Explore every episode of the podcast Freely Filtered, a NephJC Podcast
| Title | Pub. Date | Duration | |
|---|---|---|---|
| FF99 Late Breaking and High Impact Clinical Trials Session at KidneyWk: Pregnancy Outcomes after Kidney Donation | 22 Oct 2026 | 01:32:00 | |
This is our second time releasing a podcast simultaneous with presentation and publication. Super exciting. This podcast covers a retrospective trial study on pregnancy complications in kidney donors. The Filtrate Joel Topf @kidney_boy Swapnil Hiremath @hswapnil.medsky.social Anna Gaddy @GaddyAnnaR Nayan Arora @captainchloride Sophia Ambruso @sophia_kidney Special Guests Amit Garg @AmitXGarg, Nephrologist at Western University, London and PI of the current study
Joel Topf The Kidney Connection written and performed by Timothy Yau Show Notes Previous appearances by Dr Garg: Episode 56 MyTEMP Episode 63 Enhance Access to Kidney Transplantation and Living Kidney Donation (EnAKT LKD) (Late breaking and High impact clinical trial session at KidneyWeek 2023 in Philadelphia Our last attempt to podcast about preeclampsia did not go so well: Episode 70: Predicting Preeclampsia, the PRAECIS trial and Episode 70b Do Over: Predicting Preeclampsia, the PRAECIS trial (https://www.nephjc.com/freelyfiltered/2024/freely-filtered-70b-do-over-preeclampsia) The use of the words “men” and “women” in scientific papers, an editorial Garg’s prior work on male donors and scrotal surgery: Risk for Scrotal Surgery After Laparoscopic Donor Nephrectomy : A Population-Based Cohort Study PubMed Garg’s prior work on donor and pregnancy outcomes: Gestational Hypertension and Preeclampsia in Living Kidney Donors NEJM The Consensus Statement of the Amsterdam Forum on the Care of the Live Kidney Donor 2004 Transplantation KDIGO 2017 Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors KDIGO Tubular Secretion Swapnil Babylon 5 on AmazonPrime Wikipedia Sophia The Gentleman, the series on NetFlix Wikipedia and Gentleman, the film Wikipedia Anna and her boat, Freshwater Deficit. Heavy Weather Sailing by Adlard Coles Amazon Nayan William Osler: A Life in Medicine Amazon Amit Law and Order ethics Joel All the NephJC activities at Kidney Week: The Run | The other run | The Party | |||
| FF98 FIND-CKD Finerenone Tackles non-diabetic CKD | 15 Oct 2026 | 01:28:24 | |
The Filtrate Joel Topf @kidney_boy Swapnil Hiremath @hswapnil.medsky.social Anna Gaddy @annagaddy.bsky.social Natalie Freidin Program director at Medical University of South Carolina Special Guests Brendon “Brendo” Neuen The first Five-Time guest on Freely Filtered. Nephrologist and Director, Kidney Trials, Royal North Shore Hospital. Associate Professor of Medicine at the George Institute
Natalie Freidin The Kidney Connection written and performed by Timothy Yau Show Notes Donate to the fall pledge drive: https://www.nephjc.com/news/2026/9/8/nephjc-fall-pledge-drive Come to the ASN NephJC Night in Denver the Kidney Week: https://www.nephjc.com/news/2026/9/13/the-2026-nephjc-night FIND-CKD: Finerenone in Persons with Chronic Kidney Disease without Diabetes NEJM | NephJC 2-year GFR data on sibeprelimab Incidence of ESRD in the US due to IgAN (estimate using USRDS data) Heinz 57 wikipedia Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. The Lancet 1997. The REIN trial for people with nephrotic range proteinuria (>3 grams/day) Renoprotective properties of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria, The Lancet 1999 REIN Stratum 1 for sub-nephrotic range proteinuria (1-3 grams/day) Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes FIDELIO in NephJC | NEJM Benefits of aldosterone receptor antagonism in chronic kidney disease BARACK-D RCT PubMed We discussed the run in. Importantly the run in for FIDELIO and FIGRO did not give finerenone. This is sometimes done to assure that participants in a trial will tolerate the study drug but this will over inflate data on tolerability. See NephJC’s discussion on run ins here: https://www.nephjc.com/news/run-in-period Sean Barbour on Freely Filtered talking about the TESTING Trial FINALITY-HF A randomized, double-blind, placebo-controlled pragmatic study to evaluate FINerenone on clinicAL effIcacy and safeTY in patients with Heart Failure and reduced ejection fraction who are intolerant of or not eligible for treatment with steroidal mineralocorticoid receptor antagonists. ClinicalTrials.gov Boehringer provides update on EASi-KIDNEY trial 😢 Pooled finerenone data INFINITY Pooled Analysis Tubular Secretion Swapnil The Will of the Many by James Islington (Amazon) Anna The Art Thief: A True Story of Love, Crime, and a Dangerous Obsession by Michael Finkel (Amazon) Brendo John Mayer Electric Guitar (PRS Guitar) Natalie Great Big Beautiful Life by Emily Henry (Amazon) Joel Come to the NephJC party at Kidney Week! | |||
| FF97 MERCURI-2, Can a Flozin prevent AKI? | 27 Sep 2026 | 01:20:01 | |
Bypass surgery continues to be the laboratory where we test the most innovative ideas on the prevention of AKI The Filtrate Joel Topf @kidney_boy Swapnil Hiremath @hswapnil.medsky.social Vipin Varghese Sophia Ambruso Special Guests Rahul Ganatra Deputy Editor NEJM Clinician. https://clinician.nejm.org/editors/AU3406 Jay Koyner Professor of Medicine, University of Chicago. https://www.uchicagomedicine.org/find-a-physician/physician/jay-koyner
Vipin Varghese The Kidney Connection written and performed by Timothy Yau Show Notes Back to the Future: https://youtu.be/BDuZqYeNiOA?is=r-RE2DgIDBazRAlW Amino Acids for AKI: The PROTECTION Study NephJC: Trial by Combat: Do Amino Acids provide PROTECTION to the Kidneys? In 2016 the FDA posted a warning that SGLT2i could induce AKI. This Nature Reviews Nephrology explores possible mechanisms for the AKI: Acute kidney injury from SGLT2 inhibitors: potential mechanisms https://www.nature.com/articles/nrneph.2016.159 But by 2019 the SMART-C Collaboration was looking at the risk of AKI in the large RCTs and found Flozins to be protective: SGLT2 inhibitors for the prevention of kidney failure in patients with type 2 diabetes: a systematic review and meta-analysis. https://www.thelancet.com/journals/landia/article/PIIS2213-8587(19)30256-6/abstract If you are actually looking for the best data you should look at the updated meta-analysis from 2025 which extends the findings to patients with and without diabetes and to patients with and without CKD: SGLT2 Inhibitors and Kidney Outcomes by Glomerular Filtration Rate and Albuminuria https://pmc.ncbi.nlm.nih.gov/articles/PMC12595549/ 2012 KDIGO AKI Guidelines: https://kdigo.org/wp-content/uploads/2016/10/KDIGO-2012-AKI-Guideline-English.pdf The 2025/2026 AKI Draft guidelines: https://kdigo.org/wp-content/uploads/2026/03/KDIGO-2026-AKI-AKD-Guideline-Public-Review-Draft-March-2026.pdf Meta-analysis of frusemide to prevent or treat acute renal failure https://www.bmj.com/content/early/2005/12/31/bmj.38902.605347.7C Euglycemic Diabetic Ketoacidosis: A Potential Complication of Treatment With Sodium–Glucose Cotransporter 2 Inhibition https://diabetesjournals.org/care/article-abstract/38/9/1687/37246/Euglycemic-Diabetic-Ketoacidosis-A-Potential Topic of this podcast, the MERCURI-2 trial: Dapagliflozin and Acute Kidney Injury Following Cardiac Surgery https://jamanetwork.com/journals/jama/article-abstract/2852324 | NephJC: Too sweet to be true? Prophylactic SGLT2 inhibitors before cardiac surgery https://www.nephjc.com/news/2026/8/18/mercuri2 MERCURI-1 Pilot trial is described here. Looks like it was only published as a pre-print. The first link provides a glimpse at MERCURI-3 https://www.medrxiv.org/content/10.1101/2024.03.27.24304998v1.full.pdf Vipin Varghese used to believe in the urinalysis: Diagnostic Utility of Serial Microscopic Examination of the Urinary Sediment in Acute Kidney Injury https://pubmed.ncbi.nlm.nih.gov/35373012/ MERCURI-2 in ClinicalsTrials.gov: proMoting Effective Renoprotection in Cardiac sURgery Patients by Inhibition of SGLT-2 (MERCURI-2) https://clinicaltrials.gov/study/NCT05590143 Roger Rodby’s 4 favortite equations in Nephrology from Channel Your Enthusioasm: https://pca.st/episode/abff985f-6a87-41f9-bcc9-80b8a85c2441?t=3257.0 IDEAL ICU Timing of Renal-Replacement Therapy in Patients with Acute Kidney Injury and Sepsis https://www.nejm.org/doi/full/10.1056/NEJMoa1803213?referrer=https%3A%2F%2Fwww.google.com%2F Rethinking the definition of oliguria: Identification of an optimal threshold to define oliguria in critically ill patients: an observational study https://pubmed.ncbi.nlm.nih.gov/37254158/ Editorial on MERCURI-2 in JAMA by Wolfgang Winkelmayer and Glenn Chertow https://jamanetwork.com/journals/jama/fullarticle/2852331
Tubular Secretion Swapnil Spider Noire Amazon Prime Sophia Bernadoodle via Starlight Bernadoodle https://starlightbernedoodles.com Rahul Derry Girls on Netflix Vipin Tennis Cincinnati Open and the US Open. The death of the one handed backhand. Jay Slow Horses on Apple TV and Adults on Hulu Joel Silo season three. Mountain biking. | |||
| FF96 MAJESTY, or Mentor Two | 30 Aug 2026 | 01:20:01 | |
The Filtrate Joel Topf @kidney_boy Swapnil Hiremath @hswapnil.medsky.social Natalie Freidin Program director at Medical University of South Carolina AC @medpeedskidneys.bsky.social Special Guests Fernando Fervenza Professor of Medicine, The Mayo Clinic
Vip Vergues The Kidney Connection written and performed by Timothy Yau Show Notes MENTOR NephJC | NEJM | Freely Filtered episode 7 PLA2r in 2009 M-Type Phospholipase A2 Receptor as Target Antigen in Idiopathic Membranous Nephropathy NEJM MAJESTY NephJC | NEJM Obinutuzumab or Tacrolimus in Primary Membranous Nephropathy Giuseppe Remuzzi discovers rituximab works in primary membranous. Rituximab for idiopathic membranous nephropathy The Lancet 2002 Fervenza’s 15-person study of Rituximab treatment of idiopathic membranous nephropathy Kidney International 2008. Larry Beck’s NEJM PLA2r study M-Type Phospholipase A2 Receptor as Target Antigen in Idiopathic Membranous Nephropathy NEJM 2009 2011 (not 2010) JASN paper where using banked serum from two prior rituximab studies in membranous nephropathy, Beck and Fervenza showed that declines in anti-PLA2R antibodies preceded reductions in proteinuria and predicted subsequent clinical remission, establishing the concept that immunologic remission precedes clinical remission. Rituximab-Induced Depletion of Anti-PLA2R Autoantibodies Predicts Response in Membranous Nephropathy PubMed The National Institute of Animal Health…a Fervenza fiction Robert A. Star, M.D. NIH Daniel C. Cattran, M.D. NephCure Tubular Secretions Swap do not go to see Mandalorian and Grogu or Supergirl AC doing nothing Natalie The Wealth Ladder by Nick Maggiulli (amazon) Fernando South Portugal and GlomCon Hawaii Joel The Boundary Waters Canoe Area | |||
| FF95 The PUSH trial. Push it real good! | 23 Aug 2026 | 01:06:17 | |
The Filtrate Joel Topf@kidney_boy Vipin Verghese@vipvargh.bsky.social Nayan Arora @captainchloride Special Guests David Goldfarb Professor of Medicine, NYU (COI) Megan Prochaska Assistant professor of medicine at University of Chicago John Asplin Medical Director Consultant LithoLink (Twitter)
Anna Gaddy The Kidney Connection written and performed by Timothy Yau Show Notes Kidney Treks, University of Chicago. For medical students. The Push Trial: Prevention of urinary stones with hydration: a randomised clinical trial of an adherence intervention NephJC Short | The Lancet Charlie Pak trial showing increased urine volume reduced risk of kidney stones. Evidence justifying a high fluid intake in treatment of nephrolithiasis PubMed The Borghi Trial: Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study PubMed Medical Management of Kidney Stones: AUA Guideline (2026) Weird little trial Asplin mentioned with amlodipine. But it was actually verapami. By Kemal Sarical: The effect of calcium channel blockers on stone regrowth and recurrence after shock wave lithotripsy PubMed Borghi’s other giant study in kidney stones: Comparison of Two Diets for the Prevention of Recurrent Stones in Idiopathic Hypercalciuria NEJM The No Stone Trial: Hydrochlorothiazide and Prevention of Kidney-Stone Recurrence NephJC | NEJM Gary Curhan epidemiologic data from the Nurses Health Study and the Health Professionals Follow-up Study: Twenty-four-hour urine chemistries and the risk of kidney stones among women and men PubMed Gary Curhan epidemiologic data on sugar sweetened beverages and risk of kidney stones. Soda and other beverages and the risk of kidney stones PubMed Eric Topol’s tweet: Goldfarb’s scathing editorial on said guidelines, not on NephJC as I said but, on Fred Coe’s website at the University of Chicago. Link Tubular Secretions Nayan: Shrinking on Apple TV Wikipedia David: The deaths of Sonny Rollins (Wikipedia) and James Blood Ulmer (Wikipedia) Megan: Sri Lanka for travel (National Geographic) Vipin: Memory Eternal: Living with Grief as Orthodox Christians (Amazon) John: A History of Rock Music in 500 Songs (Link) Patty Smith’s memoir, Just Kids (Amazon) Joel: This is How You Lose The War by Amal El-Mohtar and Max Gladstone (Amazon) for the second time, and Acquired PodCast (Link) | |||
| FF94 C3 Glomerulopathy with Carla Nester | 17 Jul 2026 | 01:14:13 | |
The Filtrate Joel Topf kidneyboy.bsky.social Swapnil Hiremath @hswapnil.medsky.social Natalie Freidin Program director at Medical University of South Carolina Sophia Ambruso @sophia_kidney AC @medpeedskidneys.bsky.social Special Guests Carla Nester, Professor of Medicine, Professor of Pediatrics, University of Iowa. Senior author of Valiant Editing Natalie Freidin The Kidney Connection written and performed by Timothy Yau Show Notes Trial of Pegcetacoplan in C3 Glomerulopathy and Immune-Complex MPGN NEJM | NephJC Tubular Secretions Swapnil: City of Last Chances by Adrian Tchaikovsky (Amazon) Natalie: Heated Rivalry, the books by Rachel Reid Carla: Rowing and gold fiber embroidery AC: Audiobooks, that are appropriate for children: The Giver and Tuck Everlasting Sophia: Greeking Out podcast and the Wheel of Time by Robert Jordan (Wikipedia) Joel: This is How You Lose The War by Amal El-Mohtar and Max Gladstone (Amazon) | |||
| FF93 Hyponatremia Interventional Trial | 30 Jun 2026 | 01:30:21 | |
The Filtrate Joel Topf kidneyboy.bsky.social Swapnil Hiremath @hswapnil.medsky.social Pedro Teixeira @nephcrit.bsky.social Special Guests Ewout J. Hoorn, Professor of Medicine Erasmus MC, Netherlands. One of the primary authors. Harish Seethapathy, Assistant physician at Massachusetts General Hospital Editing Vipin Verghese The Kidney Connection written and performed by Timothy Yau Show Notes A Randomized Trial of Targeted Hyponatremia Correction in Hospitalized Patients in NEJM Evidence, in PubMed, in NephJC Seethapathy: Severe Hyponatremia Correction, Mortality, and Central Pontine Myelinolysis in NEJM Evidence MacMillan: Osmotic Demyelination Syndrome in Patients Hospitalized with Hyponatremia in NEJM Evidence SALSA: Risk of Overcorrection in Rapid Intermittent Bolus vs Slow Continuous Infusion Therapies of Hypertonic Saline for Patients With Symptomatic Hyponatremia: The SALSA Randomized Clinical Trial in JAMA Internal Medicine SALT 1 and 2: Tolvaptan, a Selective Oral Vasopressin V2-Receptor Antagonist, for Hyponatremia in NEJM Hyponatremia registry: Current treatment practice and outcomes. Report of the hyponatremia registry in Kidney International The Richard Sterns’ article on the lower mortality with more severe hyponatremia: Mortality and Serum Sodium: Do Patients Die from or with Hyponatremia? in CJASN The European Hyponatremia Guidelines: Clinical practice guideline on diagnosis and treatment of hyponatraemia in The European Journal of Endocrinology The American Hyponatremia Guidelines: Diagnosis, Evaluation, and Treatment of Hyponatremia: Expert Panel Recommendations in American Journal of Medicine Treating hyponatremia: damned if we do and damned if we don't by Tom Berl in Kidney International Prospective (clamp) versus reactive (rescue) DDAVP in hyponatremia: Safety and efficacy of proactive versus reactive administration of desmopressin in severe symptomatic hyponatremia: a randomized controlled trial in Nature Scientific Reports and as covered in PBFluids Helbert Rondon’s RCT of urea Urea for Chronic Hyponatremia on ClinicalTrials.gov Tubular Secretions Swapnil: Catfishing on CatNet: A Novel by Naomi Kritzer (Amazon) Harish: Disney Cruise Edward: Flesh: A Novel (Booker Prize Winner) by David Szalay (Amazon) Pedro: Scrubs reboot (IMDB) Joel: KIDNEYcon | |||
| FF92 Live from Dublin, The Irish Nephrology Society | 09 Jun 2026 | 01:35:55 | |
The Filtrate Joel Topf kidneyboy.bsky.social Special Guests Dr. Samir Parikh, President of the American Society of Nephrology Prof. Donal Reddan, President, Irish Nephrology Society Prof. Catherine Godson Editing Joel Topf The Kidney Connection written and performed by Timothy Yau Show Notes Tubular Secretions Joel Topf, the Dublin Port Greenway Link Catherine Godson: never heard of the Dublin Port Greenway Samir Parikh: Trinity College Dublin and specifically the Eavan Boland Library, named after the Irish poet. Donal Reddan: Something about rugby | |||
| FF91 Liberate-D | 30 Mar 2026 | 01:35:55 | |
The Filtrate Joel Topf kidneyboy.bsky.social Pedro Teixeira @nephcrit.bsky.social Nayan Arora @captainchloride.bsky.social Anna Gaddy @annagaddy.bsky.social Swapnil Hiremath @hswapnil.medsky.social and on LinkedIn Special Guests Ian McCoy, MD @NephroNinja study author and UCSF Chi-yuan Hsu Senior author and Chief of the Division of Nephrology at UCSF Samuel Silver Associate Professor at Queens University in Canada Editing Vipin Verghese and Joel Topf Show Notes NephJC Discusion: Dialyze Less, Recover More? AKI’s Chance to Get LIBERATE-D Manuscript: A Conservative Dialysis Strategy and Kidney Function Recovery in Dialysis-Requiring Acute Kidney InjuryThe Liberation From Acute Dialysis (LIBERATE-D) Randomized Clinical Trial JAMA | PubMed Ben’s pilot study: RAD-AKI Pilot study: Recovery After Dialysis-Requiring Acute Kidney Injury (RAD-AKI) (ClinicalTrials.gov) STARRT-AKI NephJC Editorial in JAMA: A-E-I-O-U and Sometimes Why—Dialysis in Acute Kidney Injury (JAMA) What Is Dialytrauma? (Nephrology Times) How Fragile Are the Results of a Trial? The Fragility Index (PubMedCentral) Shiffl Trial: Daily Hemodialysis and the Outcome of Acute Renal Failure (NEJM) AKIKI: Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit (NEJM) AKIKI2: How Late it was, How Late! (NephJC) Sam Silver’s study: Promoting Kidney Recovery After Acute Kidney Injury Receiving Dialysis (Recover-AKI) (ClinicalTrial.Gov) Marie Kondo (Wikipedia) Tubular Secretions Swap: The smutty dragon novels of novels of Rebecca Yarros (Wikipedia) Specifically The Empyrean series Anna: Brisket recipes Pedro: The Naked Gun (Wikipedia) with Liam Neeson Ian: ASN Kidney Health Guidance on the Outpatient Management of Patients with Dialysis-Requiring Acute Kidney Injury (PubMed) he really doesn’t get Tubular Secretions. Nayan: Tilt: A Novel by Emma Pattee (Amazon) Chi: The Year of Magical Thinking by Joan Didion (Wikipedia) and Innovations in Nephrology (Springer Nature) Sam: Monopoly Super Electronic Banking Board Game (Amazon) Joel: Song Sung Blue (Wikipedia) | |||
| FF90 NephMadness 2026: Animal House | 21 Mar 2026 | 01:25:14 | |
The Filtrate Joel Topf (kidneyboy.bsky.social) AC (@medpeedskidneys.bsky.social)NephMadness Anna Gaddy (@AnnaGaddy) Vipin Verghese (@vipvargh.bsky.social) Natalie Freidin Program director at Medical University of South Carolina Special Guests Anna Vinnikova (@kidneywars.bsky.social) Long time game maker for NephMadness and Associate Professor at Virginia Commonwealth University Autumn Harris Associate Professor of Veterinary Medicine at NC State Sarah Street MD PhD Assistant Professor of Medicine at Virginia Commonwealth University Editing Joel Topf Show Notes Animal House scouting report Autumn Harris on Team Cat Cheese! | |||
| FF 89 Top Stories of 2025 | 31 Jan 2026 | 01:51:15 | |
I know 2026 feels like it ihas been here for months, but only a few weeks ago we were celebrating the nephrology accomplishments of 2025. The New Filtrate came together to review the year. Joel Topf @kidneyboy.bsky.social (COI) Swapnil Hiremath @hswapnil.medsky.social and on LinkedIn Editor in Chief of Kidney International Case Reports Anna Gaddy (@AnnaGaddy) Winner of NephJC Rookie of the Year 2020 Nayan Arora (@CaptainChloride.bsky.social) AC (@medpeedskidneys.bsky.social) Vipin Verghese (@vipvargh.bsky.social) co-winner of NephJC Engaged Scientist of the Year in 2021 Brian Rifkin (@brianrifkin.bsky.social) Co-Editor in Chief NephJC. Winner of NephJC Rookie of the Year 2021 Cristina Popa (@NephroSeeker) Co-Editor in Chief NephJC. Wwinner of NephJC Rookie of the Year 2022 and MVP 2023 Editing and Show Notes by Anna Gaddy and Joel Topf The Kidney Connection written and performed by Tim Yau Show Notes Top Stories in Nephrology 2025 (NephJC) First Top sories in Nephrology 2010! (Renal Fellow Network) Links to all of the Top Stories in Nephrology, hosted on NephJC since 2017 (NephJC) 1. IgA Nephropathy VISIONARY: Sibeprenlimab in IgA Nephropathy — Interim Analysis of a Phase 3 Trial (NEJM) ORIGIN 3: A Phase 3 Trial of Atacicept in Patients with IgA Nephropathy (NEJM) APPLAUSE-IgA Alternative Complement Pathway Inhibition with Iptacopan in IgA Nephropathy (NEJM) Aliza M. Thompson, MD, MS (ASN) 2. Lupus Nephritis REGENCY: Efficacy and Safety of Obinutuzumab in Active Lupus Nephritis (NEJM) 3. Nobel prize winner and peripheral immune tolerance 4. Xenotransplantation 5. GLP1ra Revolution Remodel REMODELing mechanistic trials for kidney disease: a multimodal, tissue-centered approach to understand the renal mechanism of action of semaglutide (Kidney International) SURPASS-CVOT Tirzepatide vs. Dulaglutide Is Associated with Reduced Major Kidney Events in Patients with Type 2 Diabetes, CVD, and Very High-Risk Kidney Diseases (Kidney Week abstract in JASN) Poll: 1 in 8 Adults Say They Are Currently Taking a GLP-1 Drug for Weight Loss, Diabetes or Another Condition, Even as Half Say the Drugs Are Difficult to Afford (KFF survey) 6. GDMT implementation in CKD: lessons learnt from CONFIDENCE and MIRO-CKD Confidence Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes (NEJM) MIRO-CKD Balcinrenone in combination with dapagliflozin compared with dapagliflozin alone in patients with chronic kidney disease and albuminuria: a randomised, active-controlled double-blind, phase 2b clinical trial (The Lancet) 7. Flozin Meta analysis SMART-C. SGLT2 Inhibitors and Kidney Outcomes by Glomerular Filtration Rate and Albuminuria. A Meta-Analysis (JAMA) SMART-C. Effects of Sodium Glucose Cotransporter 2 Inhibitors by Diabetes Status and Level of Albuminuria. A Meta-Analysis (JAMA) 8. Paradigm Shift: Aiming for CKD Remission 9. Fish Oil and Dialysis PISCES Fish-Oil Supplementation and Cardiovascular Events in Patients Receiving Hemodialysis (NEJM) 10. Decline in Dialysis Patients in the United States USRD 2025 Annual Data Report (USRDS) Tubular Secretion Swapnil Hiremath Alien Earth on FX Hulu (Wikipedia) AC A Christmas Carol by Charles Dickens (Wikipedia) and The Muppet Christmas Carol (Wikipedia) Anna Monty Don (Wikipedia) Nayan Back Street Boys at The Sphere (Wikipedia) Brian Marty Supreme (Wikipedia) Cristina The Yellow Tie (Wikipedia) Vipin Stranger Things, good for a four year old? (Wikipedia) Joel Crash Course: The Universe with Katie Mack and John Green (Apple PodCasts) | |||
| FF 86 Atacicept for IgAN. Third attempt | 28 Dec 2025 | 01:15:28 | |
The Filtrate Joel Topf @kidneyboy.bsky.social (COI) Sophia Ambruso @sophia-kidney.bsky.social Swapnil Hiremath @hswapnil.medsky.social and on LinkedIn Special Guests Jonathan Barratt Professor of Renal Medicine, University of Leicester Google Scholar (COI: all the companies) Editing and Show Notes by Nayan Arora @captainchloride.bsky.social The Kidney Connection written and performed by Tim Yau Show Notes Proteinuria Reduction as a Surrogate End Point in Trials of IgA Nephropathy (Aliza Thompson, 2019 PubMed) The number, quality, and coverage of randomized controlled trials in nephrology (PubMed 2004) A Randomized, Controlled Trial of Rituximab in IgA Nephropathy with Proteinuria and Renal Dysfunction (PubMed 2017) BLISS Belimumab in lupus nephritis (NephJC | PubMed) The Phase 2 trial of atacicept A phase 2b, randomized, double-blind, placebo-controlled, clinical trial of atacicept for treatment of IgA nephropathy (PubMed) The phase 3 trial of atacicept, the subject of this podcast A Phase 3 Trial of Atacicept in Patients with IgA Nephropathy (PubMed | NephJC) The use of Gd-IgA1 in the Testing Trial Role of Systemic Glucocorticoids in Reducing IgA and Galactose-Deficient IgA1 Levels in IgA Nephropathy (PubMed) If you can’t get enough Jon Barratt, take a look at his grand rounds at The University of Ottawa. Updates to the KDIGO Guidelines for the treatment of IgA nephropathy, with Prof Jonathan Barratt (YouTube) Tubular Secretion Swapnil Hiremath Pluribus on Apple TV (Wikipedia) Jon Barratt Lynyrd Skynyrd (Wikipedia) Slow Horses (Wikipedia) on AppleTV Joel Topf the new ASN | |||
| FF 88 BICARICU-2, Bicarbonate in the ICU, still not helpful? | 27 Dec 2025 | 01:24:41 | |
The Filtrate Joel Topf @kidneyboy.bsky.social (COI) Pedro Teixeira @nephcrit.bsky.social Ana Gaddy @AnnaGaddy Nayan Arora @captainchloride.bsky.social Special Guests David Goldfarb Professor of Medicene, NYU (COI) Editing by Pedro Teixeira The Kidney Connection written and performed by Tim Yau Show Notes BICARBICU 2018 (Lancet) BICARBICU-2 2025 (JAMA) SOFA score (Wikipedia) Sodium bicarbonate administration for metabolic acidosis in the intensive care unit: a target trial emulation (PubMed) Effect of sodium bicarbonate on intracellular pH under different buffering conditions (PubMed) Evaluating the clinical and cost-effectiveness of Sodium Bicarbonate administration for critically ill patients with Acute Kidney Injury (MOSAICC) (ICNARC Site) SODium BICarbonate for Metabolic Acidosis in the ICU (SODa-BIC) (ClinicalTrials.gov) Surviving Sepsis Campaign Guidelines 2021 (Website) Tubular Secretions Nayan: Louise Penny, The Black Wolf (Amazon) Anna: Broom Gate: A Curling Scandle (CBC) Pedro: One Battle After Another! (Wikipedia) David: Patti Smith (Wikipedia) Joel: Boys in the Boat by Daniel James Brown (Film Wikipedia | Book Wikipedia) | |||
| FF 87 Can Fish Oil Knock the Crap out of Dialysis Associated CV Disease? | 14 Dec 2025 | 01:20:20 | |
The Filtrate Joel Topf @kidneyboy.bsky.social (COI) Swapnil Hiremath @hswapnil.medsky.social and on LinkedIn Pedro Teixeira @nephcrit.bsky.social Special Guests Charmaine E Lok, MD Professor of Medicine at the Faculty of Medicine, University of Toronto Editing and Show Notes by Joel Topf The Kidney Connection written and performed by Tim Yau Show Notes Fish-Oil Supplementation and Cardiovascular Events in Patients Receiving Hemodialysis NEJM | NephJC What works in hemodialysis? Iron: PIVOTAL Trial (NEJM) Hemodiafiltration: CONVINCE (NEJM) Earlier work on vascular access, The FISH Trial: Effect of fish oil supplementation on graft patency and cardiovascular events among patients with new synthetic arteriovenous hemodialysis grafts: a randomized controlled trial JAMA Eskimo myth: "Fishing" for the origins of the "Eskimos and heart disease" story: facts or wishful thinking? (PubMed) Dialysis patients have low levels of fish oil in their body (PubMedCentral) Positive trial in non-dialysis patients: REDUCE-IT Negative trial of fish oil in non-dialysis patients: STRENGTH ACC does not recommend FISH Oil for primary or secondary prevention of CV events (ACC) Poisson distribution (Wikipedia) Ocean Nutrition Canada (Wikipedia) Ocean Nutrition was bought by DSM (Press Release) DSM merged with Firmenich (Press Release) Vanguard feasibility trials (PubMed) Freezing fish oil caps will eliminate the fishy aftertaste (Pharmacists Letter) The study also received a philanthropic donation from Mr. Alexander Epstein (UHN Research) Selection Bias, Interventions and Outcomes for Survivors of Cardiac Arrest (PubMedCentral) Effectiveness of fish oil in controlling inflammation in adult patients undergoing hemodialysis: A systematic review and meta-analysis (PubMed) Tubular Secretions Swapnil Hiremath: Michael Clayton (IMDB) Pedro: Fifa World Cup Soccer coming to North America with Portugal! (FIFA) Charmaine: New Puppy, Rose. It’s a Barbet (Wikipedia) Joel Topf: The Dark Forrest by Liu Cixin (Wikipedia) | |||
| FF 86 Atacicept for IgAN with Jon Barratt | 28 Nov 2025 | 01:15:27 | |
The Filtrate Joel Topf @kidneyboy.bsky.social (COI) Sophia Ambruso @sophia-kidney.bsky.social Swapnil Hiremath @hswapnil.medsky.social and on LinkedIn Special Guests Jonathan Barratt Professor of Renal Medicine, University of Leicester Google Scholar (COI: all the companies) Editing and Show Notes by Nayan Arora @captainchloride.bsky.social The Kidney Connection written and performed by Tim Yau Show Notes Proteinuria Reduction as a Surrogate End Point in Trials of IgA Nephropathy (Aliza Thompson, 2019 PubMed) The number, quality, and coverage of randomized controlled trials in nephrology (PubMed 2004) Updated here (PubMed | NephJC discussion) A Randomized, Controlled Trial of Rituximab in IgA Nephropathy with Proteinuria and Renal Dysfunction (PubMed 2017) BLISS Belimumab in lupus nephritis (NephJC | PubMed) The Phase 2 trial of atacicept A phase 2b, randomized, double-blind, placebo-controlled, clinical trial of atacicept for treatment of IgA nephropathy (PubMed) The phase 3 trial of atacicept, the subject of this podcast A Phase 3 Trial of Atacicept in Patients with IgA Nephropathy (PubMed | NephJC) Christos’ Bluesky post: https://bsky.app/profile/christosargyrop.bsky.social/post/3m5bsujwg3s2q The use of Gd-IgA1 in the Testing Trial Role of Systemic Glucocorticoids in Reducing IgA and Galactose-Deficient IgA1 Levels in IgA Nephropathy (PubMed) If you can’t get enough Jon Barratt, take a look at his grand rounds at The University of Ottawa. Updates to the KDIGO Guidelines for the treatment of IgA nephropathy, with Prof Jonathan Barratt (YouTube) Tubular Secretion Swapnil Hiremath Pluribus on Apple TV (Wikipedia) Jon Barratt Lynyrd Skynyrd (Wikipedia) Slow Horses (Wikipedia) on AppleTV Joel Topf the new ASN | |||
| FF 85 Live at Kidney Week | 17 Nov 2025 | 00:49:43 | |
The Filtrate Joel Topf @kidneyboy.bsky.social Sophia Ambruso @sophia-kidney.bsky.social Nayan Arora @captainchloride.bsky.social Special Guests Brian Rifkin @brianrifkin.bsky.social Anna Gaddy @AnnaGaddy Editing and Show Notes by Joel Topf The Kidney Connection written and performed by Tim Yau Show Notes Brian Rifkin and Cristina Popa ascend to co-editors in chief of NephJC. Paresh Jadav receives the first NephJC Champion award. Dr. Jadav hosted the NephJC night and saved NephJC thousands of dollars. It makes a huge difference in our fund raising. Thank you. Also a big thank-you to Jade Teakell for buying the cowboy hats! The first pick of the draft, by Sophia is Fish oil for dialysis: Fish-Oil Supplementation and Cardiovascular Events in Patients Receiving Hemodialysis (NEJM) Rajiv Agarwal’s mediation analysis to show how much of finerenone’s beneficial renal effects are captured by the reduction proteinuria: Impact of Finerenone-Induced Albuminuria Reduction on Chronic Kidney Disease Outcomes in Type 2 Diabetes : A Mediation Analysis (PubMed) Anna has the third pick and it goes to Katherine Tuttle and the REM0DEL Trial: REMODELing mechanistic trials for kidney disease: a multimodal, tissue-centered approach to understand the renal mechanism of action of semaglutide (Science Direct) Nayan goes off-board and picks a poster by a med student (backed by Testani) Mechanism and Effects of Manipulating Chloride Homeostasis in Stable Heart Failure (ClinicalTrials.gov) For the final pick in the draft Joel went with a little Lilly on Lilly violence: Tirzepatide vs. Dulaglutide Is Associated with Reduced Major Kidney Events in Patients with Type 2 Diabetes, CVD, and Very High-Risk Kidney Diseases (JASN) Bring out your dead…What’s left on the draft board. Liberate-D A Conservative Dialysis Strategy and Kidney Function Recovery in Dialysis-Requiring Acute Kidney Injury: The Liberation From Acute Dialysis (LIBERATE-D) Randomized Clinical Trial (JAMA) Atacicept for IgAN A Phase 3 Trial of Atacicept in Patients with IgA Nephropathy (NEJM) Lilia Cervantes crushed it with Community Health Worker Support for Hispanic and Latino Individuals Receiving Hemodialysis: The Navigate-Kidney Randomized Clinical Trial (JAMA) Tubular Secretion Brian: Late Breaking and High Impact Clinical Trials. Including Sibe! REGENCY Biopsy Data. Sophia: Flying Home. No, really it’s the Electrolyte Quiz Joel: The Poster Session, the Quiz Session, and Nayan: Flying to AHA to talk about dual-heart-kidney-transplant Anna: Kidney STARS! and Melanie Hoenig’s session on potassium | |||
| FF 84 ACHIEVE: Spironolactone flops in dialysis | 02 Nov 2025 | 01:29:05 | |
The Filtrate Joel Topf @kidneyboy.bsky.social Swapnil Hiremath@hswapnil.medsky.social AC @medpeedskidneys.bsky.social Special Guest Mike Walsh Associate Professor in the Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University as well as a Scientist at the Population Health Research Institute and a nephrologist at St. Joseph’s Healthcare Hamilton where he is the Chair of the Clinical Nephrology Research Group. Editing and Show Notes by Sophia Ambruso The Kidney Connection written and performed by Tim Yau Show Notes ALCHEMIST (NephJC Shorts, Rossignol et al Lancet 2025) AC is in her 83rd year of med-peds fellowship. Joel’s monologue brings us all down. Prophylactic ICD therapy doesn’t improve sudden cardiac death or all-cause mortality in HD patients in the ICD2 trial (Jukema JW et al. Circulation 2019) Initiation with statins do not impact MACE endpoints or atherosclerotic events (4D AURORA trial Fellstrom BC et al. NEJM 2009 & SHARP trial Baigent C et al. Lancet 2011) Mike tries to liven up the mood by mentioning positive outcomes with iron therapy in heart failure with the PIVOTAL trial (Macdougall IC et al. NEJM 2018) TOPHAT trial revealed treatment with spironolactone in HFpEF did not affect MACE outcomes. (Pitt B et al. NEJM 2014) NephTrials ‘Run-in periods in clinical trials: What can we ACHIEVE?’ SPIN D trial - spironolactone dose finding trial in ESRD (Charytan DM et al. Kidney Int 2018) Mike shares the human experience of the trial after being instructed to end the trial prematurely and being told they have “answered their question” Study in Japan - spironolactone predominantly benefits male over females (cannot find this) Male vs female benefit not observed in ACHIEVE despite Mike’s initial hypothesis Swap compares and contrasts ACHIEVE, ALCHEMIST & Meta-analysis (Pyne L et al. Lancet 2025) Mike discusses how nonadherence to spironolactone impacted the intention to treat outcomes in the trial. What is a high risk of bias for dummies? Mike, Swap & Joel ponder future nsMRA or ASI trials hemodialysis? Tubular secretions Swap is probably stalking Martha Wells by now, has moved on from Witch King, now onto Queen Demon on Good Reads AC is adding to her brood, 2 dogs (Snickers & Harper), 1 child Dungeon Crawler Call - a science fantasy book series by Matt Dinniman (on goodreads), which he lovingly referred to as complete nerd trash. Joel is binging on the series Task on HBO max, featuring Mark Ruffalo as FBI agent. NephJC is having its annual fundraiser (get your tickets here) at ASN. Providing a party shuttle that is leaving every 30 minutes from the conference center. As always, it will feature a live podcast recording covering the ASN late breaking, high impact clinical trials. Swap describes the high impact model at ASN this year - go big or go home. | |||
| FF 83 CONFIDENCE: Can We Start Flozins and Finerenone Simultaneously? | 21 Oct 2025 | 01:29:10 | |
The Filtrate Joel Topf @kidneyboy.bsky.social Swapnil Hiremath @hswapnil.medsky.social Nayan Arora captainchloride.bsky.social Sopia Ambruso @sophia-kidney.bsky.social Special Guests Brendon Neuen @brendonneuen.bsky.social Associate Professor and Program Lead, Renal and Metabolic at The George Institute for Global Health. Nephrologist and Director of Kidney Trials at Royal North Shore Hospital. Neuen has had three prior appearances on Freely Filtered: EMPA Kidney, DUPLEX and Sparsentan in FSGS, FLOW and Semaglutide Muthiah Vaduganathan @mvaduganathan on X. Cardiologist at Brigham and Women's Hospital and Harvard Medical School. Assistant Professor of Medicine. Editing by Joel Topf The Kidney Connection written and performed by Tim Yau Show Notes DONATE to NephJC! Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes NEJM | NephJC Summary FIDELIO Bakris et al, NEJM 2020 | NephJC Summary; subgroup throws doubt on efficacy of finerenone in patients on flozins FIGARO Pitt et al, NEJM 2021; subgroups clearly shows finerenone works, flozins or not NEJM editorial (wrongly) saying do not use Flozins unless on RASi Don’t use dual RAS blockade ONTARGET Yusuf et al, NEJM 2008; VA NEPHRON-D Fried et al NEJM 2013 Why we cannot study finerenone in HFrEF (RALES Pitt et al NEJM 1999) Muthu is jealous of GFR slope and albuminuria surrogate endpoints and wants to borrow them for HFpEF (Inker et al EHJ 2025) Combination therapy and CV outcomes in hypertension (Wang et al JAMA Card 2024 on low dose combinations and BP; Egan et al Blood Pressure 2022 review of topic) CONFIRMATION HF trial registry entry (Finerenone and Empagliflozin in hospitalized patients with HF) 23:20: Nayan and Swap miss a chance to say ‘de-flozination’ to discuss stopping a flozin which would allow a patient to be included in the trial Finerenone is a CYP3A4 substrate (Heinig et al Clin Pharmacokinetics 2023); Useful list of CYP3A4 inducers and inhibitors Everyone should get an ABPM (Bugeja et al CMAJ 2022) EASiKIDNEY study design Albuminuria mediates CKD benefits with Finerenone (Agarwal et al Ann Intern Med 2023) GFR slope and Albuminuria and the FDA (Taylor et al eClin Med 2025) Dapagliflozin and Eplerenone combination crossover trial (Provenzano et al JASN 2022) Joel gets promoted! (PBFluids reflection) Bluesky NephJC Chat discussion on ‘renal remission’ Withdrawal of Finerenone and worse outcomes from FINEARTS (Vaduganathan et al JACC 2025) Combination therapies Analysis from Brendan and Muthu (Neuen et al Circulation 2024) Do not use KFRE when GFR > 60 (KDIGO Practice Point 2.2.4: Note that risk prediction equations developed for use in people with CKD G3–G5, may not be valid for use in those with CKD G1–G2) Finerenone vs Spironolactone trial in Primary Aldosteronism (Hu et al Circulation 2025) FIND CKD trial design (Heerspink et al NDT 2025) FINE-ONE trial design (Heerspink et al Diab Res Practice 2023) Tubular Secretions Nayan keeping his chin up as Yankees lose and Mariners follow (MLB Playoffs) Sophia’s adventures with Beekeeping (Royal Jelly?) Brendon loves listening to ‘Susan’ by Raye Muthu is back into Taekwondo Swap is still reading Martha Wells (Witch King on GoodReads) Joel will be hiking the Laugavegur trail in Iceland | |||
| FF 82 DDAVP up the nose to prevent biopsy bleeding | 08 Aug 2025 | 00:59:49 | |
The Filtrate Joel Topf Bluesky: @kidneyboy.bsky.social AC @medpeedskidneys.bsky.social Nayan Arora @captainchloride.bsky.social Special Guest Vandana Niyyar Professor of Medicine at Emory School of Medicine Editing by Nayan Arora The Kidney Connection written and performed by by Tim Yau Show Notes American Society of Diagnostic and Interventional Nephrology (Website) ASDIN List of training sites Placement, performance and complications of the Ash Split Cath hemodialysis catheter (PubMed) Platelet Function Assay FAQ (PDF) Saint Clair’s Vascular Access Center where we do outpatient biopsies (Website) The studies: Thromboelastogram (TEG) (Life in the Fastline) Elastigirl (Wikipedia) Association of Kidney Biopsy Needle Gauge with Post-Procedure Complications and Biopsy Adequacy (PubMed) Complications of Percutaneous Renal Biopsy (PubMed) Tubular Secretions Nayan Quarterback on Netflix (Wikipedia) AC The Rehearsal on HBO (Wikipedia) Joel The Detroit Tigers (MLB) | |||
| FF 81 Metformin Termination as explored by Target Trial Emulation | 12 Jul 2025 | 01:19:43 | |
The Filtrate Joel Topf Bluesky: @kidneyboy.bsky.social Jordy Cohen Bluesky: @jordybc.bsky.social Swapnil Hiremath Bluesky: @hswapnil.medsky.social Special Guest Edouard “call me Ed” Fu Assistant Professor and Medical Student, and second author of his second paper covered on NephJC. LinkedIn | Leiden University Medical Center Editing by Simon Topf and Sophia Ambruso The Kidney Connection written and performed by by Tim Yau Show Notes Ed’s first paper on NephJC: Timing of dialysis initiation to reduce mortality and cardiovascular events in advanced chronic kidney disease: nationwide cohort study (NephJC | BMJ) Phenformin Wikipedia | Boca Raton News The metformin black box (as part of the FDA Label) WARNING: LACTIC ACIDOSIS Postmarketing cases of metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias. The onset of metforminassociated lactic acidosis is often subtle, accompanied only by nonspecific symptoms such as malaise, myalgias, respiratory distress, somnolence, and abdominal pain. Metforminassociated lactic acidosis was characterized by elevated blood lactate levels (>5 mmol/Liter), anion gap acidosis (without evidence of ketonuria or ketonemia), an increased lactate/pyruvate ratio; and metformin plasma levels generally >5 mcg/mL (see PRECAUTIONS). Risk factors for metformin-associated lactic acidosis include renal impairment, concomitant use of certain drugs (e.g. carbonic anhydrase inhibitors such as topiramate), age 65 years old or greater, having a radiological study with contrast, surgery and other procedures, hypoxic states (e.g., acute congestive heart failure), excessive alcohol intake, and hepatic impairment. Steps to reduce the risk of and manage metformin-associated lactic acidosis in these high risk groups are provided (see DOSAGE AND ADMINISTRATION, CONTRAINDICATIONS, and PRECAUTIONS). If metformin-associated lactic acidosis is suspected, immediately discontinue metformin and institute general supportive measures in a hospital setting. Prompt hemodialysis is recommended (see PRECAUTIONS). Target Trial Emulation A Framework for Causal Inference From Observational Data. Miguel A. Hernán, MD, DrPH; Wei Wang, PhD; David E. Leaf, MD JAMA 2022 Stopping Versus Continuing Metformin in Patients With Advanced CKD: A Nationwide Scottish Target Trial Emulation Study (NephJC | PubMed) Toxicokinetics of Metformin During Hemodialysis (KI Reports) Immortal Time Bias in Cohort Studies of Kidney Transplant Recipients (Kim SJ Amer J Trans 2010) Ed’s Target trial review in JASN which Jordy mentioned and includes an explanation of the obesity paradox by depletion of the susceptibles. (Fu JASN 2023) Ed’s Grand Rounds at Ottawa on YouTube. Very good. Response by Cohen et al to Letter Regarding Article, “Association of Inpatient Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Mortality Among Patients With Hypertension Hospitalized With COVID-19” by Jordy and the crew Circ Res 2000 Review article on the issue: Evaluating sources of bias in observational studies of angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker use during COVID-19: beyond confounding Jordy and a different crew J Hyperten 2021 Figure S5: Weighted cumulative incidence curves for MACE, by treatment strategy The S4 image that Swap loved Tubular Secretions Jordy Andor Season 2 on Disney+ (Wikipedia) Swapnil Murderbot on Apple TV+ (Wikipedia) Eduoard: New house and grant Grant Grant (Wikipedia) Joel Topf Three Body Problem Audio book (Audible) | |||
| FF 80 KDIGO ADPKD Guidelines | 13 May 2025 | 01:18:01 | |
The Filtrate Joel Topf AC Gomez Sophia Ambruso Nayan Arora Special Guest Charles Edelstein, MD, PhD Professor, Medicine-Renal Med Diseases/Hypertension Extra-Special Guest Michelle Rheault, MD Professor of Pediatrics, University of Minnesota Editing by Simon and Joel Topf The Kidney Connection written and performed by by Tim Yau Show Notes KDIGO ADPKD Guidelines: Guideline PDF NephJC coverage Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease (CRISP) Hy’s Law (Wikipedia) has three components: ALT or AST by 3-fold or greater above the upper limit of normal And total serum bilirubin of greater than 2× the upper limit of normal, without findings of cholestasis (defined as serum alkaline phosphatase activity less than 2× the upper limit of normal) And no other reason can be found to explain the combination of increased aminotransferase and serum total bilirubin, such as viral hepatitis, alcohol abuse, ischemia, preexisting liver disease, or another drug capable of causing the observed injury Meeting this definition yields a very high risk of fulminant kidney failure (76% in one series) Clinical Pattern of Tolvaptan-Associated Liver Injury in Subjects with Autosomal Dominant Polycystic Kidney Disease: Analysis of Clinical Trials Database (PubMed) Two of 957 patients on tolvaptan met Hy’s law criteria. None had fulminant kidney failure. Effects of Hydrochlorothiazide and Metformin on Aquaresis and Nephroprotection by a Vasopressin V2 Receptor Antagonist in ADPKD: A Randomized Crossover Trial (PubMed) Patients had a baseline urine volume on tolvaptan of 6.9 L/24 h. Urine volume decreased to 5.1 L/24 h with hydrochlorothiazide and to 5.4 L/24 h on metformin. TEMPO 3:4 Tolvaptan in Patients with Autosomal Dominant Polycystic Kidney Disease (NEJM) Reprise Trial Tolvaptan in Later-Stage Autosomal Dominant Polycystic Kidney Disease ( NEJM | NephJC ) Unified ultrasonographic diagnostic criteria for polycystic kidney disease by Edelstein in JASN (PubMed) Tolvaptan and Kidney Function Decline in Older Individuals With Autosomal Dominant Polycystic Kidney Disease: A Pooled Analysis of Randomized Clinical Trials and Observational Studies (PubMed) Charles’ draft choice Recommendation 4.1.1.1: We recommend initiating tolvaptan treatment in adults with ADPKD with an estimated glomerular filtration rate (eGFR) ‡25 ml/min per 1.73 m2 who are at risk for rapidly progressive disease (1B). Sophia’s draft choice Recommendation 1.4.2.1: We recommend employing the Mayo Imaging Classi cation (MIC) to predict future decline in kidney function and the timing of kidney failure (1B). Progression to kidney failure in ADPKD: the PROPKD score underestimates the risk assessed by the Mayo imaging classification (Frontiers of Science) AC’s draft choice Recommendation 9.2.1: We recommend targeting BP to ≤ 50th percentile for age, sex, and height or ≤ 110/70 mm Hg in adolescents in the setting of ADPKD and high BP (1D). HALT-PKD Blood Pressure in Early Autosomal Dominant Polycystic Kidney Disease (NEJM) Nayan’s draft choice Recommendation 6.1.2: We recommend screening for ICA in people with ADPKD and a personal history of SAH or a positive family history of ICA, SAH, or unexplained sudden death in those eligible for treatment and who have a reasonable life expectancy (1D). Screening for Intracranial Aneurysms in Patients with Autosomal Dominant Polycystic Kidney Disease (CJASN) Surgical Clipping Versus Endovascular Coiling in the Management of Intracranial Aneurysms (PubMed) Clipping is associated with a higher rate of occlusion of the aneurysm and lower rates of residual and recurrent aneurysms, whereas coiling is associated with lower morbidity and mortality and a better postoperative course. Joel’s editorial pick Recommendation 6.1.1: We recommend informing adults with ADPKD about the increased risk for intracranial aneurysms (ICAs) and subarachnoid hemorrhage (1C). Joel’s first draft pick The bring out your dead pick: Recommendation 4.3.1: We recommend not using mammalian target of rapamycin (mTOR) inhibitors to slow kidney disease progression in people with ADPKD (1C). Recommendation 4.4.1: We suggest not using statins specfiically to slow kidney disease progression in people with ADPKD (2D). Recommendation 4.5.1: We recommend not using metformin specifically to slow the rate of disease progression in people with ADPKD who do not have diabetes (1B). Recommendation 4.6.1: We suggest that somatostatin analogues should not be prescribed for the sole purpose of decreasing eGFR decline in people with ADPKD (2B). Perfect match: mTOR inhibitors and tuberous sclerosis complex (Orphanet Journal of Rare Diseases) Navitor Pharmaceuticals Announces Janssen Has Acquired Anakuria Therapeutics, Inc. (BioSpace) This is press release about acquiring the mTor1 inhibitor. Joel’s second draft pick Recommendation 4.2.1.1: We suggest adapting water intake, spread throughout the day, to achieve at least 2–3 liters of water intake per day in people with ADPKD and an eGFR ≥ 30 ml/min per 1.73 m2 without contraindications to excreting a solute load (2D). Nayan’s bonus draft Practice Point 4.7.1: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) should not be used to slow eGFR decline in people with ADPKD. Open-Label, Randomized, Controlled, Crossover Trial on the Effect of Dapagliflozin in Patients With ADPKD Receiving Tolvaptan (KIReports) SMART Trial of GLP-1ra in non-diabetics: Semaglutide in patients with overweight or obesity and chronic kidney disease without diabetes: a randomized double-blind placebo-controlled clinical trial (PubMed) Tubular Secretions Nayan: Landman on Paramount Plus (IMDB) Sophia: Pass Nayan: steps in with The Pitt on HBO (Wikipedia) Charles: The White Lotus, Yellowstone 1923, Poirot (IMDB) AC: The Pitt Michael Crichton’s Estate Sends The Pitt to the Courtroom (Vulture) Joel: I Must Betray you by Ruta Sepetys (Amazon) | |||
| FF 79 REGENCY, Efficacy and Safety of Obinutuzumab in Active Lupus Nephritis | 22 Apr 2025 | 01:42:51 | |
The Filtered Fragments (OG Filtrate) Joel Topf Jennie Lin Swapnil Hiremath Special Guest Brad Rovin GN God and second author from The Ohio State Koyal Jain GN Specialist from UNC Alfred Kim Rheumatologist from Washington University Editing by Simon Topf and Nayan Arora The Kidney Connection written and performed by by Tim Yau Show Notes Joel’s monologue One of the most surprising facts of nephrology is that despite conventional wisdom that lupus nephritis is an antibody mediated disease, that over a decade ago, the LUNAR investigtors were unable to find a significant benefit when rituximab was added to conventional therapy. And this was after the equally negative phase 2 trial of rituximab, EXPLORER. In fact, despite this finding rituximab has been able to burough its way into treatment of many nephrologists and rheumatologists as well as the KDIGO guidelines where it is suggested for patients with persistent disease activity or inadequate response to initial standard-of-care therapy. This long conflict is now coming to an end. Obinutuzumab, a newer, better monoclonal antibody targeting the same CD20 that we grew to love with rituximab, but it has a number of advantages. One. It is humanized antibody rather than a chimeric mouse-human antibody Two. It’s cytotoxicity is not complement dependent an particular advantage if you want to deploy it ina disease where hypocomplementemia is a disease characteristic Three, and most importantly, it causes stronger and deeper b-cell depletion than rituximab. Better B-cell depletion in the blood and tissue. And this brings us to tonight’s topic, we had already seen the phase two results of obinutuzumab which, unlike EXPLORER, were positive, we will look at the phase three regency trial. This makes the third novel lupus nephritis drug in the last 4 years. We continue to remake glomerular nephritis. LUNAR: Efficacy and safety of rituximab in patients with active proliferative lupus nephritis: the Lupus Nephritis Assessment with Rituximab study Pubmed EXPLORER: Efficacy and safety of rituximab in moderately-to-severely active systemic lupus erythematosus: the randomized, double-blind, phase II/III systemic lupus erythematosus evaluation of rituximab trial Pubmed REGENCY: Efficacy and Safety of Obinutuzumab in Active Lupus Nephritis NEJM | NephJC NOBILITY: B-cell depletion with obinutuzumab for the treatment of proliferative lupus nephritis: a randomised, double-blind, placebo-controlled trial Annals of Rheumatic Disease Comparison of intravenous and subcutaneous exposure supporting dose selection of subcutaneous belimumab systemic lupus erythematosus Phase 3 program PubMed Central Class 5 lupus nephritis is slow to respond Long-term Use of Voclosporin in Patients with Class V Lupus Nephritis: Results from the AURORA 2 Continuation Study ACR Meeting abstract Tubular Secretions Swap: Young Adult novel I Must Betray You by Ruta Sepetys (Amazon) Koyal: Taekwondo (Wikipedia) Jennie: these unprecedented times Trump NYT: Administration Freezes $1 Billion for Cornell and $790 Million for Northwestern, Officials Say Al: Acquired Podcast Brad: The Feather Thief by Kirk Wallace Johnson (Amazon) Joel: Paradise on Hulu (Wikipedia) | |||
| FF 78 NephMadness, the dialysis region | 13 Mar 2025 | 01:08:59 | |
The Filtrate Joel Topf Jordy Cohen Nayan Arora Special Guest Katie Kwon @katiekwonmd.bsky.social Mariana Murea @MarianaMurea Editing by Simon Topf and Joel Topf Show Notes NephMadness at AJKDblog.org | |||
| FF 77 Top Nephrology Stories | 26 Feb 2025 | 01:12:25 | |
The Filtrate Joel Topf Swapnil Hiremath AC Gomez Sopia Ambruso Nayan Arora Special Guests Michelle Rheault, Director, Division of Pediatric Nephrology, Professor of Medicine Tiffany Caza, Nephropathologist, Scientist and self-described Freely Filtered fan girl Editing by Simon Topf and Sophia Ambruso Show Notes 10. Healthcare Cyberattacks 9. ApoE in C3 glomerulonephropathy 8. Workforce woes in Adult and Pediatric Nephrology 7. Hyponatremia correction meta-analysis 6. Microvascular inflammation increases risk of graft loss - in all of its forms 5. Xenotransplantation 4. KDIGO CKD Guidelines 3. Hypertension control trials (ESPRIT, BPROAD) 2. The Renaissance of IgAN: IgAN treatment trials 1. FLOW: GLP-1 RAs in CKD | |||
| FF 76 FINE ARTS | 15 Dec 2024 | 01:30:38 | |
The Filtrate Joel Topf Swapnil Hiremath AC Gomez Jordy Cohen Nayan Arora Special Guest Brendon Nuen Editing by Simon Topf and Nayan Arora Show Notes FINEARTS-HF in NEJM FINEARTS Kidney outcomes in JACC FINE-HEART pooled analysis of cardiovascular, kidney and mortality outcomes in Nature Medicine discussion in NephJC BARACH-D: Low-dose spironolactone and cardiovascular outcomes in moderate stage chronic kidney disease: a randomized controlled trial (Nature Medicine) Live Freely Filtered at KidneyWk Swapnil comes out as a SpiroStan post to NephJC TOPCAT TOPCAT primary publication TOPCAT North American results TOPCAT funny business explained AHA/ACC/HFSA Heart Failure Guidelines (PDF) SGLT2i are 2a MRA are a 2b ARBs are a 2b ARNI are a 2b Kansas city cardiomyopathy questionnaire in patients with CKD without a diagnosis of heart failure: https://pubmed.ncbi.nlm.nih.gov/21187260/
Why Has it Been Challenging to Modify Kidney Disease Progression in Patients With Heart Failure? (JACC) Tubular Secretions Swap: Disclaimer on Apple TV AC: Duo Lingo Plushy (Amazon) Nayan: The Puzzle Box Jordy: Project Hail Mary Brendon has a podcast, The Kidney Compass with Shikha Wadhwani. And he recommends singer-songwriter, Maggie Rogers (YouTube) Joel: The Singularity Is Nearer: When We Merge with AI by Ray Kurzweil Closing music, Tim Yau with The Kidney Connection | |||
| Episode 70b Do Over: Predicting Preeclampsia, the PRAECIS trial | 16 Nov 2024 | 00:34:50 | |
The Filtrate: Joel Topf Swapnil Hiremath With Special Guest: Michelle Hladunewich, Nephrologist at the University of Toronto Mir Melamed, Maternal-Fetal Medicine at the University of Toronto Editor Simon Topf Show Notes Priscilla Smith’s letter: Dear Joel and the Freely Filtered team, I am a long-time fan of your podcast and was looking forward to hearing your recently aired discussion of the Praecis study of sflt1:PlGF use in preeclampsia. Preeclampsia and renal disease in pregnancy are areas that many nephrologists report a lack of knowledge or confidence in discussing and managing. I am a nephrologist who has been co-leading a renal pregnancy clinic in London while writing a PhD on progression of renal disease in pregnancy. I have had the immense privilege of working with experts and key opinion leaders in preeclampsia research both in the UK and internationally. As you know, preeclampsia is a serious and significant condition contributing to global maternal mortality and is also associated with future CKD and CVD risk so is both relevant and important within our professional group. Sadly, I found myself disappointed by the episode and felt it was a missed opportunity. I appreciate that you had difficulties obtaining appropriate experts to join the discussion, but perhaps it would have been better to delay production. While you all valiantly proceeded to discuss this important study, the topic is complex and there appeared to be a lack of understanding of the surrounding literature and pathogenesis of preeclampsia. Sadly, the maternal medicine expert’s comments at the end of the podcast added little as she seemed determine to negate any benefit from the results despite declaring she had no experience or expertise in the use of these biomarkers. There are many people who understand the clinical aspects of preeclampsia as well as having direct experience of the use and utility of these biomarkers who would have been able to contribute much to your conversation. I look forward to future discussions of renal disease in pregnancy on your podcast and would be happy to suggest some expert panellists if you ever find yourself stuck. Kind regards, Priscilla Excess placental soluble fms-like tyrosine kinase 1 (sFlt1) may contribute to endothelial dysfunction, hypertension, and proteinuria in preeclampsia (JCI 2003) sFlt background: Pathogenesis of Preeclampsia and Therapeutic Approaches Targeting the Placenta (PubMed) PlGF background: Perspectives on the Use of Placental Growth Factor (PlGF) in the Prediction and Diagnosis of Pre-Eclampsia: Recent Insights and Future Steps (PubMed) The PRAECIS trial (NephJC | NEJM Evidence) | |||
| FF 75 NephJC Night at Kidney Week | 04 Nov 2024 | 02:17:47 | |
We had a great NephJC get together. We recorded the whole event and packaged it into a podcast. Musical entertainment Too Sweet by Hozier Fairy Tale of New York by written Jem Finer and Shane MacGowan. Hear it performed by the Pogues. Interview of Tom Mueller Tom Mueller author of How to Make a Killing Interview of Tom Mueller Tom Mueller author of How to Make a Killing NephMadness logo reveal NephJC Kidneys NephJC Manuscript of the Year: Flow accepted by Meg Jardine Manjula Kurella Tamura, winner of the 2015 NephMadness, oh and author of NEJM manuscripts and subject of a NYT article. NephJC Visual Abstract of the Year: Corina Teodusiu, creator of the Flozinator logo NephJC Social Justice Award: ISN petition to the WHO on Kidney Health Most Engaged Scientist Award: Michelle Rheault Rookie of the Year: Milagros Flores MVP: Christina Popa NephJC Founders Award: Joshua Waitzman Nathan Hellman Social Media Project of the Year: Edgar Lerma and the ASN Visual Abstract Team More Music with Tim Saginaw, Michigan as performed by Johny Cash Betty, written by Taylor Swift The Kidney Connection Freely Filtered Kidney Week Draft Previous drafts List of all the simultaneous publications from Kidney Week 2024 Sophia: SMART Trial (Link goes to the new KidneyCompass podcast that interview lead author Hiddo Heerspink Jordy’s editorial in the European Heart Journal. Link Josh: APPLAUSE Alternative Complement Pathway Inhibition with Iptacopan in IgA Nephropathy in the NEJM APPLAUSE results announcement at The World Congress of Neophrology in Buenos Aries Iptapocan is a factor B inhibition Jordy: POISE-3 with simultaneous publication in KI Mentions she wanted to pick KAT-AKI because she worked with Perry Wilson. Per Nayan, Amit Garg is the Beyonce of Nephrology Accord Trial (NEJM) Joel: HSK21541 for Pruritus Correction link to source (graph) Nayan: FINEARTS-HF with simultaneous publication in JACC BARACH-D: Low-dose spironolactone and cardiovascular outcomes in moderate stage chronic kidney disease: a randomized controlled trial (Nature Medicine) Swapnil comes out as a SpiroStan TOPCAT funny business PATHWAY-2 Trial (NephJC coverage) Swap: K Bath and cardiac arrhythmia with simultaneous publication in Kidney International CAST: A study that rocked the cardiology world and became the poster child for evidence-based medicine (Link) Tubular Secretions Swap: Late breaking and high impact sessions Nayan: Intro to… Joel: Student poster on blood pressure technique Jordy: The Penguin. A couple of mentee posters Sophie: Tracks her sessions on paper. Josh: Quiz and Questionaire session with JC Velez, Bea Concepcione, Anna Burgner, Roger Rodby. | |||
| Episode 74: Amino Acids for AKI | 18 Oct 2024 | 01:32:54 | |
The Filtrate: Jennie Lin Joel Topf Josh Waitzman Swapnil Hiremath With Special Guests Pedro Teixeira Jay Koyner Editor Sophia Ambruso Show Notes The article: A Randomized Trial of Intravenous Amino Acids for Kidney Protection KDIGO Clinical Practice Guideline for Acute Kidney Injury (PDF) Steve Coca study Evaluation of Short-Term Changes in Serum Creatinine Level as a Meaningful End Point in Randomized Clinical Trials (PubMed) Using Nephrocheck to prevent AKI: Prevention of cardiac surgery-associated AKI by implementing the KDIGO guidelines in high risk patients identified by biomarkers: the PrevAKI randomized controlled trial (PubMed) Brenner’s Review of protein intake and renal hemodynamics: Dietary Protein Intake and the Progressive Nature of Kidney Disease: — The Role of Hemodynamically Mediated Glomerular Injury in the Pathogenesis of Progressive Glomerular Sclerosis in Aging, Renal Ablation, and Intrinsic Renal Disease (NEJM) Husain-Syed a look at preoperative renal functional reserve and risk of AKI: Preoperative Renal Functional Reserve Predicts Risk of Acute Kidney Injury After Cardiac Operation (PubMed) Dana Fuhrman review of renal functional reserve: The Role of Renal Functional Reserve in Predicting Acute Kidney Injury (PubMed) Use of SGLT2i prevented AKI in the placebo controlled trials. Clinical Adverse Events Associated with Sodium-Glucose Cotransporter 2 Inhibitors: A Meta-Analysis Involving 10 Randomized Clinical Trials and 71 553 Individuals (PubMed) Assessment of P values for demographic data in randomized controlled trials (PubMed) Tubular Secretions Swapnil The Lord of the Rings: Rings of Power Season 2 on Amazon Prime (Wikipedia) Josh Fortnite (Website) Pedro CRRT Academy at University of Alabama Birmingham (Website) Jay Koyner Slow Horses on AppleTV (Wikipedia) Jennie Linn #KidneyWk Run Club Friday 10/25 at 6:15 am PST Meet in front of Sally’s Fish House ~2 miles. Easy pace (10-12 min/mile) (Strava) Joel Topf Your Honor on Netflix (Wikipedia) | |||
| Episode 73: The KDIGO CKD 2024 Guideline Draft | 01 Aug 2024 | 01:32:16 | |
The draft order: Sophia Ambruso Nayan Arora Swapnil Hiremath AC Gomez Joel Topf Editor Nayan Arora Show Notes Previous drafts: 2021 KDIGO Hypertension —Joel, Sophia, Swap, Nayan, Josh 2021 ASN Kidney Week Draft—Joel, Sophia, Swap, Nayan, Jennie 2022 The ISPD Peritonitis Guideline— Joel, Sophia, Swap, Nayan 2022 ASN Kidney Week Draft—Joel, Sophia, Swap, Nayan 2023 ASN Kidney Week Draft—Joel, Sophia, Swap, Nayan, AC, Josh 2024 KDIGO CKD Clinical Practice Guideline —Joel, Sophia, Swap, Nayan, Josh, AC The NephJC discussion Part 1 | Part 2 First Round Sophia’s Pick 3.7.1 We recommend treating patients with type 2 diabetes (T2D), CKD, and an eGFR ≥20 ml/min per 1.73 m2 with an SGLT2i (1A).
Nayan’s Pick 2.2.1: In people with CKD G3–G5, we recommend using an externally validated risk equation to estimate the absolute risk of kidney failure (1A).
Practice Point 2.2.1: A 5-year kidney failure risk of 3%–5% can be used to determine need for nephrology referral in addition to criteria based on eGFR or urine ACR, and other clinical considerations. Practice Point 2.2.2: A 2-year kidney failure risk of >10% can be used to determine the timing of multidisciplinary care in addition to eGFR-based criteria and other clinical considerations. Practice Point 2.2.3: A 2-year kidney failure risk threshold of >40% can be used to determine the modality education, timing of preparation for kidney replacement therapy (KRT) including vascular access planning or referral for transplantation, in addition to eGFR-based criteria and other clinical considerations. Swap’s Pick 3.15.1.1: In adults aged ‡50 years with eGFR <60 ml/min per 1.73 m2 but not treated with chronic dialysis or kidney transplantation (GFR categories G3a–G5), we recommend treatment with a statin or statin/ezetimibe combination (1A). AC’s Pick 3.7.2: We recommend treating adults with CKD with an SGLT2i for the following (1A): eGFR ≥20 ml/min per 1.73 m2 with urine ACR ≥200 mg/g (≥20 mg/mmol), or heart failure, irrespective of level of albuminuria. (1A) Joel’s Pick 3.10.1: In people with CKD, consider use of pharmacological treatment with or without dietary intervention to prevent development of acidosis with potential clinical implications (e.g., serum bicarbonate <18 mmol/l in adults). Practice Point 3.10.2: Monitor treatment for metabolic acidosis to ensure it does not result in serum bicarbonate concentrations exceeding the upper limit of normal and does not adversely affect BP control, serum potassium, or fluid status. Second Round Joel’s Pick 3.3.1.1: We suggest maintaining a protein intake of 0.8 g/kg body weight/d in adults with CKD G3–G5 (2C). 3.3.1.1: Avoid high protein intake (>1.3 g/kg body weight/d) in adults with CKD at risk of progression. 3.3.1.2: In adults with CKD who are willing and able, and who are at risk of kidney failure, consider prescribing, under close supervision, a very low–protein diet (0.3–0.4 g/kg body weight/d) supplemented with essential amino acids or ketoacid analogs (up to 0.6 g/kg body weight/d). 3.3.1.3: Do not prescribe low- or very low–protein diets in metabolically unstable people with CKD. AC’s Pick 3.9.1: In adults with T2D and CKD who have not achieved individualized glycemic targets despite use of metformin and SGLT2 inhibitor treatment, or who are unable to use those medications, we recommend a long-acting GLP-1 RA (1B). Swapnil’s Pick Practice Point 5.4.1: Initiate dialysis based on a composite assessment of a person’s symptoms, signs, QoL, preferences, level of GFR, and laboratory abnormalities. IDEAL Trial: A Randomized, Controlled Trial of Early versus Late Initiation of Dialysis NEJM Timing of dialysis initiation to reduce mortality and cardiovascular events in advanced chronic kidney disease: nationwide cohort study NephJC Nayan’s Pick Practice Point 1.1.4.2: Use tests to establish a cause based on resources available (Table 6b). Sophia’s Pick Practice Point 1.1.1.2: Following incidental detection of elevated urinary albumin-to-creatinine ratio (ACR), hematuria, or low estimated GFR (eGFR), repeat tests to confirm presence of CKD. Joel’s cystatin C Tweet The cystatin C guideline recommendation 1.1.2.1: In adults at risk for CKD, we recommend using creatinine-based estimated glomerular filtration rate (eGFRcr). If cystatin C is available, the GFR category should be estimated from the combination of creatinine and cystatin C (creatinine and cystatin C– based estimated glomerular filtration rate [eGFRcr-cys]) (1B). Nayan’s additional thoughts. He is not a fan of Practice Points 3.6.4 and 3.6.5 Practice Point 3.6.4 Continue ACEi or ARB therapy unless serum creatinine rises by more than 30% within 4 weeks following initiation of treatment or an increase in dose. and Practice Point 3.6.5: Consider reducing the dose or discontinuing ACEi or ARB in the setting of either symptomatic hypotension or uncontrolled hyperkalemia despite medical treatment, or to reduce uremic symptoms while treating kidney failure (estimated glomerular filtration rate [eGFR] <15 ml/min per 1.73 m2). Tubular Secretion Swap The Murderbot Diaries by Martha Wells Nayan Searching for Hobey Baker Narrated by David Duchovny Sophia Bassnectar How to fix the Apple Music automatically playing when you connect to bluetooth. Joel The Veil with Elizabeth Moss | |||
| Episode 72: Nefecon for IgAN, The NefIgArd part B trial | 15 Jun 2024 | 01:32:16 | |
The Filtrate: Joel Topf Josh Waitzman With Special Guest: Brad Rovin (@BradRovin) Chief of nephrology at The Ohio State University Wexner Medical Center, one of the authors of the Nefigard trial. Koyal Jain (@koyaljainMD) Program director of the GN Fellowship at University of North Carolina Roger Rodby (@NephRodby) Associate program director of the Rush University Nephrology Fellowship Editor Sophia Ambruso Show Notes The manuscript (The Lancet | PubMed | NephJC) The Results of Part A (Kidney Int | PubMed) Edmund (Ed) Louis memorium by Steve Korbet in KI Steve Korbet Do not miss this tweet TESTING Freely Filtered #48 with Sean Barbour Iptapocan at the World Congress of Nephrology: WCN24-1506 Efficacy And Safety Of Iptacopan In Patients With IgA Nephropathy: Interim Results From The Phase 3 APPLAUSE-IgAN Study FDA and mandatory post-marketing studies. What happens when the study is negative (or not completed) (UNDARK) Who should treat lupus nephritis: rheumatologists or nephrologists? (Nature Reviews Nephrology) Protein and albumin-to-creatinine ratios in random urines accurately predict 24 h protein and albumin loss in patients with kidney disease (PubMed) MEST Scores in NephJC Risk scores in IgAN in NephJC Repeat renal biopsy improves the Oxford classification-based prediction of immunoglobulin A nephropathy outcome (NDT) Tarpeyo pills 4 mg. Four pills once a day. (WellRx has a picture of the pills) IgA nephropathy in African Americans: uncommon but possible (PubMed Central) Aberrantly Glycosylated IgA1 in IgA Nephropathy: What We Know and What We Don’t Know (PubMed Central) Effectiveness of Mycophenolate Mofetil Among Patients With Progressive IgA Nephropathy (JAMA Network Open) Tubular Secretions Joel: Constellation on Apple TV (Wikipedia). Not good. Dune audio books are excellent. (Audible) Josh: Podcasts about donating a kidney One Is Enough Podcast (National Kidney Registry) Donor Diaries (National Kidney Donation Organization) Roger Iceland (Wikipedia) Koyal India (Wikipedia) Brad Fishing in Dubai | |||
| Episode 71: The Spice must FLOW! | 01 Jun 2024 | 01:23:59 | |
The Filtrate: Joel Topf Swapnil Hiremath Josh Waitzman Nayan Arora Sophia Ambruso With Special Guest: Brendon Neuen Super smart guy and clinical trialist Vlado Perkovic Lead author of FLOW and friend of NephJC Editor Joel Topf Show Notes The manuscript (NEJM): Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes The acronym FLOW from the title: evaluate renal Function with semagLutide Once Weekly (Twitter) Joel wrote a blog post prior to the FLOW publication to try to set the table: Peeking Inside Schrödinger’s Box Brendon’s Neuen’s tweet about total versus chronic slope (X | Twitter) Modification of Association of Cystatin C With Kidney and Cardiovascular Outcomes by Obesity (Science Direct) Semaglutide and Diabetic Retinopathy Risk in Patients with Type 2 Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials (PubMed) The Efficacy and Safety of the Combination Therapy With GLP-1 Receptor Agonists and SGLT-2 Inhibitors in Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis (Frontiers in Pharmacology) Statistical considerations for testing multiple endpoints in group sequential or adaptive clinical trials (PubMed) Proteinuria Thresholds Are Irrational: A Call for Proteinuria Indexing (Nephron Clinical Practice) Frank Harrel on why the NNT sucks (data methods) Regulation of Na+/H+ exchanger NHE3 by glucagon-like peptide 1 receptor agonist exendin-4 in renal proximal tubule cells (PubMed) Switching Between Glucagon-Like Peptide-1 Receptor Agonists: Rationale and Practical Guidance (PubMed) Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial (PubMed) Doctors are like the pyromaniac fireman (PBFluids) Suggest topics for NephMadness (Twitter) Design of the COmbinatioN effect of FInerenone anD EmpaglifloziN in participants with chronic kidney disease and type 2 diabetes using a UACR Endpoint study (CONFIDENCE) (PubMed) Albuminuria-Lowering Effect of Dapagliflozin, Eplerenone, and Their Combination in Patients with Chronic Kidney Disease: A Randomized Crossover Clinical Trial (PubMed) Spitzer’s involvement in revolutionizing nephrology is part of this lecture I did at the University of Nebraska Diabetes Symposium. (Dropbox: Start on slide 29) Spitzer Resigns, Citing Personal Failings (New York Times) Tubular Secretions Swap: Dumb Money on NetFlix (Wikipedia) Josh: Hiking Zion National Park (National Park Service) Sophia: Lost in Space 2018 TV series on NetFlix (Wikipedia) Nayan: Pelican Hill resort (Website) Joel: Bodkin NephJC Summer Book Club: Covenant of Water by Abraham Verghese (Amazon) | |||
| Episode 70: Predicting Preeclampsia, the PRAECIS trial | 26 May 2024 | 01:16:20 | |
The Filtrate: Joel Topf Swapnil Hiremath AC Gomez Nayan Arora With Special Guest: Anuja Java, complement god and pre-eclampsia research (Twitter) Shannon M. Clark, MD, FACOG, an honest to god, true, maternal-fetal medicine specialist. (Website | Instagram) Editor Nayan Arora Show Notes CHIP Study from 2015 (NEJM | NephMadness 2015) CHAP study from 2022 (NEJM | NephJC) NephMadness 2024 coverage of the diagnosis of preeclampsia sFlt background: Pathogenesis of Preeclampsia and Therapeutic Approaches Targeting the Placenta (PubMed) PlGF background: Perspectives on the Use of Placental Growth Factor (PlGF) in the Prediction and Diagnosis of Pre-Eclampsia: Recent Insights and Future Steps (PubMed) The PRAECIS trial (NephJC | NEJM Evidence) You may just want to listen to Anna Burgner discuss preeclampsia with Kenar Jhaveri and Koyal Jain (GN in Ten) for the NephMadness PodCrawl Bene Gesserit (Wikipedia) Pathogenesis of preeclampsia: the genetic component (PubMed) Tubular Secretions Swap Slow Horses on Apple TV (Wikipedia) AC Hidden Figures (Amazon) Nayan Baseball, little league Anuja Young Sheldon (Wikipedia) Joel Dune audiobook (Amazon) | |||
| Episode 69:DUPLEX Sparsentan, it’s no Acthar Gel | 22 Apr 2024 | 01:41:55 | |
The Filtrate: Joel Topf Swapnil Hiremath Priya Yenebere Nayan Arora With Special Guest: Brendon Neuen Super smart guy and clinical trialist Michelle Rheault Lead author of DUPLEX and friend of the pod Show Notes Sparsentan versus Irbesartan in Focal Segmental Glomerulosclerosis NephJC Summary | PubMed | NEJM KDIGO FSGS Guidelines 2021 (PDF) Characterization of the Clinical Evidence Supporting Repository Corticotropin Injection for FDA-Approved Indications, A Scoping Review (JAMA Internal Medicine) DUET: A Phase 2 Study Evaluating the Efficacy and Safety of Sparsentan in Patients with FSGS (PubMed) Vlado Perkovic, mentor and sponsor extradenoire (UNSW Sydney) Shimer Its a floor wax and a desert topping (TikTok) SONAR: Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease: a double-blind, randomised, placebo-controlled trial. (NephJC) Travere Therapeutics Announces FDA Accelerated Approval of FILSPARIᵀᴹ (sparsentan), the First and Only Non-immunosuppressive Therapy for the Reduction of Proteinuria in IgA Nephropathy (Travere press release) GFR Slope: Chronic vs Total slope: A meta-analysis of GFR slope as a surrogate endpoint for kidney failure (Nature Medicine) There are dozens of us! Dozens! (Know your Meme) Brendon’s Neuen’s tweet about total versus chronic slope (X | Twitter) Julie R. Ingelfinger, deputy editor for the New England Journal of Medicine (Wikipedia) You know nothing, John Snow (YouTube shorts) Tubular Secretions Swapnil Foundation season two on Apple TV Wheel of Time season two Amazon Prime Brendon Andor Priya Poverty, by America Mattew Desmond Nayan The Armor of Light: A Novel by Ken Follett Michelle Lessons in Chemistry: A Novel by Bonnie Garmus | |||
| Freely Filtered 68: Inpatient hypertension | 16 Mar 2024 | 01:28:08 | |
The Filtrate: Joel Topf Swapnil Hiremath Jordy Cohen AC Gomez With Special Guest: Tim Anderson @TimAndersonMD Editor: Priya Yenebere Show Notes Clinical Outcomes of Intensive Inpatient Blood Pressure Management in Hospitalized Older Adults NephJC Summary | PubMed | JAMA Internal Medicine The Jordy AC collab: An Interactive Ambulatory Nephrology Curriculum for Internal Medicine Interns: Design, Implementation, and Participant Feedback (PubMed) Clinical Outcomes After Intensifying Antihypertensive Medication Regimens Among Older Adults at Hospital Discharge (PubMed) Trends in Blood Pressure Treatment Intensification in Older Adults With Hypertension in the United States, 2008 to 2018 (PubMed) Overlap Weighting: A Propensity Score Method That Mimics Attributes of a Randomized Clinical Trial (JAMA Guide to Statistics and Methods) Tubular secretions Swap The Dispatcher by John Scalzi (Wikipedia) AC A Heart that Works by Rob Delaney (NYT Review) Tim Demon Copperhead by Barbara Kingsolver (Amazon) Jordy The Anthropocene Reviewed: Essays on a Human-Centered Planet (Amazon) Joel The Dolomites for hiking n Northern Italy | |||
| Freely Filtered 67: NephMadness and Animal House | 07 Mar 2024 | 00:47:44 | |
Animal House Region NephMadness description by Tiffany Truong Editorial by Kelly Hyndman @DrKeeksPhD They May Look Cute, But Are All Animals Sweet? The Filtrate: Joel Topf Swapnil Hiremath Sophia Ambruso Josh Waitzman With Special Guest: Kelly Hyndman Editor: Sophia Ambruso Show Notes Animal House 2018 with Mark Zeidel, MD (AJKDblog) Animal House 2021 with Kelly Hyndman (AJKDBlog) Animal House 2022 with Kelly Hyndman (AJKDBlog) Mount Desert Island Summer Junket (Website) First person account go a Gila Monster bite (YouTube) Looks like Gila Hank, the gun toting mascot of Eastern Arizona College has been replaced by a non-gun toting Gila monster cowboy. Old logo (Reddit) | New logo (Gila Valley Central Newspaper) Discovery, characterization, and clinical development of the glucagon-like peptides (Drucker JCI 2017) The rationale, design and baseline data of FLOW, a kidney outcomes trial with once-weekly semaglutide in people with type 2 diabetes and chronic kidney disease (Rossing NDT 2023) Semaglutide 1.0 mg demonstrates 24% reduction in the risk of kidney disease-related events in people with type 2 diabetes and chronic kidney disease in the FLOW trial (Novo Nordisk) King Gizzard & The Lizard Wizard - Gila Monster (YouTube) Tubular Secretions Swap: Three Body Problem (Wikipedia) Josh: Animal Crossing (Nintendo) Sophie: Pyelonephritis in inflammatory bowel disease. Is this a thing? Joel: Maggie Moore(s) (Wikipedia) | |||
| Freely Filtered 66: NephJC Summer Book Club | 28 Feb 2024 | 01:15:09 | |
How Medicine Works, and When It Doesn’t The Filtrate: With Special Guest: Editor: Joel Topf Show Notes Understanding Medical Research: Your Facebook Friend is Wrong. Coursera Illusory truth effect (Wikipedia) Number needed to treat (Wikipedia) NNT at MedPage Today: NNT on NephJC Deaths of Despair: Suicide (CDC 2001-2021) Drug Overdose (CDC 2001-2021) Steve Jobs delayed therapy for his treatable pancreatic cancer (ABC News) Residents are unionizing at Mass General Brigham. Here's what you need to know (WBUR) Pi and bouncing bricks (YouTube) Doctors in New Zealand—the only non-U.S. country that allows DTC advertising—call for bans (FiercePharma) The Surgisphere Scandal: What Went Wrong? (The Scientist) VITAL SIGNS: FERTILITY; A Study Links Prayer and Pregnancy (The New York Times) Researcher Pulls His Name From Paper on Prayer and Fertility (The New York Times) Tubular Secretions Josh: Glomerular Nephritis by Thomas Addis (Review in JAMA from 1948) Jennie: The Chicago Marathon Jade: The People’s Hospital (Amazon) Perry: Anathem by Neal Stephenson (Amazon) | |||
| Freely Filtered 065: BEST Fluids | 10 Feb 2024 | 01:10:36 | |
The Filtrate: Joel Topf Nayan Aurora Sophia Ambruso With Special Guest: Michael Collins Editor: Nayan Aurora Show Notes: Twitter is now X (NYT) Michael Collins (the astronaut, not the real one) PlasmaLyte by Baxter NephJC BEST Fluids summary Early Goal Directed Therapy for Sepsis NEJM manuscript which changed practice patterns and welcomed in an era of massive fluid resuscitation. PLUS Trial NEJM SPLIT Trial JAMA BaSICS NephJC Summary SALTED and SMART NephJC Summary Adaptive minimization wikipedia BEST Fluids in CLinicalTrials.gov Delayed Graft Function review in American Journal of Transplant Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis in NEJM Evidence A pragmatic, open-label, randomized controlled trial of Plasma-Lyte-148 versus standard intravenous fluids in children receiving kidney transplants (PLUTO) in Kidney International Tubular Secretion Nayan finally getting around to Succession on HBO Sophia autoimmune protocol diet Michael Stephen Fry reading Harry Potter | |||
| Freely Filtered 064: Freely Filtered with The Curbsiders Live at Kidney Week! | 12 Nov 2023 | 01:32:08 | |
The Filtrate: Joel Topf Swapnil Hiremath Sophia Ambruso AC Gomez Josh Waitzman Jennie Lin Nayan Arora The Curbsiders Matt F. Watto (@DoctorWatto) Paul Nelson Williams, America’s primary care physician (@PaulNWilliamz) With Special Guest: JD Foster (@KidneyVet) Sayed Tabatabai (@TheRealDoctorT) Nephrologist in Austin and the author of These Vital Signs Michelle Rheault (@rheault_m) Chief of Pediatric Nephrology at the University of Minnesota and lead author of the DUPLEX Trial Editor: Joel Topf Show Notes: Lily toxicity in the cat (PubMed) Surgeons perform kidney transplants in cats amid rising demand for advanced pet care (ABC News) Treatment of ibuprofen toxicity with serial charcoal hemoperfusion and hemodialysis in a dog (PubMed) Nephrology in Veterinary Medicine (Kidney 360) Star Wars Society of San Antonio (FaceBook) These Vital Signs (Amazon) Dr Tabatabai read a short story called The Handholder, here is the original tweet thread for that story (ThreadReader) The pearl not the patient (PubMed) Late Braking and High Impact Clinical Trial press release MENTOR, Rituximab or Cyclosporine in the Treatment of Membranous Nephropathy, was in 2019 not 2017 (NEJM) KALM-1, A Phase 3 Trial of Difelikefalin in Hemodialysis Patients with Pruritus, was in 2019 not 2017 (NEJM) Sophie’s number one pick: Efficacy and safety of sparsentan versus irbesartan in patients with IgA nephropathy (PROTECT): 2-year results from a randomised, active-controlled, phase 3 trial (Lancet) Patients in the sparsentan group had a slower rate of eGFR decline than those in the irbesartan group. eGFR chronic 2-year slope (weeks 6–110) was −2·7 mL/min per 1·73 m2 per year versus −3·8 mL/min per 1·73 m2 per year (difference 1·1 mL/min per 1·73 m2per year, 95% CI 0·1 to 2·1; p=0·037); total 2-year slope (day 1–week 110) was −2·9 mL/min per 1·73 m2 per year versus −3·9 mL/min per 1·73 m2 per year (difference 1·0 mL/min per 1·73 m2 per year, 95% CI −0·03 to 1·94; p=0·058). Clinical Trial Considerations in Developing Treatments for Early Stages of Common, Chronic Kidney Diseases: A Scientific Workshop Cosponsored by the National Kidney Foundation and the US Food and Drug Administration (AJKD) AC Gomez’s Pick: MDR-101-MLK Update: Operational Immune Tolerance Achieved in Living Related HLA-Matched Kidney Transplant Recipients (ASN-Online.org) Josh’s Pick: A Phase 2 Trial of Sibeprenlimab in Patients with IgA Nephropathy (NEJM) Nayan’s Pick: The EnAKT LKD Cluster Randomized Clinical Trial (JAMA Internal Medicine) The Freely Filtered simultaneous release (NephJC) Freely Filtered is now a verb. Swap’s Pick: Strategies for the Management of Atrial Fibrillation in PatiEnts Receiving Dialysis (SAFE-D) (ASN-Online.org) Joel’s Pick: AYAME Study: Randomized, Double-Blind, Placebo-Controlled Phase 3 Study of Bardoxolone Methyl in Diabetic Kidney Disease (DKD) Patients (ASN-Online.org) Reata is a no-show to the 2012 ASN Kidney Week (PBFluids) Michelle’s Pick: Sparsentan versus Irbesartan in Focal Segmental Glomerulosclerosis. The DUPLEX Study (NEJM) DUET: A Phase 2 Study Evaluating the Efficacy and Safety of Sparsentan in Patients with FSGS (PubMed) | |||
| Freely Filtered 063: Late Breaking and High Impact Clinical Trial Simultaneous Release! | 03 Nov 2023 | 02:05:22 | |
The Filtrate: Joel Topf Swapnil Hiremath Sophia Ambruso AC Gomez With Special Guest: Amit Garg (@AmitXGarg) Nephrologist at Western University, London, and lead PI of the EnAKT LKD trial. Susan Q. McKenzie (LinkedIn) Co-Founder & Chair, Transplant Ambassador Program. President of the Kidney Patient and Donor Alliance of Canada. Editor: Joel Topf Show Notes: Late Braking and High Impact Clinical Trial press release MyTEMP trial Personalised cooler dialysate for patients receiving maintenance haemodialysis (MyTEMP): a pragmatic, cluster-randomised trial (PubMed | NephJC | Freely Filtered) Transplant is cheaper! An economic assessment of contemporary kidney transplant practice (PDF) Transplant is better! Survival for waitlisted kidney failure patients receiving transplantation versus remaining on waiting list: systematic review and meta-analysis (PubMed) Transplant disparities Association of Race and Ethnicity With Live Donor Kidney Transplantation in the United States From 1995 to 2014 (PubMed) MUC1 Kidney Disease Autosomal Dominant Tubulointerstitial Kidney Disease: An Emerging Cause of Genetic CKD (Kidney International Reports) This study has all the adjectives: “We conducted a pragmatic, two-arm, parallel-group, open-label, registry-based, superiority, cluster- randomized clinical trial.” Explore Transplant by Amy Waterman, PhD Kidney Failure Risk Equation A Predictive Model for Progression of Chronic Kidney Disease to Kidney Failure (JAMA | Calculator) The complete protocol A Quality Improvement Intervention to Enhance Access to Kidney Transplantation and Living Kidney Donation (EnAKT LKD) in Patients With Chronic Kidney Disease: Clinical Research Protocol of a Cluster-Randomized Clinical Trial (PDF) Pre-published statistical plan Enhance Access to Kidney Transplantation and Living Kidney Donation (EnAKT LKD): Statistical Analysis Plan of a Registry-Based, Cluster-Randomized Clinical Trial (PubMed) Hawthorne effect (Wikipedia) The Advancing American Kidney Health Initiative “Aim for 80% of new American ESRD patients in 2025 receiving either home dialysis or a transplant” (NKF) Tubular Secretions Swapnil The Time Travelers Wife by Audrey Niffenegger (Wikipedia) and HBO movie of the same name (Wikipedia). Sophia The Wheel of Time streaming on Amazon (Wikipedia) based on the series of books of the same name by Robert Jordan and Brandon Sanderson. Susan The Woman Who Loved Giraffes movie (Website) Amit Canadians cannot get Visas to visit India (Reuters) AC Eagles are good at Football (Fox Sports) and Alport Connect Meeting in San Diego (Alport Syndrome Foundation Website) Joel Live podcast recording at Kidney Week (NephJC) | |||
| Freely Filtered 062: Inaxaplin for APOL1 Kidney Disease | 25 Sep 2023 | 01:31:17 | |
The Filtrate: Joel Topf Jennie Lin Josh Waitzman With Special Guest: AC Gomez MedPeds nephrology fellow at Mass General/Brigham and Boston Children’s | Twitter Gentian Hall Assistant Professor of Medicine Duke Department of Medicine Editor: Sophia Ambruso Show Notes: APOL1 review by the OG Scientists APOL1 Nephropathy: From Genetics to Clinical Applications MYH9 and APOL1 connection: The population genetics of chronic kidney disease: insights from the MYH9–APOL1 locus Worldwide Frequencies of APOL1 Renal Risk Variants (NEJM) Kidney Disease-Associated APOL1 Variants Have Dose-Dependent, Dominant Toxic Gain-of-Function End-Stage Renal Disease in African Americans With Lupus Nephritis Is Associated With APOL1 HEK293 Cells Wikipedia Tubular Secretions Josh: From Serial and the New York Times: The Retrievals Jennie: Marathon induced hyponatremia (NEJM) Gentian: Vivien Thomas wikipedia. HBO Movie: Something the Lord Made AC: Talking to the FDA about SGLT2i Tweet Joel: NephJC 2023 Fund drive | |||
| Freely Filtered 061: Bicarb in Transplant | 24 Sep 2023 | 01:18:11 | |
Bicarbonate did not slow the loss of GFR in this well done Swiss, single-blind study of transplant patients. The Filtrate: Joel Topf Nayan Arora Swapnil Hiremath Pirya Yenebere With Special Guest: Nav Tangri nephrologist and epidemiology at the University of Manitoba Editor: Nayan Arora Show Notes: The London study that kicked it all off! de Brito-Ashurst, I., Varagunam, M., Raftery, M. J., & Yaqoob, M. M. (2009). Bicarbonate supplementation slows progression of CKD and improves nutritional status. Journal of the American Society of Nephrology: JASN, 20(9), 2075–2084. The multi center (but unblinded) UBI Study with mortality benefit! Di Iorio, B. R., Bellasi, A., Raphael, K. L., Santoro, D., Aucella, F., Garofano, L., Ceccarelli, M., Di Lullo, L., Capolongo, G., Di Iorio, M., Guastaferro, P., Capasso, G., & UBI Study Group. (2019). Treatment of metabolic acidosis with sodium bicarbonate delays progression of chronic kidney disease: the UBI Study. Journal of Nephrology, 32(6), 989–1001. The BiCARB Study: Double blinded and negative BiCARB study group. (2020). Clinical and cost-effectiveness of oral sodium bicarbonate therapy for older patients with chronic kidney disease and low-grade acidosis (BiCARB): a pragmatic randomised, double-blind, placebo-controlled trial. BMC Medicine, 18(1), 91. The initial Veverimer Study Wesson, D. E., Mathur, V., Tangri, N., Stasiv, Y., Parsell, D., Li, E., Klaerner, G., & Bushinsky, D. A. (2019). Long-term safety and efficacy of veverimer in patients with metabolic acidosis in chronic kidney disease: a multicentre, randomised, blinded, placebo-controlled, 40-week extension. In The Lancet (Vol. 394, Issue 10196, pp. 396–406). doi.org/10.1016/s0140-6736(19)31388-1 The Valor CKD trial is still unpublished. But here is the press release. VALOR-CKD design manuscript The study of the night: Sodium bicarbonate for kidney transplant recipients with metabolic acidosis in Switzerland: a multicentre, randomized, single-blind, placebo-controlled, phase 3 trial Alkali with normal bicarb? Sure, take a look at: Goraya, N., Simoni, J., Jo, C., & Wesson, D. E. (2012). Dietary acid reduction with fruits and vegetables or bicarbonate attenuates kidney injury in patients with a moderately reduced glomerular filtration rate due to hypertensive nephropathy. Kidney International, 81(1), 86–93. Metforminator! The BASE Trial: Raphael, K. L., Isakova, T., Ix, J. H., Raj, D. S., Wolf, M., Fried, L. F., Gassman, J. J., Kendrick, C., Larive, B., Flessner, M. F., Mendley, S. R., Hostetter, T. H., Block, G. A., Li, P., Middleton, J. P., Sprague, S. M., Wesson, D. E., & Cheung, A. K. (2020). A Randomized Trial Comparing the Safety, Adherence, and Pharmacodynamics Profiles of Two Doses of Sodium Bicarbonate in CKD: the BASE Pilot Trial. Journal of the American Society of Nephrology: JASN, 31(1), 161–174. Tubular Secretions Swap The Three-Body Problem (novel) | Netflix Nayan Women’s World Cup Tangri English Premier Soccer and Inflation Priya Silo on Apple TV | |||
| Freely Filtered 059: Furosemide v Torsemide | 03 Jul 2023 | 01:02:29 | |
The Filtrate: Joel Topf Nayan Arora Sophia Ambruso With Special Guest: Boback Ziaeian @boback Assistant Professor of Medicine David Geffen School of Medicine at UCLA. His Google Schoolar page is better than yours. And returning for her fourth time (why do we keep inviting her back?) Editor: Priya Yenebere Show Notes: Diuretic Therapy review by. Craig Brater NEJM The manuscript in JAMA | NephJC Metoprolol vs Carvedilol: Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial (Lancet) EMPULSE: The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure: a multinational randomized trial (Nature Medicine) Effect of Aliskiren on Postdischarge Mortality and Heart Failure Readmissions Among Patients Hospitalized for Heart Failure The ASTRONAUT Randomized Trial Effects of Oral Tolvaptan in Patients Hospitalized for Worsening Heart Failure The EVEREST Outcome Trial Sophia ended up placing fifth in NephMadness 2023. (Link) Joel finished 697th After winning in the opening round, Northwestern lost to UCLA, in the second round of the March Madness tournament, 68-63. Torsemide to furosemide equivalents CardioMems positive trial: Sustained efficacy of pulmonary artery pressure to guide adjustment of chronic heart failure therapy: complete follow-up results from the CHAMPION randomised trial (The Lancet) CardioMems negative trial: Haemodynamic-guided management of heart failure (GUIDE-HF): a randomised controlled trial (The Lancet) Estimation of the Absolute Risk of Cardiovascular Disease and Other Events: Issues With the Use of Multiple Fine-Gray Subdistribution Hazard Models (Circulation) Torasemide in chronic heart failure: results of the TORIC study (PubMed) Tubular Secretions Nayan: Louise Penny A World of Curiosities: A Novel (Amazon) Sadiya: Ted Lasso season three Sophia:The Last of Us on HBO and SNL skit Mario Cart as Prestige Drama Boback: Duolingo for Japanese | |||
| Freely Filtered 060: HCTZ v Kidney Stones, The NOSTONE trial | 25 Jun 2023 | 01:42:42 | |
The Filtrate: Joel Topf Swapnil Hiremath Josh Waitzman Nayan Arora Sophia Ambruso With Special Guest: Megan Prochaska Assistant professor of medicine at University of Chicago John Asplin Medical Director Consultant LithoLink (Twitter) Editor: Joel Topf Show Notes: The LithoLink website Stone Camp tweet Prevention of Repeated Episodes of Kidney Stones in Adults: A Clinical Practice Guideline From the American College of Physicians (link) NOSTONE in the NEJM and NephJC Fred Coe Google Scholar | YouTube | Blog Hypercalcuria. Curhan et al. 24-h uric acid excretion and the risk of kidney stones PubMed EQUIL2 software to evaluate urinary super saturation Anna Zisman Racial Differences in Risk Factors for Kidney Stone Formation (CJASN) Potassium Citrate on GoodRx Potassium and citrate by Fred Coe (blog) Thiazide Diuretics and Fracture Risk: A Systematic Review and Meta‐Analysis of Randomized Clinical Trials (PubMed) Chlorthalidone promotes mineral retention in patients with idiopathic hypercalciuria by Coe et al (PubMed) NHANES 24-hour urine Na (Abstract) Kidney Stone risk is reduced with empagliflozin (PubMed) Prospective trial to determine the effect of SGLT2i on urinary supersaturation (BMJ Open) GLP agonists and kidney stone risk
Tubular Secretions Swap: Star Wars: Thrawn Series by Timothy Zahn (Penguin Random House) Josh: Little League Megan: Renal related podcasts Sophia Renal Stone Camp and ABCKidney.com Nayan: Ted Lasso Robert Galbraithand The Comoran Strike Novels (home page) John: Fred Coe’s Blog Joel: Spiderman across the Spider-Verse (Wikipedia) | |||
| Freely Filtered 057: NephMadness 2023 TMA | 11 Mar 2023 | 01:21:41 | |
The Filtrate: Joel Topf Swapnil Hiremath Josh Waitzman Sophia Ambruso With Special Guest: Anna Vinakova Associate Professor of Medicine at Virginia Commonwealth University. NephMadness Executive. Vanuja Java is a transplant nephrologist at Washington University in St. Louis, MO. Her research involves functional characterization of genetic variants in complement-mediated diseases. She co-chairs the ClinGen complement gene curation expert panel. Editor: Sophia Ambruso Show Notes: #NephMadness 2023: Thrombotic Microangiopathy Region TMA Review article in the NEJM from 2014: Syndromes of Thrombotic Microangiopathy Dr. Anuja Java Co-chairs Working Group in an International Committee for Revising aHUS Nomenclature Nephrology Secrets 4th Edition at Amazon University of Iowa Genetic testing for aHUS Early Eculizumab Withdrawal in Patients With Atypical Hemolytic Uremic Syndrome in Native Kidneys Is Safe and Cost-Effective: Results of the CUREiHUS Study. KI reports. This is the Netherlands study. They used home urine dipsticks to monitor for relapses. Clinical promise of next-generation complement therapeutics Nature reviews. Drug Discovery Tubular Secretions Swap: Neuromancer and the works of William Gibson (@GreatDismal) Sophia: The Magicians on Netflix Anna: Recommends nephrology. Says it is awesome. Anuja: Dope Sick on Hulu and Women in Nephrology mentor program Josh: Mobituaries with Mo Rocca. Specifically “Death of a Banana” Joel: Ivory by TapBot | |||
| Say "Hi" to the #NephMadness PodCrawl | 01 Mar 2023 | 00:01:16 | |
Welcome to the NephMadness PodCrawl The idea behind a podcrawl is for a variety of podcasts to coordinate on timing and topic to push a theme and get each other’s listeners to explore all of the podcasts. One of the first goals behind NephMadness was to build a community and in the early years of Twitter, NephMadness was central to the formation of #NephTwitter and defining the ethos that makes our online community kind, intelligent, vibrant, and interesting. The NephMadness Podcrawl hopes to inspire and grow the nephrology podcast community in the same way. For 2023, our second year, the PodCrawl has assembled the Avengers of Medical Pods! Go to NephMadness.com/podcrawl for more information and links to all of the podcasts! Core IM will be covering Kidney Transplant in their classic Five Pearl format The CardioNerds will be covering the effect of Heart Failure Devices on Kidney Health Freely Filtered will try to understand thrombotic microangiopathy ISN Global Kidney Care goes deep on IgA nephropathy The Cribsiders look at transitions, first the Peditrics to Adult nephrology transition and then from living to death with palliative nephrology Fellow on Call will be covering Onconephrology And finally, The Nephron Segment looks at Transgender Health and CKD | |||
| Freely Filtered 056: MyTEMP | 07 Feb 2023 | 01:21:21 | |
The Filtrate: Joel Topf Swapnil Hiremath Nayan Arora Sophia Ambruso With Special Guest: Amit Garg @AmitXGarg, Nephrologist at Western University, London, and lead PI of the MYTEMP trial. Editor: Joel Topf Show Notes: MyTEMP in pubmed: Personalised cooler dialysate for patients receiving maintenance haemodialysis (MyTEMP): a pragmatic, cluster-randomised trial MyTEMP Summary on NephJC It’s really cold in Ontario The NephTrials blog summary on Pragmatic Trials The pragmatic TiME trial on longer time on dialysis (ahem, sabotaged by site investigators like Joel who cut dialysate time) Dember et al in JASN Poor quality of trial data preceding MyTEMP, a systematic review from Mustafa et al in JASN The 2007 European Best Practice Guideline (EBPG) from 2007, recommending “Cool dialysate temperature dialysis (35–36°C) or isothermic treatments by blood temperature controlled feedback should be prescribed in patients with frequent episodes of IDH (Evidence level I).” in NDT 47% of centres from a DOPPS study of 273 centers routinely use of lower dialysate temperature, Dasgupta et al in JASN How do you convert from C to F? Almanac.com (35.5 C is 96.9 F; 37 C is 98.6 F) More on the rationale and design of MyTEMP: Al-Jaishi et al in CJKHD How big is 4.3 million (the number of hemodialysis treatments in MyTEMP)? Very big indeed. NephJC discussion of another cluster RCT and granular data only on a subset SSASS Participants in dialysis clinical trials are not representative of the real world dialysis cohorts, Smyth et al in JAMA Int Med Peritoneal dialysis numbers in Ontario are high, Blake et al in PDI, though with ~ 60% CVC rates, Blake et al in Kidney360 Dialysate Magnesium #DreamRCT from Swap, NephTrials discussion of DialMag Statistical analysis plan of MyTEMP, Dixon et al in CJKHD Tubular Secretions Swap: Watch Everything, Everywhere All At Once on Prime Nayan: Read The Midnight Ride from Ben Mezrich (brother of Josh Mezrich from the NephJC Summer Book Club 2021) Sophia: Making nephrology education fun at the UC Denver Amit: The wrestling team at Western U from 1990-91 Joel: House of the Dragon on HBO Max | |||
| Freely Filtered 055: STOP ACE! | 29 Jan 2023 | 01:18:12 | |
The Filtrate: Joel Topf Swapnil Hiremath Jordy Cohen With Special Guest: Laurie Tomlinson. @Roxytonin Nephrologist at University Hospitals Sussex and research hero of Jordy. Editor: Priya Yenebere Show Notes: STOP-ACE in pubmed: Renin-Angiotensin System Inhibition in Advanced Chronic Kidney Disease STOP-ACE Summary in NephJC Prior data showing preservation of renal function by stopping ACEi: The impact of stopping inhibitors of the renin-angiotensin system in patients with advanced chronic kidney disease Efficacy and Safety of Benazepril for Advanced Chronic Renal Insufficiency: NEJM Dr. Tomlinson’s article on creatinine changes in RASi from 2017: Serum creatinine elevation after renin-angiotensin system blockade and long term cardiorenal risks: cohort study NephJC | PubMed Accuracy of eGFR at low GFR: A new equation to estimate glomerular filtration rate Strong opinions, loosely held. “Permissive AKI” with treatment of heart failure. Editorial by Chirag Parish and Steven Coca The rational for NICE avoiding RASi in black patients: Hypertension and ethnic group AASK trial showing superiority of RASi in African Americans. JAMA ALLHAT post-hoc analysis of outcomes by self-reported race. JAMA | PubMed Sophisticated Swedish observational study that Swap loved. Stopping Renin-Angiotensin System Inhibitors in Patients with Advanced CKD and Risk of Adverse Outcomes: A Nationwide Study Target Trials in Nephrology Dr Edouard Fu grand rounds at Ottawa Nephrology, YouTube Target Trial EmulationA Framework for Causal Inference From Observational Data by Miguel Hernán in JAMA Tubular Secretions Jordy: Third season of His Dark Materials on HBO Swap: Movies by Wes Anderson on Disney Plus Laurie: The Book, “Nearly All the Men in Lagos are Mad” Jordy: How Medicine Works and When It Doesn't: Learning Who to Trust to Get and Stay Healthy | Amazon Joel EO | NYT Review | |||
| Freely Filtered 054: EMPA Kidney! | 25 Dec 2022 | 01:31:28 | |
The Filtrate: Joel Topf Swapnil Hiremath Josh Waitzman Sophia Ambruso Priya Yenebere With Special Guest: Brendon Neuen, Secretariat of the SGLT2 Trialists Consortium and cool guy on Twitter. Editor: Sophia Ambruso Show Notes: Joel’s Conflict of Interest Statement. Sophia is also conflicted with Astra Zeneca and Brendon with everybody in the SGLT2i space. Joel starts off with a history of SGLT2i EMPA-REG Outcomes. First! CANVAS. OMG this signal is reproducible! CREDENCE (🎧). It works in a dedicated population at high risk of kidney disease. And in a study designed for renal end-points. DAPA-CKD (🎧). It’s not just for diabetics! EMPA-Kidney. It works at really low GFR. And without albuminuria. And again in non-diabetics. SGLT Inhibitors for Type 1 Diabetes: Proceed With Extreme Caution Click to find the supplement (requires a subscription) EMPA-Kidney 40% DAPA-Kidney 50% CREDENCE doubling of serum Cr Usability Testing of a Sick-Day Protocol in CKD (Pubmed) New Guidelines for Statistical Reporting in the Journal (link, commentary on said guidelines by Frank Harrell) The Peripheral on Amazon Prime Unsealed the Tylenol Murders Podcast Project Hail Mary by Andrew Weir Lizzy McAlpine Singer Song Writer Rachel Maddow Presents: Ultra Twitter chaos continues. Get your Med-Mastodon handle | |||
| Freely Filtered 053: The Kidney Week Draft | 11 Dec 2022 | 01:04:34 | |
The Filtrate: Joel Topf Swapnil Hiremath Nayan Arora Sophia Ambruso Editor: Nayan Arora Show Notes: Joel’s Conflict of Interest Statement EMPA-Kidney is “off the board” Lunch Symposium on Current and Future Approaches to the Diagnostic Assessment and Management of AKI in Patients with Cirrhosis provided by an educational grant from Mallinckrodt Pharmaceuticals The CONFIRM Trial Terlipressin plus Albumin for the Treatment of Type 1 Hepatorenal Syndrome in NephJC Clinical Practice Session Leveraging Social Media to Create, Learn, Teach, Advocate, and Dispel Misinformation The BEST-Fluids Trial: A Randomized Controlled Trial of Balanced Crystalloid Solution vs. Saline to Prevent Delayed Graft Function in Deceased Donor Kidney Transplantation - Michael G. Collins, Magid Fahim, Elaine Pascoe, Carmel Hawley, David W. Johnson, Philip A. Clayton, Steven J. Chadban (ClinicalTrials.gov) The Late Breaking and High Impact Trials Session line up Stop ACEi Effects of Pantoprazole on Kidney Outcomes: Post Hoc Analyses From the COMPASS Randomized Controlled Trial by Lonnie Pyne, et al No Stone: Hydrochlorothiazide for the Prevention of Kidney Stone Recurrence by Daniel Foster, et al Clinical Practice Session Best of NephJC “We'd Now Like To Open The Floor To Shorter speeches disguised as questions.” ASN Task Force on the Future of Nephrology Attracting Osteopathic Medical Students Into Nephrology Hasan Minhaj’s joke at the expense of DOs TRANSFORM-HF: Torsemide vs. Furosemide in Treating Patients With HF Point-of-Care Ultrasound in Nephrology specifically VExUS | |||
| Freely Filtered 052: Acetazolamide for Acute Decompensated Heart Failure (ADVOR) | 26 Nov 2022 | 01:09:56 | |
The Filtrate: Joel Topf Jordy Cohen Nayan Arora Sophia Ambruso Special Guests: Boback Ziaeian @boback Assistant Professor of Medicine David Geffen School of Medicine at UCLA returns for his second episode (SODIUM-HF). His Google Schoolar page is better than yours. David Ellison @dhekidney is professor of medicine at Oregon Health Science University and head of the Oregon Clinical & Translational Institute. Show Notes: Ultrafiltration in Decompensated Heart Failure with Cardiorenal Syndrome (The CARESS Trial) Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure (The UNLOAD trial) Diuretic Strategies in Patients with Acute Decompensated Heart Failure (The DOSE Trial) Diuretic Strategies for Loop Diuretic Resistance in Acute Heart Failure (The 3T Trial) Sequential nephron blockade with a thiazide diuretic has a 1 B-NR (non-radomized) grade in the AHA/ACC Heart Failure Guidelines (7.2) Three important acute decompensated heart failure with SGLT2i: 1. Sotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure (SOLOIST-WHF Trial) 2. The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure: a multinational randomized trial (The EMPULSE Trial) 3. Effects of Early Empagliflozin Initiation on Diuresis and Kidney Function in Patients With Acute Decompensated Heart Failure (EMPAG-HF) Cardiologist Sues Epic Over Copyright Infringement Outcomes associated with a strategy of adjuvant metolazone or high-dose loop diuretics in acute decompensated heart failure: a propensity analysis. Acetazolamide to increase natriuresis in congestive heart failure at high risk for diuretic resistance (PubMed) Efficacy and Safety of Spironolactone in Acute Heart Failure (ATHENA Trial) Joel with a video on acetazolamide for altitude sickness. The Butchering Art: Joseph Lister's Quest to Transform the Grisly World of Victorian Medicine(Amazon) | |||