Podcasts about ckd

Welcome to the Hot Topics podcast from NB Medical with Dr Neal Tucker. Lots going on in this new episode! Three new pieces of research and an interview with Dr Anna Martinez, consultant paediatric dermatologist at GOSH, talking about a skin fragility condition many of us may not have heard of before - epidermolysis bullosa - in conjunction with DEBRA, the leading charity for EB awareness and research. In research, we look at two papers published this week in finerenone. Does it have a role in CKD management in patients without diabetes, and if so, how good is it?Second, retatruide - the latest injectable weight loss medication making a splash across the headlines - could it be used as monotherapy for recent onset type 2 diabetes?ResourcesNB Medical Epidermolysis bullosa free online educational moduleDEBRANEJM Finerenone for CKDLancet Finerenone MALancet Retatrutide for early T2DMwww.nbmedical.com/podcast

Guest: John W. Ostrominski, MD, MPH Despite advances in glycemic management, blood pressure control, lipid lowering, and disease-modifying therapies, patients with chronic kidney disease (CKD) and type 2 diabetes continue to face substantial residual cardiovascular risk. In this program, Dr. John Ostrominski reviews emerging evidence linking low-grade systemic inflammation to adverse cardiovascular outcomes in this high-risk population, highlighting findings from the FIDELITY pooled analysis of FIDELIO-DKD and FIGARO-DKD. Dr. Ostrominski is a fellow specializing in cardiovascular disease and obesity medicine at Brigham and Women's Hospital and Harvard Medical School. He spoke about this topic at the 2026 American Diabetes Association Scientific Sessions.

In this powerful episode of Diary of a Kidney Warrior Podcast, host Dee Moore is joined by Rebecca Griffiths, who shares her extraordinary journey through kidney failure, dialysis, kidney transplantation and transplant loss.   Rebecca's story is one of resilience, determination and hope. After gaining approximately 25kg of fluid in a matter of days and requiring emergency treatment to drain fluid from around her heart, she found herself facing kidney failure without the support of a renal team. What followed was a life-changing journey that included dialysis, a kidney transplant, the devastating loss of that transplant and the challenge of starting again.   In this episode, Rebecca discusses:  

GFR is one of the most important kidney lab values to know for NP boards because it tells you how well the kidneys are functioning and helps determine chronic kidney disease staging. In this minisode, I break down the key GFR cutoffs, explain how to think of CKD stages as a simple ladder, and review the clinical decisions that often show up on exams, including medication adjustments, kidney protection strategies, and when dialysis becomes necessary.          Follow us on Instagram: instagram.com/smnpreviewsofficial

It's in the News! The top diabetes stories and headlines happening now. Top stories this week include: Afrezza inhaled Insulin is Approved for Kids, CGM + Ketone Monitor gets European approval, Food Coloring & Diabetes Study, Device Recalls include Omnipod and Dexcom, Beta Bionics shares more about their patch pump, ADA conference info and more! This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider. Announcing Community Commericals! Learn how to get your message on the show here. Learn more about studies and research at Thrivable here Please visit our Sponsors & Partners - they help make the show possible! Omnipod - Simplify Life All about Dexcom  All about VIVI Cap to protect your insulin from extreme temperatures The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  Episode transcripts: Welcome! I'm your host Stacey Simms and this is an In The News episode.. where we bring you the top diabetes stories and headlines happening now. A reminder that you can find the sources and links and a transcript and more info for every story mentioned here in the show notes. ADA starts this week – safe travels to those of you heading to New Orleans. We'll be covering remotely so please follow on social – make sure to Like the FB page or join the group. We've got a wrap up episode planned for this podcast as well as some indepth interviews with the newsmakers from the conference. I will see some of you next week in Chicago. We have a couple of seats left for our Club 1921 dinner on June 10th in Northbrook – this is a FREE dinner for HCPs and patient leaders – all about screening for T1D. More info on the website under the events tab. Okay.. our top story this week: XX Afrezza inhaled insulin is now approved for kids and teens. The FDA okayed MannKind's afrezza for children 6 and older with type 1 and type 2 diabetes. MannKind says its proprietary Technosphere drug delivery platform enables the rapid absorption of insulin into systemic circulation. This follows FDA approval earlier this year for an update that revises recommendations for the starting mealtime dosage when patients switch from subcutaneous mealtime insulin regimens. MannKind also completed enrollment in February for a study evaluating the initiation of Afrezza therapy shortly after type 1 diabetes diagnosis in pediatric patients.   The company said it made Afrezza available for eligible patients for $35 or less per month. Desmond Schatz, professor of pediatrics at the University of Florida College of Medicine, said: "Mealtime insulin can be especially challenging for children because eating and snacking patterns, activity levels, and daily settings like school and sports often vary. With its rapid onset and dosing at the start of a meal, Afrezza may help clinicians better match insulin therapy to how children and families live day to day, while offering a needle-free mealtime option." Lots more to come on this – we're working on a bonus episode with one of the pediatric endos who worked on the clinical trials that led to this approval – hopefully have that out later this week. https://www.massdevice.com/mannkind-fda-approval-inhaled-insulin-children/ XX FDA has agreed to consider a new drug for the treatment of adults with type 1 and chronic kidney disease. Finerenone (fy-near-uh-known) is currently approved in the US for adults with CKD associated with type 2 diabetes and for adults with heart failure with left ventricular ejection fraction of 40% or greater. Chronic kidney disease (CKD) is present in over one-third of adults with diabetes, and because it's such a serious condition, interventions are needed to reduce its incidence and help people live a long and prosperous life. https://www.docwirenews.com/post/fda-grants-priority-review-to-finerenone-snda-for-type-1-diabetes-associated-ckd XX Abbot gets European approval for the world's first dual glucose‑ketone sensing technology for people with diabetes. They're calling this Libre Duo and Libre Duo 10 Day, and it's designed to continuously measure glucose and ketone levels every minute. Abbott plans to begin launching Libre Duo systems in select European countries later this year. Libre Duo delivers up to 15 days of wear and will be offered to adults ages 18 and older. Libre Duo 10 Day offers up to 10 days of wear and is intended for people ages 2 and older. Abbott is also working with leading pump companies to allow automated insulin delivery (AID) systems to connect with the sensors. https://abbott.mediaroom.com/2026-05-27-Abbott-secures-CE-Mark-for-worlds-first-dual-glucose-ketone-sensing-technology-for-people-with-diabetes   XX Huge recall for Omnipod. Insulin says a manufacturing issue through ongoing product monitoring that could result in insulin under-delivery  with specific lots of its Omnipod 5, Dash and Eros pods. Insulet said the scope of this action reaches approximately 7 million pods. This issue is separate from the March recall that affected certain Omnipod 5 lots. According to the Acton, Massachusetts-based company, some of its affected pods may have a small tear in the tubing (cannula) just above the skin. This tear lands between the pod and the point where the cannula enters the body. If this occurs, insulin may leak outside of the device instead of being fully delivered into the body as intended. This may lead to under-delivery of the therapeutic.   Individuals using an affected pod may notice wetness on the skin or pod adhesive or detect the smell of insulin. However, some cases may prove difficult to detect and go unnoticed. Of the approximately 7 million pods included in the action, approximately 60% have been consumed or are expired. The pods affected by the correction represent approximately 8.5% of the 2025 global Omnipod pod prodcution. Insulet says it has sufficient supply to replace affected pods. It expects no disruption to product availability. The company said it has notified the FDA and all other relevant regulatory authorities of its action.   The full list of affected pod lots can be found here. https://www.massdevice.com/insulet-another-omnipod-5-recall-dash-eros/ XX Dexcom is warning that certain scrapped glucose sensors have been stolen and resold. Dexcom said it has not received any reports of severe adverse events associated with the stolen product. One lot of scrapped devices carries a risk of infection for sensors that are not properly sterilized, and another lot had an elevated internal testing failure rate, meaning users would have an increased risk of having no sensor readings available. Dexcom said the affected sensors were stolen during the destruction process and then sold by third parties. The company routinely scraps sensors that do not meet its standards. The sensors are sent to a third-party vendor for destruction and recycling.   Dexcom said it traced sales of the stolen devices to Pharmsource, which is not an authorized Dexcom distributor but supplies some independent pharmacies and U.S. durable medical equipment distributors. Because of this, pharmacies that purchase products from Pharmsource should review their inventory, Dexcom said.   People with sensors from the affected lots should not use those sensors and can call customer support to request replacements. Dexcom has set up a website to help users check if their devices are affected. https://www.medtechdive.com/news/dexcom-warns-of-scrapped-glucose-sensors-being-resold/821139/ XX XX   Beta Bionics plans to debut its first insulin patch pump by the end of the second quarter of 2027, subject to Food and Drug Administration clearance. The device, called Mint, would be compatible with Beta Bionics' interoperable automated glycemic controller, a software that allows for the pump to automatically adjust insulin delivery based on readings from a glucose sensor. Beta Bionics first unveiled the prototype for Mint last year at the American Diabetes Association's Scientific Sessions. The device is expected to have a similar size and wear time, at three days, to Insulet's patch pumps on the market. It would have a 200-unit insulin reservoir.   Mint differs by containing a mix of reusable and disposable components. Beta Bionics plans to make the device exclusively available in the pharmacy channel, building on its existing agreements for its current iLet insulin pump. Beta Bionics is one of several diabetes tech companies developing patch pumps to compete with market leader Insulet. Tandem Diabetes Care and Medtronic spinoff MiniMed have also announced planned patch pumps. Tandem said it plans to file a 510(k) submission this quarter for a tubeless version of its small, durable pump, and Medtronic plans to submit its patch pump to the FDA this fall.   https://www.medtechdive.com/news/beta-bionics-to-launch-its-first-insulin-patch-pump-to-compete-with-insulet/821091/ XX CVS puts Zepbound back on it's coverage list – with it's Caremark PBM. They also added Foundayo, Lilly's obesity pill. CVS had dropped Lilly's Zepound last summer but kept competitor Wegovy. It'll be back at Caremark October first. All three of the nation's largest pharmacy ⁠benefit managers ​now cover Lilly's full obesity medicine portfolio. https://www.reuters.com/legal/litigation/cvs-brings-back-coverage-lillys-obesity-drug-zepbound-2026-05-28/   More to come, including a new benefit from metformin for women, something new from Tidepool, big news for T1D in Austalia and more.. XX A new study suggests that higher long-term exposure to food colouring additives — including both synthetic and natural colourings commonly found in processed foods and beverages — may be associated with an increased risk of developing type 2 diabetes. Researchers analyzed data from more than 108,000 adults in the French NutriNet-Santé cohort between 2009 and 2023, following participants for a median of just over eight years. During that time, 1,131 participants developed type 2 diabetes. The study found that people with the highest intake of total food colouring additives had a 38% higher risk of developing type 2 diabetes compared with non- or low-consumers.   Several specific additives were linked to increased risk, including caramel colouring additives such as total caramel (E150 family), plain caramel (E150a), sulphite ammonia caramel (E150d), and beta-carotene (E160a). Additional associations were observed for curcumin (E100), anthocyanins (E163), paprika extract (E160c), lutein (E161b), and cochineal-derived colourings (E120). "Our findings revealed positive associations between widely consumed food colouring additives and type 2 diabetes incidence," the authors wrote, adding that further research is needed to better understand the mechanisms behind the findings and whether food colouring regulations should be reevaluated. https://www.medscape.com/viewarticle/use-common-food-colours-tied-high-type-2-diabetes-risk-2026a1000hes XX Big news for Australia – their Therapeutic Goods Administration (TGA) approves Tzield. Tzield is now approved in Australia to delay the onset of stage 3 (or clinical) T1D in people aged eight years and older with stage 2 T1D – the early, pre-symptomatic stage of the condition, where changes in blood glucose levels have begun but insulin therapy is not yet required. Breakthrough T1D Australia Chief Executive Officer, Sydney Yovic, said the approval represented a transformational moment for Australians affected by T1D. https://newshub.medianet.com.au/2026/05/landmark-approval-of-tzield-in-australia-ushers-in-a-new-era-of-delay-for-type-1-diabetes/155036/ XX https://www.theatlantic.com/health/2026/05/diabetes-pregnancy/687324/ XX A common diabetes drug may hold great potential to help with aging, even if scientists aren't exactly sure why. According to a study, the drug metformin doesn't just help patients to effectively manage their type 2 diabetes. it may also give older women a better chance of living to 90. Scientists in the US and Germany used data from a long-term US study of postmenopausal women.   Records for a total of 438 people were selected – half of whom took metformin to treat diabetes, and half of whom took a different diabetes drug, sulfonylurea.   While there are some caveats and asterisks to the study, those in the metformin group were calculated to have a 30 percent lower risk of dying before the age of 90 than those in the sulfonylurea group. The study used age 90 as the marker for 'exceptional' longevity. However, scientists aren't yet sure that the drug extends lifespan, especially in humans – which is part of the reason for this study. RCTs could follow further down the line to dig deeper into these results, the researchers suggest. In the meantime, as the global population continues to skew older, studies continue to find ways to keep us healthier for longer and reduce damage to the body as we age. https://www.sciencealert.com/a-common-diabetes-drug-is-linked-with-exceptional-longevity-in-women XX The American Diabetes Association® (ADA) will host the 2026 Scientific Sessions from June 5-8 in New Orleans. The ADA's Scientific Sessions is the world's largest diabetes meeting, convening an expected audience of over 12,000 leading physicians, scientists, researchers, and healthcare professionals from around the globe. The premier diabetes meeting, which is also offered virtually, will feature the latest scientific findings in diabetes and obesity, where leading experts and peers will share findings in research for prevention, care, and cures at the Ernest N. Morial Convention Center. Key themes will include: Advancing obesity and metabolic health: Prevention, early detection, and disease modification: Improving cardiometabolic outcomes: Transforming care through innovation and access: New research will highlight how technology, artificial intelligence, and implementation strategies are reshaping diabetes care—reducing treatment burden, expanding access, and enabling more person-centered care. Advancing beta cell replacement and cure strategies: Fostering innovation: On Saturday, June 6, from 4:30-6:00 p.m., the Innovation Challenge, which debuted in 2023, invites emerging companies to pitch novel ideas to improve the lives of people living with diabetes. A panel of judges, with input from a live audience, determines which contestants will earn a private audience with potential funders. XX Tidepool, the nonprofit leader advancing innovation in diabetes technology, announced that Tidepool+ Direct Connect is now available through the Epic Showroom. Built on SMART on FHIR, Direct Connect brings interactive diabetes device data directly into Epic workflows, helping clinicians use patient data during routine care. "Tidepool has always focused on making diabetes data more accessible and actionable," said Brandon Arbiter, CEO. "We're excited to empower clinicians using Epic with insightful, intuitive patient data that fits directly into their encounter workflow so they can use it to improve care in the moment it matters."   Tidepool+ Direct Connect supports scalable deployment across Epic-enabled health systems. This architecture enables faster, more intuitive rollouts, enhancing Tidepool's existing EHR integration capabilities.   Direct Connect is part of Tidepool's ongoing work to improve how clinicians can use timely and relevant diabetes device data during patient visits to help drive better health outcomes.   The feature is now available in the Connection Hub of the Epic Showroom.   https://www.businesswire.com/news/home/20260527780274/en/Tidepool-Launches-in-Epic-Showroom-to-Bring-Diabetes-Device-Data-into-the-Point-of-Care XX

What if we could cut hospitalizations nearly in half—before symptoms even show up? Kelly Constable, CEO of CloudCath, is making that a reality with a breakthrough remote monitoring platform that detects infections early for dialysis patients—replacing subjective, manual checks with continuous, data-driven insight at home. In this episode, Kelly shares how CloudCath is transforming chronic kidney disease (CKD) care by enabling earlier intervention, reducing hospitalizations, and helping patients stay out of the ER while preserving quality of life. She dives into the power of real-world data, the shift toward home-based and value-driven care, and why scalable, tech-enabled solutions are essential in the face of workforce shortages. We also explore the business of healthcare innovation—from building the right board and network to commercializing medtech and scaling adoption in complex ecosystems. Topics: remote patient monitoring, chronic kidney disease (CKD), home dialysis, early infection detection, digital health innovation, AI and data in healthcare, value-based care, medtech commercialization

Early detection of chronic kidney disease (CKD) means little if it does not lead to timely treatment, yet a significant gap persists between when CKD is found and when evidence-based therapies are started. That disconnect is the focus of the second episode of Beyond the Silo: Integrated Care Across the CRM Continuum, a podcast series from The American Journal of Managed Care®, in which Ralph Riello, PharmD, BCPS, leads a conversation with Nihar Desai, MD, MPH, on how to shift CKD care from a reactive, late-stage model to one that is proactive, pathway-driven, and equitable. The discussion builds on the first episode's focus on urine albumin-to-creatinine ratio underutilization, stipulating that screening has occurred and asking what must happen next. You can listen to the first episode here: https://www.ajmc.com/link/89943

https://www.patreon.com/highyieldfamilymedicineIntro (0:35),Definition and KDIGO Staging (1:47),Screening for CKD (4:30).Diabetic Nephropathy (6:22),Hypertensive Nephrosclerosis (8:17),Nephrotoxic Medications (9:53),Autosomal Dominant Polycystic Kidney Disease (12:07),IgA Nephropathy (14:06),Minimal Change Disease (15:06),FSGS (15:55),Membranous Nephropathy (16:26),Anemia of CKD (16:52),Mineral Bone Disorder (18:40),Hyperkalemia (21:11),Metabolic Acidosis (23:40),Volume Overload (25:25),Uremia (25:50),Renal Replacement Therapy (28:35),Practice Questions (31:43)

Today I want to show you what happens when we GET to do more as veterinary nurses and technicians. I'm very aware that, as primarily a referral RVN, there are differences in what I do in referral vs what I do when I work in GP. However, there's one thing that remains the same regardless of the clinic I'm working in that day - I still get to use my skills with medical patients. Internal medicine sounds fancy, but it just means 'medicine'. We all see medicine every day. I was nursing CKD patients, diabetics, dyspnoeic cats, dogs with diarrhoea, etc, WAY before I went into referral. So if you're thinking there's less you can do with your patients because you're in general practice, I want to challenge that thought today. In this episode, I don't just want to tell you what you can do, I want to SHOW you. And to do that, I'm bringing you the real in-clinic stories from the over 200 nurses and technicians that I've worked with inside the Medical Nursing Academy. Those nurses have all done things they should be incredibly proud of. They've helped their patients in new ways, they've changed their clinic culture, and they've indirectly helped the rest of their nursing team develop and cultivate their passions, too. It doesn't matter where you work - you can still use more of your skills and make even more of a difference to your patients, your clients, and your colleagues. So grab a cuppa and let's talk about how. --- Looking for medical nursing CPD?

Phosphate additives are commonly used in processed and convenience foods, yet many patients and healthcare professionals remain unaware of how significantly they contribute to phosphorus burden in chronic kidney disease (CKD). Elevated phosphorus levels can negatively impact bone, cardiovascular, and overall kidney health, making phosphorus management an important aspect of kidney care. In this episode of Kidney Commute, an interprofessional panel featuring a nephrologist, dietitian, policy expert, and patient advocate discusses the clinical impact of phosphate additives, the differences between naturally occurring phosphorus and additive-based phosphorus, and the practical challenges patients face when trying to identify hidden phosphorus sources in foods and medications. The discussion also explores socioeconomic barriers, food labeling limitations, and ongoing policy and advocacy efforts aimed at improving phosphorus transparency and patient education. Listeners will gain practical strategies and insights to better support phosphorus management in clinical practice and daily life.

Welcome to another episode of Diary of a Kidney Warrior Podcast. In this powerful Kidney Warrior Story episode, host Dee Moore is joined by Johanna, who shares her lifelong journey living with Chronic Kidney Disease (CKD). Diagnosed as a young child after years of unexplained symptoms, Johanna opens up about growing up with kidney disease, navigating dialysis, experiencing transplant loss, and undergoing multiple kidney transplants. She speaks honestly about the physical and emotional realities of living with CKD for decades, including the uncertainty that comes with transplantation and the challenges of returning to dialysis. Johanna also shares the impact kidney disease has had on her mental wellbeing, family life, pregnancy, identity, and future plans. Throughout the conversation, she highlights the importance of resilience, support, advocacy, and finding joy in life despite the ongoing challenges of chronic illness. This episode is an honest and deeply moving insight into the realities of long-term kidney disease and the strength it takes to keep moving forward through every stage of the journey. In this episode, Johanna discusses: Being diagnosed with kidney disease as a child Growing up with CKD The symptoms that led to diagnosis Starting dialysis Receiving her first kidney transplant The emotional impact of transplant loss Returning to dialysis Undergoing further kidney transplants Pregnancy after transplantation The uncertainty of living with CKD Mental health and emotional resilience Finding hope whilst living with chronic illness If you are living with kidney disease, supporting someone who is, or want to better understand the realities of CKD, this episode is not to be missed.

Building on the concepts introduced in the previous episode Rethinking the Design and Conduct of Kidney Trials, this episode explores how innovative ideas in nephrology research can be translated into practical trial strategies. Experts discuss novel approaches to trial design, evolving endpoint selection, and the importance of engaging patients, clinicians, regulators, and other stakeholders throughout the research process. Drawing on insights from the ISN Consensus Meeting on Changing Paradigms of Studies in CKD (Vancouver, Nov 22-23, 2024), the discussion highlights how more pragmatic and implementation-focused trials can help generate evidence that is meaningful for clinical practice and patient care worldwide. Speakers Adeera Levin Professor of Medicine, University of British Columbia, Canada, and Past-President of the International Society of Nephrology (ISN). Dr. Levin is a global leader in kidney health research, with extensive experience in chronic kidney disease (CKD) management, clinical trials, and international health system strengthening. David Wheeler Professor of Kidney Medicine at University College London, UK and Honorary Consultant Nephrologist at the Royal Free Hospital. His research focuses on the management of chronic kidney disease and the evaluation of therapies through large-scale clinical trials. He was co-principal investigator of the landmark DAPA-CKD trial and served as Co-Chair of KDIGO from 2012–2019.  Kevin Weinfurt Professor and Vice Chair of Faculty, Department of Population Health Sciences, Duke University School of Medicine, USA. Dr. Weinfurt is a behavioural scientist specializing in patient-reported outcomes (PROMs), ethical aspects of research participation, and improving the relevance of clinical trials to patients lived experiences. Hiddo J. Lambers Heerspink Professor of Clinical Trials and Personalized Medicine, University Medical Center Groningen, The Netherlands. Dr. Heerspink's work bridges pharmacology, nephrology, and precision medicine, focusing on optimizing kidney and cardiovascular outcomes through innovative clinical trial design and biomarker discovery. To read more, explore the related paper Changing Paradigms of Studies in Kidney Diseases published in Kidney International. 

In today’s VETgirl online veterinary continuing education podcast, Dr. Ragen T.S. McGowan, Pet Behaviorist at Purina, discusses how veterinarians and pet owners can use at-home pet tech like activity trackers and litter box analytics to detect early signs of diseases such as CKD and arthritis. She highlights real examples, client engagement strategies, realistic device expectations, and the promising future of smart pet technology in veterinary care.Sponsored By: Purina

Welcome to the Hot Topics podcast from NB Medical with Dr Neal Tucker. More new research to discuss for the world of general practice.First, which antibiotic is actually best for managing uncomplicated UTI - is UK guidance offering the best choice to women?Second, are you using the Kidney Failure Risk Equation in your patients with CKD? New research on how your risk of death may be much more important than your risk of end-stage renal disease.Finally, does empathy work in telephone consultations, and can it improve important hard outcomes such as symptom control?ReferencesLancet Abx for UTIBJGP Kidney Failure Risk Equation, Death and ESRDKidneyfailurerisk.co.ukBJGP Empathy and the telephoneCARE measurewww.nbmedical.com/podcast

We have only recently become aware of the close relationship between the heart and the kidneys. In today's discussion, Dr. Neil Skolnik speaks with Dr. Josephine Harrington to gain insight into these newly-discovered links between cardiovascular risk and CKD. This special episode is sponsored with support from Bayer. Please listen to the episodes by clicking on the podcast player below or by freely subscribing to Diabetes Core Update via Apple Podcasts, Amazon Music, Spotify, or your preferred podcast platform. Presented by: -Neil Skolnik, MD, Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health -Josephine Harrington, M.D., Assistant Professor of Medicine in the Division of Cardiology at the University of Colorado School of Medicine. Selected references: -Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026. The American Diabetes Association's Standards of Care 2026, Diabetes Care 2026;49 (Supplement_1):S246–S260 -Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes. N Engl J Med 2020;383:2219-2229 -Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med 2020;383:1436-1446 -Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes. N Engl J Med 2024;391:109-121

Anemia in chronic kidney disease remains common, complex, and rapidly evolving. In this episode, experts discuss key updates from the 2026 KDIGO Clinical Practice Guidelines and AJKD commentary, including a stronger focus on identifying and treating iron deficiency and refining treatment strategies. The conversation explores the clinical impact of anemia on cardiovascular risk and quality of life, reviews evidence supporting proactive IV iron use, and examines emerging therapies such as HIF stabilizers. The panel also addresses real world challenges in managing anemia, particularly in non dialysis CKD populations, where access, adherence, and care coordination play a critical role. This episode provides practical insights to support individualized, evidence based anemia care. Please click here to access the commentary.

Chronic kidney disease (CKD) affects an estimated 37 million Americans, yet most cases go undiagnosed until the disease has significantly progressed. A urine albumin-to-creatinine ratio (uACR) test can detect kidney damage years before a decline in the estimated glomerular filtration rate (eGFR), but it remains underutilized. In the first episode of Beyond the Silo: Integrated Care Across the CRM Continuum, a podcast series from The American Journal of Managed Care®, Marc P. Bonaca, MD, MPH, moderates a discussion with Josephine Harrington, MD, on why uACR has not yet become a standard of care, how CKD fits into the broader cardio-renal-metabolic (CRM) disease continuum, and what changes are needed across specialties, systems, and workflows. Bonaca is a cardiologist and vascular medicine specialist at the University of Colorado Anschutz and the executive director of CPC Clinical Research. Harrington is also a cardiologist, specializing in advanced heart failure and transplant cardiology at UCHealth's Heart and Vascular Center at the University of Colorado Hospital. Throughout the conversation, they emphasize that CKD is an early integral part of the CRM continuum, as it is both a driver and consequence of cardiovascular risk, with uACR elevation often appearing before eGFR decline and signaling increased risk even at mild levels. Despite strong guideline support, uACR screening remains underused due to structural barriers. Therefore, the experts explained that the primary barrier is not the test itself but the lack of streamlined workflows that make screening routine and results actionable without adding clinician burden. They concluded that early detection is critical because it enables the timely use of therapies such as SGLT2 inhibitors, glucagon-like peptide-1 receptor agonists, and finerenone, which improve outcomes. To close the gap, the experts noted that uACR should be treated as a routine vital sign for cardiometabolic risk and embedded into health system quality metrics to ensure consistent, accountable use.

This podcast discusses a post hoc analysis of the STOP-ACEi trial, examining whether baseline loop diuretic use modifies the effect of Renin–Angiotensin System Inhibitors in advanced CKD.

Guest: Deborah Clegg, PhD For decades, potassium restriction has been a cornerstone of dietary management in patients with chronic kidney disease (CKD), but is it always necessary? Here to answer that exact question is Dr. Deborah Clegg. Since many patients may already be consuming potassium at restricted levels, she emphasizes the importance of individualized dietary assessment before imposing further limitations. Dr. Clegg is the Vice President for Research and a Professor in the Department of Internal Medicine at Texas Tech University Health Sciences Center in El Paso.

Guest: Deborah Clegg, PhD Not all potassium is created equal, especially in the context of chronic kidney disease (CKD). That's why Dr. Deborah Clegg joins us to explore the key differences between potassium from whole foods and additives, emphasizing how bioavailability impacts serum potassium levels and hyperkalemia risk. She also examines how kidney function, comorbidities, medications, and metabolic factors all influence potassium tolerance. Not only is Dr. Clegg the Vice President for Research and a Professor in the Department of Internal Medicine at Texas Tech University Health Sciences Center in El Paso, but she also spoke about this topic at the 2026 National Kidney Foundation Spring Clinical Meeting.

Guest: Jeanette Andrade, PhD, RDN, LDN, FAND Food and nutrition insecurity in chronic kidney disease (CKD) can be difficult to detect, even when patients appear clinically stable. To help highlight this challenge, Dr. Jeanette Andrade presents a case from her research illustrating how social and financial stressors affected a dialysis patient's dietary intake and food access. Dr. Andrade is an Associate Professor and the Director of the Master's in Dietetic Internship Program at the University of Florida, and this patient case was part of her presentation at the 2026 National Kidney Foundation Spring Clinical Meeting.

Guest: Jeanette Andrade, PhD, RDN, LDN, FAND Food and nutrition insecurity are increasingly recognized as critical factors affecting outcomes for patients with chronic kidney disease (CKD). That's why Dr. Jeanette Andrade joins us to share practical screening strategies and emerging solutions, like dialysis center food pantries and digital health tools. Dr. Andrade is an Associate Professor and the Director of the Master's in Dietetic Internship Program at the University of Florida, and she spoke about this topic at the 2026 National Kidney Foundation Spring Clinical Meeting.

BP Lowering in CKD: Consistent. Comprehensive. Compelling.

Kidney care rarely takes center stage in Congress, but a recent hearing is bringing renewed attention to prevention, innovation, and patient access. In this episode, host Raphy Rosen is joined by Dr. Suzanne Watnick, who testified as a witness at the March 18 Ways and Means Health Subcommittee hearing, along with Dr. Dan Weiner. Together, they unpack key themes across CKD, dialysis, and transplantation, and explore what emerging legislative efforts could mean for patients and providers. Tune in for an inside look at how kidney care is shaping national health policy.

Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!In this episode of Diabetes Dialogue, recorded on-site at the American Association of Clinical Endocrinology (AACE) Annual Meeting 2026 in Las Vegas, Nevada, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, welcome Viral Shah, MD, professor of endocrinology at Indiana University, for a discussion centered on the evolving role of GLP-1 receptor agonists and broader diabetes classification in type 1 diabetes care. Shah challenges the traditional distinction between type 1 and type 2 diabetes, emphasizing that type 2 diabetes lacks a definitive diagnostic test and is instead a diagnosis of exclusion based on phenotypic characteristics. He explains that patients with type 1 diabetes can also exhibit features of type 2 diabetes, making these categories non–mutually exclusive and supporting the rationale for dual diagnoses when clinically appropriate.The group explores how this framework informs the use of GLP-1 receptor agonists in type 1 diabetes, particularly for patients with obesity, cardiovascular disease, heart failure, or chronic kidney disease. Shah notes that while obesity provides a clear indication for GLP-1 therapy, he is also comfortable using these agents in patients with lower BMI when cardiovascular or renal protection is the primary goal, with careful attention to dose adjustment and avoidance of excessive weight loss or muscle mass reduction. He adds that SGLT2 inhibitors may be preferable in some leaner patients, particularly when renal indications predominate, and highlights recent clarification that SGLT2 inhibitor use for CKD in type 1 diabetes is not considered off-label when prescribed for kidney protection rather than glycemic control.The conversation then shifts to Shah's broader view that type 1 and type 2 diabetes differ more in pathophysiology than in long-term disease course. He argues that both conditions share progressive beta cell dysfunction and overlapping complication risks, suggesting the field should move away from rigid separation and toward a more unified understanding of diabetes progression.This perspective leads into a discussion of “prediabetes,” a term Shah critiques as outdated and insufficient. He reviews its historical origins as a label for intermediate hyperglycemia and argues that it has unintentionally minimized urgency by framing the condition as merely a risk factor rather than part of the disease continuum. Citing evidence of significantly elevated cardiovascular, kidney, and mortality risk in people with prediabetes, he advocates for staging type 2 diabetes similarly to type 1 diabetes, rather than maintaining an artificial threshold between “no disease” and diabetes. He notes that while therapies such as metformin, semaglutide, and tirzepatide have demonstrated benefit in delaying progression, regulatory limitations persist because prediabetes is not formally recognized as a disease state.The episode concludes with a discussion of autoantibody screening in adults labeled with prediabetes. Shah supports broader antibody testing, particularly in younger adults, to identify individuals with early-stage type 1 diabetes who may otherwise be misclassified and present later with DKA. He emphasizes that accessible antibody testing and therapies such as teplizumab make earlier identification increasingly meaningful, while also acknowledging the importance of patient preference and individualized decision-making. Across the discussion, Shah calls for greater flexibility in diabetes classification, earlier intervention across the disease spectrum, and a more proactive approach to preventing complications rather than waiting for traditional diagnostic thresholds to be crossed.

Please visit answersincme.com/860/101064703-replay to participate, download slides and supporting materials, complete the post test, and get a certificate. Presented by Muthiah Vaduganathan, MD, MPH and Nosheen Reza, MD, MS. In this activity, experts in cardio-kidney-metabolic syndrome (CKM) discuss emerging evidence on nonsteroidal mineralocorticoid receptor antagonists (nsMRAs) and practical strategies for incorporating these therapies into care for patients with heart failure, with or without chronic kidney disease (CKD) or type 2 diabetes (T2D). Upon completion of this activity, participants should be better able to: Specify the rationale for nonsteroidal mineralocorticoid receptor antagonists (nsMRAs) as treatment for adult patients with HF, with or without CKD or T2D; Differentiate the risk-benefit profiles between nsMRAs and the current standard of care for the treatment of HFmrEF or HFpEF, based on the available evidence; and Recommend patient-centered, long-term care strategies to integrate nsMRAs into clinical practice for patients with HF, with or without overlapping CKD or T2D.

In this episode of the RCP Medicine Podcast, Professor Jeremy Levy, consultant nephrologist in London, joins Dr Alex Crowe, consultant physician in Liverpool, for an insightful and practical conversation about chronic kidney disease (CKD). Together, they explore why CKD is so common, and often silent. How to distinguish acute from chronic kidney problems, and which investigations matter most.The discussion also highlights the growing importance of cardiorenal metabolic medicine, offering clinicians a clear approach to assessing risk, optimising treatment, and supporting long‑term health. From EGFR trends to SGLT2 inhibitors, from lifestyle change to coding accuracy, this episode provides an essential, up‑to‑date guide for managing CKD in everyday practice.Resources For kidney sake podcast:  Home | ForKidneysSake.com Excellent resources on CKD here from NHS NW London:  Chronic kidney diseaseNICE guidelines: Overview | Chronic kidney disease: assessment and management | Guidance | NICE Hypertension in CKD from UK kidney association  FINAL UKKA NICE-KDIGO commentary December 2022.pdfExercise and Lifestyle in CKD from UK kidney association   Exercise and Lifestyle in CKD clinical practice guideline33_v4_FINAL_0.pdf SGLT2i in CKD  from UK kidney association  Sodium Glucose Co transporter 2 - UK Kidney Association.KDIGO (international) guidelines on CKD management   CKD Evaluation and Management – KDIGOKIDGO prognosis of CKD by Albuminuria Categories: KIDGO 2012 S126American Diabetes Association guidelines including CKD   Volume 48 Issue Supplement_1 | Diabetes Care | American Diabetes AssociationFor Kidneys SakeFor Kidneys Sake is a clinician-led podcast from Imperial College Healthcare NHS Trust and North West London Integrated Care Board, offering practical, evidence-based insight into chronic kidney disease and cardio-renal care. Through short, accessible conversations with experts across primary and secondary care, the series supports shared learning on CKD detection, risk management and integrated patient care. The podcast is for GPs, pharmacists, nurses and multidisciplinary teams, and is relevant for clinicians, patients and anyone interested in improving kidney health.Explore our CPD portfolio by your career stageRCP | Education and professional developmentRCP LinksEducationRCP Social MediaInstagramLinkedInFacebookBlueskyMusic Episode 50 onward - Bensound.com  Episodes 1 - 49 'Impressive Deals' - Nicolai Heidlas Any adverts within this podcast may use computer generated voices

What does the difference a year make? Less than a year ago, Cam was in hospital — so unwell that he didn't want his children to see him. Now… he's preparing to run a marathon and attempt a world record. In this powerful episode of Diary of a Kidney Warrior Podcast, Cam shares his journey from a seemingly minor ear infection… to crashing into emergency dialysis with no warning, no preparation, and his life turned upside down overnight.   This is a story about shock, survival, and what it really takes to rebuild your life after a diagnosis you never saw coming.  

Dalam Keluar Sekejap Episod 193, perbincangan tertumpu kepada konflik yang semakin memuncak antara AS–Israel dan Iran, serta implikasi geopolitik dan ekonomi yang mungkin dirasai oleh Malaysia.Turut disentuh ialah kontroversi melibatkan ahli perniagaan Victor Chin, yang mendakwa kewujudan rangkaian “mafia korporat” berkait urusan NexG Bhd, termasuk dakwaan tentang seorang perantara dikenali sebagai “Mr R” yang dikaitkan dengan pembayaran RM9.5 juta.Selain itu, episod ini membincangkan laporan mengenai BYD yang didakwa menilai semula rancangan membuka kilang pemasangan CKD di Tanjong Malim, susulan syarat yang dikatakan dikenakan oleh MITI, walaupun kementerian tersebut telah menafikan dakwaan berkenaan.Episod ini juga menyentuh insiden kemalangan maut akibat pemandu mabuk di Klang, yang meragut nyawa Amirul Hafiz Omar (33), seorang bapa kepada tiga orang anak, dan kembali mencetuskan perbahasan tentang penguatkuasaan serta keselamatan jalan raya.Ingin jenama anda dikenali oleh ribuan pendengar?Taja episod Keluar Sekejap 2026!Hubungi +6011-1919 1783 atau emel commercial@ksmedia.my

Please visit answersincme.com/FGV860 to participate, download slides and supporting materials, complete the post test, and get a certificate. Presented by Janet B. McGill, MD, MA, FACP, MACE. In this activity, an expert in the management of diabetes discusses evolving data on emerging strategies to enhance cardiorenal outcomes in patients with type 1 diabetes (T1D). Upon completion of this activity, participants should be better able to: Review the limitations of current treatment strategies for chronic kidney disease (CKD) in type 1 diabetes (T1D); Identify the pathophysiologic mechanisms underlying CKD in patients with T1D; and Assess current and emerging treatment strategies for their potential to improve cardiorenal outcomes in patients with T1D.

CME credits: 0.25 Valid until: 31-03-2027 Claim your CME credit at https://reachmd.com/programs/cme/stuck-on-antihistamines-for-managing-patients-with-ckd-ap-time-to-reconsider/37607/ Despite effective and recommended therapies, many healthcare providers still consider antihistamines as the first-choice treatment for CKD-associated pruritus. Join Drs. Antoine Lanot and Gil Yosipovitch as they review a clinical patient case from a multidisciplinary perspective and consider best practices for the diagnosis, treatment, and management of CKD-aP.=

What is it like to be diagnosed with polycystic kidney disease (PKD) at just 10 years old—and to know it runs through your family?   In this powerful episode of Diary of a Kidney Warrior Podcast, Dee Moore speaks with Natasja about her lived experience of PKD, a hereditary kidney condition that has affected multiple generations of her family.   From her great-grandmother to her mother and beyond, kidney disease is not just part of Natasja's story, it's part of her family history.   In this honest and deeply personal conversation, Natasja shares what it's like growing up with chronic kidney disease (CKD), navigating the emotional and physical realities of a lifelong condition, and facing serious complications along the way.   In this episode, we cover: What polycystic kidney disease (PKD) is Being diagnosed with kidney disease at a young age The impact of hereditary kidney disease across generations Living with chronic kidney disease (CKD) Navigating serious health complications Finding strength through lived experience   ⚠️ Content note: This episode includes discussion of serious complications related to kidney disease that some listeners may find difficult.   This episode is a powerful reminder that behind every diagnosis is a real story, one of resilience, strength, and lived experience.   Follow Diary of a Kidney Warrior:  

If you have chronic kidney disease, you've probably been told to cut out potassium, avoid phosphorus-rich foods, and brace for dialysis. But what if most of that advice is outdated and the foods you've been avoiding are actually the ones that could protect your kidneys?In this episode, you'll hear from Jen Hernandez RDN, CSR, LDN, who makes the case that the most powerful thing people with CKD can do isn't eliminate more foods, but stop fearing the ones that were never the problem to begin with.Connect with Destiny:  Instagram / Facebook______________________________

Hosted by Dr. Sam Kant, this Kidney Commute: Pit Stop episode explores the Cerebronephrology region of NephMadness 2026 and the emerging concept of the brain–kidney axis. Drs. David Drew and Colton Jensen examine how chronic kidney disease and ESKD with dialysis contribute to cognitive impairment—an underrecognized complication affecting a large proportion of patients. From early microvascular injury, albuminuria, and hypertension in CKD to cerebral hypoperfusion, ischemia, and structural brain changes during dialysis, this discussion highlights the bidirectional relationship between kidney and brain health. Join us as we unpack where brain injury begins and what this means for earlier recognition and improved patient care.

Good morning from Pharma Daily: the podcast that brings you the most important developments in the pharmaceutical and biotech world. Today, we delve into the transformative landscape of the pharmaceutical and biotechnology sectors, where scientific innovation, regulatory progression, and strategic adjustments define the industry's current trajectory.A significant spotlight is on Bayer's recent clinical success with Kerendia (finerenone) in treating non-diabetic chronic kidney disease (CKD). Previously approved for CKD linked with type 2 diabetes, the positive outcomes from the FIND-CKD study suggest an expanded therapeutic scope for Kerendia. This advancement not only enhances Bayer's foothold in nephrology but provides a potential new treatment avenue for millions suffering from CKD without diabetes, underscoring the urgent global need to address this chronic condition effectively.In parallel, Eli Lilly's promising Phase 3 trial results for Ebglyss, an IL-13 inhibitor intended for atopic dermatitis in children, signal a potential expansion of treatment options for younger patients. Atopic dermatitis can severely impact quality of life, and Lilly's progress illustrates a broader industry commitment to fulfilling unmet medical needs across various patient groups.Turning to regulatory achievements, AstraZeneca's Imfinzi has secured European Union approval for perioperative use in gastric cancer treatment. This development underscores a growing regulatory momentum favoring oncology therapies and highlights an increasing emphasis on perioperative cancer care. Such advancements are crucial as they aim to improve surgical outcomes and enhance long-term survival rates for cancer patients.The industry is also navigating significant challenges as major drug patents approach expiration in 2026. The looming end of exclusivity spells increased competition from generics and presses companies to innovate or optimize mature product portfolios. This situation necessitates strategic agility as firms endeavor to sustain revenue streams amid pricing pressures.In a legal context, Johnson & Johnson has filed a lawsuit against a former oncology employee now associated with Summit Therapeutics, alleging theft of trade secrets. This case highlights the intense competitive nature within biopharma and the critical importance of protecting intellectual property in a fiercely contested market.Meanwhile, Structure Therapeutics has reported compelling phase results for aleniglipron, an oral GLP-1 drug candidate achieving a 16% weight loss efficacy. This positions aleniglipron as a strong player in obesity management innovations, showcasing ongoing advancements in metabolic disease treatment strategies. The drug demonstrated significant weight loss results over 44 weeks in Phase 2 trials, setting the stage for further program launches this year and suggesting potential competition with industry leaders like Novo Nordisk and Eli Lilly by offering less invasive therapy alternatives.BioMarin's reassessment of its clinical strategies for Voxzogo studies reflects mounting competition in treating achondroplasia. This move illustrates broader industry challenges where companies must balance development priorities against competitive pressures effectively. However, BioMarin has faced setbacks after temporarily halting dosing and enrollment in two studies of its growth-related drug Voxzogo due to safety concerns following hip injury reports. This development emphasizes vigilance in monitoring drug safety profiles during trials within competitive therapeutic areas.Amazon's intriguing entry into healthcare with its AI health agent marks a potential revolution in patient engagement by delivering personalized health insights and enhancing access to healthcare professionals. This convergence of technology and healthcare bears significant implications for future patient care delivery models.RegulatSupport the show

GLP-1 medications are being talked about everywhere right now — but what do they mean for people living with chronic kidney disease and dialysis?   In Part 2 of this two-part series, we focus on GLP-1 receptor agonists, how these medications work, and what kidney patients need to understand when considering weight loss treatments in the context of kidney transplant eligibility.   For many people living with chronic kidney disease (CKD), weight can influence access to transplant surgery. But navigating weight loss while on dialysis is complex, and treatments like GLP-1 medications should always be considered with specialist guidance.   In this episode of the Diary of a Kidney Warrior Podcast, host Dee Moore is joined by Dr Adrian Brown, Associate Professor in Nutrition and Dietetics, NIHR Advanced Fellow, and Senior Specialist Weight-Management and Bariatric Dietitian.   Together they explore:   • What GLP-1 receptor agonists are and how they work • Why these medications must never be used without medical supervision • The risks of buying weight-loss treatments online • How GLP-1 medications may be considered for some kidney patients • Why conversations about weight and transplant eligibility are often more complex than people realise   This episode highlights the importance of evidence-based information, patient safety, and open conversations between patients and their renal teams.   ⚠️ This episode is for educational purposes only and does not replace personalised medical advice. Always speak with your healthcare team about your individual circumstances.  

In this special edition on Obesity as a Chronic Disease our host, Dr. Neil Skolnik will discuss epidemiology, pathophysiology and screening for CKD in People with Diabetes. This special episode is supported by an independent educational grant from Bayer. Presented by: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health Holly Kramer, M.D., Professor of Public Health Sciences and Medicine in the Division of Nephrology and Hypertension at Loyola University Chicago, past-president of the National Kidney Foundation, Editor-in-Chief of the National Kidney Foundation's journal,  Advances in Kidney Disease and Health (AKDH).   Selected references: Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026 . The American Diabetes Association's Standards of Care 2026, Diabetes Care 2026;49 (Supplement_1) :S246–S260  

 In this episode, Dr. Annoushka Ranaraja  discusses the relationship between Chronic Kidney Disease and osteoporosis based on a case study of a 68 yo female with CKD who sustained a pelvic fracture. Link: https://pmc.ncbi.nlm.nih.gov/articles/PMC7555655/ Want to make sure you stay up to date in all things Geriatrics in less than 3 minutes every other week? Join thousands of others in our free MMOA Digest Email list - https://institute-of-clinical-excellence.kit.com/a3837f54b7

Wann sollte man in der Hausarztpraxis an eine chronische Nierenkrankheit (CKD) denken – und warum sagt die eGFR allein wenig über den Nierenzustand aus? Mit Prof. Dr. med. Jean-François Chenot sprechen wir über die wichtigsten Parameter zur Risikoeinschätzung, aktuelle Studien und ein pragmatisches Vorgehen im Praxisalltag. Eine Podcast-Folge für alle, die CKD schnell und sicher einordnen möchten.

Episode 213: HIV PrEP Review H. Nicole Magaña, medical student, reviews the history of PrEP and outlines the currently FDA-approved medications used for HIV prevention. Dr. Arreaza provides additional perspective on long-acting injectable options, including how quickly they begin to protect patients after initiation.   Written by Nicole Magana, MSIV, American University of the Caribbean. Comments and edits by Hector Arreaza, MD. You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice. Pre-exposure prophylaxis for HIV. Previous episodes related to HIV:  -Episode 67, HIV history (September 2021) -Episode 68, HIV transmissibility (October 2021) -Episode 70 (October 2021), HIV prevention (including HIV Prep with oral medications) -Episode 98 (June 2022), we introduced Apretude, the first injectable for HIV PrEP. Apretude was approved in December 2021.  What is Pre-Exposure prophylaxis (PrEP)? Pre-exposure prophylaxis, or PrEP, is the use of antiretroviral medications taken by individuals who are HIV-negative to prevent HIV acquisition. There are 30,000 new HIV infections annually in the US.  How effective is it? When taken as prescribed, PrEP is highly effective at reducing the risk of HIV transmission through sexual exposure and injection drug use. Patients who are adherent to PrEP can lower their risk of contracting HIV by 99%. The effectiveness of oral PrEP is highly adherence dependent. In trials with 70% adherence, the relative risk of HIV acquisition was 0.27, compared to 0.51 with 40-70% adherence and no significant benefit with adherence ≤40%. How does PrEP work? PrEP works by maintaining therapeutic drug levels in the bloodstream and in target tissues. If HIV exposure occurs, viral replication is inhibited, preventing the establishment of infection. Brief History of PrEP. The concept of PrEP originated from early animal studies demonstrating that antiretroviral medications could prevent retroviral transmission when administered before exposure. In 2010, the iPrEx trial showed that daily oral tenofovir disoproxil fumarate (known as Truvada) with emtricitabine significantly reduced HIV acquisition among men who have sex with men and transgender women. This was the first large clinical trial to demonstrate the effectiveness of PrEP. In 2012, the FDA approved oral Truvada, which is TDF/FTC (tenofovir disoproxil and emtricitabine) for HIV prevention. Since then, additional studies have expanded indications and introduced new formulations, including long-acting injectable options. Who Should Be Offered PrEP? PrEP should be considered for any HIV-negative individual at increased risk of HIV acquisition, including Men who have sex with men, transgender individuals, heterosexual men and women with an HIV-positive partner, individuals with recent bacterial sexually transmitted infections, people who inject drugs, individuals engaging in condomless sex with partners of unknown HIV status. Remember that PrEP should be offered in a nonjudgmental, patient-centered manner, make it a safe space to talk openly about prevention of HIV.  Available HIV PrEP Options. Daily Oral PrEP: There are 2 formulations of Tenofovir. There is Tenofovir disoproxil fumarate (TDF)/ Truvada and Tenofovir alafenamide (TAF)/ Descovy. Each is available in a tablet combined with Emtricitabine a nucleoside reverse transcriptase inhibitor. Truvada: It is approved for all populations at risk through sexual exposure or injection drug use. Something to look out for before starting this medication is for pre-existing CKD. Do not give to patients who have an estimated glomerular filtration rate of less than 60 mL/min. (6) Descovy: This option is approved for men who have sex with men and transgender women but is not approved for individuals at risk through receptive vaginal sex. It has less impact on renal function and bone mineral density compared to Truvada. It can be used in moderately reduced kidney function (GFR between 30-60 mL/min). Truvada and Descovy are taken orally once a day.  After patients start taking these medications, when are they considered to be protected?  Nicole: With daily oral PrEP, guidelines differ with WHO and International Aids Society-USA stating it takes about 7 days, while CDC states 21 days to allow for adequate concentration in tissues (1). Adherence is critical for efficacy. Injectable HIV PrEP. In 2021, the FDA approved the first Injectable PrEP option Long-acting cabotegravir (CAB-LA)- known on the market as Apretude. Cabotegravir is an integrase strand transfer inhibitor administered as an intramuscular injection.Dosing consists of an initial injection, a second injection one month later, and then maintenance injections every two months (1). Another option is Lenacapavir (Yeztugo). The Yeztugo as a pre-exposure prophylaxis (PrEP) for HIV in Oct 2024. Yeztugo is the first and only FDA-approved HIV prevention treatment that requires just two injections per year, offering a long-acting option for people who weigh at least 35kg. It is given as 2 injections every 6 months. First dose is given with 2 tablets on Day 1 and Day 2, then every 6 months 2 injections on the same day. Clinical trials, including HPTN 083 and HPTN 084, demonstrated that injectable cabotegravir is superior to daily oral PrEP in preventing HIV infection. This advantage is largely due to improved adherence rather than differences in intrinsic drug potency. There have been no head-to-head comparisons between Yeztugo and Apretude, but they are both very effective. Apretude starts protecting 7 days after the first dose, and Yeztugo starts protecting 2 hours after Day 2 (if patient takes the oral loading dose) or 3-4 weeks if no oral load is taken. Injectable PrEP is particularly beneficial for patients who struggle with daily pill adherence, have trouble swallowing pills, prefer a discreet option, have difficulty storing their medication or have renal or bone disease that limits the use of tenofovir-based regimens like Truvada and Descovy (6). In one unpublished report by Medline, patients who received Apretude had an increase in bone mineral density compared to those who received Truvada (1). Tests prior to starting PrEP. Before initiating PrEP, patients must be confirmed to be HIV-negative. Baseline evaluation includes HIV testing with a fourth-generation antigen/antibody assay, HIV RNA testing if acute infection is suspected, renal function testing for oral PrEP, Hepatitis B screening, sexually transmitted infection screening, and pregnancy testing when appropriate. PrEP should not be started in individuals with known or suspected acute HIV infection. Monitoring for patients on HIV PrEP. Monitoring typically includes HIV testing every 2 to 3 months, STI screening every 3 to 6 months, renal function monitoring for those on oral PrEP (tenofovir- based), ongoing adherence and risk-reduction counseling. And for injectable PrEP, adherence to the injection schedule is essential, as delayed dosing may increase the risk of resistance if HIV infection occurs. HIV PrEP is not a prevention for other STIs. Screening for STIs and counseling about prevention is essential. Breakthrough HIV infections on PrEP are rare and most often associated with poor adherence or delayed diagnosis. Truvada is more studied in all populations and is considered safe during pregnancy and breastfeeding. There is less data regarding the injectable option in patients who are pregnant, may become pregnant, or whose primary risk factor is injection drug use (1). Injectable PrEP provides an important alternative for patients with chronic kidney disease and bone disease (1). Key Takeaway Pre-exposure prophylaxis is a safe, effective, and evidence-based strategy for HIV prevention. With both daily oral and long-acting injectable options available, PrEP can be individualized to meet patient needs. Normalizing PrEP discussions in clinical practice is essential to reducing new HIV infections and advancing public health goals.  Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week!  References: Antiretroviral Drugs for Treatment and Prevention of HIV in Adults: 2024 Recommendations of the International Antiviral Society–USA Panel. The Journal of the American Medical Association. 2025. Gandhi RT, Landovitz RJ, Sax PE, et al. Long-Acting Lenacapavir Acts as an Effective Preexposure Prophylaxis in a Rectal SHIV Challenge Macaque Model. The Journal of Clinical Investigation. 2023. Bekerman E, Yant SR, VanderVeen L, et al. Pharmacokinetics and Safety of Once-Yearly Lenacapavir: A Phase 1, Open-Label Study. Lancet. 2025. Jogiraju V, Pawar P, Yager J, et al.

Doctors Lisa and Sara talk to Consultant Endocrinologist Dr Rupinder Kochhar about patients with Type 2 Diabetes. Using hypothetical cases, we talk a little bit about diagnosis, but spend most of the time discussing the details of management in younger patients as well as how to de-escalate treatment and what the goals might be in a more frail elderly patient. Disclaimer: All educational content in this podcast was developed as part of the Circulation Health collaborative working project between Boehringer Ingelheim Limited, Greater Manchester Primary Care Provider Board and Health Innovation Manchester. Content has been created by Circulation Health Clinical Leads for educational purposes, reflecting NHS Clinical Lead and guideline-based recommendations. Boehringer Ingelheim had no input into content development. They have provided financial resources to support Podcast recordings related to this project. You can use these podcasts as part of your CPD - we don't do certificates but they still count :) Resources: NICE draft guideline - Type 2 diabetes in adults: management: https://www.nice.org.uk/guidance/gid-ng10336/documents/450 Managing Heart Failure, CKD and T2DM in Primary Care: https://pckb.org/e/managing-heart-faiure-ckd-and-t2dm-in-primary-care/ Essential steps in primary care management of older people with Type 2 diabetes: an executive summary on behalf of the European geriatric medicine society (EuGMS) and the European diabetes working party for older people (EDWPOP) collaboration: https://pmc.ncbi.nlm.nih.gov/articles/PMC10628003/ Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes: https://diabetesjournals.org/care/article/45/11/2753/147671/Management-of-Hyperglycemia-in-Type-Diabetes Diabetes UK: https://www.diabetes.org.uk/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it's release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

What is it really like to grow up knowing kidney disease runs in your family?   In this powerful episode of Diary of a Kidney Warrior Podcast, Dee is joined by Jamie from Texas, USA, who shares her lived experience of Autosomal Dominant Polycystic Kidney Disease (ADPKD) — a genetic kidney condition that affects generations.   Jamie opens up about:

Episode 212: Managing HFpEFHyo Mun and Jordan Redden (medical students) explain how to manage HFpEF with medications and touch some basics about nonpharmacologic treatments. Dr. Arreaza asks insightful questions to guide the discussion. Written by Hyo Mun, MSIV, American University of the Caribbean; and Jordan Redden, MSIV, Ross University School of Medicine. Comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Treatment of HFpEFArreaza: Mike, if you had to name the one therapy everyone with HFpEF should be on, what is it?Mike: That's easy! SGLT-2 inhibitors. This is the one slam-dunk we have in HFpEF. Empagliflozin (Jardiance) or dapagliflozin (Farxiga) should be started in essentially every patient with HFpEF, and it doesn't matter if they have diabetes or not.Jordan: And that's worth repeating, because people still think of these as “diabetes drugs.” They're not anymore. In HFpEF, SGLT-2 inhibitors reduce heart-failure hospitalizations, improve symptoms, improve quality of life, and even reduce cardiovascular death.Dr. Arreaza: They're also simple. Empagliflozin 10 mg daily or dapagliflozin 10 mg daily. No titration, no drama. The effectiveness of these meds was established around 2019 with DAPA-HF and later with DELIVER. These were trials thatdemonstrated that dapagliflozin reduces worsening heart failure and cardiovascular events across the full spectrum of heart failure, from reduced to preserved ejection fraction, independent of diabetes status.Mike: And the number needed to treat is about 28 to prevent one heart-failure hospitalization. That's excellent for a disease where we historically had almost nothing that worked.Jordan: They're also safe in chronic kidney disease down to an eGFR of about 25, which makes them even more useful in this population.Dr. Arreaza: Alright. We got SGLT-2 inhibitor, what's next?Mike: Volume management. Loop diuretics are still the backbone of symptom control in HFpEF. If the patient is volume overloaded, you diurese, and you diurese aggressively.Jordan: The goal is euvolemia. Dry weight, no edema, no orthopnea, no waking up gasping for air. A lot of these patients end up needing chronic oral loop diuretics to stay there.Dr. Arreaza: Something to remember: HFpEF patients don't tolerate congestion well, and being “a little wet” is not benign. Let's move into RAAS inhibition. Where do ARBs and ACE inhibitors fit in?Mike: Between ARBs and ACE inhibitors, ARBs are the winners in HFpEF. They actually reduce heart failure hospitalizations—drugs like candesartan, losartan, valsartan. ACE inhibitors? Not so much. They showed minimal benefit in older HFpEF patients, which is why we go with ARBs instead.Jordan: But a lot of clinicians get nervous about ACE inhibitors and ARBs because of kidney function, so it's worth talking through how these drugs actually work in the kidney.Dr. Arreaza: Yes, misunderstanding may lead to unnecessary drug discontinuation.Jordan: Under normal conditions, the afferent arteriole brings blood into the glomerulus, and the efferent arteriole is constricted by angiotensin II. That constriction keeps pressure high in the glomerulus and maintains filtration.Mike: Here's what happens with an ACE inhibitor: you block angiotensin II, the efferent arteriole relaxes, glomerular pressure drops, and GFR dips slightly. Creatinine bumps up a little, and that scares people, but that's actually the whole point—that's how you get kidney protection long-term.Jordan: High intraglomerular pressure causes hyperfiltration injury and scarring over time. Lowering that pressure protects the kidney long-term. The short-term GFR drop is the price you pay for long-term benefits.Dr. Arreaza: So let's talk about CKD, because this is where people panic.Mike: Right. ACE inhibitors and ARBs are not contraindicated in chronic kidney disease. In fact, they're recommended even in advanced stages. They reduce progression to kidney failure by about a third.Jordan: The key is how you use them. Start low. Check creatinine and potassium one to two weeks after starting, then periodically. A creatinine rise up to 30% from baseline is acceptable. That's not kidney injury, that's physiology.Dr. Arreaza: And what about potassium creeping up?Mike: You adjust the dose or add a potassium binder. You don't just automatically stop the drug.Dr. Arreaza: Now there is one absolute contraindication everyone needs to know about! (board exam test)Jordan: Bilateral renal artery stenosis. This is the big one. In these patients, the kidneys are completely dependent on angiotensin II–mediated efferent constriction to maintain GFR. Take that away, and GFR collapses.Mike: Creatinine can jump dramatically within days. If you see a creatinine rise of 20% or more shortly after starting an ACE inhibitor, you should be thinking about bilateral renal artery stenosis and stopping the drug immediately.Dr. Arreaza: After revascularization, though, many patients can tolerate ACE inhibitors again, so this isn't always permanent. What about cardiorenal syndrome? That's where things get uncomfortable.Mike: It is uncomfortable, but cardiorenal syndrome isn't a contraindication. These patients have severe heart failure and kidney disease, and their mortality is actually higher than patients with heart failure alone.Jordan: ACE inhibitors still reduce mortality and slow kidney disease progression in this group. Studies show that stopping ACE inhibitors during acute heart-failure admissions increases in-hospital mortality three- to four-fold.Dr. Arreaza: So we are cautious, but we don't avoid it.Mike: Exactly. Start low, titrate slowly, monitor labs closely, accept up to a 30% creatinine rise. You only stop if kidney function keeps worsening, or potassium gets dangerously high.Dr. Arreaza: Alright. Let's move on. What about mineralocorticoid receptor antagonists… MRA?Jordan: Spironolactone or eplerenone might reduce hospitalizations in HFpEF, but the data is mixed. This is more of a “select patients” situation.Mike: And you have to watch potassium and kidney function carefully, especially if they're already on an ACE inhibitor or ARB.Dr. Arreaza: What about sacubitril-valsartan, also known as Entresto®?Mike: Entresto may help patients with mildly reduced EF roughly in the 45 to 57% range. It's not first-line for HFpEF, but in select patients, it's reasonable.Dr. Arreaza: Now let's clarify one of the biggest sources of confusion: beta blockers.Jordan: Beta blockers are not a treatment for HFpEF itself. They're only indicated if the patient has another reason to be on them, like coronary disease or atrial fibrillation.Mike: And timing really matters here. You absolutely do not start beta blockers during acute decompensated heart failure. Their negative inotropic effects can make things worse when patients are volume overloaded.Jordan: But, and this is critical, you also don't stop them if the patient is already taking one. Abrupt withdrawal causes a sympathetic surge and dramatically increases mortality.Dr. Arreaza: If a patient is admitted on a beta blocker, what do we do?Mike: Continue it at the same dose or reduce it slightly if they're really unstable. Once they're euvolemic and stable, you can carefully titrate up.Jordan: And watch for chronotropic incompetence. HFpEF patients often rely on heart-rate response to exercise, and beta blockers can worsen exercise intolerance.Dr. Arreaza: Beyond medications, HFpEF is really about treating comorbidities. Aerobic activity can be an initial strategy to improve exercise intolerance and has evidence of improving aerobic function and quality of life. Sodium restriction: improves symptoms, does not decrease risk of death or hospitalizations.Mike: Hypertension control is huge. For diabetes, the SGLT-2 inhibitors will perform double duty. For obesity, weight loss improves symptoms, and GLP-1 agonists like semaglutide are absolute gamechangers.Jordan: Don't forget sleep apnea, atrial fibrillation, and lifestyle. Exercise improves the quality of life, even if it doesn't change hard outcomes. Lifestyle is the main treatment. Dr. Arreaza: And when should you refer to cardiology?Mike: You should refer when the diagnosis isn't clear; symptoms are not responding to treatment, difficult volume management, end-organ dysfunction, or if you are concerned about advanced heart failure.Dr. Arreaza: So, it has been a great discussion. What is the takeaway?Mike: HFpEF treatment isn't about one magic drug -- it's about volume control, SGLT2 inhibitors, smart use of RAAS blockade, and aggressive management of comorbidities.Jordan: And it's understanding the physiology, so you don't withhold life-saving therapies out of fear.Dr. Arreaza: Well said. If you found this helpful, share it with a friend or colleague and rate us wherever you listen. This is Dr. Arreaza, signing off.Jordan/Mike: Thanks! Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Barzin A, Barnhouse KK, Kane SF. Heart Failure With Preserved Ejection Fraction. Am Fam Physician. 2025;112(4):435-440.Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure. Circulation. 2022;145(18):e895-e1032.Kittleson MM, Panjrath GS, Amancherla K, et al. 2023 ACC expert consensus decision pathway on management of heart failure with preserved ejection fraction. J Am Coll Cardiol. 2023;81(18):1835-1878.Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021;385(16):1451-1461.Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022;387(12):1089-1098.Pitt B, Pfeffer MA, Assmann SF, et al. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014;370(15):1383-1392.Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction. Lancet. 2003;362(9386):777-781.Solomon SD, McMurray JJV, Anand IS, et al. Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction. N Engl J Med. 2019;381(17):1609-1620.Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med. 2023;389(12):1069-1084.Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022;28(3):583-590.Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from COVID-19. JAMA Cardiol. 2020;5(11):1265-1273.Basso C, Leone O, Rizzo S, et al. Pathological features of COVID-19-associated myocardial injury. Eur Heart J. 2020;41(39):3827-3835.Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601-615.Badve SV, Roberts MA, Hawley CM, et al. Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in adults with estimated GFR less than 60 mL/min per 1.73 m². Ann Intern Med. 2024;177(8):953-963.Navis G, Faber HJ, de Zeeuw D, de Jong PE. ACE inhibitors and the kidney: a risk-benefit assessment. Drug Saf. 1996;15(3):200-211.Textor SC, Novick AC, Tarazi RC, et al. Critical perfusion pressure for renal function in patients with bilateral atherosclerotic renal vascular disease. Ann Intern Med. 1985;102(3):308-314.Hackam DG, Spence JD, Garg AX, Textor SC. Role of renin-angiotensin system blockade in atherosclerotic renal artery stenosis and renovascular hypertension. Hypertension. 2007;50(6):998-1003.Ronco C, Haapio M, House AA, et al. Cardiorenal syndrome. J Am Coll Cardiol. 2008;52(19):1527-1539.Prins KW, Neill JM, Tyler JO, et al. Effects of beta-blocker withdrawal in acute decompensated heart failure. JACC Heart Fail. 2015;3(8):647-653.Jondeau G, Neuder Y, Eicher JC, et al. B-CONVINCED: Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode. Eur Heart J. 2009;30(18):2186-2192.Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.

Kidney-friendly eating doesn't have to mean bland, boring, or restrictive. This episode breaks down how thoughtful cooking techniques and simple ingredient shifts can protect kidney health without sacrificing flavor or enjoyment.You'll learn how to reframe dietary limits into creative opportunities, build satisfying plant-forward meals, and plan in ways that actually make life easier—especially after a new CKD diagnosis. This conversation offers practical hope for anyone who wants food to feel empowering again, not overwhelming.Guest Bio:Chef Duane, a current instructor at the Inland Northwest Culinary Academy, successfully put his own CKD into remission through diet. He now travels the United States, sharing his culinary expertise and journey with medical professionals and fellow patients.Quote:“I love my kidney disease. It has made me a better cook.”Question of the Day:What is one kidney-friendly ingredient or cooking technique you'd like to try adding to your meals this week?On This Episode You Will Learn:How to turn kidney diet “restrictions” into flavorful opportunitiesWhy plant-forward meals can reduce kidney stressCore principles behind building kidney-friendly recipes that still taste greatSimple meal-planning strategies for busy or low-energy daysHow flavor, texture, and satisfaction keep healthy eating sustainableConnect with Yumlish!Yumlish Website: YumlishYumlish on Instagram: @yumlish_Yumlish on Facebook: YumlishYumlish on Twitter: @yumlish_Yumlish on LinkedIn: YumlishConnect with Duane Sunwold!Website URL: chefduane.com LinkedIn URL:https://www.linkedin.com/in/duane-sunwold-23b767b/ YouTube: https://www.youtube.com/@ckdchefduane9517

In this powerful Kidney Warrior Story, host Dee Moore is joined by Hakeem, who openly shares his lived experience of growing up with sickle cell disease (SC genotype) and later being diagnosed with chronic kidney disease (CKD).   From early health challenges to navigating kidney failure, dialysis, and the emotional impact of long-term illness, Hakeem reflects on the realities of living with multiple long-term conditions — and the resilience it takes to keep going. This conversation explores identity, acceptance, faith, mindset, and the importance of hope when the journey feels overwhelming.   If you are living with kidney disease, sickle cell, dialysis, or supporting someone who is, this episode offers reassurance, representation, and a reminder that you are not alone.   In this episode, we discuss:   • Growing up with sickle cell disease and its impact on health • Being diagnosed with chronic kidney disease • Navigating dialysis and long-term treatment • The emotional and mental health challenges of CKD • Finding strength, purpose, and hope through lived experience • Why sharing kidney warrior stories matters  

I know 2026 feels like it ihas been here for months, but only a few weeks ago we were celebrating the nephrology accomplishments of 2025. The New Filtrate came together to review the year.The FiltrateJoel Topf‍ ‍@kidneyboy.bsky.social‬ (COI)Swapnil Hiremath @hswapnil.medsky.social and on LinkedIn Editor in Chief of Kidney International Case ReportsAnna Gaddy (@AnnaGaddy) Winner of NephJC Rookie of the Year 2020Nayan Arora (@CaptainChloride.bsky.social)AC (@medpeedskidneys.bsky.social)Vipin Verghese (@vipvargh.bsky.social) co-winner of NephJC Engaged Scientist of the Year in 2021Brian Rifkin (@brianrifkin.bsky.social) Co-Editor in Chief NephJC. Winner of NephJC Rookie of the Year 2021Cristina Popa (@NephroSeeker) Co-Editor in Chief NephJC. Wwinner of NephJC Rookie of the Year 2022 and MVP 2023Editing and Show Notes byAnna Gaddy and Joel TopfThe Kidney Connection written and performed by Tim YauShow NotesTop Stories in Nephrology 2025 (NephJC)First Top sories in Nephrology 2010! (Renal Fellow Network)Links to all of the Top Stories in Nephrology, hosted on NephJC since 2017 (NephJC)1. IgA NephropathyVISIONARY: Sibeprenlimab in IgA Nephropathy — Interim Analysis of a Phase 3 Trial (NEJM)ORIGIN 3: A Phase 3 Trial of Atacicept in Patients with IgA Nephropathy (NEJM)APPLAUSE-IgA Alternative Complement Pathway Inhibition with Iptacopan in IgA Nephropathy (NEJM)Aliza M. Thompson, MD, MS (ASN) 2. Lupus NephritisREGENCY: Efficacy and Safety of Obinutuzumab in Active Lupus Nephritis (NEJM)3. Nobel prize winner and peripheral immune tolerance4. Xenotransplantation5. GLP1ra RevolutionRemodel REMODELing mechanistic trials for kidney disease: a multimodal, tissue-centered approach to understand the renal mechanism of action of semaglutide (Kidney International)SURPASS-CVOT Tirzepatide vs. Dulaglutide Is Associated with Reduced Major Kidney Events in Patients with Type 2 Diabetes, CVD, and Very High-Risk Kidney Diseases (Kidney Week abstract in JASN)Poll: 1 in 8 Adults Say They Are Currently Taking a GLP-1 Drug for Weight Loss, Diabetes or Another Condition, Even as Half Say the Drugs Are Difficult to Afford (KFF survey)6. GDMT implementation in CKD: lessons learnt from CONFIDENCE and MIRO-CKDConfidence Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes (NEJM)MIRO-CKD Balcinrenone in combination with dapagliflozin compared with dapagliflozin alone in patients with chronic kidney disease and albuminuria: a randomised, active-controlled double-blind, phase 2b clinical trial (The Lancet)7. Flozin Meta analysisSMART-C. SGLT2 Inhibitors and Kidney Outcomes by Glomerular Filtration Rate and Albuminuria. A Meta-Analysis (JAMA)SMART-C. Effects of Sodium Glucose Cotransporter 2 Inhibitors by Diabetes Status and Level of Albuminuria. A Meta-Analysis (JAMA)8. Paradigm Shift: Aiming for CKD Remission9. Fish Oil and DialysisPISCES Fish-Oil Supplementation and Cardiovascular Events in Patients Receiving Hemodialysis (NEJM)10. Decline in Dialysis Patients in the United StatesUSRD 2025 Annual Data Report (USRDS)Tubular SecretionSwapnil Hiremath Alien Earth on FX Hulu (Wikipedia)AC A Christmas Carol by Charles Dickens (Wikipedia) and The Muppet Christmas Carol (Wikipedia)Anna Monty Don (Wikipedia)Nayan Back Street Boys at The Sphere (Wikipedia)Brian Marty Supreme (Wikipedia)Cristina The Yellow Tie (Wikipedia)Vipin Stranger Things, good for a four year old? (Wikipedia)Joel Crash Course: The Universe with Katie Mack and John Green (Apple PodCasts)

Chronic kidney disease (CKD) now affects about 788 million adults worldwide, more than double the number in 1990, making it one of the most widespread and underrecognized health threats A recent systematic analysis published in The Lancet revealed that CKD is now the ninth leading cause of death globally, responsible for roughly 1.48 million deaths in 2023 alone High blood sugar, elevated blood pressure, and excess body weight are the leading drivers of CKD worldwide, together accounting for most of the disease's overall health burden Early-stage CKD affects over 13% of the adult population globally, yet most cases remain undiagnosed because symptoms often don't appear until the disease is advanced You can lower your risk of CKD by keeping your blood pressure and blood sugar in check, getting regular movement, staying hydrated, reducing processed foods, and supporting kidney function with balanced nutrition

Luke Hedrick, Dave Furfaro, and recurrent RFJC guest Robert Wharton are joined again today by Nicole Ng to discuss the FIBRONEER-IPF trial investigating Nerandomilast in patients with IPF. This trial was published in NEJM in 2025 and looked at Neradomilast vs placebo for treating patients with IPF, on or off background anti-fibrotic therapy. This agents is now FDA approved for pulmonary fibrosis, and understanding the trial results is essential for any pulmonary physician treating patients with IPF or progressive pulmonary fibrosis. Article and Reference Today’s episode discusses the FIBRONEER-IPF trial published in NEJM in 2025. Richeldi L, Azuma A, Cottin V, Kreuter M, Maher TM, Martinez FJ, Oldham JM, Valenzuela C, Clerisme-Beaty E, Gordat M, Wachtlin D, Liu Y, Schlecker C, Stowasser S, Zoz DF, Wijsenbeek MS; FIBRONEER-IPF Trial Investigators. Nerandomilast in Patients with Idiopathic Pulmonary Fibrosis. N Engl J Med. 2025 Jun 12;392(22):2193-2202. doi: 10.1056/NEJMoa2414108. Epub 2025 May 18. PMID: 40387033. https://www.nejm.org/doi/abs/10.1056/NEJMoa2414108 Meet Our Guests Luke Hedrick is an Associate Editor at Pulm PEEPs and runs the Rapid Fire Journal Club Series. He is a senior PCCM fellow at Emory, and will be starting as a pulmonary attending at Duke University next year. Robert Wharton is a recurring guest on Pulm PEEPs as a part of our Rapid Fire Journal Club Series. He completed his internal medicine residency at Mt. Sinai in New York City, and is currently a pulmonary and critical care fellow at Johns Hopkins. Dr. Nicole Ng is an Assistant Profess of Medicine at Mount Sinai Hospital, and is the Associate Director of the Interstitial Lung Disease Program for the Mount Sinai National Jewish Health Respiratory Institute. Infographic Key Learning Points Why this trial mattered IPF therapies remain limited: nintedanib and pirfenidone slow (but do not stop) decline and often cause GI side effects. Nerandomilast is a newer agent (a preferential PDE4B inhibitor) with antifibrotic + immunomodulatory effects. Phase 2 data (NEJM 2022) looked very promising (suggesting near-“halt” of FVC decline), so this phase 3 trial was a big test of that signal. Trial design essentials Industry-sponsored, randomized, double-blind, placebo-controlled, large multinational study (332 sites, 36 countries). Population: IPF diagnosed via guideline-aligned criteria with central imaging review and multidisciplinary diagnostic confirmation. Intervention: nerandomilast 18 mg BID, 9 mg BID, or placebo; stratified by background antifibrotic use. Primary endpoint: change in FVC at 52 weeks, analyzed with a mixed model for repeated measures. Key secondary endpoint: time to first acute exacerbation, respiratory hospitalization, or death (composite). Who was enrolled Typical IPF trial demographics: ~80% male, mean age ~70, many former smokers. Many were already on background therapy (~45% nintedanib, ~30–33% pirfenidone). Notable exclusions included significant liver disease, advanced CKD, recent major cardiovascular events, and psychiatric risk (suicidality/severe depression), reflecting class concerns seen with other PDE4 inhibitors. Efficacy: what the primary endpoint showed Nerandomilast produced a statistically significant but modest reduction in annual FVC decline vs placebo (roughly 60–70 mL difference). Importantly, it did not halt FVC decline the way the phase 2 data suggested; patients still progressed. Important nuance: interaction with pirfenidone Patients on pirfenidone had ~50% lower nerandomilast trough levels. Clinically: 9 mg BID looked ineffective with pirfenidone, so 18 mg BID is needed if used together. In those not on background therapy or on nintedanib, 9 mg and 18 mg looked similar—suggesting the apparent “dose-response” might be partly driven by the pirfenidone drug interaction Secondary and patient-centered outcomes were neutral No demonstrated benefit in the composite outcome (exacerbation/resp hospitalization/death) or its components. Quality of life measures were neutral and declined in all groups, emphasizing that slowing FVC alone may not translate into felt improvement without a disease-reversing therapy. The discussants noted this may reflect limited power/duration for these outcomes and mentioned signals from other datasets/pooling that might suggest mortality benefit—but in this specific trial, the key secondary endpoint was not positive. Safety and tolerability Diarrhea was the main adverse event: Higher overall with the 18 mg dose, and highest when combined with nintedanib (up to ~62%). Mostly mild/manageable; discontinuation due to diarrhea was relatively uncommon (but higher in those on nintedanib). Reassuringly, there was no signal for increased depression/suicidality/vasculitis despite psychiatric exclusions and theoretical class risk. How to interpret “modest FVC benefit” clinically The group framed nerandomilast as another tool that adds incremental slowing of progression. They emphasized that comparing absolute FVC differences across trials (ASCEND/INPULSIS vs this trial) is tricky because populations and “natural history” in placebo arms have changed over time (earlier diagnosis, improved supportive care, etc.). They highlighted channeling bias: patients already on antifibrotics may be sicker (longer disease duration, lower PFTs, more oxygen), complicating subgroup comparisons. Practical takeaways for real-world use All three antifibrotics are “fair game”; choice should be shared decision-making based on goals, tolerability, dosing preferences, and logistics. Reasons they favored nerandomilast in practice: No routine lab monitoring (major convenience advantage vs traditional antifibrotics). Generally better GI tolerability than nintedanib. BID dosing (vs pirfenidone TID). Approach to combination therapy: They generally favor add-on rather than immediate combination to reduce confusion about side effects—while acknowledging it may slow reaching “maximal therapy.” Dosing guidance emphasized: Start 18 mg BID for IPF, especially if combined with pirfenidone (since dose reduction may make it ineffective). 9 mg BID may be considered if dose reduction is needed and the patient is not on pirfenidone (e.g., monotherapy or with nintedanib).

00:00 Four-Minute Offense 7:00 Beer Friday 9:30 T-Shirts from Penny Royal! 14:00 Let's Go!! 18:40 Doug's Big One = Stop Talking about CKD! 28:50 Breakdown Breakdown Breakdown 51:40 Cards Insider Howard Balzer 1:40:20 Football Deep Dive 1:55:23 UofA @ Bama 2:02:50 Vs Vegas