Exercise during Hemodialysis in Patients with Chronic Kidney Failure (Anding-Rost, NEJM Evidence 2023)
✏️ Taurolidine to prevent CRBSI
🤔 Self managed BP control after pregnancy
Long-Term Blood Pressure Control After Hypertensive Pregnancy Following Physician-Optimized Self-Management: The POP-HT Randomized Clinical Trial (Kitt, JAMA 2023)
✏️ Salt reduction still lowers BP
Effect of Dietary Sodium on Blood Pressure: A Crossover Trial (Gupta, JAMA 2023)
We know reducing sodium intake lowers blood pressure (BP), but what is truly the effect in those with normal BP versus high BP? Those taking BP meds versus those who do not? In the Coronary Artery Risk Development in Young Adults (CARDIA)–SSBP trial (Gupta et al, JAMA 2023), the investigators enrolled 213 individuals either with normal BP or not, and either on BP meds with controlled or uncontrolled hypertension. They crossed over from the usual diet to low sodium (diet with 500 mg i.e. ~ 25 mmol sodium) and high sodium (with 2 bouillon packets, each containing 1100 mg of sodium added to the usual diet). The low sodium diet did result in lower BP in all subgroups, by about 5 - 6 mmHg SBP in the normotensive/controlled hypertension subgroups to about 9 - 190 mmHg SBP in the uncontrolled/untreated hypertension subgroups. Though the authors say these are not significantly different based on interaction p values, the subgroups are woefully underpowered to say that. Note that diet allocation was on alternate days, so this was not a randomized trial. Additionally - despite being provided food and daily phone calls, people on low sodium couldn’t stick to the provided saltless diet (24 hour urine sodium 1.7g rather than 0.5 g) and even the high sodium group couldn’t stomach the extra 2.2g bouillon (24 hour urine sodium went up from 4.6 to 5.5 rather than expected 6.8 g/day). So, an extremely low sodium diet does lower BP a bit, but it’s hard to achieve even if you are provided the food. Salt substitutes are so much more pragmatic!
Swapnil Hiremath
🤔 Mendelian randomization suggests thiazides do reduce stones
Mendelian Randomization Analysis of Genetic Proxies of Thiazide Diuretics and the Reduction of Kidney Stone Risk (Triozzi, JAMA Network Open 2023)
🤔 A digital intervention to increase physical activity in CKD
Evaluating the effect of a digital health intervention to enhance physical activity in people with chronic kidney disease (Kidney BEAM): a multicentre, randomised controlled trial in the UK (The EMPA-KIDNEY Collaborative Group The Lancet Digital Health 2024)
🤔 EMPA KIDNEY analysis by CKD diagnosis
Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial (The EMPA-KIDNEY Collaborative Group The Lancet 2023)
🤔 EMPA Kidney sub-group analysis by DM and ACR status
Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial (The EMPA-KIDNEY Collaborative Group 2023)
🤔 Albuminuria reduction drives Finerenone's kidney benefit
Impact of Finerenone-Induced Albuminuria Reduction on Chronic Kidney Disease Outcomes in Type 2 Diabetes (Agarwal et al, Annals IM 2023)
🤔 Cuff size and BP: the Cuff (SZ) trial
Effects of Cuff Size on the Accuracy of Blood Pressure Readings. The Cuff(SZ) Randomized Crossover Trial (Ishigami et al JAMA IM 2023)
🤔 Does intensive BP Lowering worsen orthostatic hypotension?
Orthostatic Hypotension, Hypertension Treatment, and Cardiovascular Disease. An Individual Participant Meta-Analysis (Juraschek, JAMA 2023)
🤔 Risk of AIN with PPI/ICI overstated
Proton pump inhibitors and the risk of acute kidney injury in cancer patients receiving immune checkpoint inhibitors: A Danish population-based cohort study (Munch, International Journal of Cancer 2023)
🤔 E-alerts in AKI, the ELAIA-2 trial
A randomized clinical trial assessing the effect of automated medication-targeted alerts on acute kidney injury outcomes (Wilson, Nature Communications 2023)
🤔 RCT comparing Cefepime with Pip/Taz and AKI
Cefepime vs Piperacillin-Tazobactam in Adults Hospitalized With Acute Infection: The ACORN Randomized Clinical Trial (Quian, JAMA 2023)
🤔 Glucose absorption drives cystogenesis in PKD
Glucose absorption drives cystogenesis in a human organoid-on-chip model of polycystic kidney disease (Li, Nature Communications 2023)
🤔 Ketogenic diets in ADPKD
Feasibility and impact of ketogenic dietary interventions in polycystic kidney disease: KETO-ADPKD-a randomized controlled trial (Cukoski, Cell Reports Medicine 2023)
🤔 GWAS in IgA Nephropathy
Genome-wide association analyses define pathogenic signaling pathways and prioritize drug targets for IgA nephropathy (Kiryluk, Nature Genetics 2023)
🤔 Sibeprenlimab in IgA Nephropathy
A Phase 2 Trial of Sibeprenlimab in Patients with IgA Nephropathy (Mathur, NEJM 2024)
🤔 Sparsentan in IgA Nephropathy
Efficacy and safety of sparsentan versus irbesartan in patients with IgA nephropathy (PROTECT): 2-year results from a randomised, active-controlled, phase 3 trial (Rovin, Lancet 2023)
🤔 Severe hypocalcemia with Denosumab in Dialysis
Severe Hypocalcemia With Denosumab Among Older Female Dialysis-Dependent Patients (JAMA 2024)