Background
Brian Rifkin
Potassium Rollercoaster Heartbreak

This week, we will discuss the use of 3K dialysis bath with sodium zirconium cyclosilicate versus 2K bath and no potassium lowering medications in dialysis patients and the associated risk of arrhythmia.

Potassium Rollercoaster Heartbreak
Background
Jade Teakell
FLOZINATing to the Future- Long Term Effects of ...

This week, we will discuss post-trial follow-up for EMPA-Kidney. What are the longer-term effects of empagliflozin for patients with chronic kidney disease?

FLOZINATing to the Future- Long Term Effects of Empagliflozin in Patients with CKD
Background
Brian Rifkin
The Ondansetron Ballet: Torsades de Pointes

Nausea is a very common and distressing problem. Some medications that treat nausea carry a higher risk for arrhythmias, like Torsades de Pointes, and sudden cardiac death. Is ondansetron safe for use in patients on hemodialysis?

The Ondansetron Ballet: Torsades de Pointes
Background
Cristina Adriana Popa
Re”FINE”ing the role of non steroidal MRAs in ...

This week, we will discuss non-steroidal mineralocorticoid antagonist in the multiverse of cardiovascular-kidney-metabolic. What FINEHEART pooled analysis would add to what we already learned from FIDELIO-DKD trial?

Re”FINE”ing the role of non steroidal MRAs in Cardio Kidney Metabolic syndrome
Background
Cristina Adriana Popa
Playing It Safe: Can Felzartamab Fill the Gap ...

This week is time antibody mediated rejection treatment in kidney transplant. A new molecule targeting CD38, on the horizon, safely tested in a phase 2 trial

Playing It Safe: Can Felzartamab Fill the Gap in AMR Treatment?

✏️ 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

Here We KDIGO Again: Lupus Nephritis 2024

New KDIGO guidelines since 2021, Lupus Nephritis is seeing lots of new therapeutics in the pipeline.