Click here to take the survey and receive your certificate.

Download a PDF of the deck, "Best Practices to Beat the Cardio-Renal-Metabolic Triad" (PDF will download to your computer or open in new window, depending on your browser settings)

Resource Toolkit for "Best Practices to Beat the Cardio-Renal-Metabolic Triad"

T2D, CVD/HF, and CKD

1. Marassi M and Fadini GP, The cardio-renal-metabolic connection: a review of the evidence. Cardiovasc Diabetol.. 22023;22:195. 

Coexistence of Cardio-Renal-Metabolic Systems

1. Wong K, et al. Comparison of demographic factors and cardiovascular risk factor control among U.S. adults with type 2 diabetes by insulin treatment classification, J Diabetes Complications. 2012;26:169-174.
2. Feng X, et al. CKD Prevalence Among Patients With and Without Type 2 Diabetes: Regional Differences in the United States, Kidney Med. 2022;4(1):100385.
3. Burrows NR, et al. Reported Cases of End-Stage Kidney Disease — United States, 2000–2019, MMWR Morb Mortal Wkly Rep. 2022;71(11):412-415.

1. Muralidaran Y, et al. Diabetic Cardiomyopathy: A New Perspective of Mechanistic Approach Nephrol Dial Transplant. 2012;27:2269-2274.
2. Sattar N, et al. SGLT2 Inhibition and cardiovascular events: why did EMPA-REG Outcomes surprise and what were the likely mechanisms? Diabetologia. 2016;59(7):1333-1339
3. Wanner, C. EMPA-REG OUTCOME: The Nephrologist's Point of View Am J Cardiol. 2017;120(1S):S59-S67.
4. Sattar N, McGuire D, Pathways to Cardiorenal Complications in Type 2 Diabetes Mellitus, Circulation. 2018;138:7–9.
5. U.S. Department of Health and Human Services. Effect of Sodium-Glucose Cotransport-2 Inhibitors on Blood Pressure in People With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of 43 Randomized Control Trials With 22 528 Patients. J Am Heart Assoc.2017;6(6):e004007
   
    

CV Event Risk in Diabetes is Amplified by CKD

1. Foley RN, et al., Chronic Kidney Disease and the Risk for Cardiovascular Disease, Renal Replacement, and Death in the United States Medicare Population, 1998 to 1999, J Am Soc Nephrol. 2005 Feb;16(2):489-95.

1. Ronco C, et al., Cardiorenal syndrome, J Am Coll Cardiol 2008 Nov 4;52(19):1527-39.
2. Rangaswami J, et al. Cardiorenal Syndrome: Classification, Pathophysiology, Diagnosis, and Treatment Strategies: A Scientific Statement From the American Heart Association, Circulation. 2019;139:e840–e878.

PCPs Often the First Source for Care

1. Rangaswami J, et al. Cardiorenal Protection With the Newer Antidiabetic Agents in Patients With Diabetes and Chronic Kidney Disease: A Scientific Statement From the American Heart Association, Circulation. 2020 Oct 27;142(17):e265-e286.
2. Kushner PR, et al. Role of Primary Care Clinicians in the Management of Patients With Type 2 Diabetes and Cardiorenal Diseases Clin Diabetes. 2022 Fall;40(4):401-412.
3. Alfego D, et al. Chronic Kidney Disease Testing Among At-Risk Adults in the U.S. Remains Low: Real-World Evidence From a National Laboratory Databases, Diabetes Care.. 2021 Sep;44(9):2025-2032.
4. Shin J, et al. Albuminuria Testing in Hypertension and Diabetes: An Individual-Participant Data Meta-Analysis in a Global Consortium, Hypertension.. 2021 Sep;78(4):1042-1052.

Role of the PCP

1. Shubrook JH, et al. Management of chronic kidney disease in type 2 diabetes: screening, diagnosis and treatment goals, and recommendations. Postgraduate Medicine, 134:4, 376-387. 

Screening for CKD in diabetes

1. American Diabetes Association Professional Practice Committee. 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2025 Diabetes Care. 2024;48(Suppl_1)S239-S251.
   
    

Screening for CKD in patients with diabetes

1. de Boer IH, et al. Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO). Diabetes Care, 2022 Dec 1;45(12):3075-3090. 
    

The race-neutral eGFR Calculator

1. American Kidney Fund. eGFR Test Change: Removal of Race from the Calculation, November 23, 2021. Accessed March 17, 2025.
   
    

1. Ninomaya T, et al. Albuminuria and kidney function independently predict cardiovascular and renal outcomes in diabetes, J Am Soc Nephrol.. 2009 Aug;20(8):1813-21.
2. Figure reprinted with permission from Ninomiya et al, Albuminuria and Kidney Function Independently Predict Cardiovascular and Renal Outcomes in Diabetes, J Am Soc Nephrol. 20(8):1813-1821. 
3. Heerspink, H.J.L., Grams, M.E., Sang, Y., et al Proteinuria or albuminuria as markers of kidney and cardiovascular disease risk: An individual patient-level meta-analysis. Annals of Internal Medicine. 2025 Nov 4. https://doi.org/10.7326/ANNALS-25-02117 

ADA, KDIGO, and AHA Recommendations

1. American Diabetes Association Professional Practice Committee. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025. Diabetes Care. 2025;48(Supplement_1):S181–S206.
2. KDIGO Diabetes Work Group. KDIGO 2024 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease, Kidney Int. 2024 Apr;105(4S):S117-S314.
3. Rangaswami J, et al. Cardiorenal Protection With the Newer Antidiabetic Agents in Patients With Diabetes and Chronic Kidney Disease: A Scientific Statement from the American Heart Association, Circulation. 2020;142:e265-e286.

SGLT-2 Inhibitors: Kidney Outcome Trial and HF Trial Results

1. McMurray JJV, et al. N Engl J Med. 2019;381:1995-2008; Dapagliflozin in Patient with Heart Failure and Reduced Ejection Fraction.
2. Solomon SD, et al. N Engl J Med. 2022;387:1089-1098; Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction.
3. Packer M, et al. N Engl J Med. 2020;383:1413-1424; Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure.
4. Anker SD, et al. N Engl J Med. 2021; 385:1451-1461; Empagliflozin in Heart Failure with a Preserved Ejection Fraction.
5. Bhatt DL, et al. N Engl J Med. 2021;384:117-128. Sotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure.

SGLT-2 Inhibitors: Expanded Indications

1. Farxiga package insert
2. Inpefa package insert
3. Invokana package insert
4. Jardiance package insert

SGLT-2 Inhibitors: Expanded Indications

1. Aklilu AM, et al. Kidney360. 2023, Outcomes Associated with Sodium-Glucose Cotransporter-2 Inhibitor Use in Acute Heart Failure Hospitalizations Complicated by Acute Kidney Injury.

Treatment for Cardiorenal Syndrome (CRS)

1. Rangaswami J, et al. Circulation. 2019;139(16):e840-e878. Cardiorenal Syndrome: Classification, Pathophysiology, Diagnosis, and Treatment Strategies: A Scientific Statement From the American Heart Association, https://www.ahajournals.org/doi/10.1161/CIR.0000000000000664

Combined SGLT-2 Inhibitor and MRA Benefit

1. Heerspink HJL, et al. Diabetes Obes Metab. 2023. doi:10.1111/dom.15232. Dapagliflozin reduces albuminuria in patients with diabetes and hypertension receiving renin-angiotensin blockers

Utilization of Therapies for Cardio-Renal-Metabolic Diseases

1. Tuttle KR, et al. Moving from Evidence to Implementation of Breakthrough Therapies for Diabetic Kidney Disease. Clin J Am Soc Nephrol. 2022;17:1092-1103.
2. Tuttle KR, et al. Moving from Evidence to Implementation of Breakthrough Therapies for Diabetic Kidney Disease. JAMA Netw Open. 2019;2;e1918169.
3. Murphy DP, et al. GFR Slope as a Surrogate End Point for Kidney Disease Progression in Clinical Trials: A Meta-Analysis of Treatment Effects of Randomized Controlled Trials. J Am Soc Nephrol. 2019;30:1314-1321.
4. Tuttle KR, et al. Dulaglutide versus insulin glargine in patients with type 2 diabetes and moderate-to-severe chronic kidney disease (AWARD-7): a multicentre, open-label, randomised trial. Lancet Diabetes Endocrinol. 2018;6:605-617. 
5. Burrows NR, et al. Reported Cases of End-Stage Kidney Disease - United States, 2000-2019. MMWR Morb Mortal Wkly Rep. 2022;71:412-415.

Overcoming Barriers to Use of Evidence-Based Therapies

1. Nee R, et al. Nephrol Dial Transplant. Overcoming barriers to implementing new guideline-directed therapies for chronic kidney disease. 2023;38(3):532-541.