Questioning Medicine17 Syys 2024

Episode 331: 329. Should We Give AceI or ARBs to Patients with CKD 4 and 5?

https://www.acpjournals.org/doi/10.7326/M23-3236

Angiotensin-converting–enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) seldom are initiated among patients with chronic kidney disease (CKD) stage 4 or 5, despite guideline recommendations for these agents--- 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines - ScienceDirect

“In adults with hypertension and CKD (stage 3 or higher or stage 1 or 2 with albuminuria [≥300 mg/d, or ≥300 mg/g albumin-to-creatinine ratio or the equivalent in the first morning void]), treatment with an ACE inhibitor is reasonable to slow kidney disease progression “

Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers for Advanced Chronic Kidney Disease: A Systematic Review and Retrospective Individual Participant–Level Meta-analysis of Clinical Trials: Annals of Internal Medicine: Vol 177, No 7 (acpjournals.org)

In a patient-level meta-analysis of 18 randomized trials, researchers identified 1700 patients with stage 4 or 5 CKD to determine if initiating ACE inhibitors or ARBs affected progression to dialysis or death. follow-up ≈3 years.

Patients with CKD stage 4 or 5 (mean eGFR, 22 mL/minute/1.73 m2) who initiated ACE inhibitors or ARBs (vs. placebo or other antihypertensive agents) were less likely to progress to dialysis (12% vs. 17% annually; number needed to treat, 20), mortality was similar (≈3% annually).

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Episode 435: 442. 7 article review

we unpack whether rivaroxaban followed by aspirin improves thromboprophylaxis after hip and knee arthroplasty, put oral GLP-1 therapy orforglipron head-to-head with dapagliflozin for type 2 diabetes, ...

10 Syys 33min

Episode 434: 441. Coronary Artery Calcium (CAC) -- Yacky Yack, the details on CAC

Does a Coronary Artery Calcium (CAC) scan still earn its place in modern cardiovascular prevention? This podcast cuts through the headlines to examine the recent research, challenge overconfident conc...

31 Elo 48min

Episode 433: 440. CME Understanding Medical Stats

OMED lecture on how to understand medical stats

21 Elo 33min

Episode 432: 439. 6 articles in 2026

CME

24 Heinä 25min

Episode 431: 438. CME- What To Do AFTER PE Diagnosis

OMED lecture

21 Heinä 26min

Episode 430: edit fix 437. A Brief Review of the Medical Literature!

Xin X, et al. Optimal exercise modalities and dosages for blood pressure reduction in adults with prehypertension and established hypertension: A network meta-analysis and dose–response relationship s...

8 Heinä 32min

Episode 429: 436. postpartum burnout., asundexian, semaglutide and ETOH, neck infection, varenicline

Jafari K, et al. Risk factors for pediatric deep neck infection revisit after emergency department discharge for pharyngitis or localized neck symptoms. Ann Emerg Med 2026 May; 87:605. DOI: 10.1016/j....

15 Kesä 31min

Episode 428: 435. Evolocumab, Statin and CKD, PCN allergy, MRI vs Rotator Cuff

https://pubmed.ncbi.nlm.nih.gov/41903215/ Evolocumab to Reduce First Major Cardiovascular Events in Patients Without Known Significant Atherosclerosis and With Diabetes: Results From the VESALIUS-CV ...

8 Touko 17min