![]() I was in a dense, gloomy forest fantastic, gigantic boulders lay about among huge jungle-like trees. But two months later, he had a disturbing dream, which he recounted in his autobiography, Memories, Dream, Reflections: At the time Jung found the dream obscure. Nineteen years later, in November of 1922, Jung had a dream in which his father (who had died in 1896) came to him with questions about marital psychology. But Jung never wavered and, once he achieved financial independence, he courted her persistently and married her in 1903. This was highly improbable, given that Emma Rauschenbach was then only 14, the daughter of a rich industrial family, and he was an impoverished medical student with many years of education ahead of him. During this visit Jung had a fleeting glimpse of a young girl and he knew intuitively that he had seen his future wife. In 1896, when he was 21 years old and living in Basel as a medical student, Jung was asked by his mother to pay a social call on an old family friend, Frau Rauschenbach. Jung experienced this repeatedly in his personal life. ![]() Intuition is that function that allows us to see around the corner of the future. doi: 10.1056/nejm199311113292004.Carl Jung was known for many things: his work with dreams his early work as a psychiatrist with association experiments leading to the concept of the “complex,” work that brought him to the attention of Sigmund Freud his interest in archetypes, which became such a feature of his brand of psychology that it often is labeled “archetypal psychology.” What is not so well known is Jung’s very keen intuitive nature, which manifested in his quick assessment of his patients’ conditions and, outside the clinical arena, in both his personal life and his role as a public figure. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. Lewis EJ, Hunsicker LG, Bain RP, Rohde RD. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. Lewis EJ, Hunsicker LG, Clarke WR, et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. Webster AC, Nagler EV, Morton RL, Masson P. Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis. (Funded by Boehringer Ingelheim and others EMPA-KIDNEY number, NCT03594110 EudraCT number, 2017-002971-24.).Ĭopyright © 2022 Massachusetts Medical Society.įox CS, Matsushita K, Woodward M, et al. ![]() The rates of serious adverse events were similar in the two groups.Īmong a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86 95% CI, 0.78 to 0.95 P = 0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72 95% confidence interval, 0.64 to 0.82 P<0.001). The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to <10 ml per minute per 1.73 m 2, a sustained decrease in eGFR of ≥40% from baseline, or death from renal causes) or death from cardiovascular causes.Ī total of 6609 patients underwent randomization. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m 2 of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m 2 with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. ![]() The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. ![]()
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