TheHeterogeneity in Blood Pressure Response to 4 Antihypertensive Drugs: A randomized clinical trial (Sundstrom, JAMA 2023)
🤔 Epo production in kidneys
The transcriptional and regulatory identity of erythropoietin producing cells (Kragesteen, Nature Medicine 2023)
🤔 Precision diagnostics of kidney allograft biopsies
An automated histological classification system for precision diagnostics of kidney allografts (Yoo, Nature Medicine 2023)
🤔 Screening for albuminuria is cost-effective
Population-Wide Screening for Chronic Kidney Disease: A Cost-Effectiveness Analysis (Cusick, Annals Int Med 2023)
🤔 RASi might be harmful in COVID
Effect of Angiotensin-Converting Enzyme Inhibitor and Angiotensin Receptor Blocker Initiation on Organ Support–Free Days in Patients Hospitalized With COVID-19 (REMAP-CAP Investigators, JAMA 2023)
🤔 RASi + diuretics better than RASi + CCB in CKD?
A nationwide cohort study comparing the effectiveness of diuretics and calcium channel blockers on top of renin-angiotensin system inhibitors on chronic kidney disease progression and mortality (Faucon, Kidney International 2023)
🤔 Improving Fatigue in Dialysis - The TACCare trial
Effects of Technology Assisted Stepped Collaborative Care Intervention to Improve Symptoms in Patients Undergoing Hemodialysis (Jhamb, JAMA Internal Medicine 2023)
🤔 Intradialytic exercise improves physical functioning
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)
Here We KDIGO Again: Lupus Nephritis 2024
New KDIGO guidelines since 2021, Lupus Nephritis is seeing lots of new therapeutics in the pipeline.
🤔 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)