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1. CKD Progression:
Pharmacological Approach
Mohammed Abdel Gawad
Nephrology Consultant - Alexandria - Egypt
MD Nephrology - Mansoura University
European Specialty Examination in Nephrology (ESENeph)
NephroTube Founder/Admin
drgawad@gmail.com
@Gawad_Nephro

2. Hypertension Management
Blood Pressure Target • 130 vs 140 according to ACR
• SPRINT < 120, ?? Adverse events
ACE-I / ARBs • Cornerstone for management
• Decreased sodium intake improves efficacy
• Don’t combine
MRA • Generally decrease albuminuria
• Finerenone: lower risks of CKD in type 2 DM with CKD
Glycemic Control
HbA1c% Targets • < 6.5% vs < 8%: according to severity of CKD, comorbidities, risk of hypoglycemia
SGLT2 Inhibitors • Reno-protective effect
• Dapagliflozin approved to use in non-DM CKD
GLP-1 Receptor Agonists • Reno-protective effect
SGLT2 Inhibitors vs GLP-1
Receptor Agonists
• SGLT2 inhibitors appear to be more effective in slowing kidney disease progression
Others
Chronic Metabolic Acidosis • CKD patients with bicarbonate <22 mmol/L should be treated with oral alkali therapy
Nephrotoxins • Avoid
• PPI: only if strongly indicated and for the shortest time, try alternatives
Asymptomatic Hyperuricemia • ??
Talk
Outline
Medications
Medications

3. Hypertension Management
Blood Pressure Target • 130 vs 140 according to ACR
• SPRINT < 120, ?? Adverse events
ACE-I / ARBs • Cornerstone for management
• Decreased sodium intake improves efficacy
• Don’t combine
MRA • Generally decrease albuminuria
• Finerenone: lower risks of CKD in type 2 DM with CKD
Glycemic Control
HbA1c% Targets • < 6.5% vs < 8%: according to severity of CKD, comorbidities, risk of hypoglycemia
SGLT2 Inhibitors • Reno-protective effect
• Dapagliflozin approved to use in non-DM CKD
GLP-1 Receptor Agonists • Reno-protective effect
SGLT2 Inhibitors vs GLP-1
Receptor Agonists
• SGLT2 inhibitors appear to be more effective in slowing kidney disease progression
Others
Chronic Metabolic Acidosis • CKD patients with bicarbonate <22 mmol/L should be treated with oral alkali therapy
Nephrotoxins • Avoid
• PPI: only if strongly indicated and for the shortest time, try alternatives
Asymptomatic Hyperuricemia • ??
Talk
Outline
Medications
Medications

4. Am J Kidney Dis. 2021 Jun;77(6):969-983

5. Am J Kidney Dis. 2021 Jun;77(6):969-983

6. N Engl J Med 2015; 373:2103-2116
n= 9361 persons without diabetes
<120 mm Hg <140 mm Hg

7. N Engl J Med 2015; 373:2103-2116
n= 9361 persons without diabetes
<120 mm Hg <140 mm Hg
1st occurrence of
MI, ACS, stroke,
heart failure, or
death from CV
causes

8. N Engl J Med 2015; 373:2103-2116
n= 9361 persons without diabetes
<120 mm Hg <140 mm Hg
Intensive BP
control did not
prevent adverse
kidney outcomes

9. N Engl J Med 2015; 373:2103-2116
n= 9361 persons without diabetes
<120 mm Hg <140 mm Hg
intensive BP control
resulted in
a 3.5-fold higher risk
of ≥30% reduction in
eGFR to < 60

10. N Engl J Med 2015; 373:2103-2116
n= 9361 persons without diabetes
Higher rates of some adverse
events were observed in the
intensive-treatment group

11. Hypertension Management
Blood Pressure Target • 130 vs 140 according to ACR
• SPRINT < 120, ?? Adverse events
ACE-I / ARBs • Cornerstone for management
• Decreased sodium intake improves efficacy
• Don’t combine
MRA • Generally decrease albuminuria
• Finerenone: lower risks of CKD in type 2 DM with CKD
Glycemic Control
HbA1c% Targets • < 6.5% vs < 8%: according to severity of CKD, comorbidities, risk of hypoglycemia
SGLT2 Inhibitors • Reno-protective effect
• Dapagliflozin approved to use in non-DM CKD
GLP-1 Receptor Agonists • Reno-protective effect
SGLT2 Inhibitors vs GLP-1
Receptor Agonists
• SGLT2 inhibitors appear to be more effective in slowing kidney disease progression
Others
Chronic Metabolic Acidosis • CKD patients with bicarbonate <22 mmol/L should be treated with oral alkali therapy
Nephrotoxins • Avoid
• PPI: only if strongly indicated and for the shortest time, try alternatives
Asymptomatic Hyperuricemia • ??
Talk
Outline
Medications
Medications

12. Hypertension Management
Blood Pressure Target • 130 vs 140 according to ACR
• SPRINT < 120, ?? Adverse events
ACE-I / ARBs • Cornerstone for management
• Decreased sodium intake improves efficacy
• Don’t combine
MRA • Generally decrease albuminuria
• Finerenone: lower risks of CKD in type 2 DM with CKD
Glycemic Control
HbA1c% Targets • < 6.5% vs < 8%: according to severity of CKD, comorbidities, risk of hypoglycemia
SGLT2 Inhibitors • Reno-protective effect
• Dapagliflozin approved to use in non-DM CKD
GLP-1 Receptor Agonists • Reno-protective effect
SGLT2 Inhibitors vs GLP-1
Receptor Agonists
• SGLT2 inhibitors appear to be more effective in slowing kidney disease progression
Others
Chronic Metabolic Acidosis • CKD patients with bicarbonate <22 mmol/L should be treated with oral alkali therapy
Nephrotoxins • Avoid
• PPI: only if strongly indicated and for the shortest time, try alternatives
Asymptomatic Hyperuricemia • ??
Talk
Outline
Medications
Medications

13. Am J Kidney Dis. 2021 Jun;77(6):969-983

14. Am J Kidney Dis. 2021 Jun;77(6):969-983

15. Am J Kidney Dis. 2021 Jun;77(6):969-983
Decreased sodium intake may enhance the
renoprotective effects of RAAS inhibitors
Clin J Am Soc Nephrol. 2015;10(9):1542-1552

16. N Engl J Med. 2013 Nov 14;369(20):1892-903

17. Hypertension Management
Blood Pressure Target • 130 vs 140 according to ACR
• SPRINT < 120, ?? Adverse events
ACE-I / ARBs • Cornerstone for management
• Decreased sodium intake improves efficacy
• Don’t combine
MRA • Generally decrease albuminuria
• Finerenone: lower risks of CKD in type 2 DM with CKD
Glycemic Control
HbA1c% Targets • < 6.5% vs < 8%: according to severity of CKD, comorbidities, risk of hypoglycemia
SGLT2 Inhibitors • Reno-protective effect
• Dapagliflozin approved to use in non-DM CKD
GLP-1 Receptor Agonists • Reno-protective effect
SGLT2 Inhibitors vs GLP-1
Receptor Agonists
• SGLT2 inhibitors appear to be more effective in slowing kidney disease progression
Others
Chronic Metabolic Acidosis • CKD patients with bicarbonate <22 mmol/L should be treated with oral alkali therapy
Nephrotoxins • Avoid
• PPI: only if strongly indicated and for the shortest time, try alternatives
Asymptomatic Hyperuricemia • ??
Talk
Outline
Medications
Medications

18. Hypertension Management
Blood Pressure Target • 130 vs 140 according to ACR
• SPRINT < 120, ?? Adverse events
ACE-I / ARBs • Cornerstone for management
• Decreased sodium intake improves efficacy
• Don’t combine
MRA • Generally decrease albuminuria
• Finerenone: lower risks of CKD in type 2 DM with CKD
Glycemic Control
HbA1c% Targets • < 6.5% vs < 8%: according to severity of CKD, comorbidities, risk of hypoglycemia
SGLT2 Inhibitors • Reno-protective effect
• Dapagliflozin approved to use in non-DM CKD
GLP-1 Receptor Agonists • Reno-protective effect
SGLT2 Inhibitors vs GLP-1
Receptor Agonists
• SGLT2 inhibitors appear to be more effective in slowing kidney disease progression
Others
Chronic Metabolic Acidosis • CKD patients with bicarbonate <22 mmol/L should be treated with oral alkali therapy
Nephrotoxins • Avoid
• PPI: only if strongly indicated and for the shortest time, try alternatives
Asymptomatic Hyperuricemia • ??
Talk
Outline
Medications
Medications

19. J Hypertens. 2019 Dec;37(12):2307-2324
31 randomized controlled trials evaluated the efficacy and safety of MRAs
(spironolactone, eplerenone, canrenone, or finerenone)
The use of MRAs (alone or on top of RAS blockade) compared with placebo
decreased UACR, UPCR, and 24h albumin excretion
MRAs also reduced UACR compared with calcium-channel blockers
No differences were found when MRAs compared with a second
ACEi/ARB or non-potassium sparing diuretics

20. J Hypertens. 2019 Dec;37(12):2307-2324

21. J Hypertens. 2019 Dec;37(12):2307-2324

22. N Engl J Med. 2020 Dec 3;383(23):2219-2229
5734 patients with CKD
and type 2 DM

23. N Engl J Med. 2020 Dec 3;383(23):2219-2229
5734 patients with CKD
and type 2 DM

24. N Engl J Med. 2020 Dec 3;383(23):2219-2229
5734 patients with CKD
and type 2 DM

26. Hypertension Management
Blood Pressure Target • 130 vs 140 according to ACR
• SPRINT < 120, ?? Adverse events
ACE-I / ARBs • Cornerstone for management
• Decreased sodium intake improves efficacy
• Don’t combine
MRA • Generally decrease albuminuria
• Finerenone: lower risks of CKD in type 2 DM with CKD
Glycemic Control
HbA1c% Targets • < 6.5% vs < 8%: according to severity of CKD, comorbidities, risk of hypoglycemia
SGLT2 Inhibitors • Reno-protective effect
• Dapagliflozin approved to use in non-DM CKD
GLP-1 Receptor Agonists • Reno-protective effect
SGLT2 Inhibitors vs GLP-1
Receptor Agonists
• SGLT2 inhibitors appear to be more effective in slowing kidney disease progression
Others
Chronic Metabolic Acidosis • CKD patients with bicarbonate <22 mmol/L should be treated with oral alkali therapy
Nephrotoxins • Avoid
• PPI: only if strongly indicated and for the shortest time, try alternatives
Asymptomatic Hyperuricemia • ??
Talk
Outline
Medications
Medications

27. Hypertension Management
Blood Pressure Target • 130 vs 140 according to ACR
• SPRINT < 120, ?? Adverse events
ACE-I / ARBs • Cornerstone for management
• Decreased sodium intake improves efficacy
• Don’t combine
MRA • Generally decrease albuminuria
• Finerenone: lower risks of CKD in type 2 DM with CKD
Glycemic Control
HbA1c% Targets • < 6.5% vs < 8%: according to severity of CKD, comorbidities, risk of hypoglycemia
SGLT2 Inhibitors • Reno-protective effect
• Dapagliflozin approved to use in non-DM CKD
GLP-1 Receptor Agonists • Reno-protective effect
SGLT2 Inhibitors vs GLP-1
Receptor Agonists
• SGLT2 inhibitors appear to be more effective in slowing kidney disease progression
Others
Chronic Metabolic Acidosis • CKD patients with bicarbonate <22 mmol/L should be treated with oral alkali therapy
Nephrotoxins • Avoid
• PPI: only if strongly indicated and for the shortest time, try alternatives
Asymptomatic Hyperuricemia • ??
Talk
Outline
Medications
Medications

28. Am J Kidney Dis. 2021 Jun;77(6):969-983

29. Lancet Diabetes Endocrinol. 2017;5(6):431-437
A meta-analysis of the ADVANCE, ACCORD, UKPDS, and VADT trials

30. Kidney Int. 2020 Oct;98(4S):S1-S115

31. Glycemic Control
HbA1c% Targets • < 6.5% vs < 8%: according to severity of CKD, comorbidities, risk of hypoglycemia
SGLT2 Inhibitors • Reno-protective effect
• Dapagliflozin approved to use in non-DM CKD
GLP-1 Receptor Agonists • Reno-protective effect
SGLT2 Inhibitors vs GLP-1
Receptor Agonists
• SGLT2 inhibitors appear to be more effective in slowing kidney disease progression
Others
Chronic Metabolic Acidosis • CKD patients with bicarbonate <22 mmol/L should be treated with oral alkali therapy
Nephrotoxins • Avoid
• PPI: only if strongly indicated and for the shortest time, try alternatives
Asymptomatic Hyperuricemia • ??
Medications
Hypertension Management
Blood Pressure Target • 130 vs 140 according to ACR
• SPRINT < 120, ?? Adverse events
ACE-I / ARBs • Cornerstone for management
• Decreased sodium intake improves efficacy
• Don’t combine
MRA • Generally decrease albuminuria
• Finerenone: lower risks of CKD in type 2 DM with CKD
Medications
Talk
Outline

32. Glycemic Control
HbA1c% Targets • < 6.5% vs < 8%: according to severity of CKD, comorbidities, risk of hypoglycemia
SGLT2 Inhibitors • Reno-protective effect
• Dapagliflozin approved to use in non-DM CKD
GLP-1 Receptor Agonists • Reno-protective effect
SGLT2 Inhibitors vs GLP-1
Receptor Agonists
• SGLT2 inhibitors appear to be more effective in slowing kidney disease progression
Others
Chronic Metabolic Acidosis • CKD patients with bicarbonate <22 mmol/L should be treated with oral alkali therapy
Nephrotoxins • Avoid
• PPI: only if strongly indicated and for the shortest time, try alternatives
Asymptomatic Hyperuricemia • ??
Medications
Hypertension Management
Blood Pressure Target • 130 vs 140 according to ACR
• SPRINT < 120, ?? Adverse events
ACE-I / ARBs • Cornerstone for management
• Decreased sodium intake improves efficacy
• Don’t combine
MRA • Generally decrease albuminuria
• Finerenone: lower risks of CKD in type 2 DM with CKD
Medications
Talk
Outline

33. Am J Kidney Dis. 2021 Jun;77(6):969-983

34. Lancet Diabetes Endocrinol. 2019 Nov;7(11):845-854

36. N Engl J Med. 2020 Oct 8;383(15):1436-1446

37. N Engl J Med. 2020 Oct 8;383(15):1436-1446
Safety profiles were similar between the 2 treatment arms
with the exception of:
• volume depletion (more common with dapagliflozin)
• major hypoglycemia (more common with placebo)

39. N Engl J Med. 2020 Oct 8;383(15):1436-1446

40. Glycemic Control
HbA1c% Targets • < 6.5% vs < 8%: according to severity of CKD, comorbidities, risk of hypoglycemia
SGLT2 Inhibitors • Reno-protective effect
• Dapagliflozin approved to use in non-DM CKD
GLP-1 Receptor Agonists • Reno-protective effect
SGLT2 Inhibitors vs GLP-1
Receptor Agonists
• SGLT2 inhibitors appear to be more effective in slowing kidney disease progression
Others
Chronic Metabolic Acidosis • CKD patients with bicarbonate <22 mmol/L should be treated with oral alkali therapy
Nephrotoxins • Avoid
• PPI: only if strongly indicated and for the shortest time, try alternatives
Asymptomatic Hyperuricemia • ??
Medications
Hypertension Management
Blood Pressure Target • 130 vs 140 according to ACR
• SPRINT < 120, ?? Adverse events
ACE-I / ARBs • Cornerstone for management
• Decreased sodium intake improves efficacy
• Don’t combine
MRA • Generally decrease albuminuria
• Finerenone: lower risks of CKD in type 2 DM with CKD
Medications
Talk
Outline

41. Glycemic Control
HbA1c% Targets • < 6.5% vs < 8%: according to severity of CKD, comorbidities, risk of hypoglycemia
SGLT2 Inhibitors • Reno-protective effect
• Dapagliflozin approved to use in non-DM CKD
GLP-1 Receptor Agonists • Reno-protective effect
SGLT2 Inhibitors vs GLP-1
Receptor Agonists
• SGLT2 inhibitors appear to be more effective in slowing kidney disease progression
Others
Chronic Metabolic Acidosis • CKD patients with bicarbonate <22 mmol/L should be treated with oral alkali therapy
Nephrotoxins • Avoid
• PPI: only if strongly indicated and for the shortest time, try alternatives
Asymptomatic Hyperuricemia • ??
Medications
Hypertension Management
Blood Pressure Target • 130 vs 140 according to ACR
• SPRINT < 120, ?? Adverse events
ACE-I / ARBs • Cornerstone for management
• Decreased sodium intake improves efficacy
• Don’t combine
MRA • Generally decrease albuminuria
• Finerenone: lower risks of CKD in type 2 DM with CKD
Medications
Talk
Outline

42. Lancet Diabetes Endocrinol. 2019 Oct;7(10):776-785

43. Glycemic Control
HbA1c% Targets • < 6.5% vs < 8%: according to severity of CKD, comorbidities, risk of hypoglycemia
SGLT2 Inhibitors • Reno-protective effect
• Dapagliflozin approved to use in non-DM CKD
GLP-1 Receptor Agonists • Reno-protective effect
SGLT2 Inhibitors vs GLP-1
Receptor Agonists
• SGLT2 inhibitors appear to be more effective in slowing kidney disease progression
Others
Chronic Metabolic Acidosis • CKD patients with bicarbonate <22 mmol/L should be treated with oral alkali therapy
Nephrotoxins • Avoid
• PPI: only if strongly indicated and for the shortest time, try alternatives
Asymptomatic Hyperuricemia • ??
Medications
Hypertension Management
Blood Pressure Target • 130 vs 140 according to ACR
• SPRINT < 120, ?? Adverse events
ACE-I / ARBs • Cornerstone for management
• Decreased sodium intake improves efficacy
• Don’t combine
MRA • Generally decrease albuminuria
• Finerenone: lower risks of CKD in type 2 DM with CKD
Medications
Talk
Outline

44. Glycemic Control
HbA1c% Targets • < 6.5% vs < 8%: according to severity of CKD, comorbidities, risk of hypoglycemia
SGLT2 Inhibitors • Reno-protective effect
• Dapagliflozin approved to use in non-DM CKD
GLP-1 Receptor Agonists • Reno-protective effect
SGLT2 Inhibitors vs GLP-1
Receptor Agonists
• SGLT2 inhibitors appear to be more effective in slowing kidney disease progression
Others
Chronic Metabolic Acidosis • CKD patients with bicarbonate <22 mmol/L should be treated with oral alkali therapy
Nephrotoxins • Avoid
• PPI: only if strongly indicated and for the shortest time, try alternatives
Asymptomatic Hyperuricemia • ??
Medications
Hypertension Management
Blood Pressure Target • 130 vs 140 according to ACR
• SPRINT < 120, ?? Adverse events
ACE-I / ARBs • Cornerstone for management
• Decreased sodium intake improves efficacy
• Don’t combine
MRA • Generally decrease albuminuria
• Finerenone: lower risks of CKD in type 2 DM with CKD
Medications
Talk
Outline

45. Circulation. 2019 Apr 23;139(17):2022-2031
Broad kidney end point (new-onset macroalbuminuria
sustained doubling of serum Cr or a 40% decline in eGFR, ESKD,
or death of renal cause)
Kidney outcome excluding macroalbuminuria

46. Circulation. 2019 Apr 23;139(17):2022-2031
Broad kidney end point (new-onset macroalbuminuria
sustained doubling of serum Cr or a 40% decline in eGFR, ESKD,
or death of renal cause)
Kidney outcome excluding macroalbuminuria
SGLT2 inhibitors appear to be more effective in slowing kidney disease
progression and should be considered before GLP-1 receptor agonists

47. Kidney Int. 2020 Oct;98(4S):S1-S115

48. Glycemic Control
HbA1c% Targets • < 6.5% vs < 8%: according to severity of CKD, comorbidities, risk of hypoglycemia
SGLT2 Inhibitors • Reno-protective effect
• Dapagliflozin approved to use in non-DM CKD
GLP-1 Receptor Agonists • Reno-protective effect
SGLT2 Inhibitors vs GLP-1
Receptor Agonists
• SGLT2 inhibitors appear to be more effective in slowing kidney disease progression
Others
Chronic Metabolic Acidosis • CKD patients with bicarbonate <22 mmol/L should be treated with oral alkali therapy
Nephrotoxins • Avoid
• PPI: only if strongly indicated and for the shortest time, try alternatives
Asymptomatic Hyperuricemia • ??
Medications
Hypertension Management
Blood Pressure Target • 130 vs 140 according to ACR
• SPRINT < 120, ?? Adverse events
ACE-I / ARBs • Cornerstone for management
• Decreased sodium intake improves efficacy
• Don’t combine
MRA • Generally decrease albuminuria
• Finerenone: lower risks of CKD in type 2 DM with CKD
Medications
Talk
Outline

49. Glycemic Control
HbA1c% Targets • < 6.5% vs < 8%: according to severity of CKD, comorbidities, risk of hypoglycemia
SGLT2 Inhibitors • Reno-protective effect
• Dapagliflozin approved to use in non-DM CKD
GLP-1 Receptor Agonists • Reno-protective effect
SGLT2 Inhibitors vs GLP-1
Receptor Agonists
• SGLT2 inhibitors appear to be more effective in slowing kidney disease progression
Others
Chronic Metabolic Acidosis • CKD patients with bicarbonate <22 mmol/L should be treated with oral alkali therapy
Nephrotoxins • Avoid
• PPI: only if strongly indicated and for the shortest time, try alternatives
Asymptomatic Hyperuricemia • ??
Medications
Hypertension Management
Blood Pressure Target • 130 vs 140 according to ACR
• SPRINT < 120, ?? Adverse events
ACE-I / ARBs • Cornerstone for management
• Decreased sodium intake improves efficacy
• Don’t combine
MRA • Generally decrease albuminuria
• Finerenone: lower risks of CKD in type 2 DM with CKD
Medications
Talk
Outline

50. Clin J Am Soc Nephrol. 2019 Jul 5;14(7):1011-1020

51. Clin J Am Soc Nephrol. 2019 Jul 5;14(7):1011-1020
Patients with CKD and bicarbonate of <22 mmol/L should also be treated
with oral alkali therapy to maintain their bicarbonate concentrations in the
normal range, recognizing the risks of increased BP and edema
Am J Kidney Dis. 2019;74(2):263-275

52. Glycemic Control
HbA1c% Targets • < 6.5% vs < 8%: according to severity of CKD, comorbidities, risk of hypoglycemia
SGLT2 Inhibitors • Reno-protective effect
• Dapagliflozin approved to use in non-DM CKD
GLP-1 Receptor Agonists • Reno-protective effect
SGLT2 Inhibitors vs GLP-1
Receptor Agonists
• SGLT2 inhibitors appear to be more effective in slowing kidney disease progression
Others
Chronic Metabolic Acidosis • CKD patients with bicarbonate <22 mmol/L should be treated with oral alkali therapy
Nephrotoxins • Avoid
• PPI: only if strongly indicated and for the shortest time, try alternatives
Asymptomatic Hyperuricemia • ??
Medications
Hypertension Management
Blood Pressure Target • 130 vs 140 according to ACR
• SPRINT < 120, ?? Adverse events
ACE-I / ARBs • Cornerstone for management
• Decreased sodium intake improves efficacy
• Don’t combine
MRA • Generally decrease albuminuria
• Finerenone: lower risks of CKD in type 2 DM with CKD
Medications
Talk
Outline

53. Glycemic Control
HbA1c% Targets • < 6.5% vs < 8%: according to severity of CKD, comorbidities, risk of hypoglycemia
SGLT2 Inhibitors • Reno-protective effect
• Dapagliflozin approved to use in non-DM CKD
GLP-1 Receptor Agonists • Reno-protective effect
SGLT2 Inhibitors vs GLP-1
Receptor Agonists
• SGLT2 inhibitors appear to be more effective in slowing kidney disease progression
Others
Chronic Metabolic Acidosis • CKD patients with bicarbonate <22 mmol/L should be treated with oral alkali therapy
Nephrotoxins • Avoid
• PPI: only if strongly indicated and for the shortest time, try alternatives
Asymptomatic Hyperuricemia • ??
Medications
Hypertension Management
Blood Pressure Target • 130 vs 140 according to ACR
• SPRINT < 120, ?? Adverse events
ACE-I / ARBs • Cornerstone for management
• Decreased sodium intake improves efficacy
• Don’t combine
MRA • Generally decrease albuminuria
• Finerenone: lower risks of CKD in type 2 DM with CKD
Medications
Talk
Outline

54. CJASN December 2018, 13 (12) 1897-1908

55. Am J Kidney Dis. 2020 Apr;75(4):497-507

56. Am J Kidney Dis. 2020 Apr;75(4):497-507

57. Am J Kidney Dis. 2020 Apr;75(4):497-507

58. Am J Kidney Dis. 2020 Apr;75(4):497-507

59. Glycemic Control
HbA1c% Targets • < 6.5% vs < 8%: according to severity of CKD, comorbidities, risk of hypoglycemia
SGLT2 Inhibitors • Reno-protective effect
• Dapagliflozin approved to use in non-DM CKD
GLP-1 Receptor Agonists • Reno-protective effect
SGLT2 Inhibitors vs GLP-1
Receptor Agonists
• SGLT2 inhibitors appear to be more effective in slowing kidney disease progression
Others
Chronic Metabolic Acidosis • CKD patients with bicarbonate <22 mmol/L should be treated with oral alkali therapy
Nephrotoxins • Avoid
• PPI: only if strongly indicated and for the shortest time, try alternatives
Asymptomatic Hyperuricemia • ??
Medications
Hypertension Management
Blood Pressure Target • 130 vs 140 according to ACR
• SPRINT < 120, ?? Adverse events
ACE-I / ARBs • Cornerstone for management
• Decreased sodium intake improves efficacy
• Don’t combine
MRA • Generally decrease albuminuria
• Finerenone: lower risks of CKD in type 2 DM with CKD
Medications
Talk
Outline

60. Glycemic Control
HbA1c% Targets • < 6.5% vs < 8%: according to severity of CKD, comorbidities, risk of hypoglycemia
SGLT2 Inhibitors • Reno-protective effect
• Dapagliflozin approved to use in non-DM CKD
GLP-1 Receptor Agonists • Reno-protective effect
SGLT2 Inhibitors vs GLP-1
Receptor Agonists
• SGLT2 inhibitors appear to be more effective in slowing kidney disease progression
Others
Chronic Metabolic Acidosis • CKD patients with bicarbonate <22 mmol/L should be treated with oral alkali therapy
Nephrotoxins • Avoid
• PPI: only if strongly indicated and for the shortest time, try alternatives
Asymptomatic Hyperuricemia • ??
Medications
Hypertension Management
Blood Pressure Target • 130 vs 140 according to ACR
• SPRINT < 120, ?? Adverse events
ACE-I / ARBs • Cornerstone for management
• Decreased sodium intake improves efficacy
• Don’t combine
MRA • Generally decrease albuminuria
• Finerenone: lower risks of CKD in type 2 DM with CKD
Medications
Talk
Outline

63. Available online 15 May 2020

66. Our abstract next ASN 2021

67. Glycemic Control
HbA1c% Targets • < 6.5% vs < 8%: according to severity of CKD, comorbidities, risk of hypoglycemia
SGLT2 Inhibitors • Reno-protective effect
• Dapagliflozin approved to use in non-DM CKD
GLP-1 Receptor Agonists • Reno-protective effect
SGLT2 Inhibitors vs GLP-1
Receptor Agonists
• SGLT2 inhibitors appear to be more effective in slowing kidney disease progression
Others
Chronic Metabolic Acidosis • CKD patients with bicarbonate <22 mmol/L should be treated with oral alkali therapy
Nephrotoxins • Avoid
• PPI: only if strongly indicated and for the shortest time, try alternatives
Asymptomatic Hyperuricemia • ??
Medications
Hypertension Management
Blood Pressure Target • 130 vs 140 according to ACR
• SPRINT < 120, ?? Adverse events
ACE-I / ARBs • Cornerstone for management
• Decreased sodium intake improves efficacy
• Don’t combine
MRA • Generally decrease albuminuria
• Finerenone: lower risks of CKD in type 2 DM with CKD
Medications
Talk
Outline
Home
Messages

68. Thank You