New data from a 42,000-patient retrospective cohort challenges prior concerns about perioperative SGLT2 inhibitor use
◆ CLINICAL BOTTOM LINE
Practice change: These data support reconsidering blanket "hold SGLT2i" policies perioperatively, particularly in patients with CKD and preserved eGFR. A risk-stratified approach is warranted.
Dr. Priya Mehta
Associate Professor, Division of Nephrology, Johns Hopkins
Dual endothelin-angiotensin receptor antagonism demonstrates durable proteinuria reduction and eGFR preservation
◆ CLINICAL BOTTOM LINE
Sparsentan should now be considered first-line add-on therapy for IgA nephropathy with proteinuria >1g/day, particularly in patients with progressive disease despite optimized RAS blockade.
DIAMOND trial confirms potassium binder strategy allows higher doses of spironolactone in patients previously intolerant due to hyperkalemia
◆ CLINICAL BOTTOM LINE
Potassium binders should be considered a routine enabler of RAAS optimization in CKD patients with HFrEF, not merely a rescue therapy for established hyperkalemia.
Machine learning model outperforms standard pharmacokinetic dosing in a multicenter randomized trial
◆ CLINICAL BOTTOM LINE
AI-guided immunosuppression dosing represents a clinically meaningful advance in transplant management and should be evaluated for implementation in transplant programs with appropriate informatics infrastructure.
Updated meta-analysis of 7 RCTs confirms survival benefit of HDF in patients achieving adequate convection volumes
◆ CLINICAL BOTTOM LINE
For dialysis centers with HDF capability, achieving convection volumes ≥23L/session should be a quality target. Patient selection should prioritize those with high cardiovascular risk and residual kidney function.
Sparsentan in IgA Nephropathy — annotate, discuss, earn CME credit