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Hello everyone my name is christian diaz and i’m going to talk about empathy closing and progression of kindness this is in tied to diabetes definition tied to diabetes is a serious where the insulin of your pancreas can work properly or your friend just can make enough insulin this means your blood glucoses levels keep rising diabetes comforts and increase

Risk of others cardiovascular and renal hiddens chronic kidney disease ckd is a progressive condition that leads to end-stage kidney disease and eventually death while ckd primarily affects kidney function it also increases a patient’s risk of cardiovascular events in fact patients with ckd and type 2 diabetes t2d are three times more likely to die from

A cardiovascular event than patients with t2d alone approximately 374 million people have type 2 diabetes worldwide up to 40 of these patients also have ckd in patients with ckd and t2d three major categories of pathophysiological drivers promote ckd progression hemodynamic factors like increased blood pressure metabolic factors like elevated blood glucose

Inflammatory and fibrotic factors like pro-inflammatory and pro-fibrotic proteins one of these is unaddressed by the current standard of care inflammation and fibrosis in the kidneys the mineralocorticoid receptor or mr is a key trigger of inflammation and fibrosis under normal conditions mr signaling regulates electrolyte and fluid balance within the kidneys

The mr may become pathologically over activated under certain conditions like type 2 diabetes in patients with ckd and t2d pathological mr activation in the kidneys is believed to be due to increased expression of the mr and its activators which leads to the production of pro-inflammatory and pro-fibrotic proteins inducing inflammation and fibrosis within the

Kidneys renal inflammation and fibrosis gradually cause thickening and hardening of the glomeruli and injure the kidneys tubules over time inflammation and fibrosis may lead to a progressive decline in kidney function increasing the risk of end-stage kidney disease and cardiovascular events like myocardial infarction or stroke because all three categories of

Drivers contribute to ckd progression all three should be addressed in order to alter the course of ckd in type 2 diabetes application of medicine in the infrared outcome material and public flossing and sodium glucose transporter to invader reduces the risk of major adverse cardiovascular events in patients with type 2 diabetes at high risk of cardiovascular

Events we want to determine the long-term renal effects of empathy flossing and analyzing there was a a specific a component of the secondary vascular outcome of that trial the emperor’s study was a study testing the efficacy of impact glyphosate in patients with diabetes and for the first time after 25 years we have a drug that showed a reduction in mortality

And morbidity but not just overall mortality but also the occurrence of new heart failure cases this is very important because of the safety concerns that we had with previous drugs like the glitter zones or the sum of the glyptons and therefore the results of the emperor tell us that we have new class of drugs that can be safely used in patients with heart

Failure of course there are neutral trials ongoing to address specifically the efficacy of the sdgl2 uh inhibitors in patients with heart failure and this the results of these studies will be important not just to confirm the results of empiric that seems to be also mirrored by the interim analysis of the other trials with the sdgl2 inhibitors but also to teach

Us how to use friendly these drugs in patients with heart failure one important point is that now cardiologists are empowered for to treat diabetic patients with heart failure we shouldn’t leave diabetes to other specialties and the guidelines specifically say that patients with diabetes should be supervised by a cardiologist press and counts for us improving

Hyper filtration in patients with taiwan diabetes and these effects might translate into inferior right now outcomes comes incident the property defined as a progression to microalgae in new year associated with long-term adverse renal effects the emperor egg outcomes study was a study designed to assess primarily the safety of empagliflosin in patients at high

Risk of cardiovascular disease so the study had a goal of showing that empagliflosin was safe and did not increase cardiovascular risk but at the same time it was designed to look at whether there would be any benefit of giving this drug to patients with cardiovascular disease did it reduce mortality and cardiovascular events such as myocardial infarction stroke

And heart failure patient population were patients with type 2 diabetes who had a hemoglobin a1c of greater than 7 who also had cardiovascular disease and that was defined as a prior heart attack triple vessel coronary disease or single vessel coronary disease with evidence of provokable ischemia or they had a prior stroke or they had peripheral vascular disease

They had to have a creatinine clearance uh sorry an estimated glomerular filtration rate of greater than 30 and they couldn’t have a body mass index of greater than 45. empirical flossin is a sodium glucose co-transporter inhibitor and it blocks the uptake of glucose by the proximal tubule in the kidney so it blocks both glucose and sodium uptake there so it

Increases glucose it causes glycosyria so the patient passes glucose in their urine and it’s the glucose urea which the excretion of glucose which results in glucose lowering and glycemic control they’re quite powerful agents they in fact they lower blood glucose more than the dpp4 inhibitors for example so the use of these agents is in all patients with type

2 diabetes who have renal adequate renal function and so they have they have quite a wide application issue applied in ecuador it is necessary to make health professionals and patients aware of these new risks and inform then so that they take the necessary measures to prevent them from appearing since information has praised as a non-dramatic amputation is more

Risky especially for the third and the use of these antidiabetic medications to treat abnormalities severes case of diabetic heteroacetosis and acute renal failure the least the conclusion in patients with type 2 diabetes at high cardiovascular risk and body flossing was associated with slower progression of kindness disease and lower rates of clean calories

Relevant renal events that was a placebo when added to the standard carrier thank you so much you

Transcribed from video