In this edition of NephTrials, we will discuss the bewildering world of master protocols, comprising of platform, umbrella and basket trials - with the example of the RENAL LIFECYCLE trial.

This week, we will discussing the EMPA-Kidney Study! Expanding flozin kidney protection to a lower level of GFR and albuminuria.

SGLT2 inhibitors lower MACE in Diabetes. Then they decrease kidney failure in DM. Then Heart Failure in DM and non-DM. And now decrease kidney failure in nonDM too! Let’s see how strong the data really is

SGLT2i are the wonder drug for our age. But do we know how they work? How does their natriuretic effect actually work? Let’s dig deeper into this week’s mechanistic study that explores this question

This week, we will discuss the CREDENCE trial, simply the most important nephrology trial in a generation.

Were the EMPA-REG Renal results chance, or is this a class effect? Let's take a deep dive into CANVAS, published in the NEJM recently, which examined the cardiovascular safety of canaglifozin in type 2 diabetes. 

This week, nephrologists hope they found the key to no-dialysis-land, where kindness and detailed, multistep interventions make the path to kidney transplant much easier. This was foreseen in our Freely Filtered episode and disputed during #KidneyWK 2023 late-breaking clinical trials session. Still, when it comes to RCTs’ results, will it be Deja Vu or a happy ending?

This week, we put our best fluid forward to discuss whether balanced crystalloids reduce the incidence of DGF after deceased donor kidney transplant compared to normal saline.

This week, we will discuss the effects of oral bicarbonate therapy in kidney transplant recipients.
Preserve-Transplant Study from Lancet.

This week, we will discuss whether pretransplant workup matters. This topic is also a bracket for NephMadness this year. Let’s dive in!

This week, we will discuss the ADMIRAL DNA, which sells the cell-free donor derived DNA as the shiny new thing which will make diagnostics easy in kidney transplants. Or will it?

This week, we will discuss the published case report from the UAB on one of the early xenotransplantations from genetically engineered pig kidneys.

It’s back! The NephJC Summer Book Club with great read by Joshua Mezrich, When Death Becomes Life, Notes from a Transplant Surgeon. Part history book, part memoir, Mezrich explores the past, future and the current realities of organ transplant through the experiences of the pioneers, recipients, and donors. Join us August third and fourth to chat about this summer’s community read.

This week we discuss the BiRT trial. It has long been a dogma to treat asymptomatic bacteriuria in kidney transplant recipients. Let’s upend this accepted truth by discussing the BiRT trial.

We measure cyclosporine and tacrolimus levels. But don’t bother with mycophenolate levels - why is it? Is it too difficult? Does it not matter? NephJC tackles a different kind of study this time - a literature review, albeit conducted systematically.

Join us to discuss this extension of the TUMORAPA trial - in a joint session with the #DermJC. Should kidney transplant recipients with squamous cell cancer be switched to sirolimus?

The opioid epidemic is tragically providing a lot of organs for transplant. We are using more over-dose death organs than ever before. Do they measure up?

This week, we will discuss the JAMA paper on disparities in living donor kidney transplant *rates* across race/ethnicities. There is a parallel paper from the UK, which shows somewhat similar findings. Join us Feb 6 and 7 to discuss on #NephJC!

Chat on Tuesday and Wednesday April 11 and 12. EDTA Descartes Work Group white paper on the risk of kidney donation.

What do you do when you suspect AIN (and eosinophils aren’t helpful) and you can’t get a kidney biopsy? CXCL9 is a newly discovered urinary marker that may help in the diagnosis of AIN. This week we will discuss the process of isolating and utilizing this new diagnostic test.

Pip/Tazo and Vanco is the new new kid on the block for antibiotic induced AKI. Does it deserve its bad boy reputation?

This week we’ll be discussing a Kidney 360 paper validating two recent methods of prognostication of AKI by evaluation of the urine sediment.

This week we discuss the AKi Alert trial from BMJ. Surely alerting us to AKI earlier will be helpful, right? Maybe - or maybe not. Join us to discuss this very important trial with some counter intuitive results.

This week, we will discuss the fresh-off-the-press STARRT AKI trial. The final, definitive trial to let us know about the timing of KRT in the ICU.

This week, we will discuss a pilot trial of using mannitol to treat intradialytic hypotension. A daily occurence in our practice, hence providing some much needed data.

Its March. Which means it is NephMadness.

In conjunction with NephMadness - Pain Region discussion, we discuss a recent JAMA Network Open study, reporting higher kidney risk in young men taking NSAIDs.

There is AKI. You are ready to discharge the patient. Should you restart their ACEI/ARB? Or they were never on an ACEI/ARB - but surely with a history of heart failure, they should be on one? How do you decide? Join us to discuss some exciting new data

Randomized controlled trial of restrictive versus liberal IV fluid strategy around abdominal surgery.

March 13/14 we will discuss the pair of trials in NEJM from Vanderbilt: comparing balanced solutions to normal saline in critically ill & not ill patients. Join us for the next #NephJC to parse through SMART & SALT-ED

Join us Dec 19 and 20 as we discuss the MYRE trial from JAMA. Using a high cutoff dialyzer and removing light chains to help the kidneys heal faster

This week, we will discuss the fresh-off-the-press NEJM paper on the utility of using NAC (vs placebo) or bicarb-based hydration (vs saline) in preventing contrast AKI. A medical reversal that has taken almost 2 decades...

This week NephJC goes back to basic science to look at mRNA inhibition in ADPKD.

This week, we will discuss the use of lanreotide - a somoatostatin analogue, for the treatment of autosomal dominant polycystic kidney disease. An RCT, published in JAMA.

This week, we discuss some amazing advances made in our understanding of the PKD protein - using a technology called CryoEM. Check out the video explainer and summary.

This week, we will discuss the fresh-off-the-press and fresh from KidneyWk REPRISE trial, which was also presented at the late breaking clinical trial session. Join us to discuss the nitty-gritty on Nov 14th and 15th

This week, we will have a salty debate on what nephrologists love the most: hyponatremia and numbers. The main question: are guideline hyponatremia rates a waste of time?

This week, we discuss an RCT that tests if fluid restriction even works in SIAD.

The new generation of potassium binders bind potassium but can they improve patient outcomes? These second order questions are starting to be answered. Join us this week to discuss the use of patiromer and spironolactone in patients with resistant hypertension.The AMBER Study

They always said not to correct hypernatremia faster than 0.5 mmol/L/hour but what do they know and who are they anyways? New data questions this ancient dogma.

This week, we will discuss an observational study - a very large series of using DDAVP for treatment of hyponatremia. Yes, you read that right. Read the paper for free thanks to Am J Med and join us on March 27/28 to discuss. 

Thiazide induced hyponatremia occurs in about 10% of people. Is there a genetic link? Does that genetic link give clues to the mechanism of thiazide induced hyponatremia? Find out in the next exciting edition of #NephJC

This week, we will discuss some groundbreaking work on elucidating the adaptive and maladaptive cellular transcription and gene activation of the kidney in healthy and diseased states.

This week NephJC goes back to basic science to look at mRNA inhibition in ADPKD.

It’s back! The NephJC Summer Book Club with Walter Isaacson’s book which is part Jennifer Doudna biography and part an examination of CRISPER technology and its implications.

This week, we will discuss the study on the effect of clonal hematopoiesis on the kidneys. What is CHIP anyways?

This week, we will discuss the discovery of anti-nephrin antibodies and the elucidation of their role in minimal change disease

Glomeruli seem fun and interesting, but the final common pathway for all kidney diseases is fibrosis. Irreversible and relentless once it sets in. Here we discuss some meticulous and groundbreaking work on how this develops, using really cool techniques.

We are now in GN territory this month - or rather ANCA Vasculitis month! First we start off with this paper from London, which uses some data from the RAVE trial along with additional experiments to show some intriguing results on the role of MPO.

Some cases of ADTKD are due to mutations of the MUC-1 gene, one mutation is a frame shift mutation that results in a premature stop codon. which results in accumulation of the abnormally short, and toxic protein MUC-1 fs . The researchers found a small protein, BRD4780, that reroute MUC-1fs to lysosomes, preventing proteinopathy and possibly altering the natural history of the disease.

This week, we go back to basic science with Jennie Lin leading us through two important papers on single cell RNA sequencing.

This week, we discuss some amazing advances made in our understanding of the PKD protein - using a technology called CryoEM. Check out the video explainer and summary.

Growing organs in a dish? Even more specific - growing a kidney organoid for one particular patient with a specific purpose. Join us to discuss this fascinating topic - the authors will be joining us too.

This week, we will discuss the final results of the NEFIGARD trial with the GFR slope data. Is targeted release budesonide aka Nefecon really a way to provide steroid efficacy without steroid side effects?

This week, we will discuss another IgA Nephropathy trial - Sparsentan this time. A dual endothelin antagonist and angiotensin receptor antagonist.

This week, we will discuss the MAIN trial of MMF monotherapy in IgA Nephropathy. Pairs nicely with the NephMadness IgA Region discussion!

This week, we will discuss NEFIGARD, the trial of a targeted release steroid. It reduces proteinuria in IgA nephropathy - should it upstage humble prednisone?

This week, we will discuss the updated 2021 GN guidelines from KDIGO. They have always been the most useful of all GN guidelines. Let’s see what has changed

This week, we will discuss a risk score which helps to prognosticate the most common glomerular disease. Not only is IgA most common - it is quite heterogeneous, which makes the problem of who should get treated quite difficult.

Stop-IgAN suggested steroids may not be useful in patients with intermediate range proteinuria. Now, in a different population with more proteinuria, TESTING finds a mixed result: some benfit + more adverse events. Should we keep on TESTING? 

This week, we tag along with NephMadness. It will be hard to stay impartial while discussing the role of angiogenic and antiangiogenic factors in severe preeclampsia prognosis.

This week, we have a practice changing study about the treatment of mild hypertension during pregnancy. Join us on Tuesday (9 EDT) and Wednesday (9 IST).

This week, we will discuss the SLEEP-HD trial, which examined if trazodone or CBT are better than placebo in helping people sleep.

This week, we will discuss CONVINCE, a randomized controlled trial, about the long-lasting battle between hemodialysis and hemodiafiltration. Will it convince the unconvinced, or will it diffuse even more uncertainty into community?

This week, we will discuss a systematic review challenging a common practice: the use of sodium thiosulfate in calciphylaxis.

AskASN is back with a discussion about medical director responsibilities - from the ASN: Excellent Patient Care workgroup

This week, we will discuss the MYTEMP trial from Lancet. A cool idea, a cool cluster design. Warmly embraced by the Ontario dialysis community. But did it work?

The next #Nephtrials discussion will feature a deep dive into convection/hemodiafiltration, and the ongoing registry based trial, H4RT

This week, we will discuss the potential harm of widespread antibiotic use, and how some of them may contribute to sudden death in hemodialysis

This week, we will discuss the intricate analysis using target trial emulation - applied for the initiation of dialysis in CKD. Let’s fix problems of lead time and immortal time bias.

This week, we will discuss the LUST trial, to see if use of a POCUS changes your focus enough to help improve clinical outcomes

This week, we will discuss the small but elegant trial which combines CGM and a closed loop insulin delivery - dialysis patients with type 2 diabetes.

As the Tour de France goes on, it is timely to discuss the role of exercise, while on dialysis. The CYCLEHD trial reported a lowering of left ventricular mass. Let’s dig deeper, as we do.

The HIF inhibitor trials were announced almost a year and half ago at KidneyWk 2019. We are finally seeing the trials get published. Here are the first two, a sub-group analysis of three dialysis studies focused on incident dialysis patients and a placebo controlled pre-dialysis study.

This week, we will discuss an unusual feature in nephrology: a trial in NEJM from nephrology that is positive. And on vascular access at that!

This week we will be discussing the KALM-1 trial which was presented at the Late Breaking and High Impact Trial Session at the recently completed #KidneyWk. It was simultaneously published in the NEJM. Kalm-1 investigated whether difelikefalin, a opioid kappa agonist, decreased uremic pruritus.

Can PIVOTAL pivot us to pump more iron? It is indeed a pivot from the lazy, halycon days of the ESA era, now to the evil ESA empire crumbling under the strong iron attack. Join us to discuss!

First chat of 2019 - showcasing again the honest brokers of nephrology trials with another negative trial. Also note we will be having a NephJC Asia chat starting this week!

Proposition 8 is on the ballot. It pits the labor unions against the dialysis corporations. Simple right? Wrong. Check out the details and join us Oct 16.  

Retrospective analysis of apixaban vs warfarin for atrial fibrillation in dialysis patients.

The VA squares off against Medicare in a grudge battle to see which one provides better care for patients with advanced CKD.

The ACTIVE trial tested the hypothesis that longer dialysis would be better for quality of life. Sadly, this did not turn out to be the case. Is the end of longer being better? Join us as we dissect the study at the next NephJC.

This week, we will discuss the fresh-off-the-press ISPD guidelines on encapsulating peritoneal sclerosis. We are happy to have support from the ISPD for organizing this - and making the manuscript open, and also the ISPD Vancouver 2018 team, who will be co-hosting the #NephJC chat. 

This week, we will discuss the recently published KDIGO lupus guidelines. Published a couple of years after the big GN guidelines - let us dive in to see what’s new in lupus nephritis

We have a long awaited huge update on the ISPD peritonitis guidelines. Bugs change and we need to change how we treat them. We break down the evidence for you in this summary

This week, we will discuss the updated 2021 GN guidelines from KDIGO. They have always been the most useful of all GN guidelines. Let’s see what has changed

This week, we will discuss the one guideline to rule them all. KDIGO takes on blood pressure, and simplifies it down to one number. 120.

This week, we will discuss the fresh-off-the-press KDIGO guidelines on Diabetes. RAS Blockade and SGLT2i, needless to say - but is there more? There is. Read on as we break it down for you.

This week, we will discuss the fresh-off-the-press ISPD recommendations on what they call as ‘prescribing high quality, goal directed’ PD. No mention of adequacy even in the title, in a subtle shade at the move away from numbers to things that really matter.

Join us as we dissect a few key aspects of the mammoth undertaking that was the 2017 ACC/AHA blood pressure guidelines!

Join us this week as we discuss guidelines - with a difference. Hypertension, but in children - as the AAP unveiled them recently. The entire manuscript is over 70 pages, so make sure you read this succinct summary from Cathy Quinlan.  

This week, we will discuss the fresh-off-the-press ISPD guidelines on encapsulating peritoneal sclerosis. We are happy to have support from the ISPD for organizing this - and making the manuscript open, and also the ISPD Vancouver 2018 team, who will be co-hosting the #NephJC chat. 

This week, we will discuss yet another endothelin antagonist trial, on a background of flozins, in proteinuric CKD. Will flozins help breakthrough the endothelin badness?

This week, we will discuss a systematic review challenging a common practice: the use of sodium thiosulfate in calciphylaxis.

This week, we will discuss the intricate analysis using target trial emulation - applied for the initiation of dialysis in CKD. Let’s fix problems of lead time and immortal time bias.

This week, we will discuss the CLICK trial. Another medical reversal - showing that this old and cheap drug, chlorthalidone, might actually work in advanced CKD. Click through to read more.

This week, we will discuss the hot off the press. On the quest to solve the disparity created by GFR calculations, we discuss the new equations. Is it time to drop the race coefficient, or is it time to drop serum creatinine entirely?

Truly a LANDMARK trial. The investigators went to prove that lanthanum is superior to calcium for phosphate binding. What they found will surprise no one.

The HIF inhibitor trials were announced almost a year and half ago at KidneyWk 2019. We are finally seeing the trials get published. Here are the first two, a sub-group analysis of three dialysis studies focused on incident dialysis patients and a placebo controlled pre-dialysis study.

Join us for the first edition of the #NephTrials chat. Let’s take a deep dive into pragmatic trials, and take a specific example - the Phosphate trial, to anchor the discussion.

SGLT2 inhibitors lower MACE in Diabetes. Then they decrease kidney failure in DM. Then Heart Failure in DM and non-DM. And now decrease kidney failure in nonDM too! Let’s see how strong the data really is

This week, we will review the herculean task from the authors of the Annals paper, which examines whether PCR is just as good as ACR.

This week, we discuss the latest from CRIC, an examination of NSAIDs versus opioids for patients with CKD. Join us May 12 and 13th to discuss with #NephJC.

This week, we will discuss a paper from Nature Medicine. Cystatin C has been around for a while, but not taken off in routine practice. Is it time for it to do so? In this study, authors from Glasgow using the UKBiobank data show that cystatin C improves the prediction of bad outcomes.

This week, we will discuss a perspective peice looking at the use of race in the eGFR formulas routinely used in the hospital. #NephJC chat. 

This week, we will discuss the CREDENCE trial, simply the most important nephrology trial in a generation.

Its March. Which means it is NephMadness.

In conjunction with NephMadness - Pain Region discussion, we discuss a recent JAMA Network Open study, reporting higher kidney risk in young men taking NSAIDs.

First chat of 2019 - showcasing again the honest brokers of nephrology trials with another negative trial. Also note we will be having a NephJC Asia chat starting this week!

Join us as we discuss this study which meticulously collected data from Nicaragua to shed more light on the potential mechanism of mesoamerican nephropathy

How much water should we drink? Does drinking more water help flush the kidney? Join us as we discuss the definitive trial done to answer this question.