Returned at home midnight last night from this (photo) and wrote my first #flozin and #paxlovid prescription for the day 10 hours later (not in the same person).

Endothelin blockade works (eg PRECISION, and PROTECT) but does cause sodium retention. What’s the best way to proactively prevent this? In the RCTs they exclude patients with HF or high BNP, and still see weight gain. Should they be combined with a natriuretic, as @ChristosArgyrop and others have suggested?

In this small 🐀 study, adding a #Flozin to #Zibotentan did just that. Makes a lot of sense. Two good meds being synergistic. Let’s do a human trial now!

https://academic.oup.com/ndt/advance-article/doi/10.1093/ndt/gfad078/7143782?rss=1

A first for a #Flozin

No benefit with #empagliflozin in #COVID from the #RECOVERY trial

Preprint https://www.medrxiv.org/content/10.1101/2023.04.13.23288469v1.full.pdf+html

1/

There will likely be a generic #flozin in the US next year. There are already generic #flozins #sglt2i available in many countries that do not even have the costs used in this simulation, and thus the results don't apply to them. So, while the calculations are likely to become irrelevant in the US very soon, the paper will be used to restrict access to these drugs through formularies in many locales.
https://jamanetwork.com/journals/jamacardiology/fullarticle/2802216?utm_source=twitter&utm_campaign=content-shareicons&utm_content=article_engagement&utm_medium=social&utm_term=030523#.ZATGQTbUGiE.twitter

They are too old/not proteinuric enough/have not optimized their RASi (the latter after being on 2.5mg of lisinopril for 5 years) so they can't get #flozin , #SGLT2i , #finerenone etc for their (diabetic) kidney disease

From Ed Fu et al - but not target trial emulation, this is a propensity score matched analysis

#GLP1RA vs #Flozin

Focusing on safety outcomes

https://journals.lww.com/cjasn/Abstract/9900/Safety_of_Sodium_Glucose_Cotransporter_2.94.aspx in #CJASN

Flozins =

More fracture

More LL amputations

More genital mycotoxins infections

But 1/

Another one from the giant Taiwan database

Propensity score matched etc

#Flozin vs DPP4i and subsequent #AKI - of course it’s less

But some info about why? See Figure 3 below

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2801729 in @mike_johansen fav journal

Are these testable hypothesis @Bneuen from existing trials? (As cause of AKI)

@ChristosArgyrop @Kidney_boy

@mike_johansen @ChristosArgyrop @hswapnil Bexacat is labeled for treating DM in cats (without insulin). Diabetic cats are more like people w/ T2DM & currently treated with Lantus, ~$200/vial. I have been trying to set up a #flozin study in cats for years- pharma wasn’t interested. Better chances now with Elanco having interest in additional labeled indications for their drug.

This supplemental fig from EMPA-KIDNEY is particularly useful to all of us in the US who have to deal with insurance companies : #flozin (SGLT2i) may work even if not on RAS therapy. Caveat emptor applies (85% of participants were on RASi subgroup analysis etc)
#CKD #nephmastodon #cardiomastodon #endomastodon
@Kidney_boy @hswapnil @edgarvlermamd @mike_johansen

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7614055/

This supplemental fig from EMPA-KIDNEY is particularly useful to all of us in the US who have to deal with insurance companies : #flozin (SGLT2i) may work even if not on RAS therapy. Caveat emptor applies (85% of participants were on RASi subgroup analysis etc)
#CKD #nephmastodon #cardiomastodon #endomastodon
@Kidney_boy @hswapnil @edgarvlermamd @mike_johansen

Physicians’ Considerations and Practice Recommendations Regarding the Use of Sodium-Glucose Cotransporter-2 Inhibitors
Just another #flozin paper by your's truly

https://www.mdpi.com/1882738

#Bexagliflozin aka bexacat for cats and brenzavvy for humans approved by FDA

https://endpts.com/theracosbio-aims-to-challenge-big-pharma-blockbusters-with-newly-approved-sglt2-for-diabetes/

another #Flozin - let's see if they compete by cost?
@ChristosArgyrop @mike_johansen

This is one of the graphs that justify doing a clinical trial of a #SGLT2I ie #flozin (or a #DRA , Direct Renin Antagonist) + #MRA (Mineralocorticoid Antagonist) in post #covid19 states with persistent detection of the spike antigen in the blood. If the spike is detectable, then it screws up ratios of Ang1-9,Ang1-7 to AngII ➡️? cardiovascular disease post covid.
#sarscov2

@Nephron post on twitter as the source of this graph
https://twitter.com/nephronus/status/1601831332094644225?t=ygKLhDAoDS_vvGx6UV9qyA&s=19

#Finerenone is no #Flozin #SGLT2i. Goodrx has this at $600 per month. I'll take spiro/eplere and use the ~$580 to pay for food for the rest of the month.

https://academic.oup.com/eurheartj/article/43/6/474/6433104?login=false#supplementary-data

Very cool #flozin trial in JASN
N = 14 with SIAD crossover with placebo/Empagliflozin

https://jasn.asnjournals.org/content/early/2022/11/16/ASN.2022050623

cc @ChristosArgyrop @Kidney_boy

Do we need a larger trial, or is this enough? #hyponatremia #nephrology

@cnewtoncheh @GermHunterMD @idjclub Can we just do each of the ~12 #flozin trials? It will bring me so much joy, although some might find the content redundant. 😜