preparing patients for end-stage renal disease with timely nephrology referrals and vascular access placement.
Diabetic kidney disease is a common complication of long-standing diabetes that can progress to kidney failure. It is characterized by persistent protein in the urine and declining kidney function over time. Risk factors include poor blood sugar and blood pressure control, family history, smoking, and genetic predisposition. Symptoms may not appear until late stages, so regular screening of urine protein and kidney function is important. Treatment focuses on strict blood sugar and blood pressure control through medications and lifestyle changes. Newer drugs that target additional disease pathways are being studied to help slow progression as current therapies are often not sufficient on their own. Proper management can help prevent or delay the need for dialysis or transplantation in patients with end-stage renal disease.
Diabetic kidney disease, also called diabetic nephropathy, is a type of chronic kidney disease caused by damage to the kidneys as a result of diabetes. Over time, high blood glucose levels associated with diabetes can damage the tiny filters in the kidneys called glomeruli. This can progressively reduce their ability to filter waste from the blood, potentially leading to kidney failure. Symptoms of diabetic kidney disease may include swelling, poor sleep or concentration, nausea or weakness. It can be diagnosed through urine and blood tests and managed through strict control of blood sugar and blood pressure levels.
This document summarizes diabetic kidney disease (DKD), the leading cause of end-stage renal disease in the United States. DKD risk factors include age, sex, race, family history, hypertension, and poor glycemic control. Intensive glucose and blood pressure control can delay DKD progression. While current therapies can slow DKD, innovation is still needed to improve outcomes given residual risks. Novel drug classes targeting DKD mechanisms may provide future treatment options.
Chronic Kidney Disease: An Update (Part II) provides information on:
1. The pathophysiology, signs and symptoms, disease progression, and treatment interventions for chronic kidney disease.
2. Treatment strategies for chronic kidney disease including screening for risk factors, slowing disease progression through treatment of comorbid conditions, and preparing for renal replacement therapies like dialysis and transplant as kidney function declines.
3. The role of controlling cardiovascular risk factors like blood pressure, cholesterol, and blood sugar in treating chronic kidney disease and preventing associated complications like cardiovascular disease. Intensive treatment can help slow kidney disease progression.
This document provides an overview of diabetic kidney disease. It discusses how diabetes is the leading cause of chronic kidney disease and end-stage renal disease. It covers the diagnosis of diabetic kidney disease based on albuminuria and decreased estimated glomerular filtration rate. Risk factors, pathogenesis, natural history, and management strategies such as glycemic control, blood pressure control, angiotensin inhibition, and reducing proteinuria are described in detail. The roles of various drug classes and lifestyle modifications in slowing the progression of diabetic kidney disease are also summarized.
This document provides clinical practice guidelines for the diagnosis, evaluation, and treatment of acute kidney injury (AKI). It was developed by an international work group using a systematic review of the evidence and outlines recommendations for:
1. Defining and classifying AKI according to increases in serum creatinine and decreases in urine output.
2. Evaluating patients at risk for AKI and implementing general management strategies.
3. Preventing AKI through hemodynamic monitoring, glycemic control, and minimizing nephrotoxic medications.
4. Treating established AKI through renal replacement therapy, including criteria for initiation and discontinuation as well as specific modalities and procedures.
Chronic Kidney Disease - What You Need to KnowEvan Dechtman
Chronic Kidney Disease (CKD) is a condition where the kidneys are damaged and cannot properly filter waste from the blood. The kidneys help regulate blood pressure, make red blood cells, and remove waste. CKD is defined as kidney damage for 3 or more months as shown by blood and urine tests or imaging tests. Risk factors include diabetes, high blood pressure, heart disease, family history, smoking, obesity, and use of certain medications. Early CKD often has no symptoms but can eventually cause fatigue, swollen limbs, and other issues. Treatment focuses on controlling blood pressure and diabetes, exercise, diet, and medication. End-stage renal disease requires dialysis or transplant. Screening those at high risk can
Diabetic kidney disease " Challenging the Dogma"Saddam Hassan
Saddam Hassan is a lecturer of Nephrology at Benha University who discusses various topics related to diabetic kidney disease (DKD) including the conventional paradigms and biomarkers. The document addresses whether DKD is more glomerular or tubule-centric in nature and debates challenging current dogmas regarding renin-angiotensin-aldosterone system blockade and glycemic control. It also explores opportunities for more personalized approaches and multi-pathway signal blockade to treat DKD.
This document discusses the relationship between diabetes, blood sugar control, and cardiovascular disease risk. It reviews observational studies and clinical trials that have examined the effects of intensive glucose control on cardiovascular outcomes. The studies show mixed results, with some finding benefits of tight control for reducing heart attacks and others finding no benefits or even potential harms of very tight control, especially in older patients or those with existing heart disease. The document concludes that an A1C target of less than 7% is generally appropriate for most patients, but that goals need to be individualized based on age, comorbidities, and other factors. Very tight control to A1C levels below 6.5% may not be safe and could potentially increase risks in some high
A limited presentation about a) age related renal functional changes b) management of CKD, including advance care planning and transplantation referral c) management of potentially risky drugs in the elderly with CKD (NOACs)
Ponencia realizada por el Dr. José Ramón González-Juanatey del Hospital Clínico Universitario de Santiago de Compostela en la sesión 'Diabetes 2021. Cardiólogos y endocrinólogos: ¿matrimonio o divorcio?' del 13 de mayo de 2021
The FIGARO-DKD trial found that:
1) Finerenone significantly reduced the risk of the primary cardiovascular outcome (composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or hospitalization for heart failure) by 13% compared to placebo in patients with chronic kidney disease and type 2 diabetes.
2) The cardiovascular benefit was primarily driven by a reduction in hospitalization for heart failure despite excluding patients with symptomatic heart failure with reduced ejection fraction.
3) Finerenone did not significantly reduce the risk of a sustained 40% decline in eGFR but did trend toward improving the clinically accepted outcome of a sustained 57% decline in eGFR compared to placebo.
pathophysiology and therapy of diabetic nephropathyMuhamed Al Rohani
This document discusses diabetic nephropathy, which is the leading cause of end-stage renal disease. It begins with an overview of the epidemiology and risk factors for diabetic nephropathy. It then covers the pathophysiology and pathological stages, explaining the progression from increased glomerular filtration rate to decreased GFR and kidney damage. Treatment focuses on tight blood glucose and blood pressure control using ACE inhibitors, ARBs, or a combination to slow the progression of kidney disease. Clinical trials demonstrate that these drugs can reduce proteinuria and prevent worsening of renal function in patients with diabetes.
a-comprehensive-approach-to-kidney-disease-and-hypertension by HazwanMohd Hanafi
This document discusses kidney disease and hypertension. It begins by outlining the key functions of the kidneys, including regulating blood pressure through the renin-angiotensin-aldosterone system. It then examines the causes and classifications of acute and chronic kidney disease. Chronic kidney disease is a growing problem due to its asymptomatic nature in early stages. The document reviews factors that can damage the kidneys and lead to reduced glomerular filtration rate. It also discusses how chronic kidney disease and reduced kidney function are linked to increased risk of cardiovascular disease, anemia, and bone disease like renal osteodystrophy. Hypertension is both a common cause and complication of chronic kidney disease. Tight blood pressure control is important to slow
Recent advancement in managing diabetic nephropathypp_shivgunde
This document discusses recent advances in managing and understanding diabetic nephropathy. It begins with an introduction to diabetes and chronic kidney disease prevalence and prognosis. It then covers the pathophysiology of diabetic nephropathy and the current standard tripartite approach of intensive blood glucose control, blood pressure control, and RAAS blockade. Novel therapeutic modalities such as exploiting the renin-angiotensin-aldosterone axis through dual or combined blockade and aldosterone antagonism are also discussed.
The document summarizes chronic kidney disease (CKD) and its management. It defines CKD and outlines the new classification system. It discusses evaluating kidney function through estimated GFR and albuminuria. It covers managing CKD progression through blood pressure control, RAAS interruption, glycemic control, and treating complications like anemia. It recommends lowering protein intake in later stages and salt intake. Overall, the document provides clinical practice guidelines for defining, evaluating, and managing CKD and its progression and complications.
- The document discusses the burden of diabetic kidney disease and the benefits of SGLT2 inhibitors (SGLT2i).
- It notes that progression of diabetic kidney disease depends on glomerular blood pressure and that SGLT2i lower intraglomerular pressure through their mechanisms of action.
- Clinical trials show that SGLT2i provide renal benefits including postponing end-stage renal disease and that earlier treatment provides longer-term protection of kidney function.
This document summarizes the background and qualifications of Dr. Gwei-Bian Gao, a cardiologist and diabetes specialist. It lists his medical education, areas of specialty training, positions held at major hospitals, awards for diabetes care quality, and current practice at Muh-Kang Clinic in Kaohsiung, Taiwan. The clinic focuses on cardiology, pulmonology, endocrinology, and diabetes management. Recent clinical trials show that SGLT2 inhibitors can protect cardiac and renal function in patients with type 2 diabetes.
This document provides an overview of chronic kidney disease (CKD), including definitions, stages, methods for measuring glomerular filtration rate and proteinuria, risk factors for progression, complications, and management strategies. Key points covered include defining and staging CKD, estimating GFR using creatinine clearance and the MDRD equation, screening for and treating anemia, hypertension, hyperlipidemia, renal osteodystrophy, and acidosis, and preparing patients for end-stage renal disease with timely nephrology referrals and vascular access placement.
Diabetic kidney disease is a common complication of long-standing diabetes that can progress to kidney failure. It is characterized by persistent protein in the urine and declining kidney function over time. Risk factors include poor blood sugar and blood pressure control, family history, smoking, and genetic predisposition. Symptoms may not appear until late stages, so regular screening of urine protein and kidney function is important. Treatment focuses on strict blood sugar and blood pressure control through medications and lifestyle changes. Newer drugs that target additional disease pathways are being studied to help slow progression as current therapies are often not sufficient on their own. Proper management can help prevent or delay the need for dialysis or transplantation in patients with end-stage renal disease.
Diabetic kidney disease, also called diabetic nephropathy, is a type of chronic kidney disease caused by damage to the kidneys as a result of diabetes. Over time, high blood glucose levels associated with diabetes can damage the tiny filters in the kidneys called glomeruli. This can progressively reduce their ability to filter waste from the blood, potentially leading to kidney failure. Symptoms of diabetic kidney disease may include swelling, poor sleep or concentration, nausea or weakness. It can be diagnosed through urine and blood tests and managed through strict control of blood sugar and blood pressure levels.
This document summarizes diabetic kidney disease (DKD), the leading cause of end-stage renal disease in the United States. DKD risk factors include age, sex, race, family history, hypertension, and poor glycemic control. Intensive glucose and blood pressure control can delay DKD progression. While current therapies can slow DKD, innovation is still needed to improve outcomes given residual risks. Novel drug classes targeting DKD mechanisms may provide future treatment options.
Chronic Kidney Disease: An Update (Part II) provides information on:
1. The pathophysiology, signs and symptoms, disease progression, and treatment interventions for chronic kidney disease.
2. Treatment strategies for chronic kidney disease including screening for risk factors, slowing disease progression through treatment of comorbid conditions, and preparing for renal replacement therapies like dialysis and transplant as kidney function declines.
3. The role of controlling cardiovascular risk factors like blood pressure, cholesterol, and blood sugar in treating chronic kidney disease and preventing associated complications like cardiovascular disease. Intensive treatment can help slow kidney disease progression.
This document provides an overview of diabetic kidney disease. It discusses how diabetes is the leading cause of chronic kidney disease and end-stage renal disease. It covers the diagnosis of diabetic kidney disease based on albuminuria and decreased estimated glomerular filtration rate. Risk factors, pathogenesis, natural history, and management strategies such as glycemic control, blood pressure control, angiotensin inhibition, and reducing proteinuria are described in detail. The roles of various drug classes and lifestyle modifications in slowing the progression of diabetic kidney disease are also summarized.
This document provides clinical practice guidelines for the diagnosis, evaluation, and treatment of acute kidney injury (AKI). It was developed by an international work group using a systematic review of the evidence and outlines recommendations for:
1. Defining and classifying AKI according to increases in serum creatinine and decreases in urine output.
2. Evaluating patients at risk for AKI and implementing general management strategies.
3. Preventing AKI through hemodynamic monitoring, glycemic control, and minimizing nephrotoxic medications.
4. Treating established AKI through renal replacement therapy, including criteria for initiation and discontinuation as well as specific modalities and procedures.
Chronic Kidney Disease - What You Need to KnowEvan Dechtman
Chronic Kidney Disease (CKD) is a condition where the kidneys are damaged and cannot properly filter waste from the blood. The kidneys help regulate blood pressure, make red blood cells, and remove waste. CKD is defined as kidney damage for 3 or more months as shown by blood and urine tests or imaging tests. Risk factors include diabetes, high blood pressure, heart disease, family history, smoking, obesity, and use of certain medications. Early CKD often has no symptoms but can eventually cause fatigue, swollen limbs, and other issues. Treatment focuses on controlling blood pressure and diabetes, exercise, diet, and medication. End-stage renal disease requires dialysis or transplant. Screening those at high risk can
Diabetic kidney disease " Challenging the Dogma"Saddam Hassan
Saddam Hassan is a lecturer of Nephrology at Benha University who discusses various topics related to diabetic kidney disease (DKD) including the conventional paradigms and biomarkers. The document addresses whether DKD is more glomerular or tubule-centric in nature and debates challenging current dogmas regarding renin-angiotensin-aldosterone system blockade and glycemic control. It also explores opportunities for more personalized approaches and multi-pathway signal blockade to treat DKD.
This document discusses the relationship between diabetes, blood sugar control, and cardiovascular disease risk. It reviews observational studies and clinical trials that have examined the effects of intensive glucose control on cardiovascular outcomes. The studies show mixed results, with some finding benefits of tight control for reducing heart attacks and others finding no benefits or even potential harms of very tight control, especially in older patients or those with existing heart disease. The document concludes that an A1C target of less than 7% is generally appropriate for most patients, but that goals need to be individualized based on age, comorbidities, and other factors. Very tight control to A1C levels below 6.5% may not be safe and could potentially increase risks in some high
A limited presentation about a) age related renal functional changes b) management of CKD, including advance care planning and transplantation referral c) management of potentially risky drugs in the elderly with CKD (NOACs)
Ponencia realizada por el Dr. José Ramón González-Juanatey del Hospital Clínico Universitario de Santiago de Compostela en la sesión 'Diabetes 2021. Cardiólogos y endocrinólogos: ¿matrimonio o divorcio?' del 13 de mayo de 2021
The FIGARO-DKD trial found that:
1) Finerenone significantly reduced the risk of the primary cardiovascular outcome (composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or hospitalization for heart failure) by 13% compared to placebo in patients with chronic kidney disease and type 2 diabetes.
2) The cardiovascular benefit was primarily driven by a reduction in hospitalization for heart failure despite excluding patients with symptomatic heart failure with reduced ejection fraction.
3) Finerenone did not significantly reduce the risk of a sustained 40% decline in eGFR but did trend toward improving the clinically accepted outcome of a sustained 57% decline in eGFR compared to placebo.
pathophysiology and therapy of diabetic nephropathyMuhamed Al Rohani
This document discusses diabetic nephropathy, which is the leading cause of end-stage renal disease. It begins with an overview of the epidemiology and risk factors for diabetic nephropathy. It then covers the pathophysiology and pathological stages, explaining the progression from increased glomerular filtration rate to decreased GFR and kidney damage. Treatment focuses on tight blood glucose and blood pressure control using ACE inhibitors, ARBs, or a combination to slow the progression of kidney disease. Clinical trials demonstrate that these drugs can reduce proteinuria and prevent worsening of renal function in patients with diabetes.
a-comprehensive-approach-to-kidney-disease-and-hypertension by HazwanMohd Hanafi
This document discusses kidney disease and hypertension. It begins by outlining the key functions of the kidneys, including regulating blood pressure through the renin-angiotensin-aldosterone system. It then examines the causes and classifications of acute and chronic kidney disease. Chronic kidney disease is a growing problem due to its asymptomatic nature in early stages. The document reviews factors that can damage the kidneys and lead to reduced glomerular filtration rate. It also discusses how chronic kidney disease and reduced kidney function are linked to increased risk of cardiovascular disease, anemia, and bone disease like renal osteodystrophy. Hypertension is both a common cause and complication of chronic kidney disease. Tight blood pressure control is important to slow
Recent advancement in managing diabetic nephropathypp_shivgunde
This document discusses recent advances in managing and understanding diabetic nephropathy. It begins with an introduction to diabetes and chronic kidney disease prevalence and prognosis. It then covers the pathophysiology of diabetic nephropathy and the current standard tripartite approach of intensive blood glucose control, blood pressure control, and RAAS blockade. Novel therapeutic modalities such as exploiting the renin-angiotensin-aldosterone axis through dual or combined blockade and aldosterone antagonism are also discussed.
The document summarizes chronic kidney disease (CKD) and its management. It defines CKD and outlines the new classification system. It discusses evaluating kidney function through estimated GFR and albuminuria. It covers managing CKD progression through blood pressure control, RAAS interruption, glycemic control, and treating complications like anemia. It recommends lowering protein intake in later stages and salt intake. Overall, the document provides clinical practice guidelines for defining, evaluating, and managing CKD and its progression and complications.
- The document discusses the burden of diabetic kidney disease and the benefits of SGLT2 inhibitors (SGLT2i).
- It notes that progression of diabetic kidney disease depends on glomerular blood pressure and that SGLT2i lower intraglomerular pressure through their mechanisms of action.
- Clinical trials show that SGLT2i provide renal benefits including postponing end-stage renal disease and that earlier treatment provides longer-term protection of kidney function.
This document summarizes the background and qualifications of Dr. Gwei-Bian Gao, a cardiologist and diabetes specialist. It lists his medical education, areas of specialty training, positions held at major hospitals, awards for diabetes care quality, and current practice at Muh-Kang Clinic in Kaohsiung, Taiwan. The clinic focuses on cardiology, pulmonology, endocrinology, and diabetes management. Recent clinical trials show that SGLT2 inhibitors can protect cardiac and renal function in patients with type 2 diabetes.
Diabetic kidney disease, also known as diabetic nephropathy, is a complication of diabetes that affects the kidneys. It is characterized by persistent albuminuria, declining kidney function, and elevated blood pressure. Strict control of blood glucose and blood pressure can help prevent and slow the progression of diabetic kidney disease. Current treatments include ACE inhibitors, ARBs, SGLT2 inhibitors, and GLP-1 agonists, which have shown benefits in reducing proteinuria, slowing kidney function decline, and preventing cardiovascular disease in patients. Diabetic kidney disease remains a leading cause of chronic kidney disease and end-stage renal disease worldwide.
1) This case study describes a 60-year-old female patient with type 2 diabetes, hypertension, and dyslipidemia who is showing signs of declining kidney function and diabetic kidney disease.
2) Her HbA1c, blood pressure, lipids, and urine albumin levels have worsened over the past year despite treatment with metformin, glimepiride, and other medications.
3) Treatment options discussed include adding a DPP-4 inhibitor or SGLT2 inhibitor, or switching from glimepiride to gliclazide to help control blood sugar levels while avoiding further kidney damage and hypoglycemia. Gliclazide is presented as a safer option compared to other sulf
Sglt2i Empagliflogin canagliflogin dapagliflogin- beyond glycemic controlDrSuman Roy
This document discusses the cardiovascular and renal benefits of SGLT2 inhibitors (SGLT2i), a class of antidiabetic drugs. It summarizes data from clinical trials showing that SGLT2i like empagliflozin, canagliflozin, and dapagliflozin lower the risks of cardiovascular death, heart failure hospitalization, and progression of kidney disease in patients with type 2 diabetes. However, it also notes potential adverse effects of SGLT2i including genitourinary infections, hypotension, acute kidney injury, bone fractures, diabetic ketoacidosis, and amputations. The document concludes that SGLT2i provide risk-benefit for patients with type
This document discusses diabetic kidney disease (DKD). It provides information on the epidemiology, clinical presentation, pathogenesis, standard of care, and pharmacological interventions to reduce cardiorenal risk in patients with type 2 diabetes. Regarding standard of care, it outlines glycemic and blood pressure targets, the use of RAAS inhibitors and statins, and glucose-lowering medications. It then discusses how SGLT2 inhibitors have shown benefits in reducing cardiovascular, renal, and heart failure outcomes as well as slowing kidney disease progression in patients with DKD and type 2 diabetes.
Dapagliflozin demonstrated clear treatment benefits for cardiovascular, kidney, and mortality outcomes in patients with chronic kidney disease (CKD), regardless of the presence of diabetes. It provides glomerular protection, limits proteinuria and kidney damage, and slows the decline of glomerular filtration rate in CKD patients. The DAPA-CKD trial found that dapagliflozin reduced the risk of end-stage renal disease or death from renal causes compared to placebo in CKD patients with and without type 2 diabetes. Dapagliflozin is indicated for the treatment of CKD up to stage III and was well tolerated with a low rate of treatment discontinuation.
Management of coronary disease in diabetes - Is it different?Dr Vivek Baliga
The management of diabetes and coronary artery disease go hand in hand. This presentation by Dr Vivek talks on whether it varies from usual management.
This document summarizes a presentation on integrating SGLT-2 inhibitors into standard heart failure care. It begins by describing the role of SGLT-2 inhibitors in treating heart failure with reduced ejection fraction based on major cardiovascular outcomes trials. It then reviews the proposed mechanisms of action for the heart failure benefits and discusses the RECEDE-CHF and DAPA-HF trials. DAPA-HF was a randomized controlled trial that showed dapagliflozin reduced the primary composite outcome of worsening heart failure or cardiovascular death compared to placebo in patients with heart failure and reduced ejection fraction.
SGLT2I The paradigm change in diabetes managementPraveen Nagula
Just like ARNI, SGLT2I have changed the face of diabetes management and they have a good profile in multimodality management because of pleiotropic effects
SGLT2 Inhibitor therapy has opened up an exciting avenue for the Physicians to manage the patients with CKD . The slide set highlights the major trials on the drug showing remarkable benefits.
This document provides an overview of canagliflozin, an SGLT2 inhibitor used to treat type 2 diabetes. It discusses the pathogenesis of type 2 diabetes, progressive beta cell dysfunction, and the kidney's role in glucose regulation. It then reviews canagliflozin's mechanism of action as an SGLT2 inhibitor, increasing urinary glucose excretion and reducing blood glucose levels. The document summarizes canagliflozin's clinical trials, pharmacokinetics, efficacy, safety profile, and effects on renal function and lipids.
This document summarizes the key details of the DAPA-CKD clinical trial which assessed the effects of the SGLT2 inhibitor dapagliflozin in patients with chronic kidney disease (CKD). The trial randomized over 4,000 patients with CKD stages 2-4 and elevated urinary albumin levels to receive either dapagliflozin 10mg daily or placebo. The primary outcome was a composite of sustained decline in kidney function, need for kidney replacement therapy, or death from renal or cardiovascular causes. Secondary outcomes included safety events. The trial found that dapagliflozin reduced the primary composite outcome compared to placebo in patients with CKD with and without diabetes.
This document discusses the clinical profile and efficacy of the combination drug GLYXAMBI, which contains empagliflozin and linagliptin. It summarizes clinical trial results showing that GLYXAMBI provides significant reductions in HbA1c and body weight compared to the individual components alone in patients with type 2 diabetes. Guidelines from major diabetes organizations have been updated to recommend SGLT2 inhibitors like empagliflozin and GLP-1 receptor agonists to reduce cardiovascular risk based on positive cardiovascular outcomes trial results.
The EMPA-KIDNEY trial aims to evaluate whether empagliflozin can benefit patients with chronic kidney disease (CKD) and cardiovascular disease outcomes in patients with or without diabetes. The trial plans to enroll approximately 6,000 patients with CKD at risk of progression and randomly assign them to receive empagliflozin or placebo in addition to standard of care. The primary outcome is a composite of cardiovascular death, end-stage kidney disease, or sustained decline in kidney function. Key secondary outcomes include hospitalization for heart failure or cardiovascular death, all-cause hospitalization, and all-cause mortality. The estimated trial completion is in 2022 and will provide important data on the efficacy of empagliflo
Diabetic kidney disease remains a major global health problem. Recent research has provided insights into the pathophysiology and has identified new diagnostic and therapeutic approaches. Several large clinical trials have shown that sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, mineralocorticoid receptor antagonists, and endothelin receptor antagonists can reduce kidney disease progression and cardiovascular events in patients with diabetes and kidney disease. Ongoing trials are further evaluating combination therapies and the benefits of these agents in non-diabetic kidney disease and heart failure.
John B. Buse, MD, PhD; David Cherney, MD, PhD, FRCP(C); and Mikhail Kosiborod, MD, FACC, FAHA, prepared useful Practice Aids pertaining to SGLT2 inhibitors for this CME activity titled “Complex Cases in Contemporary Practice: Applying New Evidence for SGLT2 Inhibitors in the Management of Patients With Comorbid Cardiometabolic Diseases.” For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at https://bit.ly/3dFKZhs. CME credit will be available until July 22, 2021.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
1. Think twice for diabetes:
Cardio-renal or Renal-cardiac Benefits
of SGLT2i in diabetic patients
楊智超 醫師
腎臟科
高雄長庚紀念醫院
AUG 7th 2020
2. • The burden of diabetic kidney disease (DKD) and
cardiorenal syndrome
• Progression of DKD: glomerular blood pressure
matters!!
• Renal benefits of SGLT-2i: a wonder drug
• CVOTs of SGLT2i: The earlier, the longer, the better
• More cardiorenal benefits of SGLT-2i: Why and How
• Why Canagliflozin? : beneficial add-on effects of
GLP-1
2
Outline
3.
4. Development of Macroalbuminuria Heralds Rapid Decline in
Glomerular Filtration in Type II Diabetes
-50
-40
-30
-20
-10
0
1 1.5 2 2.5 3 3.5 4
Time years
ChangeinGFRml/min
Microalbuminuria
Macroalbuminuria
Nelson RG. et al NEJM, 1996
10ml/min/yr
SLOW PROGRESSION ?
5. 5
Adapted from Gregg EW et al. N Engl J Med 2014;370:1514
Increased life expectancy and aging kidneys!!
Era of
SGLT2i
GLP1a
?
Rennal & IDNT 2001: Macroalbuminuric DKD
6. An ACE inhibitor or ARB, at the maximum tolerated dose indicated for BP
treatment, is the recommended first-line treatment for HTN in patients with
DM and UACR>300 mg/g creatinine (A) or 30–299 mg/g creatinine (B).
Diabetes Care 2020;43(Suppl.1): S111–S134
Cardiovascular Disease and Risk Management: Standards of Medical Care
in Diabetes—2020
11. For the purpose of scientific medical exchange only
Verma and McMurray (2018) Diabetologia DOI 10.1007/s00125-018-4670-7; Diabetes Obes Metab. 2018;20:479 – 487.
SGLT-2i may reduce mostIy interstitial fluid than
intravascuIar voIume
Loop diureticsSGLT-2 inhibitors
Congestion relief without reducing arterial filling and perfusion
Limit the reflex neurohumoral stimulation
Interstitial oedema
in congestive
heart failure
12. 12
Ohara et al. Diabetol Metab Syndr (2020) 12:37 https://doi.org/10.1186/s13098-020-00545-z
Dapagliflozin decreased the extracellular volume expansion
in patients with higher baseline ECW/TBW and BNP levels
Change in ECW/TBW after 7 days of dapagliflozin
in 36 DKD patients
13. • The burden of diabetic kidney disease (DKD) and
cardiorenal syndrome
• Progression of DKD: glomerular blood pressure
matters!!
• Renal benefits of SGLT-2i: a wonder drug
• CVOTs of SGLT2i: The earlier, the longer, the better
• More cardiorenal benefits of SGLT-2i: Why and How
• Why Canagliflozin? : beneficial add-on effects of
GLP-1
13
Outline
14. Renal Events by eGFR and Albuminuria : ADVANCE Study
Renal events: death as a result of kidney disease, requirement for dialysis or transplantation, or
doubling of serum creatinine to >2.26 mg/dL (200 μmol/L)
10,640 patients with T2DM; median follow-up of 4.3 years
eGFR, estimated glomerular filtration rate; HR, hazard ratio; T2DM, Type 2 diabetes mellitus; UAE, urinary albumin excretion
Ninomiya T, et al. J Am Soc Nephrol 2009;20:1813–1821
14
15. Glomerular hypertension, hyperfiltration and nephron loss
are key culprits in CKD progression
• CKD, chronic kidney disease; GFR, glomerular filtration rate
• Kanzaki G, et al. Hypertension Res 2015;38:633–641
GFR >90 ml/min GFR >135ml/min GFR <60ml/min GFR <30ml/min
Normal Hyperfiltration CKD Stage 3 CKD Stage 4
Courtesy M. Eynatten
16. Intraglomerular blood pressure is derived from
Systemic blood pressure
Afferent arteriole tone
Efferent arteriole tone
The era of RAAS blockade
N Engl J Med 2017; 377:1765-1776
17. Natural history of diabetic nephropathy
Functional Hyperfiltration Microalbuminuria, hypertension Albuminuira, declining GFR
Vora JP, et al. In: Johnson RJ, Feehally J, eds. Comprehensive Clinical Nephrology. New York: Mosby; 2000.
Urinaryproteinexcretion
(mg/d)
Years
Glomerularfiltrationrate(GFR)
(mL/min)
0
150
100
50
5 10 15 20 25
Incipient diabetic
nephropathy
Pre Overt diabetic
nephropathy
End-stage
renal disease
1 2 3 4 5
200
1000
5000
20
Urinary protein excretionGFR
19. For training purposes only.
Dulaglutide has received positive opinion from the CHMP; however, there is no guarantee it will receive regulatory approval and become commercially available in your affiliate.
JASN April 2017, 28 (4) 1023-1039
Silent loss
Save diabetic kidneys: The earlier, the better!!
Single nephron protection!!
20. For training purposes only.
Dulaglutide has received positive opinion from the CHMP; however, there is no guarantee it will receive regulatory approval and become commercially available in your affiliate.
Case
• A 53 y/o man(173/cm/80kg) has medical history of DM more than 10 yrs, HTN
• DKD with macroalbuminuria(Bilateral nephromegaly, Cr 1.32, 57ml/min, UAER
6488 mg/g, Albumin 2.60 )
21. Natural history of diabetic nephropathy
Functional Hyperfiltration Microalbuminuria, hypertension Albuminuira, declining GFR
Vora JP, et al. In: Johnson RJ, Feehally J, eds. Comprehensive Clinical Nephrology. New York: Mosby; 2000.
Urinaryproteinexcretion
(mg/d)
Years
Glomerularfiltrationrate(GFR)
(mL/min)
0
150
100
50
5 10 15 20 25
Incipient diabetic
nephropathy
Pre Overt diabetic
nephropathy
End-stage
renal disease
1 2 3 4 5
200
1000
5000
20
Urinary protein excretionGFR
23. High-Protein Diet Is Bad for Kidney Health
• HPD increases the risk of RHF and a rapid renal function decline in the general
population
Nephrol Dial Transplant. 2020 Jan 1;35(1):98-106.
• HPD was significantly associated with a more rapid kidney function
decline in post-MI patients.
Nephrol Dial Transplant . 2020 Jan 1;35(1):106-115.
24. Amino acid-induced hyperfiltration:
Amino acids
Branched-chain
amino/keto acids
cAMP
Glucagon
2
1
1 + 2
• Increased renal
plasma flow
• HyperfiltrationLang et al. (1995): Sem Nephrol, 15, 415-418
Progression of CKD: Hyperfiltration
Among the proteinogenic amino acids, there are
three BCAAs: leucine, isoleucine and valine
tubuloglomerular feedback
29. • The burden of diabetic kidney disease (DKD) and
cardiorenal syndrome
• Progression of DKD: glomerular blood pressure
matters!!
• Renal benefits of SGLT-2i: a wonder drug
• CVOTs of SGLT2i: The earlier, the longer, the better
• More cardiorenal benefits of SGLT-2i: Why and How
• Why Canagliflozin? : beneficial add-on effects of
GLP-1
29
Outline
33. eGFR over 192 weeks
33
Mixed model repeated measures analysis using all data from patients treated with ≥1 dose of study drug
(modified intent-to-treat approach). eGFR by Chronic Kidney Disease Epidemiology Collaboration formula.
eGFR, estimated glomerular filtration rate.
11%
80% pts with ACEI/ARB; eGFR >30 ml/min; 100% CVD
N Engl J Med 2016; 375:323-334
Slop= 2 ml/min
Slop= 4~5ml/min
34. 34
Am J Nephrol. 2018 Jan; 46(6): 462–472. April 14, 2019 DOI: 10.1056/NEJMoa1811744
(<60ml/min 60%)
(macro 100%)
35. Cardiovascular Comorbidities,
5% Medicare sample, by Diabetes and CKD status, 1999-2000
Kidney International, Vol. 64, Supplement 87
(2003), pp. S24–S31
Safety issue of SGLT2i
44. European Heart Journal, ehz455
ESC/EAS dyslipidemia Guidelines 2019
Intensive care is needed for pts
with moderate to severe CKD !!
Moderate CKD (eGFR 30-59 ml/min)
Severe CKD (eGFR <30 ml/min)
47. 47
Effects of Canagliflozin on eGFR in Participants with
Baseline eGFR < 30 mL/min/1.73 m2
Prof. Carol Pollock presentation on IDF, 2019
Single nephron protection!!
48. • The burden of diabetic kidney disease (DKD) and
cardiorenal syndrome
• Progression of DKD: glomerular blood pressure
matters!!
• Renal benefits of SGLT-2i: a wonder drug
• CVOTs of SGLT2i: The earlier, the longer, the better
• More cardiorenal benefits of SGLT-2i: Why and How
• Why Canagliflozin? : beneficial add-on effects of
GLP-1
48
Outline
49. Patients’ CV-renal profile and SGLT2i effects on end-points
Baseline SBP~ 135-140 mmHg, 80%-100% pts with ACEI/ARB
DECLARE CANVUS EMPA-outcome
CREDENCE
~40% reduction
~40% reduction
Cardio-renal or
Renal-cardiac ?
50. 50
Lancet Diabetes Endocrinol 2019 Published Online September 5, 2019 http://dx.doi.org/10.1016/S2213-8587(19)30256-6
Effect of SGLT2i on substantial loss of kidney function, ESKD,
or death due to kidney disease, stratified by use of RAS blockade
• Residual renal risk is still high under RAS blockade!!
• SGLT2i can help and play as a starter!!
51. Keep flood out is better than pour water out!!
SGLT2i ACEI/ARB
52. Long-term Decline in GFR is Correlated
With Poor Control of Blood Pressure:
9 Studies on Nephropathy Progression
–14
–12
–10
–8
–6
–4
–2
0
95 97 99 101 103 105 107 109 111 113 115 117 119
MAP (mmHg)GFR
(ml/min/yr)(mmHg)
Untreated HTN
140/90130/85
Graph: (Bakris GL. J Clin Hypertens. 1999)
Trials: (Parving HH, et al. Br Med J. 1989) (Viberti GC, et al. JAMA. 1993) (Klaur S, et al. N Engl J Med. 1993*) (Herbert L, et al.
Kidney Int. 1994) (Lebovitz H, et al. Kidney Int. 1994) (Moschio G, et al. N Engl J Med. 1996*) (Bakris GL, et al. Kidney
Int. 1996) (Bakris GL, et al. Hypertension. 1997) (GISEN Group, Lancet. 1997)
121
*Trials marked by * are non-diabetic renal disease patients.
125/75 mmHg
if proteinuria
>1g/day
+SGLT2i
Untreated HTN and DM
53. For training purposes only.
Dulaglutide has received positive opinion from the CHMP; however, there is no guarantee it will receive regulatory approval and become commercially available in your affiliate.
54. 54
• In diabetics versus non-diabetics, these were “identical” with
respective HRs of 0.75 and 0.73
Reduced EF<40%
56. • The burden of diabetic kidney disease (DKD) and
cardiorenal syndrome
• Progression of DKD: glomerular blood pressure
matters!!
• Renal benefits of SGLT-2i: a wonder drug
• CVOTs of SGLT2i: The earlier, the longer, the better
• More cardiorenal benefits of SGLT-2i: Why and How?
• Why Canagliflozin? : beneficial add-on effects of
GLP-1
56
Outline
58. 58
Diabetes Care 2018;41:356–363
The strongest mediator was
hematocrit
A surrogate marker for
1. Recovery from reversible
tubulointerstitial injury!!
2. Preserved GFR and EF make
hemoconcentration possible!!
60. For training purposes only.
Dulaglutide has received positive opinion from the CHMP; however, there is no guarantee it will receive regulatory approval and become commercially available in your affiliate.
Non-diabetic model
61. Therapeutic effect of EMPA against p-Cresol-induced oxidative stress, DNA damage and
mitochondrial damage
DNA damage: γ-H2AX
Mito integrity: mitochondrial cytochrome C (mit-Mito C),
Mito damage:cytosolic cytochrome C (cyt-Cyto C)
oxidative stress
62. Therapeutic effect of EMPA against p-Cresol induced injury in cell culture study
Apoptosis: double stain of Annexin IV/PI
63. • The burden of diabetic kidney disease (DKD) and
cardiorenal syndrome
• Progression of DKD: glomerular blood pressure matters!!
• Renal benefits of SGLT-2i: a wonder drug
• CVOTs of SGLT2i: The earlier, the longer, the better
• More cardiorenal benefits of SGLT-2i: Why and How
• Why Canagliflozin? : beneficial add-on effects of GLP-1
63
Outline
64. Structure and selectivity profiles for SGLT2 over
SGLT1
Empagliflozin
Canagliflozin
Dapagliflozin
Selectivity
SGLT-1 : SGLT-2
1:2500
1:1200
1:160
Singh AK et al. Indian J Endocrinol Metab. 2015 Nov-Dec;19(6):722-30.
64
more natriuresis!!
68. Canagliflozin Lowers Postprandial Glucose and Insulin by DelayingIntestinal
Glucose Absorption in Addition to Increasing UrinaryGlucose Excretion
Endocrine Journal 2017, 64 (9), 923-931
68
Peptide tyrosine-tyrosine(PYY)抑制食慾
2~3x
69. Canagliflozin, dapagliflozin and empagliflozin
for treating type 2 diabetes: Network Meta-analysis 69
Health Technology Assessment, No. 21.2
HbA1c
BW
70. Canagliflozin, dapagliflozin and empagliflozin
for treating type 2 diabetes: Network Meta-analysis 70
Health Technology Assessment, No. 21.2
SBP
74. CKD-EPI=Chronic Kidney Disease Epidemiology Collaboration; eGFR=estimated glomerular filtration rate; UACR=urine albumin:creatinine ratio
Data presented as change from baseline [LSM (95%CI)]; Safety population, MMRM analysis; *p<0.05 and **p<0.001 vs. baseline; #p<0.05 vs. insulin glargine.
eGFR AND ALBUMINURIA Decline by Baseline Macroalbuminuria
Award 7
Beneficial renal effects of Glp-1a!!
77. GLP-1a/DPP4i: seal glue
+
SGLT2i+ARB/ACEi: wrench
to decrease the flow and
pressure
In macroalbuminuria
Complementary effect!!
Broken pipe needs wrench and seal glue!
CREDENCE pts!!
83. In the CREDENCE trial of patients with type 2
diabetes and chronic kidney disease, canagliflozin was
associated with a 30% reduction in the risk of the
primary composite endpoint, comprising end-stage
kidney disease, doubling of serum creatinine, and renal
serum creatinine, and renal or cardiovascular death, as
Pts with highest risk for both CV and renal disease!!
84. Curr Opin Nephrol Hypertens 2017, 26:345–350
SGLT2i
High BP&protein induced
hyperfiltration
High protein related
Uremic toxin