- 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 treatment of hypertension from the perspectives of primary care and metabolic departments. It discusses:
1) Treatment of hypertension in primary care is similar to specialist centers, with some minor differences in related checks and tests.
2) The metabolic department treats diseases like diabetes and its complications, and chronic kidney disease.
3) Current guidelines recommend treating hypertension according to disease status, with a focus on RAS inhibitors as first-line drugs due to their protective effects on organs like the brain, heart and kidneys.
SGLT2 inhibitors for the prevention of kidney failure in patients with type 2...Brendon Neuen
SGLT2 inhibitors were found to reduce major kidney outcomes in patients with type 2 diabetes based on a systematic review and meta-analysis of four major trials. The analysis found that SGLT2 inhibitors reduced the risk of dialysis, transplant or renal death by 33%, end-stage kidney disease by 35%, substantial loss of kidney function or end-stage kidney disease by 42%, substantial loss of kidney function or cardiovascular or renal death by 29%, and acute kidney injury by 25% compared to placebo. The kidney protective effects were consistent across various subgroups including those with and without albuminuria and those with and without blockade of the renin-angiotensin system.
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
New Approaches To The Treatment Of Hyperphosphataemia (CRF)Andre Garcia
The document discusses new approaches to treating hyperphosphataemia in patients with kidney disease. It summarizes findings from several studies that show disorders of mineral metabolism like hyperphosphatemia are associated with increased risks of cardiovascular disease and mortality in dialysis patients. One study found that treatment with the phosphate binder lanthanum carbonate was more effective at controlling serum phosphate levels and reducing the calcium-phosphate product compared to calcium-based binders, with fewer hypercalcemia side effects.
This document discusses sodium glucose cotransporter-2 inhibitors (SGLT2i) across the spectrum of renal diseases. It begins with an overview of renal glucose handling and the role of the SGLT2 channel. It then reviews the rationale for SGLT2 inhibition in diabetic and non-diabetic kidney diseases and basic SGLT2i pharmacology. Finally, it examines clinical outcomes data from trials demonstrating the cardiovascular, renal, and heart failure benefits of SGLT2is across levels of renal function and in diabetic and non-diabetic patients.
Gpc manejo de enfermedades glomerulares-kdigo-2021WilliamBarrera34
This document provides clinical practice guidelines for the management of glomerular diseases published by KDIGO (Kidney Disease: Improving Global Outcomes) in 2021. It includes 11 chapters covering various glomerular diseases and recommendations for their evaluation and treatment. Key recommendations are presented in figures and tables throughout. Evaluation of evidence and grading of recommendations follows standardized processes. The guidelines aim to provide an evidence-based framework to guide clinical decision-making for glomerular diseases.
The document contains demographic and baseline characteristic data from the DEVOTE clinical trial comparing insulin degludec to insulin glargine in patients with type 2 diabetes at high risk for cardiovascular events. A total of 7637 patients from 20 countries across 5 continents were enrolled in the trial. At baseline, the mean age was approximately 65 years for both treatment groups. Slightly over 60% of patients were male. Patients had a mean duration of diabetes of approximately 16 years and the majority (over 84%) had established cardiovascular or chronic kidney disease and were aged 50 years or older.
- 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 treatment of hypertension from the perspectives of primary care and metabolic departments. It discusses:
1) Treatment of hypertension in primary care is similar to specialist centers, with some minor differences in related checks and tests.
2) The metabolic department treats diseases like diabetes and its complications, and chronic kidney disease.
3) Current guidelines recommend treating hypertension according to disease status, with a focus on RAS inhibitors as first-line drugs due to their protective effects on organs like the brain, heart and kidneys.
SGLT2 inhibitors for the prevention of kidney failure in patients with type 2...Brendon Neuen
SGLT2 inhibitors were found to reduce major kidney outcomes in patients with type 2 diabetes based on a systematic review and meta-analysis of four major trials. The analysis found that SGLT2 inhibitors reduced the risk of dialysis, transplant or renal death by 33%, end-stage kidney disease by 35%, substantial loss of kidney function or end-stage kidney disease by 42%, substantial loss of kidney function or cardiovascular or renal death by 29%, and acute kidney injury by 25% compared to placebo. The kidney protective effects were consistent across various subgroups including those with and without albuminuria and those with and without blockade of the renin-angiotensin system.
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
New Approaches To The Treatment Of Hyperphosphataemia (CRF)Andre Garcia
The document discusses new approaches to treating hyperphosphataemia in patients with kidney disease. It summarizes findings from several studies that show disorders of mineral metabolism like hyperphosphatemia are associated with increased risks of cardiovascular disease and mortality in dialysis patients. One study found that treatment with the phosphate binder lanthanum carbonate was more effective at controlling serum phosphate levels and reducing the calcium-phosphate product compared to calcium-based binders, with fewer hypercalcemia side effects.
This document discusses sodium glucose cotransporter-2 inhibitors (SGLT2i) across the spectrum of renal diseases. It begins with an overview of renal glucose handling and the role of the SGLT2 channel. It then reviews the rationale for SGLT2 inhibition in diabetic and non-diabetic kidney diseases and basic SGLT2i pharmacology. Finally, it examines clinical outcomes data from trials demonstrating the cardiovascular, renal, and heart failure benefits of SGLT2is across levels of renal function and in diabetic and non-diabetic patients.
Gpc manejo de enfermedades glomerulares-kdigo-2021WilliamBarrera34
This document provides clinical practice guidelines for the management of glomerular diseases published by KDIGO (Kidney Disease: Improving Global Outcomes) in 2021. It includes 11 chapters covering various glomerular diseases and recommendations for their evaluation and treatment. Key recommendations are presented in figures and tables throughout. Evaluation of evidence and grading of recommendations follows standardized processes. The guidelines aim to provide an evidence-based framework to guide clinical decision-making for glomerular diseases.
The document contains demographic and baseline characteristic data from the DEVOTE clinical trial comparing insulin degludec to insulin glargine in patients with type 2 diabetes at high risk for cardiovascular events. A total of 7637 patients from 20 countries across 5 continents were enrolled in the trial. At baseline, the mean age was approximately 65 years for both treatment groups. Slightly over 60% of patients were male. Patients had a mean duration of diabetes of approximately 16 years and the majority (over 84%) had established cardiovascular or chronic kidney disease and were aged 50 years or older.
1) The document discusses a Phase 3 clinical trial investigating the effects of the ASK1 inhibitor selonsertib (SEL) in patients with diabetic kidney disease (DKD).
2) The trial did not meet its primary endpoint of a 50% improvement in eGFR from baseline to week 48. However, exploratory analyses found SEL induced acute but reversible eGFR declines followed by stabilization or improvement in eGFR slope over time.
3) Adverse events including acute kidney injury and fluid overload were similar between SEL and placebo groups. The study was limited by its short duration and data issues from two sites.
Hypertension and Diabetic Kidney Disease Progression Hypertension and Diabe...MedicineAndHealthUSA
Hypertension and diabetic kidney disease progression are linked, and reducing proteinuria is key to slowing kidney disease. The document discusses how conditions like hypertension and diabetes that cause kidney damage have increased in the US population. Landmark trials found that lowering blood pressure and proteinuria reduced kidney disease progression and cardiovascular risks. Initial therapy for kidney or diabetes patients should be an ACE inhibitor or ARB to target blood pressure under 130/80 mmHg.
Three cases of acute myocardial infarction are presented. All three patients had type 2 diabetes and other cardiovascular risk factors like hypertension and dyslipidemia. They presented with chest pain and ST-segment changes on electrocardiogram. All underwent emergency cardiac catheterization and had stents placed in obstructed coronary arteries. Strict control of blood sugar, blood pressure, and lipids is emphasized going forward to prevent further cardiovascular complications. The role of SGLT2 inhibitors in cardiovascular and renal protection for patients with diabetes is also discussed.
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.
Resultados del estudio DEVOTE (Devote 1-2-3): Comparing Cardiovascular Safety of Insulin Degludec versus Insulin Glargine in Patients with Type 2 Diabetes at HighRisk of Cardiovascular Events
Pentoxyfilline in Diabetic Renal Disease and Renal TransplantationChristos Argyropoulos
Pentoxifylline may reduce proteinuria in patients with diabetic kidney disease, according to a meta-analysis of 10 randomized controlled trials. The analysis found that pentoxifylline led to a statistically significant decline in proteinuria compared to standard renin-angiotensin system blockade alone, with an effect size similar to full-dose ACE inhibitors. However, the included studies had small sample sizes and short durations. Pentoxifylline did not significantly affect glomerular filtration rate, blood pressure, or adverse effects. Larger and longer term studies are still needed to determine if pentoxifylline can delay kidney function decline in diabetic kidney disease.
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.
Bariatric surgery, especially malabsorptive procedures like Roux-en-Y gastric bypass, significantly increases the risk of kidney stones compared to obese controls. The risk is highest with malabsorptive procedures and correlates with the degree of fat malabsorption and enteric hyperoxaluria. However, bariatric surgery does not appear to increase the risk of chronic kidney disease. Further research is still needed to fully understand the mechanisms by which bariatric surgery leads to hyperoxaluria and kidney stone formation.
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)
This document provides guidelines for the evaluation and management of chronic kidney disease (CKD) developed by the Kidney Disease: Improving Global Outcomes (KDIGO) organization. It defines CKD and staging systems based on glomerular filtration rate and albuminuria levels. The guidelines provide recommendations on screening and diagnosis of CKD, predicting progression, managing risk factors and complications, and referral to specialists. CKD is a major global public health problem, and these evidence-based guidelines aim to aid healthcare providers in delivering optimal care to patients with CKD.
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 summarizes the results of a clinical trial investigating the efficacy of oral low molecular weight hyaluronic acid (HA) in improving symptoms and function in patients with knee osteoarthritis. The study was a randomized, double-blind, placebo-controlled trial involving Taiwanese patients with knee OA. Patients received either an oral liquid containing low molecular weight HA, glucosamine, and chondroitin, or a placebo daily for 8 weeks. Outcome measures including the WOMAC scale and SF-36 questionnaire showed significant improvements in pain, physical function, and quality of life in the HA group compared to the placebo group. The study demonstrated oral low molecular HA was effective in relieving symptoms of mild knee O
The document discusses biomarkers for detecting acute kidney injury (AKI). It notes that serum creatinine is currently used but is not an early indicator. Newer biomarkers like NGAL can detect AKI earlier, within 2 hours after an event instead of 1-2 days with creatinine. Having early biomarkers could allow for improved understanding, earlier treatment and better outcomes for AKI patients. The document reviews studies on NGAL for detecting AKI in settings like cardiac surgery, contrast-induced nephropathy, sepsis, and kidney transplantation.
La insulinoterapia es un arte y actualmente contamos con nuevas formulaciones y otras en proceso de investigación y aprobación. Ponencia presentada en las jornadas del benemérito H2M.
Slidedeck of the presentation I gave during the East by Southwest conference, co-organized by the Division of Nephrology (UNM) and the Renal and Electrolyte Division (UPMC)
1) The IMPROVE-IT trial investigated whether adding ezetimibe to simvastatin therapy provides additional cardiovascular benefit compared to simvastatin monotherapy in 18,144 high-risk patients who had an acute coronary syndrome.
2) At a median follow-up of 6 years, combination ezetimibe/simvastatin therapy resulted in a statistically significant 9% relative risk reduction in major cardiovascular events compared to simvastatin alone.
3) Combination therapy also significantly reduced the risk of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke by 10% compared to simvastatin monotherapy.
SGLT-2 inhibitors have shown promising cardiovascular and renal benefits:
1) Trials have found SGLT-2 inhibitors reduce the risk of cardiovascular death in patients with type 2 diabetes and established cardiovascular disease, as well as reducing heart failure hospitalizations in those with diabetes and cardiovascular risk factors.
2) Studies also show SGLT-2 inhibitors improve outcomes for patients with heart failure with reduced ejection fraction, reducing rates of heart failure hospitalization and mortality regardless of diabetes status or background heart failure therapies.
3) SGLT-2 inhibitors were also found to reduce the risk of renal death or progression to end-stage kidney disease in patients with type 2 diabetes and macroalbuminuria.
ABSTRACT- Background: Viral hepatitis B and C can lead to the end stage liver disease and diabetes mellitus is also
a life-long chronic disease. Simultaneous presences of both of these conditions lead to synergistic detrimental outcome.
So identification of diabetes mellitus at the initial evaluation of a patient having chronic hepatitis B and C is essential.
Materials and methods: This study was designed as a retrospective single center cross-sectional study. The association
of viral hepatitis B and C with diabetes mellitus was investigated at the Liver Centre Dhaka, Bangladesh for a period of
12 years. HBsAg was tested for hepatitis B virus infection and anti-HCV for hepatitis C virus infection. Demographic
profile and biochemical data were retrieved from records.
Results: A total of 29425 cases were analyzed in the study [median age 31(19–95) years, 24615(84%) males]. HBsAg
positive were 27475 and hepatitis C were 1950. Patients with hepatitis C were older than hepatitis B (p<0.001).
Although previous history of jaundice was similar in both infections but history of blood transfusion was more common
among hepatitis C patients (p<0.001). Analyzing different conditions of liver disease, it was observed that hepatitis B
virus infection was highly responsible for acute hepatitis than hepatitis C (10.7% vs 1.1%) (p<0.001). Chronic hepatitis
was similar in rate (73.3% vs 59.9%). But in both conditions of cirrhosis of liver like compensated and decompensated
states, hepatitis C virus was significantly responsible than the hepatitis B virus 24.7% vs 9.6% (p<0.001) and 14.3% vs
6.4% (p<0.001) respectively. The most significant finding was very higher rate of diabetes among hepatitis C which
was 22.6% while only 1.8% among hepatitis B virus infection (p<0.001).
Conclusion: Hepatitis C virus was highly related with the presence of diabetes than hepatitis B.
Key-words- Diabetes mellitus, Prevalence, Hepatitis B virus, Hepatitis C virus
Simposio ALAD Avances en la prevención y el tratamiento de la diabetes tipo 2...rdaragnez
This document summarizes research on diabetes treatment and outcomes from several long-term clinical trials. It finds that intensive glucose control early in type 2 diabetes can significantly reduce cardiovascular and renal complications long-term. However, rapidly lowering glucose in those with existing cardiovascular disease may increase mortality risk. Multifactorial treatment including blood pressure and glucose control provides substantial benefits and is recommended for all type 2 diabetes patients.
1) The document discusses a Phase 3 clinical trial investigating the effects of the ASK1 inhibitor selonsertib (SEL) in patients with diabetic kidney disease (DKD).
2) The trial did not meet its primary endpoint of a 50% improvement in eGFR from baseline to week 48. However, exploratory analyses found SEL induced acute but reversible eGFR declines followed by stabilization or improvement in eGFR slope over time.
3) Adverse events including acute kidney injury and fluid overload were similar between SEL and placebo groups. The study was limited by its short duration and data issues from two sites.
Hypertension and Diabetic Kidney Disease Progression Hypertension and Diabe...MedicineAndHealthUSA
Hypertension and diabetic kidney disease progression are linked, and reducing proteinuria is key to slowing kidney disease. The document discusses how conditions like hypertension and diabetes that cause kidney damage have increased in the US population. Landmark trials found that lowering blood pressure and proteinuria reduced kidney disease progression and cardiovascular risks. Initial therapy for kidney or diabetes patients should be an ACE inhibitor or ARB to target blood pressure under 130/80 mmHg.
Three cases of acute myocardial infarction are presented. All three patients had type 2 diabetes and other cardiovascular risk factors like hypertension and dyslipidemia. They presented with chest pain and ST-segment changes on electrocardiogram. All underwent emergency cardiac catheterization and had stents placed in obstructed coronary arteries. Strict control of blood sugar, blood pressure, and lipids is emphasized going forward to prevent further cardiovascular complications. The role of SGLT2 inhibitors in cardiovascular and renal protection for patients with diabetes is also discussed.
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.
Resultados del estudio DEVOTE (Devote 1-2-3): Comparing Cardiovascular Safety of Insulin Degludec versus Insulin Glargine in Patients with Type 2 Diabetes at HighRisk of Cardiovascular Events
Pentoxyfilline in Diabetic Renal Disease and Renal TransplantationChristos Argyropoulos
Pentoxifylline may reduce proteinuria in patients with diabetic kidney disease, according to a meta-analysis of 10 randomized controlled trials. The analysis found that pentoxifylline led to a statistically significant decline in proteinuria compared to standard renin-angiotensin system blockade alone, with an effect size similar to full-dose ACE inhibitors. However, the included studies had small sample sizes and short durations. Pentoxifylline did not significantly affect glomerular filtration rate, blood pressure, or adverse effects. Larger and longer term studies are still needed to determine if pentoxifylline can delay kidney function decline in diabetic kidney disease.
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.
Bariatric surgery, especially malabsorptive procedures like Roux-en-Y gastric bypass, significantly increases the risk of kidney stones compared to obese controls. The risk is highest with malabsorptive procedures and correlates with the degree of fat malabsorption and enteric hyperoxaluria. However, bariatric surgery does not appear to increase the risk of chronic kidney disease. Further research is still needed to fully understand the mechanisms by which bariatric surgery leads to hyperoxaluria and kidney stone formation.
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)
This document provides guidelines for the evaluation and management of chronic kidney disease (CKD) developed by the Kidney Disease: Improving Global Outcomes (KDIGO) organization. It defines CKD and staging systems based on glomerular filtration rate and albuminuria levels. The guidelines provide recommendations on screening and diagnosis of CKD, predicting progression, managing risk factors and complications, and referral to specialists. CKD is a major global public health problem, and these evidence-based guidelines aim to aid healthcare providers in delivering optimal care to patients with CKD.
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 summarizes the results of a clinical trial investigating the efficacy of oral low molecular weight hyaluronic acid (HA) in improving symptoms and function in patients with knee osteoarthritis. The study was a randomized, double-blind, placebo-controlled trial involving Taiwanese patients with knee OA. Patients received either an oral liquid containing low molecular weight HA, glucosamine, and chondroitin, or a placebo daily for 8 weeks. Outcome measures including the WOMAC scale and SF-36 questionnaire showed significant improvements in pain, physical function, and quality of life in the HA group compared to the placebo group. The study demonstrated oral low molecular HA was effective in relieving symptoms of mild knee O
The document discusses biomarkers for detecting acute kidney injury (AKI). It notes that serum creatinine is currently used but is not an early indicator. Newer biomarkers like NGAL can detect AKI earlier, within 2 hours after an event instead of 1-2 days with creatinine. Having early biomarkers could allow for improved understanding, earlier treatment and better outcomes for AKI patients. The document reviews studies on NGAL for detecting AKI in settings like cardiac surgery, contrast-induced nephropathy, sepsis, and kidney transplantation.
La insulinoterapia es un arte y actualmente contamos con nuevas formulaciones y otras en proceso de investigación y aprobación. Ponencia presentada en las jornadas del benemérito H2M.
Slidedeck of the presentation I gave during the East by Southwest conference, co-organized by the Division of Nephrology (UNM) and the Renal and Electrolyte Division (UPMC)
1) The IMPROVE-IT trial investigated whether adding ezetimibe to simvastatin therapy provides additional cardiovascular benefit compared to simvastatin monotherapy in 18,144 high-risk patients who had an acute coronary syndrome.
2) At a median follow-up of 6 years, combination ezetimibe/simvastatin therapy resulted in a statistically significant 9% relative risk reduction in major cardiovascular events compared to simvastatin alone.
3) Combination therapy also significantly reduced the risk of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke by 10% compared to simvastatin monotherapy.
SGLT-2 inhibitors have shown promising cardiovascular and renal benefits:
1) Trials have found SGLT-2 inhibitors reduce the risk of cardiovascular death in patients with type 2 diabetes and established cardiovascular disease, as well as reducing heart failure hospitalizations in those with diabetes and cardiovascular risk factors.
2) Studies also show SGLT-2 inhibitors improve outcomes for patients with heart failure with reduced ejection fraction, reducing rates of heart failure hospitalization and mortality regardless of diabetes status or background heart failure therapies.
3) SGLT-2 inhibitors were also found to reduce the risk of renal death or progression to end-stage kidney disease in patients with type 2 diabetes and macroalbuminuria.
ABSTRACT- Background: Viral hepatitis B and C can lead to the end stage liver disease and diabetes mellitus is also
a life-long chronic disease. Simultaneous presences of both of these conditions lead to synergistic detrimental outcome.
So identification of diabetes mellitus at the initial evaluation of a patient having chronic hepatitis B and C is essential.
Materials and methods: This study was designed as a retrospective single center cross-sectional study. The association
of viral hepatitis B and C with diabetes mellitus was investigated at the Liver Centre Dhaka, Bangladesh for a period of
12 years. HBsAg was tested for hepatitis B virus infection and anti-HCV for hepatitis C virus infection. Demographic
profile and biochemical data were retrieved from records.
Results: A total of 29425 cases were analyzed in the study [median age 31(19–95) years, 24615(84%) males]. HBsAg
positive were 27475 and hepatitis C were 1950. Patients with hepatitis C were older than hepatitis B (p<0.001).
Although previous history of jaundice was similar in both infections but history of blood transfusion was more common
among hepatitis C patients (p<0.001). Analyzing different conditions of liver disease, it was observed that hepatitis B
virus infection was highly responsible for acute hepatitis than hepatitis C (10.7% vs 1.1%) (p<0.001). Chronic hepatitis
was similar in rate (73.3% vs 59.9%). But in both conditions of cirrhosis of liver like compensated and decompensated
states, hepatitis C virus was significantly responsible than the hepatitis B virus 24.7% vs 9.6% (p<0.001) and 14.3% vs
6.4% (p<0.001) respectively. The most significant finding was very higher rate of diabetes among hepatitis C which
was 22.6% while only 1.8% among hepatitis B virus infection (p<0.001).
Conclusion: Hepatitis C virus was highly related with the presence of diabetes than hepatitis B.
Key-words- Diabetes mellitus, Prevalence, Hepatitis B virus, Hepatitis C virus
Simposio ALAD Avances en la prevención y el tratamiento de la diabetes tipo 2...rdaragnez
This document summarizes research on diabetes treatment and outcomes from several long-term clinical trials. It finds that intensive glucose control early in type 2 diabetes can significantly reduce cardiovascular and renal complications long-term. However, rapidly lowering glucose in those with existing cardiovascular disease may increase mortality risk. Multifactorial treatment including blood pressure and glucose control provides substantial benefits and is recommended for all type 2 diabetes patients.
1) Multiple lines of evidence from meta-analyses, prospective cohort studies, and randomized controlled trials establish that LDL causes atherosclerotic cardiovascular disease (ASCVD).
2) The risk of atherosclerosis and need for treatment depends on LDL levels and increases with age from childhood through older age. Lowering LDL, including to very low levels, reduces ASCVD risk and can regress atherosclerotic plaques.
3) Intensive LDL lowering through combination therapy such as statins plus ezetimibe or PCSK9 inhibitors provides additional cardiovascular benefit beyond statin therapy alone, including in those already at very low LDL levels. The greatest risk reduction occurs in high-risk groups.
This document summarizes recent clinical trials evaluating new treatments for heart failure with reduced ejection fraction (HFrEF). It finds that sodium-glucose cotransporter-2 inhibitors (SGLT2i) like dapagliflozin and empagliflozin are now foundational therapies for HFrEF as they reduce mortality, hospitalizations, and improve outcomes. Two novel agents, vericiguat and omecamtiv mecarbil, are described as well-tolerated therapies that may provide additional benefit by reducing residual risk in select HFrEF patients. Vericiguat is now FDA-approved and recommended by guidelines for recent worsening HF, while omecamtiv me
This document summarizes the cardiovascular risk of patients with type 2 diabetes mellitus (T2DM) in India and the potential benefits of SGLT2 inhibitor treatment. It finds that:
1) The majority of Indian outpatients with T2DM have at least moderate cardiovascular disease (CVD) risk, and over 35% have known CVD.
2) T2DM confers 2-4 times greater CVD risk regardless of duration, and risk increases with longer duration.
3) Empagliflozin treatment consistently reduces the risk of cardiovascular death and heart failure hospitalizations in clinical trials of patients with T2DM and atherosclerotic CVD.
4) Empagliflozin may provide additional benefits
This document provides an overview of SGLT2 inhibitors (SGLT2is) for the treatment of heart failure and diabetes. It discusses key considerations for using SGLT2is such as evaluating appropriate patients, monitoring safety parameters like blood pressure and kidney function, and managing SGLT2i-associated euglycemic diabetic ketoacidosis. The document reviews clinical trial data on the benefits of SGLT2is in acute and chronic heart failure. It also presents two case studies on initiating SGLT2is during hospitalization and treating euglycemic ketoacidosis with insulin therapy.
The document summarizes the results of the SPRINT trial, which compared an intensive blood pressure treatment target of less than 120 mmHg systolic to a standard target of less than 140 mmHg. Key findings include:
- The intensive treatment group had a significantly lower rate of the primary composite outcome of myocardial infarction, other acute coronary syndromes, stroke, heart failure or death from cardiovascular causes.
- Benefits of intensive treatment were seen across most pre-specified subgroups including those with and without chronic kidney disease.
- Intensive treatment led to more frequent adverse events related to low blood pressure like hypotension, but no differences in falls or fractures.
- More medications were required to achieve the lower blood
This document discusses glucose-lowering therapies and the clinical place of SGLT2 inhibitor agents. It presents the case of a 52-year-old male patient with type 2 diabetes, hypertension, and coronary artery disease. It analyzes adding empagliflozin or sitagliptin to the patient's current metformin regimen and reviews long-term trial data showing empagliflozin's superior effects on HbA1c reduction, weight loss, and hypoglycemia risk reduction compared to glimepiride. The document also discusses empagliflozin's benefits on blood pressure and potential cardioprotective mechanisms of action beyond glycemic control such as reducing cardiac fibrosis. It emphasizes the importance of individual
Atorvastatin: Statins in CVD management. Is just lipid lowering enough Dr Vivek Baliga
This document discusses the benefits of statin drugs beyond their lipid-lowering effects. It summarizes several key studies that show statins reduce cardiovascular events in patients with diabetes or chronic kidney disease, even when baseline lipid levels are normal. The document highlights that atorvastatin and simvastatin have evidence from primary prevention trials of reducing cardiovascular outcomes in diabetes, whereas other statins do not. It also notes that atorvastatin seems to have greater renoprotective effects compared to rosuvastatin in diabetes patients with kidney disease and proteinuria.
This document discusses antiplatelet treatment strategies in diabetic patients with acute coronary syndrome (ACS). It summarizes several clinical trials comparing different P2Y12 inhibitors in this population. The key points are:
1. Diabetic patients with ACS have higher mortality and morbidity than non-diabetic patients. Clopidogrel response is more variable in diabetics, with higher rates of non-response.
2. A head-to-head trial found ticagrelor reduced platelet reactivity more than prasugrel in diabetic ACS patients after loading doses, with fewer patients having high on-treatment platelet reactivity.
3. Clinical trials showed ticagrelor and prasug
How to link glucose control to cv outcomesYichi Chen
Outline
1.CV risk of DM patient
2.Glucose to CV outcome - Intensive control vs Conventional control
3.Hypoglycemia
4.Different drugs, different outcomes
5.Expect to Future
Ponencia realizada el 23 de noviembre de 2022 en CardioTV titulado 'Nuevas fronteras en la reducción del riesgo CV residual. Integrando icosapento de etilo en la práctica clínica' por el Dr. Subodh Verma
This document summarizes data from clinical studies and real-world evidence on the new oral anticoagulants for atrial fibrillation. It finds that dabigatran 150mg twice daily reduces ischemic stroke and mortality compared to warfarin based on a study of 56,576 Medicare patients, but increases gastrointestinal bleeding in those over 75 years old. Real-world data also finds apixaban reduces major bleeding, hospitalizations and inpatient bleeding compared to dabigatran and rivaroxaban. Studies of patients over 75 years old initiating anticoagulants find warfarin, rivaroxaban and dabigatran have higher risks of major bleeding than apixaban. The document
The document discusses the concept of "metabolic memory" where the risks of diabetic complications can persist even after glucose levels have returned to normal. It provides evidence from animal and human studies in the 1980s and 2000s supporting this concept. It then summarizes findings from several major clinical trials that compared intensive glucose control to standard control and found reductions in microvascular and macrovascular outcomes with intensive control, though the benefits took years to emerge after trial completion.
The document discusses the cardio-renal syndrome, which refers to the bidirectional relationship between heart and kidney dysfunction. It provides several key points:
1) The cardio-renal axis is an important but often underestimated player in cardiovascular disease, as the heart and kidneys regulate many of the same processes and their dysfunction can exacerbate each other.
2) There are different types and definitions of cardio-renal syndrome depending on whether heart or kidney disease initiated or occurred secondarily.
3) Worsening renal function in heart failure is associated with higher mortality and morbidity, though it may simply indicate more severe heart failure rather than having a direct causal relationship.
4) Several studies demonstrate the link
ueda2012 glycemic control cvd debate f-d.khalifaueda2015
- While observational studies had previously suggested tighter glycemic control could reduce cardiovascular risk, these randomized trials did not find evidence of cardiovascular benefit when tightly controlling glucose levels, indicating the risks of hypoglycemia outweigh any potential benefits.
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
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5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
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- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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3. TIMI Risk Score for HF in Diabetes (TRS-HFDM)
Circulation. 2019;140:1569–1577
V
V
V
4. Meta-analysis shows modest benefit
of intensive glycemic control on macrovascular risk
Meta-analysis including 27,049 participants and 2370 major vascular events
Trials
Number of events (annual event
rate, %)
ΔHbA1c (%)
Favours more
intensive
Favours less
intensiveMore intensive Less intensive
Major cardiovascular events*
ACCORD 352 (2.11) 371 (2.29) -1.01 0.90 (0.78 – 1.04)
ADVANCE 557 (2.15) 590 (2.28) -0.72 0.94 (0.84 – 1.06)
UKPDS 169 (1.30) 87 (1.60) -0.66 0.80 (0.62 – 1.04)
VADT 116 (2.68) 128 (2.98) -1.16 0.90 (0.70 – 1.16)
Overall 1194 1176 -0.88 0.91 (0.84 – 0.99)
Stroke
Overall 378 370 -0.88 0.96 (0.83 – 1.10)
Myocardial infarction
Overall 730 745 -0.88 0.85 (0.76 – 0.94)
Hospitalised/fatal heart failure
Overall 459 446 -0.88
1.00 (0.86 – 1.16)
1.00.5 2.0
Hazard ratio (95% CI)
†
Q=1.32, p=0.72, I2=0.00%)
Hazard ratio
(95% CI)
Q=0.40, p=0.94, I2=0.00%)
Q=2.25, p=0.52, I2=0.00%)
Q=3.59, p=0.31, I2=16.4%)
*Major CV events = CV death or non-fatal stroke or non-fatal MI.
†Diamonds incorporate point estimate (vertical dashed line) and encompass 95% CI of overall effect for each outcome.
Turnbull et al. Diabetologia 2009;52:2288–98.
5. More intensive glucose control improved kidney
outcome
Lancet Diabetes Endocrinol 2017; 5: 431–37
Δ HbA1c 0.9%
6. Intensive glucose control improved kidney outcome
Lancet Diabetes Endocrinol 2017; 5: 431–37
Primarily driven by reduced risks of development of macroalbuminuria
7. What is the renal benefit of lowering glucose?
Kidney Int 2013;83:517-23 Lancet 2010;376:419-30
10. Danish registry: T2D and impact of cardiac-renal
disease on prognosis
Circ Cardiovasc Qual Outcomes. 2020;13:e006260.
DOI: 10.1161/CIRCOUTCOMES.119.006260
153,405 patients with a new T2D diagnosis
The 5-year risk of death after one CV or renal diagnosis
stratified according to time since T2D diagnosis. Only
including patients diagnosed and alive in the year
before.
12. Primary and co-primary endpoints are in cursive. Statistically significant endpoints are in bold. Due to differences in study design, inclusion criteria and study population direct comparison can
and should not be drawn between trials but are purely illustrative. Refer to slide notes for abbreviations
Zinman B et al. N Engl J Med 2015;373:2117; Neal B et al. N Engl J Med 2017;377:644; Wiviott SD et al. N Engl J Med 2019;380:347; ADA 2020 congress
#Did not include albuminuria
EMPA-REG
OUTCOME
CANVAS DECLARE-TIMI 58 VERTIS-CV
3P-MACE
HR 0.86
[CI: 0.74, 0.99]
HR 0.86
[CI: 0.75, 0.97]
HR 0.93
[CI: 0.84, 1.03]
HR 0.99
[CI: 0.88, 1.12]
CV death or hHF
HR: 0.66 [CI: 0.55,
0.79]
HR 0.72
[CI: 0.55, 0.94]
HR 0.83
[CI: 0.73, 0.95]
HR 0.88
[CI: 0.75, 1.03]
hHF
HR: 0.65
[CI: 0.50, 0.85]
HR 0.67
[CI: 0.52, 0.87]
HR 0.73
[CI: 0.61, 0.88]
HR 0.70
[CI: 0.54, 0.90]
Renal composite
HR: 0.54 [CI: 0.40,
0.75]
HR 0.59
[CI: 0.44, 0.79]
HR 0.53
[CI: 0.43, 0.66]
HR 0.81
[CI: 0.63, 1.04]
SGLT2 inhibitors CVOTs overview
13. HHF with GLP-1 RA
Lancet Diabetes Endocrinol 2019;7:776-85
Hospital admission for heart failure
14. Kidney outcomes with GLP-1 RA
Worsening of kidney function
Lancet Diabetes Endocrinol 2019;7:776-85
NNTs are calculated over an
estimated median follow-up of 3·2
years
Composite kidney outcome including macroalbuminuria
15. CANVAS
Outcome
(per 1000 patient-yr)
Canagliflozin
(n=5795)
Placebo
(n=4347)
Hazard
ratio
95% CI P
Primary outcome (CV
death, nonfatal MI, or
nonfatal stroke)
26.9 31.5 0.86 0.75–0.97
0.02 for
superiority
All-cause death 17.3 19.5 0.87 0.74–1.01
CV death 11.6 12.8 0.87 0.72–1.06
Hospitalization for HF 5.5 8.7 0.67 0.52–0.87
a. P < .001 for noninferiority
b. Primarily at the toe or metatarsal level
16. CVOTs of SGLT2is: Time to first HHF
Benefit occurred early and sustained throughout the trial
20. CKDPC meta-analysis : Albumin is a continuous predictor starting
at low levels while eGFR is predictive only below a certain threshold
eGFR <60 ml/min/1.73 m2 and UACR >1.1 mg/mmol (10 mg/g)
are independent predictors of mortality risk in the general population
5105 120 10
HR(95%CI)
8
0.5
CV mortality: eGFR
eGFR (ml/min/1.73 m2)
15 30 75
2
4
1
45 60 90
HR(95%CI)
8
0.5
CV mortality: UACR
UACR (mg/g)
2.65 300 1000
2
4
1
30
HR(95%CI)
8
0.5
All-cause mortality: eGFR
2
4
1
HR(95%CI)
8
0.5
All-cause mortality: UACR
2
4
1
Matsushita K, et al. Lancet. 2010;375:2073-81
21. 2021 ADA: Diagnosis of DKD
•Diabetic kidney disease is usually a
clinical diagnosis made based on the
presence of albuminuria and/or reduced
eGFR in the absence of signs or
symptoms of other primary causes of
kidney damage.
24. CREDENCE: Study design
Participants continued treatment if eGFR was <30 mL/min/1.73 m2 until chronic dialysis was
initiated or kidney transplant occurred.
Key inclusion criteria
• ≥30 years of age
• T2DM and HbA1c 6.5% to 12.0%
• eGFR 30 ~ 90 mL/min/1.73 m2
• UACR 300 to 5000 mg/g
• Stable max tolerated labelled dose of
ACEi or ARB for ≥4 weeks
Key exclusion criteria
• Other kidney diseases, dialysis, or kidney transplant
• Dual ACEi and ARB; direct renin inhibitor; MRA
• Serum K+ >5.5 mmol/L
• CV events within 12 weeks of screening
• NYHA class IV heart failure
• Diabetic ketoacidosis or T1DM
2-week placebo run-in
Placebo
Canagliflozin 100 mg
R
Double-blind
randomization
(1:1)
Follow-up at Weeks 3, 13, and 26 (F2F)
then every 13 weeks (alternating phone/F2F)
Jardine MJ, et al. Am J Nephrol. 2017;46(6):462-472.
25. Lower baseline renal function in CREDENCE
participants
20 26
9
60
-8 -11 -7
-88
-100
-80
-60
-40
-20
0
20
40
60
80
100
eGFR
<60
UACR
>300
1. Neal B, et al. N Engl J Med. 2017;377(7):644-657.
2. Zinman B, et al. N Engl J Med. 2015;373(22):2117-2128.
3. Raz I, et al. Diabetes Obes Metab. 2018;20(5):1102-1110.
CREDENCE
CANVAS
Program1
EMPA-REG
OUTCOME2 DECLARE3
27. CREDENCE: Primary outcome
ESKD, doubling of serum creatinine, or renal or CV death
0.
5.
10.
15.
20.
25.
0. 26. 52. 78. 104. 130. 156. 182.
Participantswithanevent
(%)
Months since randomization
Hazard ratio, 0.70 (95% CI, 0.59–0.82)
P = 0.00001
6 12 18 24 30 36 42
340 participants
245 participants
Placebo
Canagliflozin
No. at risk
Placebo 2199 2178 2132 2047 1725 1129 621 170
Canagliflozin 2202 2181 2145 2081 1786 1211 646 196
Perkovic V, et al. N Engl J Med. 2019. doi: 10.1056/NEJMoa1811744.
NNT over 3 years=19
Median FU 2.6 yr
61.2/1000 patient-year
43.2/1000 patient-year
28. CREDENCE: Across categories of baseline HbA1c, treatment
with canagliflozin resulted in similar risk reductions
Circulation. 2020 Feb 4;141(5):407-410.
29. CREDENCE
Primary outcome by screening eGFR and albuminuria
Hazard ratio
(95% CI)
Interaction
P value
Screening eGFR 0.11
30 to <45 mL/min/1.73 m2 0.75 (0.59–0.95)
45 to <60 mL/min/1.73 m2 0.52 (0.38–0.72)
60 to <90 mL/min/1.73 m2 0.82 (0.60–1.12)
Baseline UACR 0.49
≤1000 mg/g 0.76 (0.55–1.04)
>1000 mg/g 0.67 (0.55–0.81)
Favors Canagliflozin Favors Placebo
0.25 0.5 1.0 2.0 4.0
30. Anticipated effects of SGLT2 inhibitors on clinical parameters
in patients with T2DM at different CKD stages
J Am Coll Cardiol 2019;74:2511–24
31. 19. N Engl J Med 2017; 377:644-657
21. N Engl J Med 2019; 380:2295-2306
Canagliflozin reduced UACR
Mean eGFR 76 ml/min
Mean ACR 12mg/gCr
Mean eGFR 56 ml/min
Mean ACR 923 mg/gCr
Secondary renal outcomes of CANVAS/CANVAS R CREDENCE
32. Data from the United Kingdom Prospective Diabetes Study (UKPDS). Data presented as annual
transition rates with 95% confidence intervals. Adler A, et al. Kidney Int. 2003;63:225-32.
The UKPDS: Albuminuria – A marker of renal damage –
Is associated with ↑ CV morbidity and mortality
Death
No nephropathy
Microalbuminuria (MAU)
Macroalbuminuria
↑ Plasma creatinine or
renal replacement therapy
2.0%
(1.9-2.2%)
2.8%
(2.5-3.2%)
2.3%
(1.5-3.0%)
1.4%
(1.3-1.5%)
3.0%
(2.6-3.4%)
4.6%
(3.6-5.7%)
19.2%
(14.0-24.4%)
Annual transition rates through stages of albuminuria in patients with T2D
33. CREDENCE: Acute and long-term effects on eGFR
-21.
-17.5
-14.
-10.5
-7.
-3.5
0.
3.5
0 26 52 78 105 131 157
LSMeanChange(±SE)
ineGFR(mL/min/1.73m2)
Months since randomization
No. of Participants
Placebo 2178 2084 1985 1882 1720 1536 1006 583 210
Canagliflozin 2179 2074 2005 1919 1782 1648 1116 652 241
56.4 56.0
Canagliflozin Placebo
Chronic eGFR slope
Difference: 2.74/year (95% CI, 2.37–3.11)
–4.59/year
6 12 18 24 30 36 42
Baseline
60% reduction in the rate of eGFR decline
with canagliflozin
On treatment
–1.85/year
Perkovic V, et al. N Engl J Med.
2019. doi: 10.1056/NEJMoa1811744.
Average age: 63
40. CREDENCE
CV outcomes by primary & secondary prevention
Hazard ratio
(95% CI)
Interaction P value
CV death or hospitalization for heart failure
0.74 (0.54–1.03) 0.57
0.66 (0.52–0.83)
0.69 (0.57–0.83)
CV death, MI, or stroke
0.68 (0.49–0.94) 0.25
0.85 (0.69–1.06)
0.80 (0.67–0.95)
CV death
0.75 (0.48–1.16) 0.86
0.79 (0.58–1.07)
0.78 (0.61–1.00)
Favors Canagliflozin Favors Placebo
0.25 0.5 1.0 2.0 4.0
Secondary
prevention
Primary
prevention
Overall
population
Circulation. 2019;140:739–750
41. CREDENCE: NNT for the primary and CV outcomes
Circulation.
2019;140:739–
750
42. No. at risk
Placebo 2197 2169 2131 2065 1766 1177 658 182
Canagliflozin 2200 2163 2118 2071 1788 1228 667 202
CREDENCE: Lower extremity amputation
0.
6.25
12.5
18.75
25.
0. 26. 52. 78. 104. 130. 156. 182.
Months since randomization
63 participants
70 participants
Hazard ratio, 1.11 (95% CI, 0.79–1.56)Participantswithanevent(%)
6 12 18 24 30 36 42
Placebo
Canagliflozin
Includes all treated patients through the end of the trial.
43. 0.
6.25
12.5
18.75
25.
0. 26. 52. 78. 104. 130. 156. 182.
Months since randomization
CREDENCE: Fracture
68 participants
67 participants
No. at risk
Placebo 2197 2166 2128 2061 1769 1178 656 176
Canagliflozin 2200 2171 2121 2074 1785 1225 668 200
Hazard ratio, 0.98 (95% CI, 0.70–1.37)Participantswithanevent(%)
6 12 18 24 30 36 42
Placebo
Canagliflozin
Includes all treated patients through the end of the trial.
44. Primary composite outcome
Sustained ≥50% eGFR decline, ESKD, renal or CV deatha
2152 2001 1955 1898 1841 1701 1288 831 309
2152 1993 1936 1858 1791 1664 1232 774 270
DAPA 10 mg
Placebo
DAPA 10 mg
197 events
Placebo
312 events
0
4
8
12
16
20
24
0 4 8 12 16 20 24 28 32
Months from Randomization
CumulativeIncidence%
N at Risk
NNT=19
HR (95% CI) p-value
0.61 (0.51-0.72) 0.000000028
39%
RRR
aESKD defined as the need for maintenance dialysis (peritoneal or hemodialysis) for at least 28 days and renal
transplantation or sustained eGFR <15mL/min/1.73m2 for at least 28 days. Renal death was defined as death
due to ESKD when dialysis treatment was deliberately withheld for any reason.2
1. Heerspink HJL. Presented at: ESC Congress – The Digital
Experience; August 29 - September 1, 2020. 2. Heerspink HJL et al.
Nephrol Dial Transplant. 2020;35:274–282.
T2D 68%
Mean age 62
Mean eGFR 43
Mean UACR ~950
45. Primary composite outcome
Treatment benefit consistent across prespecified subgroups
Number of Events
HR (95% CI)
DAPA 10 mg
(N=2152)
Placebo
(N=2152) HR 95% CI
p-value
Interaction
Composite of ≥50% eGFR Decline, ESKD, or Renal or CV Death
All Patients 197 312 0.61 (0.51, 0.72)
T2D at Baseline 0.24
Yes 152 229 0.64 (0.52, 0.79)
No 45 83 0.50 (0.35, 0.72)
UACR (mg/g) at Baseline 0.52
≤1000 44 84 0.54 (0.37, 0.77)
>1000 153 228 0.62 (0.50, 0.76)
eGFR (mL/min/1.73m2) at Baseline 0.22
<45 152 217 0.63 (0.51, 0.78)
≥45 45 95 0.49 (0.34, 0.69)
0.13 0.50 1.00 1.25
DAPA 10 mg Better Placebo Better
Heerspink HJL. Presented at: ESC Congress – The Digital Experience; August 29 - September 1, 2020.
46. Change from baseline in eGFR
N Engl J Med 2020; 383:1436-1446
–2.86/year
–3.79/year
25% reduction in the rate of eGFR decline
with dapagliflozin
47. Secondary composite outcome
CV death or hospitalization for HF
DAPA 10
mg
100 events
Placebo
138 events
2152 2035 2021 2003 1975 1895 1502 1003 384
2152 2023 1989 1957 1927 1853 1451 976 360
DAPA 10
mgPlacebo
0
2
4
6
8
10
0 4 8 12 16 20 24 28 32
Months from Randomization
CumulativeIncidence%
N at Risk
HR (95% CI) p-value
0.71 (0.55-0.92) 0.0089
29%
RRR
Heerspink HJL. et.al. Presented at ESC2020.
T2D 68%
Mean age 62
Mean eGFR 43
Mean UACR ~950
48. DAPA-CKD
CV outcomes by primary & secondary prevention
5.5/100 pt-
yr
5.2/100 pt-
yr
1.7/100 pt-
yr
1.4/100 pt-
yr
AHA 2020
54. 2021 ADA: Factors to consider when selecting SGLT2
inhibitors in adults with T2D
CV effects Renal effects
Additional considerations
ASCVD HF
Progression
of CKD
Benefit:
empagliflozi
n,
canagliflozin
Benefit:
empagliflozi
n,
canagliflozin,
dapagliflozin
Benefit:
canagliflozin,
empagliflozi
n,
dapagliflozin
,
• Should be discontinued before any
scheduled surgery to avoid potential
risk of DKA
• DKA risk (all agents in T2D)
• Risk of bone fracture (canagliflozin)
• Genitourinary infection
• Risk of volume depletion,
hypotension
• ↑LDL-C
• Risk of Fournier’s gangrene
55. Conclusion
• CANVAS showcased CV and renal benefits of
canagliflozin in T2D patients.
• CREDENCE demonstrated significant improvements in
renal and CV outcomes in patients with T2D +
macroalbuminuria treated with canagliflozin.
• Monitor renal status, including eGFR and albuminuria in
your T2D patients.
• Get with the guideline!