As usual I can’t say enough good things about @ukkidney.org guidelines - their flozin one is fantastic, and I’m pleased to say their clear summary is supportive of this practice👇

The lines in ‘higher’ eGFR flozin RCTs (this one is DAPA-CKD) cross at 12-18 months, so if eGFR <20 but you think you’ve got longer than that until ESKD (lots of patients!) then #flozinate to slow CKD.

Side-effects may include preventing AKI, hyperkalaemia, CCF & death in a high risk group.

2. DAPA-advKD from ASN 2024. N=100, mean eGFR 19 (technically could have recruited down to eGFR 10): consistent eGFR slope efficacy in this population.

(think I stole the slide from @nephroseeker.bsky.social, thanks)

1. EMPA-KIDNEY recruited 250 patients with eGFR 18-20: consistent primary endpoint efficacy outcomes.

Apt abbreviation.

FDA committee briefing 2022 document summing the data from the 3 US RCTs terli v placebo 👇

Not observational - this is sum of the 3 large US RCTs of terli against placebo from FDA committee briefing and it’s not just ‘poor efficacy’, it’s very worrying safety data in this population.

I don’t know the answer to your norepi question which is a good one, interested to hear from others.

Paywall 😔

Our critique of the last one of these we covered in NephJC 👇 - I imagine this would come to a similar conclusion again?

www.nephjc.com/news/hyponat...