Building on the opening post rather than restating it. Agreed on chronic kidney disease, with one qualification that I think matters. The reasoning holds for the case as described. Change the starting assumption and it does not, and the starting assumption is the part nobody states.
Posting this under the heading it deserves: Chronic kidney disease and the FLOW result Everything below is what sits behind that.
Chronic kidney disease: setting out the arithmetic in full, because I have had to do it twice and I would rather nobody else did.
Every step is shown. If the answer is wrong the error will be visible, which is the point of writing it out rather than posting the result.
Building on the opening post rather than restating it.
Agreed on chronic kidney disease, with one qualification that I think matters. The reasoning holds for the case as described. Change the starting assumption and it does not, and the starting assumption is the part nobody states.
Reading back through, this was answered upthread and I missed it. My fault.
Narrowing post #3, because the general version has more than one answer.
A condition that affects nutrition or absorption changes the calculus around a treatment that reduces intake, and that interaction is mostly unstudied.
It reads as pedantry until the day it does not.
Everything in post #2 holds. The case it does not cover is the one I have.
If someone has run chronic kidney disease properly I would rather read that than my own reconstruction of it. Posting mine only because the thread has gone quiet.
Multiple comorbidities: a person with diabetes, kidney disease, and cardiovascular disease is outside the studied populations in most trials. Extrapolating to that person requires reasoning from the individual component trials and mechanisms.
Second-hand, so weight it accordingly.
Chronic kidney disease: compounds in this class have renal benefit in people with kidney disease. The benefit appears to be additive to other renal-protective agents, not a replacement for them.
Anyone with a larger sample, please post it.
One more thing on chronic kidney disease that took me far too long to see: the two figures people quote are not measuring the same quantity. Once you notice that, the apparent contradiction disappears.
Cardiovascular disease: several compounds have cardiovascular outcome trials. SELECT was in people without diabetes; SUSTAIN 6 was in high-risk diabetes. Absolute benefit is largest in high-risk people.
One of those cases where knowing the mechanism does not help the decision.
Summarising the chronic kidney disease thread so far, since it is long and the answer is buried: the first reply has the method, the fourth has the correction to it, and the rest is people agreeing at length.
Where I part company with post #9, and it is a narrow parting.
The most useful reply I ever got about chronic kidney disease was a request to state my units. It sounds like pedantry and it has saved me twice.
Post #13 is the version of this I will quote in future. One addition.
Bariatric surgery history: altered anatomy after surgery affects absorption. That matters for oral medications and for reconstituted solutions. Discussing specific medications and doses with a clinician familiar with bariatric surgery is prudent.
It took me longer than it should have to see that.
Chronic kidney disease looks different depending on whether you are reading the primary literature or the summaries of it, and the difference is not in our favour.
Where a condition is well controlled and where it is not are different questions and the published data rarely distinguishes them.
Post #13 put the caveat in the right place and I want to underline it.
What I can speak to on chronic kidney disease is narrow, so I will keep it narrow rather than generalising from it. Beyond that boundary I do not know.
Picking up post #17: that is the part I would want checked first.
The honest answer on chronic kidney disease is that it depends, and the useful part is the list of what it depends on. Four items, in rough order of how much they matter.
Most people get the first two right and then argue about the fourth.
Post #19 answers the question as asked. The question underneath it is different.
Adding a null result on chronic kidney disease. I looked, carefully, and found nothing, and null results deserve posting precisely because they never are.
I read post #20 twice before replying, because I had assumed the opposite.
Gastrointestinal conditions interact with a mechanism that slows gastric emptying in ways that are plausible and largely unstudied.
It is the kind of thing that is obvious once and never again.
Interactions between comorbidities: diabetes and kidney disease together change the risk calculation for hypoglycemia and for medication clearance. They are not independent variables.
Where somebody is on several medicines, the interaction question and the comorbidity question are entangled and both belong with a pharmacist.
Fair, and the limits you put on it are the part I will remember.
Where the honest answer is "nobody knows", giving it plainly is more useful than a confident synthesis of mechanism and anecdote.
What I would tell a new member reading about chronic kidney disease for the first time: the confident posts are not the reliable ones, and the reliable ones are longer.
Interactions between comorbidities: diabetes and kidney disease together change the risk calculation for hypoglycemia and for medication clearance. They are not independent variables.
That much is documented. The rest is how I have interpreted it.
Multiple comorbidities: a person with diabetes, kidney disease, and cardiovascular disease is outside the studied populations in most trials. Extrapolating to that person requires reasoning from the individual component trials and mechanisms.