Podcasts about ckd

It will come as no surprise to our regular listeners that kidney disease is another area in which a healthy plant-based diet supports better health. We are therefore delighted to bring you this week's bonus episode: our discussion with Cade Morant about his experience of nephrotic syndrome and a diagnosis of focal segmental glomerulonephritis. Cade has experienced a kidney transplant and ongoing dialysis, but despite these challenges has discovered plant-based diets are not just good for planetary health! https://plantbasedhealthprofessionals.com/wp-content/uploads/2023/05/CKDKidneyfactsheetPBHPUK-May23.pdfhttps://plantbasedhealthprofessionals.com/wp-content/uploads/2024/06/Reducing-potassium-in-CKD-when-you-are-following-a-plant-based-diet.pdfhttps://kdigo.org/wp-content/uploads/2025/01/Key-Takeaways_KDIGO-2024-CKD-Guideline_People-Living-with-CKD.pdf

Obesity and chronic kidney disease (CKD) are deeply interconnected as each condition increases the risk and severity of the other. In part 1 of this episode, our interprofessional panel of experts explores the science behind this bidirectional relationship and the epidemiologic data underscoring their connection. Listeners will gain insight into the underlying pathophysiology, including the roles of inflammation, altered kidney hemodynamics, and lipotoxicity. Through practical discussion and dissection of the literature, this episode highlights the importance of recognizing obesity as both a cause and consequence of CKD, and the crucial role nephrology professionals play in interrupting this cycle early. Please be sure to visit the National Kidney Foundation's Obesity in the Nephrology Clinic page for additional information and access to an infographic designed to support clinical care for managing obesity in individuals living with CKD: https://www.kidney.org/professionals/tools/obesity-nephrology-clinic Supported by Novo Nordisk

Effective management of obesity in patients with CKD requires a holistic, interprofessional approach. In part 2 of this episode, the conversation continues with translating the evolving evidence into practical guidance for nephrology teams. Experts review the importance of a person-centered approach integrating lifestyle interventions, pharmacologic therapies, and surgical options with a focus on safety, efficacy, and kidney-related outcomes. The discussion emphasizes how members of the nephrology care team can collaborate to personalize treatment, address appetite and nutrition concerns, and help patients achieve meaningful weight loss without compromising kidney health. Tune in for actionable insights and strategies to translate emerging science into individualized, kidney-friendly, weight management strategies. Please be sure to visit the National Kidney Foundation's Obesity in the Nephrology Clinic page for additional information and access to an infographic designed to support clinical care for managing obesity in individuals living with CKD: https://www.kidney.org/professionals/tools/obesity-nephrology-clinic Supported by Novo Nordisk

What happens when menopause meets chronic kidney disease? How do you know if it's your hormones, your kidneys or your medication talking? And what options are actually on the table if you're living with CKD, on dialysis or post-transplant?   In this special listener-led edition of Diary of a Kidney Warrior Podcast (in partnership with Kidney Care UK), host Dee Moore is joined again by menopause specialist Dr Vikram to answer questions sent directly from the Kidney Warrior community.   Together they unpack real-life concerns about: •Navigating menopause symptoms alongside CKD, dialysis or transplant •When HRT may or may not be suitable if you have kidney or liver disease •Non-hormonal options for hot flushes, night sweats, mood and sleep •Period changes on haemodialysis and after transplant •Bone health, osteoporosis risk and steroids •Fibroids, endometriosis, early menopause and hysterectomy in the context of CKD •How to advocate for yourself with your GP, renal team and menopause services   You'll also hear a powerful call from Dr Vikram for better research that truly includes women with CKD, especially those from ethnic minority backgrounds – and why your story and participation matter.  

A special filmed edition of Diary of a Kidney Warrior Podcast is coming on Monday 1st December!   In this listener-led conversation, menopause specialist Dr Vikram returns to answer the questions sent in by the Kidney Warrior community about menopause and chronic kidney disease (CKD).   This new edition continues the important discussion from Episode 142: Breaking the Silence: Menopause and CKD.

Are you actively and appropriately screening for chronic kidney disease (CKD) in your patients with cardio-kidney-metabolic (CKM) conditions? Credit available for this activity expires: 11/26/2026 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/screening-action-addressing-chronic-kidney-disease-reduce-2025a1000wsi?ecd=bdc_podcast_libsyn_mscpedu

Email List: ⁠⁠⁠⁠⁠⁠https://huntershealthhacks.beehiiv.com/⁠⁠⁠⁠⁠⁠Get My Book On Amazon: ⁠⁠⁠⁠⁠⁠⁠https://a.co/d/avbaV48Download⁠⁠⁠⁠⁠⁠⁠The Peptide Cheat Sheet: ⁠⁠⁠⁠⁠⁠⁠https://peptidecheatsheet.carrd.co/⁠⁠⁠⁠⁠⁠⁠Download The Bioregulator Cheat Sheet: ⁠⁠⁠⁠⁠⁠⁠https://bioregulatorcheatsheet.carrd.co/⁠⁠⁠⁠⁠⁠⁠1 On 1 Coaching Application: ⁠⁠⁠⁠⁠⁠⁠https://hunterwilliamscoaching.carrd.co/⁠⁠⁠⁠⁠⁠⁠Book A Call With Me: ⁠⁠⁠⁠⁠⁠⁠https://hunterwilliamscall.carrd.co/⁠⁠⁠⁠⁠⁠⁠Supplement Sources: ⁠⁠⁠⁠⁠⁠⁠https://hunterwilliamssupplements.carrd.co/⁠⁠⁠⁠⁠⁠⁠Amazon Storefront: ⁠⁠⁠⁠⁠⁠⁠https://www.amazon.com/shop/hunterwilliams/list/WE16G2223BXA?ref_=cm_sw_r_cp_ud_aipsflist_R7QWQC0P1RACB2ETY3DY⁠⁠⁠⁠⁠⁠⁠Socials:Instagram: ⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/hunterwilliamscoaching/⁠⁠⁠⁠⁠⁠⁠Video Topic Request: ⁠⁠⁠⁠⁠⁠⁠https://hunterwilliamsvideotopic.carrd.co/⁠In today's episode I dive deep into a topic that almost nobody talks about even though it affects tens of millions of people every single year. We're breaking down the full peptide stack for kidney health and renal longevity. When I first got into biohacking I didn't think much about kidneys at all. I assumed they just silently did their thing in the background. But over the years, as I started working with more people and publishing more content, I realized how common kidney dysfunction is and how quickly it can go downhill if you don't catch it early. That's when I went down the rabbit hole of what actually causes kidney decline and what we can do to strengthen and protect renal function long before a diagnosis ever shows up.Inside this episode I walk through the most important vulnerabilities the kidneys face as we age. These are things like oxidative stress, mitochondrial breakdown, metabolic strain, hypertension, hyperglycemia, inflammation, structural damage to the filtration barrier, and even vascular deterioration. Most people don't realize the kidneys use up to ten percent of the body's entire oxygen supply which makes them extremely sensitive to damage. I explain exactly how these vulnerabilities accumulate over time and why proactive support is just as important for someone who is “normal” as it is for someone with early-stage CKD.From there I walk you step-by-step through the five-peptide kidney restoration protocol I put together. This stack includes SS-31, Jardiance, glutathione, ARA-290, and MOTS-C. I explain what each one does, why it matters, the exact dose and frequency I recommend, and what role it plays in repairing, protecting, and unloading the kidneys. I talk about mitochondrial protection, reducing hyperfiltration, lowering mechanical stress, restoring antioxidant defenses, repairing microvasculature, activating AMPK, improving metabolic flexibility, and reversing early fibrosis. This isn't theory. I've watched these compounds move the needle for real people in the real world.I also walk you through the synergy of the full stack. When these agents work together, they offload the metabolic burden on the kidneys while strengthening the cellular machinery that has to keep you alive for decades. I compare it to walking around with a sixty-pound weight vest: eventually that load catches up. This protocol systematically removes that load while improving the kidney's structural resilience at the same time.At the end I cover what to monitor on bloodwork, how to cycle the protocol, what can be used long-term, and the signs you want to get in front of before they spiral into full kidney disease. Whether you have diagnosed kidney problems or you simply want to protect your renal function as part of your longevity plan, this episode gives you a blueprint you can use immediately.As always, make sure you are on my email list so you never miss my content even if platforms delete me. Thank you for being here and letting me bring this information to you. I have so much gratitude for everyone supporting the channel. Enjoy the episode and share it with anyone who needs it.

Clinical trial design in nephrology is evolving. In this episode, leading experts explore why a paradigm shift is needed from traditional biomarkers to patient-centered outcomes and practical strategies for advancing trial implementation. This conversation draws on insights from the ISN Consensus Meeting on Changing Paradigms of Studies in CKD (Vancouver, Nov 22-23, 2024) where clinicians, trialists, patient partners, regulators and industry scientists came together to rethink trial endpoints, outcomes and designs. Together, they discuss how reimagining kidney trials can generate more relevant, equitable, and actionable evidence for better kidney care worldwide. ParticipantsAdeera 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. Jennifer Lees Senior Clinical Lecturer and Honorary Consultant Nephrologist at the University of Glasgow, UK. Dr. Lees' research focuses on improving patient outcomes in kidney disease through better trial design, biomarker evaluation, and translational approaches linking research to clinical care. 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.

Drs. Anna Zemke and Nisha Bansal discuss the findings of their study, "Accuracy of Identification of Cardiovascular Events with International Classification of Diseases Diagnosis Codes versus Physician Adjudication in CKD and Kidney Failure."

In this powerful episode of Diary of a Kidney Warrior Podcast, Dee sits down with Louise, a kidney warrior whose journey with IgA nephropathy spans over 30 years – from diagnosis in her early 20s, to pregnancy complications and heartbreaking baby loss, to finally receiving her life-changing kidney transplant, lovingly named “Katie the Kidney.”   Louise shares how her kidney disease was first discovered during pregnancy, the devastating loss of her son, and how for decades she coped by “putting everything in a box” and carrying on with life. She talks about living abroad with only 22% kidney function, unknowingly walking 20K with undiagnosed angina, and why kidney disease can be such a silent condition.   In an emotional and hope-filled conversation, Louise describes the moment she received “the call” for transplant, watching her donor kidney arrive in a cooler from Edinburgh, and being wheeled to theatre with Katie the Kidney on the end of her bed. She also opens up about the emotional healing that came with kidney failure – exploring trapped emotions, trauma, faith, and learning to truly take responsibility for her health and wellbeing.   If you're newly diagnosed, living with chronic kidney disease (CKD), resisting the idea of dialysis or transplant, or struggling emotionally with your diagnosis, this episode will give you hope, validation and practical encouragement.   In this episode, we discuss: •Louise's first signs of kidney disease and IgA nephropathy diagnosis •Pregnancy, kidney disease and the loss of her baby son •Living 30+ years with CKD and feeling “fine” at 22% kidney function •Discovering angina during transplant workup •Getting the call and meeting “Katie the Kidney” •How transplant changed her energy, skin, and brain fog •The emotional side of kidney disease: grief, trauma, “putting it in a box” •Why acknowledging your diagnosis and caring for your mental health is essential •Louise's advice for anyone newly diagnosed or scared of dialysis / transplant   You are not alone. Kidney disease is not the end – it's part of your story, not your identity.    

It's In the News.. a look at the top headlines and stories in the diabetes community. This week's top stories: It's World Diabetes Day and we have a LOT of news to get to! Daily oral insulin tested to prevent T1D, mothers and sons and a T1D link, stem cell updates, Tandem Android news, Omnipod's workplace campaign and more! Find out how to submit your Community Commercial Find out more about Moms' Night Out  Please visit our Sponsors & Partners - they help make the show possible! Learn more about Gvoke Glucagon Gvoke HypoPen® (glucagon injection): Glucagon Injection For Very Low Blood Sugar (gvokeglucagon.com) Omnipod - Simplify Life Learn about Dexcom   Check out 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 Twitter Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  Reach out with questions or comments: info@diabetes-connections.com Episode transcription with links:   Hello and welcome to Diabetes Connections In the News! I'm Stacey Simms and every other Friday I bring you a short episode with the top diabetes stories and headlines happening now. It's world diabetes day! It is marked every year on 14 November, the birthday of Sir Frederick Banting, who co-discovered insulin along with Charles Best in 1922.   WDD was created in 1991 by International Diabetes Federation (IDF) and the World Health Organization and became an official United Nations Day in 2006 with the passage of United Nations Resolution 61/225. There will be a ton of stuff in your feeds today and that's great! I'm going to keep this to a pretty normal in the news episode.. although I do have my own World Diabetes Day announcement – I want YOUR community commercials. You could have an ad for your event or your blog or your project right here! There's a post on the website explaining it all and I'll come back at the end of the episode and tell you more. XX The Primary Oral Insulin Trial (POInT) is the first large-scale clinical trial to test whether giving at-risk children daily oral insulin could prevent or delay type 1 diabetes (T1D). Conducted by researchers from Helmholtz Munich and the Technical University of Munich across five European countries, the study enrolled more than 1,000 children with a genetic risk for T1D. Results published in The Lancet show that while oral insulin did not prevent the development of islet autoantibodies—an early sign of diabetes—it was safe and well tolerated. Importantly, researchers found that some children who received oral insulin developed diabetes more slowly than those given a placebo, suggesting potential protective effects in certain genetic subgroups.   Further analysis revealed that the response to treatment depended on the child's insulin gene variant. Children with genetic versions that raise diabetes risk appeared to benefit, showing delayed onset of the disease, while those without the risk variant did not. These findings point toward a future of personalized prevention, where genetic screening could help identify which children might benefit most from oral insulin. Researchers will continue following the participants until age 12 to assess long-term effects. The study marks a major milestone in decades of diabetes prevention research, highlighting both the promise and complexity of developing tailored, early interventions against type 1 diabetes. XX Joint US-Chinese research looking at generating new beta cells from stomach cells. Upon turning on the "genetic switch," the human stomach cells were converted to insulin-secreting cells within the mice and resembled pancreatic beta cells with respect to gene and protein expression. Encouragingly, when those experiments were done with diabetic mice, insulin secreted from the transformed human cells helped control blood sugar levels and ameliorated diabetes. The scientists hope that a similar approach can be taken to convert cells from a patient's own stomach into insulin-secreting cells directly within the body. Importantly, additional studies are needed to address if this approach is safe and effective to be used in patients. https://www.technologynetworks.com/cell-science/news/human-stomach-cells-tweaked-to-make-insulin-406694 XX A new study in Nature Metabolism may help explain why children born to mothers with type 1 diabetes are less likely to develop the disease early in life compared to those whose fathers or siblings have it. Researchers looked at nearly 2,000 mothers and their children and found that  kids whose moms have type 1 diabetes show changes in their DNA that may actually help protect them. These aren't genetic mutations, but epigenetic changes — chemical tags that turn certain genes on or off. The study found these changes in genes tied to the immune system and type 1 diabetes risk, suggesting that a mother's condition during pregnancy can shape her child's immune response in a protective way. Scientists identified more than 500 areas of DNA where these changes occurred, many in regions that control how the body's immune system works. Most of the changes appeared to calm down the kind of overactive immune response that leads to type 1 diabetes. Researchers even created a "methylation score" to help measure this protective effect. They say the next step is to confirm these results in more diverse groups and figure out exactly how these DNA changes help prevent early diabetes. https://www.news-medical.net/news/20251110/Maternal-type-1-diabetes-may-protect-children-from-developing-the-disease.aspx XX A new study from Karolinska Institutet and Stockholm University reveals that sons born to mothers with type 1 diabetes may develop early vascular dysfunction—independently of metabolic health. The finding may help shape future strategies to prevent cardiovascular disease early in life.     Children of women with type 1 diabetes are known to be at increased risk of developing cardiovascular diseases. This new study, published in Cell Reports Medicine, is the first to show that the risk is linked to early dysfunction in blood vessel cells in sons, even before any metabolic issues arise. The team is now investigating the long-term effects of maternal diabetes, with a particular focus on why sons seem to be affected earlier than daughters. https://medicalxpress.com/news/2025-11-sons-mothers-diabetes-early-vascular.html XX A new study presented at Kidney Week 2025 has shown that the drug finn-uh-near-own  a nonsteroidal mineralocorticoid-receptor antagonist, significantly reduced albuminuria—a key marker of kidney damage—in people with type 1 diabetes (T1D) and chronic kidney disease (CKD). This is the first major breakthrough for this population in more than 30 years. Researchers found that patients taking finerenone saw a 25% average reduction in albuminuria compared to placebo, an improvement that suggests a lower long-term risk for dialysis or kidney transplant. The phase 3 FINE-ONE trial involved 242 adults with T1D and CKD, and results showed benefits as early as three months. The drug was generally well tolerated, with side effects similar to those seen in patients with type 2 diabetes, though mild hyperkalemia (high potassium levels) was slightly more common. Experts say the findings could change the way doctors treat kidney complications in type 1 diabetes, an area that hasn't seen new therapies since the early 1990s. Currently, treatment options rely on blood pressure and blood sugar management, along with renin-angiotensin system (RAS) inhibitors. Finerenone, which is already approved for type 2 diabetes-related CKD, targets overactivation of a receptor that drives kidney damage. Based on these results, Bayer plans to seek FDA approval in 2026 for use in people with T1D and CKD. Researchers and clinicians alike are calling the study "groundbreaking," noting that it opens the door to future research on how finerenone might not just slow kidney decline—but possibly prevent it altogether. https://www.medscape.com/viewarticle/finerenone-offers-hope-kidney-disease-type-1-diabetes-2025a1000uzi?form=login   XX This week, Tandem Diabetes Care (Nasdaq:TNDM) announced a major milestone for its Mobi miniature durable insulin pump system. San Diego-based Tandem revealed that it received FDA approval for the Android version of its Mobi mobile app. Clearance brings Mobi — which the company describes as the world's smallest, durable automated insulin delivery system — to more users. The pump, which pairs with Tandem's Control-IQ+ algorithm, previously worked with iOS software.   Tandem — one of the largest diabetes tech companies in the world — expects to begin a limited rollout next month, followed by full commercial availability in early 2026. This marks the latest milestone for the company, which continues to expand its offerings and widen its reach within the diabetes patient population.   We had a great interview with Tandem on our previous episode, but as I said at the time, it was coming before their earnings call. So here's an update: The company plans to submit the tubeless mobi to the fda before the end of this year.. possible approval and shipping date is hoped for by middle of 2026. Trials for their fully closed loop next-generation algorithm which we tlkaed abou ton the show should be launched in 2026 The Sigi patch pump will be developed and launched as a next-generation version of the Mobi Great job by Dr. David ? Ahn – he posted on IG after getting a message from tandem CEO John Sheridan? 1. First, the Tandem X3 *is* still absolutely in development, contrary to my speculation In yesterday's video. As many of you appropriately pointed out, there is definitely a market for a 300 unit pump, a pump with a screen, and a pump that does not require smartphone control. So from our brief chat, the sense I got that is that the X3 would be more of a refresh of the X2 with newer components, such as a USB-C connector and better memory, rather than a total redesign from the ground up. In terms of timing, all I could get was that it was "not too far distant in the future," which could mean anything I guess, but at least it's still on the way! 2. Next up, he also reassured me that they are working closely with Dexcom to support the G7 15 Day sensor within the next few months. I suspected as much, but it's always good to hear confirmation. 3. Lastly, he did confirm that Tandem is far along in developing a Caregiver/Follow app to allow the remote viewing of glucose and insulin data from a Tandem pump. He explained that it will be based on Sugarmate, the popular diabetes data dashboard app that Tandem acquired back in Jun 2020. While I don't know if every feature will make it into the Tandem caregiver app, Sugarmate is well-liked for its highly customizable dashboard and highly configurable alerts. Sugarmate even has the option to send a text message or phone call for urgent lows. Regardless, a true follow/Caregiver app will be welcomed with open arms by all caregivers and Tandem users who use Libre 3 Plus. https://time.com/7318020/worlds-top-healthtech-companies-2025/ XX Senseonics submits Eversense 365 – their year long implantable CGM for a CE mark, European Approval and expect to launch there soon. Eversense will be integrated with the sequel twist pump – again I'm hearing soon but no timeline. Intersting to note that one year inseration was approved in the US just about a year ago, so the first patients will be having their CGMs changed out – for the first time – pretty soon. https://www.drugdeliverybusiness.com/senseonics-q2-2025-sales-beat-ce-mark/ XX A confusing study out of Rutgers - these researcher say  metformin reduces some of the key benefits normally gained from regular physical activity. These include improvements in blood vessel health, physical fitness, and the body's ability to regulate blood sugar. Since 2006, doctors have typically encouraged patients with elevated blood sugar levels to combine metformin with exercise, expecting that the two proven treatments would produce stronger results together. However, the new research suggests this may not be the case. In this study, Exercise alone improved vascular insulin sensitivity, meaning blood vessels responded better to insulin and allowed more blood flow to muscles. This matters because insulin's ability to open blood vessels helps shuttle glucose out of the bloodstream and into tissues, lowering blood sugar after meals. But when metformin was added, the improvements shrank. The drug also diminished gains in aerobic fitness and reduced the positive effects on inflammation and fasting glucose. The findings don't mean people should stop taking metformin or exercising, Malin said. Instead, it raises urgent questions for doctors about how the two treatments can be combined and the need for close monitoring. Malin hopes future research will uncover strategies that preserve the benefits of both. https://scitechdaily.com/popular-diabetes-drug-metformin-may-cancel-out-exercise-benefits-study-warns/ XX XX https://www.medtechdive.com/news/Revvity-Sanofi-diabetes-test-Kihealth-seed-round/802133/   XX Dexcom recalled an Android app for its G6 glucose sensor due to a software problem that could cause the app to terminate unexpectedly. The issue could cause users to miss alarms, alerts or notifications related to estimated glucose values, according to a Food and Drug Administration database entry posted Oct. 30. The glucose sensor and the app are still available, but Dexcom required users to update the app to a new version. Dexcom began the recall on Aug. 28. The FDA designated the event as a Class 1 recall, the most serious kind. Dexcom sent a notification to customers in September about the software bug, which applies to version 1.15 of the G6 Android app. To use the app, customers must update it to a new version, according to the entry. https://www.medtechdive.com/news/dexcom-recall-g6-cgm-app/804630/ XX https://www.medscape.com/viewarticle/automated-insulin-delivery-boosts-glycemic-control-youth-2025a1000ub3 XX Tidepool partners with smart ring maker OURA.. press release says: to support a groundbreaking dataset intended to be broadly available for diabetes research, with participation limited to individuals who opt in through Tidepool.         Tidepool will pair biometric data from Oura Ring – sleep, activity, heart rate, temperature trends, and menstrual cycles – with diabetes device data, including continuous glucose monitors (CGMs) and insulin pumps. The result will provide researchers with an unprecedented dataset to accelerate the development of new clinical guidelines, next-generation diabetes technology, and personalized care models.   Recruitment is expected to launch in early 2026 through an IRB-approved study. By opting in to this study, participants consent to sharing their data with Tidepool's Big Data Donation Project, where data is de-identified and, with participant consent, shared with academics, researchers, and industry innovators to accelerate diabetes research. https://aijourn.com/tidepool-collaborates-with-oura-to-advance-inclusive-diabetes-research-through-wearables/ XX Eli Lilly launches two new clinical trials for baricitinib. These phase 3 trials will investigate whether the drug can delay T1D onset or progression and will open for recruitment soon. Baricitinib has the potential to extend the "honeymoon period" of T1D, meaning that it could preserve remaining insulin-producing beta cells earlier in disease progression. More beta cells mean better blood sugar management—and potentially reduced long-term complications. JAK inhibitors, including baricitinib, are already FDA-approved for other autoimmune diseases, such as rheumatoid arthritis, alopecia, and more. JAK signaling pathways are associated with overactive immune responses, so blocking this pathway may turn down the immune response. The phase 2 Breakthrough T1D-funded BANDIT study was key in showing that this drug is safe and effective in T1D. Importantly, baricitinib is a once-daily oral pill—meaning its use is simple and easy.   https://www.breakthrought1d.org/news-and-updates/two-new-trials-baricitinib-to-delay-t1d/ XX   Insulet is taking diabetes awareness into the workplace. Having found 79% of people with diabetes have faced bias or misunderstanding at work, the medtech giant is rolling out a range of resources intended to trigger changes in how workplaces approach the condition. Lots going on for Diabetes Awareness month.. some notables.. Insulet's "The Day Diabetes Showed up to Work" campaign. based on a survey of almost 10,000 people 79% of people with diabetes have faced bias or misunderstanding at work,.   Almost 90% of people with diabetes surveyed reported experiencing barriers at work due to their condition, and more than 40% of people with diabetes and caregivers said they have workplace-related anxiety tied to the metabolic disease. Around one-quarter of respondents reported fears that diabetes could limit opportunities or lead to workplace discrimination and judgment, and a similar proportion of people said they conceal their condition. https://www.fiercepharma.com/marketing/widespread-workplace-challenges-people-diabetes-spark-insulet-campaign XX New directive issued by the Trump administration could mean people seeking visas to live in the U.S. might be rejected if they have certain medical conditions, including diabetes or obesity.   The guidance, issued in a cable the State Department sent to embassy and consular officials and examined by KFF Health News, directs visa officers to deem applicants ineligible to enter the U.S. for several new reasons, including age or the likelihood they might rely on public benefits.   The guidance says that such people could become a "public charge" — a potential drain on U.S. resources — because of their health issues or age.   The cable's language appears at odds with the Foreign Affairs Manual, the State Department's own handbook, which says that visa officers cannot reject an application based on "what if" scenarios, Wheeler said.   The guidance directs visa officers to develop "their own thoughts about what could lead to some sort of medical emergency or sort of medical costs in the future," he said. "That's troubling because they're not medically trained, they have no experience in this area, and they shouldn't be making projections based on their own personal knowledge or bias."   Immigrants already undergo a medical exam by a physician who's been approved by a U.S. embassy. https://www.npr.org/2025/11/12/nx-s1-5606348/immigrants-visas-health-conditions-trump-guidance XX SAN DIEGO---Nov. 14, 2025—DexCom, Inc. (NASDAQ: DXCM), the global leader in glucose biosensing, today unveiled 16 new diabetes advocates to represent people living with diabetes globally as part of Dexcom's World Diabetes Day campaign. The advocates – ranging from ages six to 68, spanning various types of diabetes, and hailing from four continents and five countries – were selected from 1,000 open call submissions based on their experiences advocating for people with diabetes in their communities. While each person's experience with diabetes is unique, they share a common passion for advocacy – and use of Dexcom's glucose biosensing technology. "Through advocacy, I strive to show others, especially children and newly diagnosed patients, that diabetes is not a limitation but an opportunity to grow stronger, inspire resilience and pursue ambitious goals," said Maria Alejandra Jove Valerio, one of Dexcom's new advocates. "What began as a diagnosis at age seven has grown into a lifelong mission to uplift others." This effort represents the first time Dexcom has sourced voices from the broader diabetes community specifically for its World Diabetes Day campaign, reinforcing Dexcom's history of and commitment to giving real people with diabetes a platform to share their story on a global stage. Through engaging, editorial-style portraits and deeply personal stories, the campaign highlights each advocate's personal experience with diabetes, what misconceptions about diabetes they'd like to dispel and how they want to inspire others with diabetes to discover what they're made of. To prepare for the spotlight, the group of advocates met in Los Angeles for a World Diabetes Day photoshoot which included a surprise visit from Grammy-nominated artist, actor, producer and Dexcom Warrior Lance Bass and author, producer, actress and Stelo*Ambassador Retta. This visit offered the advocates an opportunity to exchange stories and personal perspectives on the meaning of diabetes advocacy and how they live it each day. Behind the lens at the shoot was another member of the diabetes community—photographer Tommy Lundberg who lives with Type 1 diabetes. "Directing this photoshoot was nothing short of inspiring. Each of these advocates has a unique an XX On what would have been the 100th birthday of its visionary founder Alfred E. Mann, MannKind Corporation (Nasdaq: MNKD), in partnership with Alfred E. Mann Charities and The Diabetes Link, announced the launch of the Centennial Al Mann Scholarship. The new program will distribute $100,000 in scholarship funds to support at least 10 young adult students living with diabetes as they pursue higher education in life sciences.   Launched in Diabetes Awareness Month, the scholarship program honors Alfred E. Mann's enduring legacy of innovation, philanthropy, and his lifelong commitment to improving the quality of human life through medical advancement. Deeply passionate about giving back, Mr. Mann believed that his success should continue to serve humanity long after his passing, a belief that lives on through this initiative.   Each scholarship recipient will be awarded up to $10,000, distributed in annual installments of $2,500 throughout the course of their studies. Depending on the length of their degree program, recipients may receive between two and four installments (up to the full $10,000 per student). The first awards will be made for the 2026 academic year.   "Al Mann dedicated his life to helping people with serious medical conditions live longer, healthier lives. This scholarship is a reflection of that spirit," said Michael Castagna, PharmD, Chief Executive Officer of MannKind Corporation. "By supporting students living with diabetes who are pursuing careers in the life sciences and adjacent fields, we're honoring Al's legacy and investing in the future of innovation and care. This program is about giving back to the community we serve and empowering the next generation to carry forward Al's mission of making a meaningful difference in people's lives."   Alfred E. Mann Charities and MannKind will partner with The Diabetes Link to launch the program to serve young adults (aged 18-22) living with either type 1 or type 2 diabetes with their higher education goals. Those eligible will include incoming freshmen and current students pursuing 2- or 4-year degrees. The application window will open in early 2026, and for those interested in receiving notifications, an early interest form is available. More information about the scholarship will be shared on thediabeteslink.org.   "We're honored to partner with MannKind to expand access to higher education for young adults with diabetes," said Manuel Hernández, Chief Executive Officer of The Diabetes Link. "At a time when the cost of college continues to rise, this scholarship helps ease the financial burden and carries forward the spirit of Al Mann, whose vision and legacy continue to inspire us."   Mr. Mann was MannKind's Chairman of the Board from 2001 until his passing in February 2016 and served as Chief Executive Officer from November 2003 until January 2015. Driven by a desire to improve lives and fill unmet medical needs, for more than six decades he founded 17 companies and developed breakthrough medical devices, including insulin pumps, cochlear implants, cardiac pacemakers and retinal prostheses. In 1997, Mr. Mann saw the potential of a dry powder insulin formulation to change the way diabetes is treated and invested nearly $1 billion to help bring Afrezza® (insulin human) Inhalation Powder to market.   About MannKind MannKind Corporation (Nasdaq: MNKD) is a biopharmaceutical company dedicated to transforming chronic disease care through innovative, patient-centric solutions. Focused on cardiometabolic and orphan lung diseases, we develop and commercialize treatments that address serious unmet medical needs, including diabetes, pulmonary hypertension, and fluid overload in heart failure and chronic kidney disease.   With deep expertise in drug-device combinations, MannKind aims to deliver therapies designed to fit seamlessly into daily life.   Learn more at mannkindcorp.com.   About Alfred E. Mann Charities, Inc. Alfred E. Mann Charities, Inc. became active in 2016, following the passing of the organization's benefactor, Alfred E. Mann. Throughout his life, Al was passionate about philanthropy and was dedicated to prolonging and improving the quality of human lives through innovation in the fields of healthcare and the use of medical devices. It was important to Al that his success and assets continue to better human lives even after his own passing.   Alfred E. Mann Charities, Inc. (formerly known as Alfred E. Mann Family Foundation) has similarly placed its primary focus on healthcare and medical innovation, as our organization believes this is where we can have the greatest impact on humanity and human health throughout the world. Alfred E. Mann Charities, Inc. is also dedicated to promoting arts, culture, education, and community development across Los Angeles and throughout the world in order to best serve people and this planet.   Learn more at aemanncharities.org.   About The Diabetes Link The Diabetes Link is the only national nonprofit organization dedicated to empowering young adults living with diabetes. Founded by and for young adults, The Link serves this community through peer support, leadership opportunities, and practical, evidence-based resources designed for real life. Its network of campus and community chapters, active online community, and robust Resource Hub help young adults navigate the transitions of early adulthood while managing diabetes. The organization envisions a future where every young adult living with diabetes has

Dr. Priya Vart discusses the results of his study, "Effects of Dapagliflozin on Health-Related Quality of Life in Patients with CKD," with JASN Deputy Editor Manjula Kurella Tamura.

Bone mineral disorder is one of the most challenging complications of chronic kidney disease, impacting bone strength, mineral balance, and even cardiovascular health. Nutrition plays a critical role in managing this condition — but the complexity of treatment often requires a skilled, multidisciplinary approach.In this episode, host Christina Rollins talks with Sarah Gilbert, MS, RD, LD, a renal nutrition expert and Clinical Assistant Professor at the University of New England, about the dietitian's role in managing bone mineral disorder in CKD.They explore:

* Add FAAN to Anita's creds after Oct. 18.Guests: Anita Rich, DNP, RN, CHFN, CDCES, FAAN, and Jane DeMeis.Related resources:PCNA CKM tools and resources: https://pcna.net/resources/patient-education/patient-information/cardiovascular-kidney-metabolic-syndrome-resources/ 2025 ACC Expert Consensus Statement on Medical Weight Mgmt for Optimization of CV Health: https://www.jacc.org/doi/10.1016/j.jacc.2025.05.024 Adiponectin, Leptin and CV Disorders: (https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.120.314458Racial and Ethnic Disparities in Adult Obesity in the US: https://www.cdc.gov/pcd/issues/2019/18_0579.htmCardiometabolic Syndrome: A Global Health Issue: https://www.uspharmacist.com/article/cardiometabolic-syndrome-a-global-health-issueTaking Aim At Belly Fat: https://www.health.harvard.edu/newsletter_article/taking-aim-at-belly-fatGender Disparities in People Living with Obesity: https://pubmed.ncbi.nlm.nih.gov/34526743/ Systematic review and meta-analysis suggests obesity predicts onset of CKD: https://www.sciencedirect.com/science/article/pii/S0085253816307529AHA Weight-Loss Strategies for Prevention and Treatment of Hypertension: https://pubmed.ncbi.nlm.nih.gov/34538096/ Renal Fat Accumulation Assessed by MRI or CT and Metabolic Disorders: https://pmc.ncbi.nlm.nih.gov/articles/PMC12194363/See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this powerful Kidney Warrior Story, host Dee sits down with Tony to unpack a decade-spanning journey through chronic kidney disease (CKD)—from a shock Stage 4 diagnosis of IgA Nephropathy (IgAN) to Stage 5 kidney failure, peritoneal dialysis (PD) with brutal drain pain, a transition to haemodialysis (HD), line infection and coma, the courage to self-needle with a fistula, and ultimately the life-changing gift of a kidney transplant.   Tony shares the practical and emotional realities few hear about: choosing PD vs HD, APD (overnight machine) vs manual gravity bags, buttonhole vs rope-ladder needling, home haemodialysis training, fluid management, and rebuilding confidence after hospital trauma. He explains how movement and sport (from 5K Parkruns to half marathons) helped his mental health on dialysis—and how he kept going after FIVE “dry-run” transplant calls before finally receiving his match.   Post-transplant, Tony competed at the Transplant Games (bronze in cycling!), then faced a sudden cycling accident with a broken talus—and still came back stronger with kidney function over 90%. Tony's message? You're not alone. With support, information, and small, consistent steps, more is possible than you think.   WHAT YOU'LL HEAR • Early signs missed: high blood pressure and “white coat” assumptions  • Stage 4 to Stage 5 CKD: understanding IgA Nephropathy and next steps  • Peritoneal Dialysis (PD): APD vs gravity bags, real talk on drain pain  • Haemodialysis (HD): line infection → coma, then fistula and self-needling  • Buttonhole vs rope-ladder: how Tony overcame needle phobia  • Home HD routine + exercising safely on dialysis (5K to half marathons)  • Five transplant calls that didn't happen—coping tools that helped  • The call that changed everything: consent, surgery, waking the kidney  • Transplant Games success—and recovery after a serious cycling crash  • Mental health: therapy, peer groups, and why talking saves lives  • Practical tips: fluid limits, pacing activity, and building back slowly  • Community resources: Kidney Care UK, young adult kidney groups   KEY TAKEAWAYS • Movement is medicine—start with what you can manage (even 100 metres).  • Your effort matters—even when decline happens, you may be delaying harm.  • Build your circle: family, peers, clinicians, therapists, Kidney Care UK.  • Advocacy counts: read clinic posters, join groups, ask questions.  • Mindset + support = progress. Small daily actions add up.   If you're newly diagnosed or supporting someone with CKD, browse our back catalogue for in-depth episodes on PD, HD, transplant prep, and mental health.   Follow Diary of a Kidney Warrior:  

Bridge the gap between innovation and practice: are you unlocking the potential of novel agents in dialysis-dependent chronic kidney disease (CKD) anemia? Credit available for this activity expires: 10/31/26 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/1003063?ecd=bdc_podcast_libsyn_mscpedu

The FiltrateJoel Topf @kidneyboy.bsky.social‬Swapnil Hiremath @hswapnil.medsky.socialNayan Arora captainchloride.bsky.socialSopia Ambruso @sophia-kidney.bsky.socialSpecial Guests Brendon Neuen @brendonneuen.bsky.social Associate Professor and Program Lead, Renal and Metabolic at The George Institute for Global Health. Nephrologist and Director of Kidney Trials at Royal North Shore Hospital.Neuen has had three prior appearances on Freely Filtered: EMPA Kidney, DUPLEX and Sparsentan in FSGS, FLOW and SemaglutideMuthiah Vaduganathan @mvaduganathan on X. Cardiologist at Brigham and Women's Hospital and Harvard Medical School. Assistant Professor of Medicine.Editing byJoel TopfThe Kidney Connection written and performed by Tim YauShow NotesDONATE to NephJC! Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes NEJM | NephJC SummaryFIDELIO Bakris et al, NEJM 2020 | NephJC Summary; subgroup throws doubt on efficacy of finerenone in patients on flozinsFIGARO Pitt et al, NEJM 2021; subgroups clearly shows finerenone works, flozins or notNEJM editorial (wrongly) saying do not use Flozins unless on RASi Don't use dual RAS blockade ONTARGET Yusuf et al, NEJM 2008; VA NEPHRON-D Fried et al NEJM 2013Why we cannot study finerenone in HFrEF (RALES Pitt et al NEJM 1999) Muthu is jealous of GFR slope and albuminuria surrogate endpoints and wants to borrow them for HFpEF (Inker et al EHJ 2025)Combination therapy and CV outcomes in hypertension (Wang et al JAMA Card 2024 on low dose combinations and BP; Egan et al Blood Pressure 2022 review of topic) CONFIRMATION HF trial registry entry (Finerenone and Empagliflozin in hospitalized patients with HF)23:20: Nayan and Swap miss a chance to say ‘de-flozination' to discuss stopping a flozin which would allow a patient to be included in the trial Finerenone is a CYP3A4 substrate (Heinig et al Clin Pharmacokinetics 2023); Useful list of CYP3A4 inducers and inhibitors Everyone should get an ABPM (Bugeja et al CMAJ 2022)EASiKIDNEY study design Albuminuria mediates CKD benefits with Finerenone (Agarwal et al Ann Intern Med 2023)GFR slope and Albuminuria and the FDA (Taylor et al eClin Med 2025) Dapagliflozin and Eplerenone combination crossover trial (Provenzano et al JASN 2022)Joel gets promoted! (PBFluids reflection) Bluesky NephJC Chat discussion on ‘renal remission' Withdrawal of Finerenone and worse outcomes from FINEARTS (Vaduganathan et al JACC 2025)Combination therapies Analysis from Brendan and Muthu (Neuen et al Circulation 2024)Do not use KFRE when GFR > 60 (KDIGO Practice Point 2.2.4: Note that risk prediction equations developed for use in people with CKD G3–G5, may not be valid for use in those with CKD G1–G2) Finerenone vs Spironolactone trial in Primary Aldosteronism (Hu et al Circulation 2025)FIND CKD trial design (Heerspink et al NDT 2025) FINE-ONE trial design (Heerspink et al Diab Res Practice 2023) Tubular SecretionsNayan keeping his chin up as Yankees lose and Mariners follow (MLB Playoffs)Sophia's adventures with Beekeeping (Royal Jelly?) Brendon loves listening to ‘Susan' by Raye Muthu is back into Taekwondo Swap is still reading Martha Wells (Witch King on GoodReads)Joel will be hiking the Laugavegur trail in Iceland

Episode 145 — Healthy Heritage Series: African Foods & Kidney Health (Part 1)   African food is filled with memory, flavour, culture and community — and Kidney Warriors deserve to enjoy the dishes they love with confidence. In this Black History Month special, brought to you in partnership with Kidney Care UK, Dee is joined by renal dietitians Timi and Tadala, contributors to the Kidney Kitchen African & Caribbean Recipes magazine.   Together, they share practical tips for adapting traditional African meals for kidney health, including reducing potassium, salt and phosphate, choosing herbs and spices wisely, and preparing dishes such as Jollof rice, greens and cornmeal without losing cultural identity or flavour. Whether you are living with CKD, on dialysis, post-transplant, or supporting a loved one, this episode will empower you to enjoy heritage foods with knowledge and balance.  

Äntligen dags för njurmedicin i Internisten - med oss har vi dr Mats Roman som leder oss igenom studier om: EPO-behandling vid CKD - hur högt är för högt?; kontrastmedel även vid sepsis & hög risk för akut njurskada?; och ett gäng udda orsaker till akut njurskada. Vi nämner i avsnittet: SURF:s rekommendationer om jodkontrastmedel: https://slf.se/sfmr/app/uploads/2025/03/Nationella-rekommendationer-jodkontrastmedel-v7.2-2025-03-07.pdf Things we do for no reason-artikel on kontrastmedel: https://shmpublications.onlinelibrary.wiley.com/doi/abs/10.1002/jhm.70063 Artiklarna: Gammal: https://www.nejm.org/doi/full/10.1056/NEJMoa0907845 Ny: https://www.sciencedirect.com/science/article/abs/pii/S0883944118315181?via%3Dihub Udda: https://www.nejm.org/doi/full/10.1056/NEJMc1414481

Title:  "Meeting My Kidney Sister: Sarah Green-Moore's Story of Healing and Purpose"    

Episode 204: Adult Pneumococcal Vaccines in 2025.  Luz Perez (MSIV) presents all the available pneumococcal vaccines for adults. Dr. Arreaza guides the discussion about what to do with adults who have previously received pneumococcal vaccines. Written by Luz Perez, 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.Today we're answering a clinic classic: Which pneumococcal vaccine should my adult patient get—and when? This is an update of episode 90.Why pneumococcal vaccines matter?Pneumococcal vaccines prevent infections caused by the bacteria Streptococcus pneumonia. These bacteria can cause serious infections like pneumonia, meningitis, and bacteremia. In 2017, the CDC reports that there were more than 31,000 cases of pneumococcal infections and 3,500 deaths from invasive pneumococcal disease. Children are vaccinated in early childhood, before age 5, with PCV15 or PCV 20, at the age of 2, 4, 6 months and a last dose around 12-15 months. Why do we vaccinate adults?Adults are vaccinated because they're at higher risk of getting pneumococcal disease or of having worse outcomes if they do. Vaccines are important because they protect these at-risk patients and reduce the spread of infections among communities. What are the available vaccines? PCV vs PPSV.There are two pneumococcal vaccines used in practice: a polysaccharide vaccine (PPSV) and a conjugate vaccine (PCV). Both protect by targeting capsular polysaccharides from pneumococcal serotypes most often responsible for invasive disease. In simple terms, these vaccines target a part of the bacteria “coating” and create antibodies or proteins that protect the body when the strep enters the body. PPSV (polysaccharide): PPSV is made from purified pieces of the pneumococcal capsule or coating. The current vaccine PPSV23 (Pneumovax®) covers 23 serotypes (or strains) that were the leading cause of pneumococcal infections in the 1980s. PCV (conjugate): Pneumococcal conjugate vaccines (PCVs) take capsular polysaccharides from the bacterium and chemically link them to a carrier protein, which changes and strengthens the immune response. Current PCVs come in four versions: PCV13 (Prevnar 13)PCV15 (Vaxneuvance)PCV20 (Prevnar 20)PCV21 (Capvaxive) The number indicates the amount of pneumococcal capsule types covered by each vaccine. PCV21 was designed around adult disease patterns and covers many serotypes currently driving invasive disease in adults. However, it does not include serotype 4, but this serotype is covered by the PCV20 and PCV15.Who should be vaccinated? In 2024, the United States Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) updated their recommendations on Pneumococcal vaccinations for adults. Their recommendations are: Everyone 50 years or olderAdults age 19–49 with risks: chronic lung/liver disease, heart failure, diabetes; CSF leak or cochlear implant; immunocompromised states (e.g., HIV, hematologic malignancy, CKD/nephrotic syndrome); functional/anatomic asplenia.Patients with history of prior invasive pneumococcal disease: still vaccinate. What vaccine should be given for adults that have never received the Pneumococcal vaccine?For eligible adults with no prior pneumococcal vaccines, there are three choices:PCV21 oncePCV20 oncePCV15 now, followed by PPSV23 later, usually 1 year; 8 weeks if immunocompromised, CSF leak, or cochlear implant.PCV 20 or PCV21 seem more convenient. Once and done. If available, PCV21 is a great one-and-done pick for most adults because it's tailored to current adult serotypes.Serotype 4 caveat: If your patient is at higher risk for serotype 4 disease—think Navajo Nation, or folks in the Western US/Canada with substance use disorders or experiencing homelessness—choose PCV20 (or PCV15 followed by PPSV23 if PCV20 isn't available).What if the patient already received a Pneumococcal vaccine in the past?Plan depends on which vaccine they received and when.PPSV23 only: give PCV21 ≥1 year later (or PCV20 if serotype-4 risk or PCV21 unavailable).PCV10 or PCV13 only: give PCV21 (or PCV20 if PCV21 unavailable) ≥1 year later. If a PCV is not available, discuss PPSV23 now vs waiting until PCV is available.If patient receives PPSV23 now will need to return ≥1 year later to receive a PCV vaccine, and no more vaccines are needed after that.Is it safe to administer the Pneumococcal vaccine with other vaccines?Coadministration is fine with other non-pneumococcal vaccines, as long as we use different syringes and sites. Data support same-day administration of PPSV23 + influenza, and PCV20 with influenza or mRNA COVID-19 vaccines.Some patients are hesitant to receive vaccines, Are there side effects and contraindications to the vaccine?Local reactions are most common: pain/tenderness; swelling/induration (~20%); redness (~15%). Some people “baby” the arm for a couple of days. These typically resolve in 3–4 days; NSAIDs and warm compresses help.Systemic symptoms: fatigue, headache, myalgias/arthralgias, chills; fever ≥38°C is uncommon (

In this Bright Spots in Healthcare episode, host Eric Glazer brings together an all-star panel of leaders who are reshaping the future of Medicaid and social care. Our guests include: Vanita Pindolia, Vice President, Medicare Star Ratings, Emergent Holdings (BlueCross BlueShield Michigan) Jason Merola, MD, Chief Medical Officer, MVP Health Care Charlotta Eriksson, Lead Director, National VBC Partnerships (Specialty), Aetna Mary O'Connor, MD, Chief Medical Officer & Co-Founder, Vori Together, they explore: How Medicare Advantage plans are embedding Stars, CAHPS, and adherence metrics directly into provider contracts to drive accountability, improve quality, and sustain year-over-year performance gains. How payers like Aetna are expanding value-based care into specialty domains—from CKD and oncology to musculoskeletal and cardiology—by partnering with specialty-aligned organizations rather than converting individual specialists to risk models. How MVP Health Care is designing hybrid incentive structures that reward specialists for closing quality gaps and improving outcomes, without requiring full downside risk. Why MSK care is becoming pivotal to Stars success, as physical and mental health measures grow in weight through 2027, and how holistic, physician-led models are improving activity, satisfaction, and cost savings simultaneously. How digital-first specialty networks are solving access challenges, reducing “ghost network” exposure, and creating new opportunities for plans to meet CMS adequacy standards while improving the member experience. How collaboration across utilization management, Stars, and member experience teams helps avoid trade-offs, ensuring that cost controls don't come at the expense of satisfaction or CAHPS performance. Panelist Bios: https://www.brightspotsinhealthcare.com/events/stars-savings-and-satisfaction-unlocking-msk-and-specialty-care-strategies-for-medicare-advantage-success/ Download the Episode Guide: Get key takeaways and expert highlights to help you apply lessons from the episode. https://drive.google.com/file/d/1a_rX23Ev5VRrJKqb8_UwAYBd9tUBIfWA/view?usp=sharing Resources:  Maximizing 2026 Medicare Advantage Performance with Physician-Led MSK Care This report outlines how Vori's physician-led, virtual-first musculoskeletal (MSK) model helps Medicare Advantage plans:Improve up to 12 Star measures across preventive care, chronic condition management, and member experience Deliver faster access to care—appointments available within 48 hours Enhance outcomes for pain, fall prevention, and osteoporosis care while achieving an NPS of 87 Align with the new 2026 Star measures for Improving and Maintaining Physical and Mental Health To request your copy, email nroberts@brightspotsventures.com. Clinical Quality Performance of Value-Based and Fee-for-Service Models for Medicare Advantage: https://jamanetwork.com/journals/jama-health-forum/fullarticle/2839238 This JAMA Health Forum article compares clinical quality outcomes for Medicare Advantage patients whose care is delivered under value-based payment (VBP) models versus traditional fee-for-service (FFS). It finds that VBP arrangements, especially those with two-sided financial risk—in general are associated with better performance on standardized clinical quality measures than FFS. Thank you to our Episode Partner, Vori: Vori partners with health plans and providers to improve musculoskeletal (MSK) care through data-driven, physician-led solutions. Their approach helps reduce unnecessary surgeries, improve recovery outcomes, and enhance patient satisfaction—supporting plans in achieving better Stars performance and overall member experience. To learn more, visit vorihealth.com. Schedule a meeting with Mary O'Connor Chief Medical Officer, Vori: To dive deeper into how Vori can help your plan improve outcomes, reduce costs, and strengthen Medicare Advantage Star Ratings,or to schedule a meeting with Mary O'Connor. Reach out to nroberts@brightspsotsventures.com  to schedule the meeting. About Bright Spots Ventures: Bright Spots Ventures is a healthcare strategy and engagement company that creates content, communities, and connections to accelerate innovation.   We help healthcare leaders discover what's working, and how to scale it. By bringing together health plan, hospital, and solution leaders, we facilitate the exchange of ideas that lead to measurable impact. Through our podcast, executive councils, private events, and go-to-market strategy work, we surface and amplify the “bright spots” in healthcare, proven innovations others can learn from and replicate. At our core, we exist to create trusted relationships that make real progress possible. Visit our website at www.brightspotsinhealthcare.com.  

This Black History Month, Diary of a Kidney Warrior Podcast shares an inspiring story of strength, resilience, and hope.   When what began as a routine illness led to a life-changing diagnosis, Moe's world was turned upside down. In this powerful episode, he opens up about his journey through chronic kidney disease, the sudden medical crisis that tested his limits, and the discovery that changed everything.   Moe's experience shines a light on the realities of living with CKD — from malignant hypertension and often-overlooked symptoms to the mental and emotional toll of navigating serious illness. He also shares the importance of self-advocacy, support networks, and the hope found through the gift of living kidney donation.   This Black History Month special is both moving and educational — a reminder to know your numbers, check your blood pressure, and never ignore the signs your body is sending.   Listen, comment, and share to raise awareness and inspire others on their own kidney health journey.

Chronic kidney disease (CKD) affects more than 35 million U.S. adults, yet only a small percentage see a dietitian before starting dialysis. In this episode of Kidney Commute, experts and a patient share how Medical Nutrition Therapy (MNT) can slow CKD progression, improve quality of life, and support patients in making sustainable dietary changes. Listeners will also gain practical insights on insurance coverage, referral pathways, and strategies to expand access to renal nutrition care.

Phosphorus control is crucial in managing canine and feline chronic kidney disease (CKD), particularly in cats. Because the disease is progressive and incurable, monitoring a cat with CKD is vitally important. With early detection and management, you can significantly extend your patient's lifespan and maintain a good quality of life. In this VetFolio Voice podcast episode, we delve into the monitoring of CKD in cats—including assessing Blood Urea Nitrogen (BUN), creatinine, Symmetric Dimethylarginine (SDMA), proteinuria and blood pressure—and how phosphorus can get lost in the shuffle, especially if it is within the normal reference range. Learn why it is important to continue to actively monitor and manage phosphorus since it is a disease accelerant even before the concentration leaves the normal reference range. We discuss the pathophysiology behind hyperphosphatemia, how to effectively monitor phosphorous levels in order to be able to intervene early, options for managing hyperphosphatemia and updates to the IRIS guidelines.

The authors of the ASN Kidney Health Guidance on Potassium and Phosphorus Food additives discuss clinical approaches to managing hyperkalemia and CKD-mineral and bone disorder risks associated with food additives for people with kidney disease.

In Episode 142 of Diary of a Kidney Warrior Podcast, host Dee Moore sits down with Dr. Vikram Talaulikar—menopause specialist and Associate Professor in Women's Health—to demystify menopause for people living with chronic kidney disease (CKD).   If you've ever wondered whether changing periods, brain fog, poor sleep, hot flushes, joint aches or low mood are “just stress,” menopause, or CKD—this conversation is for you. We explore the menopause transition (perimenopause → menopause → postmenopause), how symptoms can overlap with CKD, and what practical steps you can take right now.   You'll hear about: •Perimenopause vs. menopause—what's normal, what to track, and why one blood test often doesn't tell the full story. •Lifestyle strategies that genuinely help (sleep hygiene, movement, nutrition, supplements to discuss with your team). •Non-hormonal options (including CBT and certain medications) and when they may be considered. •HRT in CKD—safer formulations, delivery routes, and the “lowest effective dose” principle to discuss with your clinicians. •Bone and heart health during and after the transition—and what to raise at your next appointment. •Why timely support matters and how to build a joined-up plan with your GP, kidney team, or menopause specialist.   This episode is compassionate, practical, and designed to help you advocate for yourself. We're also preparing a listener-led Q&A with Dr. Talaulikar—send us your questions! Submission details are in the show notes.   Perfect for: Women with CKD (or their supporters) navigating menopause, perimenopause, postmenopause; anyone curious about evidence-based options—including HRT—in the context of kidney health.     Follow & Subscribe: If this helped you, follow the show, leave a review, and share with a fellow Kidney Warrior. Your support helps more people find life-changing information.     Follow Diary of a Kidney Warrior:  

Welcome back to the Hot Topics podcast from NB Medical with Dr Neal Tucker. In this new season, we chat to Dr Simon Curtis about the upcoming Autumn 2025 Hot Topics course, then discuss three new pieces of research.First, in the Lancet, which are the best anti-hypertensives, what effect does increasing a dose actually have and how good are combinations? Second, in the NEJM, does giving all the drugs improve CKD outcomes? The case for finerenone and empagliflozin. Third, do ADHD drugs help outcomes beyond core symptoms such as accidents, suicide and crime? But can we rely on the research method used...?ReferencesLancet Antihypertensive Efficacy PaperNEJM Finerenone & EmpagliflozinReport on trends in CKDBMJ ADHD meds & prevention of complicationswww.nbmedical.com/podcast

GLP-1 medications like Ozempic were designed to treat diabetes—but they're quickly becoming known for weight loss and possible kidney benefits. Kidney doctor Holly Kramer and kidney patients Patrick Gee, and Jane DeMeis, are here to break down what these medications are, how they work, and what people with kidney disease need to know.   In today's episode we heard from: Holly Kramer, M.D., MPH, is a practicing nephrologist who conducts research connecting nutrition and kidney health. Her connection to the National Kidney Foundation was inspired by her mom, who was a dialysis nurse and helped create some of the first dialysis units in Northwest Indiana. Dr. Kramer finds being on the NKF Board important, because it is the largest, patient-centered organization focusing on kidney disease. Her long-term goal is to increase national funding for kidney disease research and to heighten awareness about chronic kidney disease. Jane DeMeis  became involved with the National Kidney Foundation when she was diagnosed in 2018 with stage 4 kidney disease. She is currently on home hemodialysis and the transplant waitlist. Ms. DeMeis was the Director of Education and Organizational Development for U R Medicine Home Care. Part of her responsibilities was working with clinicians in teaching them how to present education to patients. She also was the Chairperson of the Patient Family Centered Care program and worked with improving home care through patient advocacy.  In 2018, Ms. DeMeis retired. She had been fighting CKD along with Psoriatic Arthritis for many years and needed to focus on her health.  She currently serves as a member of NKF's Kidney Advocacy Committee, as an Ambassador for NKF's online communities, and also as a NKF Peer mentor. Her other volunteer activities include being on the Board of the Perinton Food Shelf and working with clients as the Lead Verifier.  She and her husband sing with the Perinton Senior Chorus and enjoy working in their garden. Patrick Gee is a Community Activist, fighting against systemic issues such as poverty, social and racial injustices, criminal justice reform, and education reform. Patrick worked for the Virginia Department of Corrections and the Virginia Department of Juvenile Justice, where during his time in service, he acquired several awards and recognitions. In April 2013, Patrick was diagnosed with Stage 3b End-Stage Kidney Disease (ESKD). He began doing Peritoneal Dialysis (PD) in December 2013. On April 21, 2017, Patrick received a kidney transplant. Patrick has been very passionate in his pursuit to speak on behalf of the underserved, undervalued, and disenfranchised communities of color. Because of this, he serves as an advocate and kidney patient expert for a number of organizations including the NKF, CMS, FDA, KHI, AKF, AAKP and HDU.  Patrick was the 2025 winner of NKF's Celeste Lee Castillo Patient Engagement Award.    Additional Resources: GLP-1 Receptor Agonists NKF Supports Proposal to Expand Access to Weight-Loss Medications   Do you have comments, questions, or suggestions? Email us at NKFpodcast@kidney.org. Also, make sure to rate and review us wherever you listen to podcasts.  

Potassium is a HOT topic in kidney disease - but doesn't get the focus is deserves for kidney stones. In This episode, Melanie breaks down potassium in your diet, where it comes from and why it matters for both kidney disease AND kidney stones.  Blog: Potential Renal Acid Load Blog: Potatoes & Kidney Disease: The Potassium Dilemma References: 1. Ikizler A, Burrowes J, Byham-Gray L, et al. KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update. Am J Kidney Dis. 2020;76(3):S1-S107. 2. MacLaughlin HL, McAuley E, Fry J, et al. Re-Thinking Hyperkalaemia Management in Chronic Kidney Disease—Beyond Food Tables and Nutrition Myths: An Evidence-Based Practice Review. Nutrients. 2024;16(1):3.    Submit a question for Melanie to answer on the podcast! Connect with The Kidney Dietitian! Work with Us! |  Instagram | Facebook | Pinterest | Facebook Group | Newsletter www.thekidneydietitian.org FREE Webinar: The 3-Step Method to Prevent Kidney Stones All information in this podcast is meant for educational purposes only and should not be used in place of advice from a medical professional.  

Welcome to another eye-opening episode of Transforming Relationships with Emotional Intelligence, where we explore the connection between emotional well-being, physical health, and the everyday relationships that shape our lives.In this vital conversation, I'm joined by a compassionate and highly experienced renal nurse (Roseline Elsie Agyekum), who sheds light on one of the most overlooked but essential parts of the body—our kidneys.Together, we explore the emotional, clinical and lifestyle aspects of chronic kidney disease (CKD)—a condition that affects millions globally but often goes undetected until it's too late. Whether you're living with chronic illness, caring for someone who is, or simply want to take better care of your health, this episode will equip you with insights and practical steps to protect your kidneys and overall well-being. In This Episode, You'll Discover:What your kidneys actually do—and why they're critical to your full-body healthThe biggest risk factors for CKD, including diabetes, hypertension, obesity, and medicationsSubtle early signs that your kidney health may be at riskPractical, evidence-based strategies for protecting your kidneys through lifestyle changesWhat patients with high blood pressure or diabetes must know to safeguard kidney functionLesser-known risks to kidney health—like certain medications and habitsHow social, environmental, and systemic factors influence kidney health and health equityThis episode is a call to awareness and a reminder that health is built in both the clinic and the community. It's a powerful invitation to take control of your health with clarity, compassion and confidence.Tune in now to gain the knowledge and motivation you need to support your kidneys and the people you care about.Work With Coach OwenicoIf you're ready to explore how emotional intelligence can transform your leadership, wellbeing, or relationships:→ Book a free private call: www.calendly.com/owenicoconsult→ Email me directly: owen@owenicoconsult.comStay ConnectedConnect with Coach Owenico: https://linktr.ee/owenicoconsultJoin our community & get free resources: Emotional Intelligence HubIf this episode inspired you, please subscribe, rate, and review—so we can continue sharing meaningful conversations that heal, inform, and empower.#Podcast #KidneyHealth #CKD #ChronicIllness #PreventiveHealth #EmotionalIntelligence #HealthAwareness #CoachOwenico #TransformingRelationships #Wellbeing #RenalNurse #HealthyHabits #HealthEquitySupport the show

Welcome to another eye-opening episode of Transforming Relationships with Emotional Intelligence, where we explore the connection between emotional well-being, physical health, and the everyday relationships that shape our lives.In this vital conversation, I'm joined by a compassionate and highly experienced renal nurse (Roseline Elsie Agyekum), who sheds light on one of the most overlooked but essential parts of the body—our kidneys.Together, we explore the emotional, clinical and lifestyle aspects of chronic kidney disease (CKD)—a condition that affects millions globally but often goes undetected until it's too late. Whether you're living with chronic illness, caring for someone who is, or simply want to take better care of your health, this episode will equip you with insights and practical steps to protect your kidneys and overall well-being.In This Episode, You'll Discover:What your kidneys actually do—and why they're critical to your full-body healthThe biggest risk factors for CKD, including diabetes, hypertension, obesity, and medicationsSubtle early signs that your kidney health may be at riskPractical, evidence-based strategies for protecting your kidneys through lifestyle changesWhat patients with high blood pressure or diabetes must know to safeguard kidney functionLesser-known risks to kidney health—like certain medications and habitsHow social, environmental, and systemic factors influence kidney health and health equityThis episode is a call to awareness and a reminder that health is built in both the clinic and the community. It's a powerful invitation to take control of your health with clarity, compassion and confidence.Tune in now to gain the knowledge and motivation you need to support your kidneys and the people you care about.Work With Coach OwenicoIf you're ready to explore how emotional intelligence can transform your leadership, wellbeing, or relationships:→ Book a free private call: www.calendly.com/owenicoconsult→ Email me directly: owen@owenicoconsult.comStay ConnectedConnect with Coach Owenico: https://linktr.ee/owenicoconsultJoin our community & get free resources: Emotional Intelligence HubIf this episode inspired you, please subscribe, rate, and review—so we can continue sharing meaningful conversations that heal, inform, and empower.#Podcast #KidneyHealth #CKD #ChronicIllness #PreventiveHealth #EmotionalIntelligence #HealthAwareness #CoachOwenico #TransformingRelationships #Wellbeing #RenalNurse #HealthyHabits #HealthEquitySupport the show

Resources:  Rutherford Chapters (10th ed.): 174, 175, 177, 178 Prior Holding Pressure episode on AV access creation: https://www.audiblebleeding.com/vsite-hd-access/ The Society for Vascular Surgery: Clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access: https://www.jvascsurg.org/article/S0741-5214%2808%2901399-2/fulltext  KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update: https://pubmed.ncbi.nlm.nih.gov/32778223/    Venous Hypertension   Definition A functioning AV circuit delivers high volume arterial flow towards a stenotic venous segment, causing buildup in pressure and venous hypertension. If there are few or no branching veins between the access and stenosis, thrombosis could occur   Etiology The most common etiology is venous stenosis caused by a history of vessel wall trauma by centrally-inserted venous devices such as tunneled and non-tunneled dialysis catheters, central lines, pacemakers, or defibrillator. In a study performed at a large academic medical center1, new hemodynamically significant central venous stenosis was associated with the duration of catheter dependence (26% in patients with CVCs for more than 6 months, versus 11% in patients with CVCs for less than 6 months). PICC lines can directly damage cephalic and basilic veins Venous stenosis can often go undetected until AV access creation occurs   Patient Presentation Symptoms of venous insufficiency will be present– most commonly regional edema, in the area of venous stenosis. If there are patent venous branches between the AV anastomosis and the stenotic area, swelling can occur throughout the arm. Pigmentation, induration, dermatosclerosis, and ulceration may also be observed. An extensive collateral network of veins may be visible throughout anterior chest, shoulder, or flank SVC obstruction can result in swelling of the head, neck and shoulders, as well as a feeling of head and neck fullness, airway compromise, and visual problems Normal palpable thrill can be replaced by a strong pulse Dialysis can be complicated by difficulty with needle access, recirculation syndrome, and arm swelling after dialysis sessions. Workup  Central vein thrombosis can be hard to detect on ultrasound because clavicle and sternum can block transmission Venography is essential to determine the presence and severity of venous stenosis or occlusion.   Prevention The ideal scenario is to avoid central dialysis catheters completely, and this involves evaluating CKD patients and placing AVF or AVG before the need for dialysis arises.  If a patient presents placement of an AVF/AVG, it is important to perform venography if a patient has a history of a central venous catheter or clinical signs of venous hypertension. A history of SVC obstruction from any cause can preclude permanent AV access creation in both upper extremities Treatment Endovascular approaches to venous outflow stenosis can be first-line treatment options, due to their minimal risk. They can also be performed at the same time as a diagnostic venogram. Angioplasty alone or with stenting are the endovascular options. In a study by Bakken et al2 that compared primary high-pressure balloon angioplasty versus stenting, primary patency was equivalent between groups, with 30-day rates of 76% for both groups and 12-month rates of 29% for angioplasty and 21% for stenting. Assisted primary patency was also equivalent with a 30-day patency rate of 81% and 12-month rate of 73% for the angioplasty group,  84% at 30 days, and 46% at 12 months for the stenting group. This study, along with others, shows that the major downside of endovascular interventions, whether angioplasty or stenting, often require repeat intervention and have poor long-term patency. For subclavian vein stenosis, angioplasty alone is appropriate due to its anatomical location that can put a stent at risk for extrinsic compression from the first rib and clavicle. Surgical bypass can be performed Possible bypasses include axillary-axillary, axillary-jugular, axillary-right atrial, and axillary-femoral. In these bypasses, the preferred conduits are autogenous saphenous or femoral veins. In cases where the proximal subclavian vein is obstructed, a jugular vein turndown can be performed. In this procedure the distal jugular vein is transected, sewed end-to-side at the distal subclavian vein, effectively acting as a bypass route for that obstructed segment. The Hemoaccess Reliable Outflow (HeRO) Vascular Access Device can be used as a hybrid approach, combining endovascular and open surgical techniques to bypass a central venous occlusion  and provide a reliable outflow for dialysis.  This device has a PTFE inflow limb that is sewn end-to-side onto the brachial artery. This limb is tunneled subcutaneously and connected to a silicone-coated nitinol outflow catheter that is inserted into a central vein and tracked directly into the right atrium. This effectively bypasses central venous stenoses. In the largest study to date on HeRO access grafts placed in 167 patients,3 HeRO primary and secondary patency was 48.8% and 90.8%, respectively, at 12 months. Interventions to maintain or re-establish patency were required in 71.3% of patients resulting in an intervention rate of 1.5/year. Access-related infections were reported in 4.3% patients. The authors concluded that HeRO device had performed comparably to standard AVGs and had proven superior to tunneled dialysis catheters in terms of patency, intervention, and infection rates. If no treatment options for venous hypertension or outflow obstruction  are available, an alternate AV access site can be created, either in the contralateral arm if the SVC is uninvolved, or through placement of femoral AV access or a peritoneal dialysis catheter.   Bleeding Access Site   Etiology and Risk Factors Bleeding can be caused by high venous pressure after dialysis, pseudoaneurysm rupture, or trauma. Patients with end stage renal disease (ESRD) have a baseline elevated risk of bleeding due to uremia-induced platelet dysfunction and use of systemic anticoagulation within the hemodialysis circuit. Additional risk factors include dialysis through an AV graft, hypertension, longer duration of access use, and compromised integrity of the vascular access due to complications (clotting, infection) or invasive procedures. Dual antiplatelet therapy is also associated with overall bleeding events in ESRD patients. Dialysis patients could be on antiplatelet therapy for management of comorbid cardiovascular risk and/or patency of AV graft Patients with bleeding fistulas often present from their dialysis unit when standard digital pressure at the cannulation site fails to stop the bleeding. This is a very serious condition since most mature fistulas have high blood flow and the patients are at risk for hemorrhagic shock and death.    Initial Management  The first step of management is to obtain hemostasis. Elevate the limb above the level of the heart and apply firm and directed pressure at the site of bleeding using gauze for at least 30-40 minutes Milosevic et al4 reviewed non-operative management of bleeding fistulas and grafts and found that compared to standard dressings, the use of specialized hemostatic dressings decreased bleeding time at arterial and venous cannulation sites. These hemostatic materials included the IRIS compression bandage and cellulose-based, chitosan-based, poly-N-acetyl glucosamine-based, and thrombin-soaked dressings. There has been a “bottlecap method” described where the hollow side of a bottlecap is pressed on top of the puncture site. Maintaining pressure on the cap will cause the cap to fill with blood and clot, which tamponades the bleeding. The provider can also place a shallow figure-of-8 or purse string stitch just below the skin surface to aid in hemostasis. It is important to avoid placing the suture too deep as this can cause inadvertent fistula ligation. During this process, an assistant applies pressure just proximal and distal to the bleeding site to stop blood flow so the sutures can be placed. If these methods fail to achieve hemostasis, apply a tourniquet proximal to the fistula and tighten it until bleeding stops and the radial pulse is lost. This signifies complete occlusion of arterial inflow to the fistula. Tourniquet use should be limited to 3 hours or less, since limb ischemia beyond this timepoint is associated with permanent neuromuscular damage. Regardless of the method used for initial hemostasis, the patient is at risk for repeat hemorrhage, hematoma formation, vessel stenosis, and thrombosis. They should be evaluated by a vascular surgeon as soon as possible.  Definitive Management Definitive management depends on etiology of each case, and there are a variety of interventions that can be pursued (i.e. aneurysmorrhaphy for aneurysmal bleeding) If skin erosion over the conduit is present, it should be assumed that the AV access is infected and emergency intervention should be pursued. A jump graft can be placed through with healthy tissue.  A covered stent could be introduced through a separate percutaneous puncture site Finally, coagulopathy can be addressed by administering cryoprecipitate, DDAVP, erythropoietin, estrogen, tranexamic acid. Aneurysms and Pseudoaneurysms   Definition and Etiology Aneurysms involve all three layers of the vessel wall and they develop due to hemodynamic changes causing remodeling of the vein wall in an AV fistula. This is necessary for vein maturation, but becomes problematic if the post-anastomotic vein continues to dilate and becomes aneurysmal.  Aneurysms can also occur at anastomosis sites due to technical aspects of the surgery. Pseudoaneurysms only involve some layers of the vessel wall caused by repeated puncture for hemodialysis.  Both aneurysms and pseudoaneurysms can enlarge due to venous outflow stenosis causing increased intraluminal pressures. Both true aneurysms and pseudoaneurysms can lead to overlying skin erosion and subsequent hemorrhage, pain, AV access dysfunction, and cannulation difficulties.  Dialysis cannulation should be avoided at the aneurysmal sites to prevent bleeding complications. Diagnosis They can be diagnosed on ultrasound, which also provide information on flow rates, presence inflow/outflow/stenoses, and vessel diameters.  Indications for Treatment Treatment is indicated for aneurysms that are rapidly expanding or ulcerating through the skin surface. These are at high risk for rupture and hemorrhage, which is life-threatening. Treatment is also indicated when the aneurysm occurs at the anastomotic site of the AV fistula, the patient has a cosmetic concern, cannulation becomes difficult, there is concern for infection, or the patient has high-output heart failure that could be exacerbated by high flow through the fistula. Treatment is not indicated in asymptomatic aneurysms, regardless of their size. True  aneurysms and pseudoaneurysms are not prone to spontaneous rupture.   Treatment Options Aneurysmorrhaphy is the most common treatment. It involves the resection of the aneurysmal vein wall to restore a normal diameter and removal of excess skin. Anastomosis is performed along the lateral wall to prevent issues with cannulation along the suture line. Aneurysm resection with interposition grafting is also possible. If multiple aneurysmal segments require treatment, staging their repairs can allow for continuation of dialysis without needing to place a temporary dialysis catheter. AV access ligation is an appropriate alternative to AV access salvage in certain situations but usually requires excision of the aneurysm/pseudoaneurysm due to the potential to develop thrombophlebitis and the cosmetic appearance of the thrombosed segment. If there is concern for an infected pseudoaneurysm or aneurysm, surgery should include removal of all infected material. References   1. Al-Balas A, Almehmi A, Varma R, Al-Balas H, Allon M. De Novo Central Vein Stenosis in Hemodialysis Patients Following Initial Tunneled Central Vein Catheter Placement. Kidney360. 2022;3(1):99-102. doi:10.34067/KID.0005202021 2. Bakken AM, Protack CD, Saad WE, Lee DE, Waldman DL, Davies MG. Long-term outcomes of primary angioplasty and primary stenting of central venous stenosis in hemodialysis patients. J Vasc Surg. 2007;45(4):776-783. doi:10.1016/j.jvs.2006.12.046 3. Gage SM, Katzman HE, Ross JR, et al. Multi-center Experience of 164 Consecutive Hemodialysis Reliable Outflow [HeRO] Graft Implants for Hemodialysis Treatment. Eur J Vasc Endovasc Surg. 2012;44(1):93-99. doi:10.1016/j.ejvs.2012.04.011 4. Milosevic E, Forster A, Moist L, Rehman F, Thomson B. Non-surgical interventions to control bleeding from arteriovenous fistulas and grafts inside and outside the hemodialysis unit: a scoping review. Clin Kidney J. 2024;17(5):sfae089. doi:10.1093/ckj/sfae089

In this podcast, expert Suneel Udani, MD, discusses the management of chronic kidney disease (CKD) and CKD-associated fluid overload, including an overview of treatment guidelines and various available therapies.

How do you know when your kidney health needs more than GP care—and how can you make sure you're getting the right tests, referrals, and treatment?   In this powerful follow-up to Episode 139, host Dee Moore is once again joined by Dr. Kristin Veighey for Part 2 of “Beyond the GP: Making Primary Care Work for Kidney Health.” Together, they dive deeper into the realities of managing chronic kidney disease (CKD) in the primary care setting, giving patients the tools to advocate for themselves and get the support they need.   This episode answers the questions so many patients ask but rarely get clear guidance on:   ✅ Know your risk factors – from diabetes, high blood pressure, and heart disease to family history and medications that can affect kidney function. ✅ Why urine tests matter – and why they often reveal problems years before blood tests. ✅ Diabetes and CKD – the number one cause of kidney disease in the UK, and why tighter blood pressure, cholesterol, and glucose targets are essential. ✅ When to push for referral – understanding the Kidney Failure Risk Equation (KFRE), what “CKD stage 4 or 5” really means, and why you don't have to wait until dialysis is on the table. ✅ The role of the multidisciplinary team – how pharmacists, nurses, and other professionals in primary care can help streamline your care and reduce unnecessary appointments. ✅ Targets that protect your kidneys – the real numbers you should be aiming for with blood pressure, cholesterol, and blood sugar.  

Alice Sheridan, MD, FASN, and Martina McGrath, MD, FASN, speak with guest editors Daniel W. Coyne, MD, and Morgan B. Schoer, MD, about their editorial "Parathyroidectomy for Treatment of Hyperparathyroidism in CKD" from nephSAP Volume 24, Number 3.

Welcome to HCPLive's 5 Stories in Under 5—your quick, must-know recap of the top 5 healthcare stories from the past week, all in under 5 minutes. Stay informed, stay ahead, and let's dive into the latest updates impacting clinicians and healthcare providers like you! Interested in a more traditional, text rundown? Check out the HCPFive! Top 5 Healthcare Headlines for August 10-16, 2025: FDA Approves 2 Generic Iron Sucrose Injections for Iron Deficiency Anemia in CKD  The FDA approved 2 generic versions of iron sucrose injection for treating iron deficiency anemia in patients with CKD, expanding access to therapy. FDA Approves PharmaTher's Ketamine for Surgical Pain Management  The FDA approved PharmaTher's ketamine formulation for surgical pain management following resolution of earlier application deficiencies. HFSA and ASPC Release Statement on Shifting to Prevention in Heart Failure  The HFSA and ASPC issued a joint statement urging clinicians to prioritize prevention and early risk management in heart failure care. Zopapogene Imadenovec First Immunotherapy Approved for Recurrent Respiratory Papillomatosis  The FDA approved zopapogene imadenovec as the first immunotherapy for recurrent respiratory papillomatosis, offering a new treatment option. AHA & ACC Release New Guidelines for High Blood Pressure to Reduce CVD Risk  The AHA and ACC released updated hypertension guidelines recommending earlier intervention to lower cardiovascular disease risk.

Thank you for listening to The Peptide Podcast. If you enjoyed the show and want to support what we do, head over to our Partners Page. You'll find some amazing brands we trust—and by checking them out, you're helping us keep the podcast going.  Today, we're diving into one of the most talked-about topics in health and weight loss right now: GLP-1 medications like semaglutide and the newer dual GIP/GLP-1s like tirzepatide. You've probably seen the headlines, scrolled past a few TikToks, or heard a friend mention it — but with all that noise comes a lot of confusion, half-truths, and flat-out myths. Today we're breaking it all down. What's real? What's hype? And what do you actually need to know if you're using these medications — or thinking about it? Let's separate science from scare tactics and get to the truth, one myth at a time. Myth #1: GLP-1s Cause Dangerous Muscle Loss The claim:  “GLP-1s cause massive muscle loss.” Truth: This is an overstatement. Some loss of lean mass is normal with any kind of weight loss — whether it's through diet, medication, or surgery. What studies show is that with medications like semaglutide (Wegovy) and tirzepatide (Zepbound), about 20–25% of the total weight lost comes from lean mass, and the rest is fat — which is exactly what we're targeting in obesity treatment. That 20–25% figure isn't unique to these meds; it's actually pretty typical in weight loss without focused resistance training or optimized protein intake. You may also hear “You'll lose all your muscle and become frail on GLP-1s.” Truth: You won't “lose all your muscle.” In fact, muscle loss is preventable by maintaining adequate protein intake, resistance training, and managing weight loss pace. Furthermore, many patients gain strength and mobility as excess weight comes off. And lastly, my favorite myth is “You can't preserve muscle on GLP-1s.” Truth: That's completely false — muscle loss isn't inevitable on GLP-1s if you take the right approach. You can absolutely preserve muscle by making a few intentional choices: aim for enough protein each day (a good goal is around 0.8 grams per pound of body weight), include some strength or resistance training a couple times a week, and avoid losing weight too quickly. These simple steps go a long way in protecting your lean mass while still getting all the benefits of weight loss. One study on semaglutide showed that people lost an average of about 15% of their body weight, and only around 3–4% of that was lean mass. So if someone drops 30 pounds, maybe 6 to 8 of those pounds might be lean mass—not ideal, but definitely not disastrous either, and very manageable with the right lifestyle habits.  The truth is, while some lean mass loss is expected with any type of weight loss, research shows that most of the weight lost on GLP-1s is actually fat, not muscle. For example, in the STEP 1 trial, about 80% of the weight lost on semaglutide came from fat, and only about 20% from lean tissue (as we mentioned earlier).  The SURMOUNT-1 trial with tirzepatide showed similar results—significant fat loss with relatively preserved muscle, especially when paired with resistance training. And that's important, because preserving muscle during weight loss helps protect metabolism, strength, and overall health. With good nutrition and movement, GLP-1s can lead to healthier body composition—not just a lower number on the scale. Okay, moving along to the next myth … Myth #2: GLP-1s Can Cause Blindness The truth: This myth stems from concerns about diabetic retinopathy worsening, which is tied to how quickly blood sugar drops, not to the drug itself. In the SUSTAIN-6 trial (Marso et al., NEJM, 2016), a small subset of patients with pre-existing advanced diabetic retinopathy saw transient worsening—but only in those with rapid improvements in A1c. No increased rates of blindness or new-onset retinopathy have been found in non-diabetic patients using GLP-1s for weight loss. The bottom line is that those without advanced diabetic eye disease, there's no increased risk of blindness. Patients with diabetic retinopathy should be monitored closely—but this is about glycemic management, not a direct effect of the medication. Myth #3: GLP-1s Cause Kidney or Liver Damage The truth: This is false. In fact, GLP-1 agonists may protect kidney and liver function—especially in patients with diabetes or fatty liver disease. The most recent notable study showing kidney‑protective effects of a GLP‑1 receptor agonist is the FLOW trial, which evaluated semaglutide in people with type 2 diabetes and chronic kidney disease (CKD). This double‑blind, randomized, placebo‑controlled trial included 3,533 participants followed for a median of 3.4 years and found that semaglutide reduced the risk of major kidney‑related events—including kidney failure, substantial eGFR decline, and death from renal or cardiovascular causes—by 24% compared to placebo. A 2025 meta-analysis of multiple randomized controlled trials (11 studies, 85,373 participants) concluded that GLP‑1 receptor agonists reduced the risk of composite kidney failure outcomes by 18%, kidney failure by 16%, and all‑cause death by 12%. And let's not forget the SMART trial, involving obese patients with kidney disease but without diabetes, found that semaglutide protected kidney function in this non‑diabetic, CKD‑affected population.  When it comes to the liver, there's actually growing evidence they're actually helping reverse non-alcoholic fatty liver disease (NAFLD). The STEP 1 MRI substudy and SURPASS-3 MRI substudy have shown people on these medications can reduce liver fat by 30 to even 50% and in some cases, completely resolve liver inflammation — that more serious form called NASH, where fat is combined with inflammation and early scarring. The LEAN trial found that nearly 60% of people taking semaglutide had resolution of NASH, without worsening their liver scarring. That's huge. And even better, we're seeing these effects even in people who don't have diabetes. Just losing weight helps fatty liver, but these meds seem to do more than that — they actually target inflammation and fat storage in the liver itself.. The bottom line is GLP-1s are not nephrotoxic or hepatotoxic. In fact, they may be organ-protective—especially for people with underlying metabolic issues. Myth #4: These Drugs Lead to Bone Loss The claim: “You'll get osteoporosis from losing too much weight!” The truth: While extreme weight loss can affect bone density, GLP-1s themselves do not cause bone loss, and may even have neutral or protective effects on bone. A 2022 study in Bone found no significant change in BMD (bone mineral density) in adults treated with semaglutide for obesity. While the SUSTAIN and PIONEER programs found no increased risk of fractures in semaglutide-treated patients versus placebo. Truly, concerns about bone loss are more relevant in extreme calorie restriction or eating disorders—not evidence-based GLP-1 treatment with appropriate nutrition. Myth #5: Everyone Gets Gastroparesis The claim: “These medications paralyze your stomach” The truth: GLP-1s slow gastric emptying, which is part of how they work—making you feel full longer. But this is dose-dependent and typically reversible. A 2023 FDA safety review found that true gastroparesis is extremely rare and resolves when the drug is stopped. Reality check: Nausea, early satiety, and mild bloating are common but manageable side effects. True, lasting gastroparesis is not typical, especially when doses are titrated gradually. Myth #6: GLP-1s Make Your Hair Fall Out The claim: “You'll lose a ton of hair—just like with crash diets” The truth: Hair shedding is not directly caused by GLP-1 medications. Instead, it's often a temporary, non-scarring condition called telogen effluvium, which can happen with any rapid weight loss, regardless of the method. A 2023 analysis from the American Academy of Dermatology emphasized that telogen effluvium is common with surgical or medical weight loss, especially if patients lose more than 10% of their body weight within a few months. In clinical trials like STEP and SURMOUNT, hair loss was not listed as a common side effect, but patient-reported data show it occurs occasionally—likely tied to nutritional stress, not the drug itself. So why does hair loss happen? We've talked about this before, but I don't want to leave this important information out.  Hair follicles are sensitive to internal stress. Rapid changes in caloric intake, nutrient levels (like iron, zinc, and biotin), or hormone balance can push hairs into the shedding phase. This is a delayed effect, often showing up 2–3 months after weight loss begins, and it typically resolves within 6–12 months. What helps is slower, sustained weight loss, prioritizing protein intake, supplementing iron, zinc, and biotin if deficient, and avoiding very low-calorie diets and over-restriction. Myth #6: GLP-1s Cause Dehydration It's a common myth that GLP-1 medications cause dehydration — but that's not exactly true. The medication itself doesn't directly dehydrate you. What can happen is that some people experience nausea, vomiting, or a reduced appetite early on, which can lead to drinking less water without realizing it. That's where the dehydration risk comes in. A good general rule for staying hydrated is to aim for half your body weight in ounces of water per day. So, for example, if you weigh 160 pounds, try to drink around 80 ounces daily — more if you're active or live in a hot climate. Electrolytes can also be really helpful, especially if you're feeling tired, dizzy, or crampy. I like LMNT packets — they're a clean option with no sugar and a good balance of sodium, magnesium, and potassium. The sodium in LMNT packets helps keep you hydrated by pulling water into your cells and helping your body retain the fluids it needs to function properly. Just one a day can make a big difference in how you feel. Myth #7: You Have to Stay on GLP-1s Forever or You'll Gain All the Weight Back The claim: “As soon as you stop taking it, all the weight comes back” The truth: Yes—some weight regain is likely after stopping GLP-1 medications. But that doesn't mean they're ineffective or that you're doomed to rebound completely. The same pattern happens after any type of weight loss intervention, whether it's a diet, surgery, or medication. The STEP 4 trial (Wilding et al., 2022) showed that participants who stopped semaglutide after 20 weeks regained an average of 6% of their weight loss over the next year. But it's important to note that they still weighed less than at baseline—and many continued to experience improvements in blood pressure, cholesterol, and insulin sensitivity. Similarly, in SURMOUNT-4, patients who stopped tirzepatide also regained weight, but less than they lost. So why does this weight gain happen? I feel like the answer to this is obvious, but I've found that it's not.  GLP-1s change your appetite and hunger cues. Once the medication is stopped, your body's baseline hunger signals return—and often with increased intensity, due to metabolic adaptation. But this isn't unique to GLP-1s. The same thing happens after crash diets, keto, intermittent fasting, or bariatric surgery if long-term changes aren't made. The real issue isn't the drug—it's the lack of a plan after the drug. To help make results sustainable, we need to use the medication as a tool, not a crutch. We should use it to help us lose weight and understand our hunger cues, while transitioning to a whole foods, protein based diet coupled with resistance training to help preserve and build muscle.  Just remember, if you're coming off a GLP-1 and want to keep the momentum going, the key is to approach it thoughtfully. Tapering slowly under medical supervision can help your body adjust and reduce the chances of weight regain. At the same time, this is a great moment to double down on the habits that helped you feel your best while on the medication. Think ongoing support—like working with a health coach, joining a support group, or even doing behavioral therapy—to help reinforce those long-term lifestyle changes. It's not just about what you stop; it's about what you keep doing that matters most. You don't necessarily have to stay on GLP-1s forever—but if you stop without a plan, some weight regain is very likely. Think of them like glasses: they help you see clearly while you build the habits to eventually navigate without them. For some, that may mean staying on a lower maintenance dose long-term—just like with blood pressure or cholesterol meds. What are my final thoughts? I want to be clear—GLP-1s aren't magic. But they are powerful tools when paired with education, support, and smart lifestyle changes.  Myths like ‘you'll go blind,' ‘you'll lose all your hair,' or ‘you'll be stuck on these meds forever' aren't just misleading and downright false—they discourage people from getting real help.  So if you're thinking about these medications, get informed, ask the hard questions, and make your decision based on science—not fear. Thank you for listening to The Peptide Podcast. If you enjoyed the show and want to support what we do, head over to our Partners Page. You'll find some amazing brands we trust—and by checking them out, you're helping us keep the podcast going.  Until next time, be well, and as always, have a happy, healthy week.

Is high protein intake responsible for chronic kidney disease? Have you ever heard that ketogenic diets are harmful to your kidneys?These are just a few of the common kidney health myths debunked in this interview with Dr. Thomas Weimbs, who says that traditional views on what causes chronic kidney disease are “definitely not founded in science.”Dr. Thomas Weimbs, professor and vice chair at UC Santa Barbara, has spent decades studying chronic kidney disease (CKD). His recent research explores the impact of ketogenic interventions on kidney function, and the findings may surprise you. Rather than harming the kidneys, Dr. Weimbs is finding that keto can actually improve kidney function in people living with CKD.According to Dr. Weimbs, “Clearly, the number one cause of chronic kidney disease is not protein in excess—it's, of course, carbohydrates in excess and type 2 diabetes. Insulin resistance is causing chronic kidney disease.”In this episode, you'll learn:Why longstanding myths about protein and kidney function need to be re-examinedWhy misconceptions around keto and kidney health existHow ketogenic diets are showing promise for chronic kidney disease (including PKD)About results from randomized controlled trials and the 2-year Virta Health studyHow ketones may directly benefit kidney healthDr. Weimbs also shares insights from his lab's ongoing research—findings that challenge conventional thinking and call for a re-examination of how we understand and treat chronic kidney disease.Expert Featured:Dr. Thomas Weimbshttps://www.facebook.com/groups/256099897773551/https://santabarbaranutrients.com/CMEs Mentioned:Managing Major Mental Illness with Dietary Change: The New Science of Hopehttps://www.mycme.com/courses/managing-major-mental-illness-with-dietary-change-9616Brain Energy: The Metabolic Theory of Mental Illnesshttps://www.mycme.com/courses/brain-energy-the-metabolic-theory-of-mental-illness-9615Follow our channel for more information and education from Bret Scher, MD, FACC, including interviews with leading experts in Metabolic Psychiatry.Learn more about metabolic psychiatry and find helpful resources at https://metabolicmind.org/About us:Metabolic Mind is a non-profit initiative of Baszucki Group working to transform the study and treatment of mental disorders by exploring the connection between metabolism and brain health. We leverage the science of metabolic psychiatry and personal stories to offer education, community, and hope to people struggling with mental health challenges and those who care for them.Our channel is for informational purposes only. We are not providing individual or group medical or healthcare advice nor establishing a provider-patient relationship. Many of the interventions we discuss can have dramatic or potentially dangerous effects if done without proper supervision. Consult your healthcare provider before changing your lifestyle or medications.

What does effective kidney care look like in the primary care setting—and who's really involved beyond your GP? In this first of a special two-part series, host Dee Moore is joined by Dr. Kristin Veighey to explore the crucial yet often misunderstood role of primary care in managing chronic kidney disease (CKD).   This episode takes you beyond the GP, highlighting the power of the multidisciplinary team—including specialist nurses, pharmacists, health coaches, social prescribers, and mental health professionals—and how each plays a unique role in supporting kidney health.   Together, they discuss: • The definition and purpose of primary care vs. secondary care • Why CKD is often overlooked or mismanaged in primary care settings • The impact of legacy thinking, outdated guidelines, and unclear care pathways • How to navigate the system, understand who does what, and advocate for yourself • The importance of tracking your eGFR, blood pressure, and asking the right questions during health checks   This empowering episode is designed to help you take control of your kidney health journey by understanding your rights, responsibilities, and the full range of support available to you.  

Join us on this episode of Nothing But The Truth as we sit down with the remarkable Juliette Ashley Valle, Miss Florida 2023! Juliette shares her inspiring journey through the world of beauty pageants and beyond, revealing how she's leveraged her platform to advocate for critical causes. More about Juliette: ▸ Miss Florida 2023: Made history as the second Hispanic titleholder and the first Miss America contestant to deliver a bilingual onstage Q&A, placing in the Top 10 nationally. ▸ Advocate for Kidney Health & Women's Empowerment: A National Ambassador for Donate Life America and the National Kidney Foundation, she founded "Rise Up, Latinas!" – a nonprofit focused on Latina leadership and mentorship. ▸ Dynamic Background: A law student, aspiring reporter, and professional performer with a B.A. from the University of Miami and current studies at St. Thomas University College of Law and Harvard University. ▸ Award-Winning Talent: Recognized with multiple preliminary competition awards, she's also a verified recording artist who donates album proceeds to CKD charities.

Episode 198: Fatigue.  Future doctors Redden and Ibrahim discuss with Dr. Arreaza the different causes of fatigue, including physical and mental illnesses. Dr. Arreaza describes the steps to evaluate fatigue. Some common misconceptions are explained, such as vitamin D deficiency and “chronic Lyme disease”. Written by Michael Ibrahim, MSIV, and Jordan Redden, MSIV, Ross University School of Medicine. Edits and comments by Hector Arreaza, MDYou 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.Dr. Arreaza: Today is a great day to talk about fatigue. It is one of the most common and most complex complaints we see in primary care. It involves physical, mental, and emotional health. So today, we're walking through a case, breaking down causes, red flags, and how to work it up without ordering the entire lab catalog.Michael:Case: This is a 34-year-old female who comes in saying, "I've been feeling drained for the past 3 months." She says she's been sleeping 8 hours a night but still wakes up tired. No recent illnesses, no weight loss, fever, or night sweats. She denies depression or anxiety but does report a lot of work stress and taking care of her two little ones at home. She drinks 2 cups of coffee a day, doesn't drink alcohol, and doesn't use drugs. No medications, just a multivitamin. Regular menstrual cycles—but she's noticed they've been heavier recently.Jordan:Fatigue is a persistent sense of exhaustion that isn't relieved by rest. It's different from sleepiness or muscle weakness.Classification based on timeline:    •   Acute fatigue: less than 1 month    •   Subacute: 1 to 6 months    •   Chronic: more than 6 monthsThis patient's case is subacute—going on 3 months now.Dr. Arreaza:And we can think about fatigue in types:    •   Physical fatigue: like muscle tiredness after activity    •   Mental fatigue: trouble concentrating or thinking clearly (physical + mental when you are a medical student or resident)    •    Pathological fatigue: which isn't proportional to effort and doesn't get better with restAnd of course, there's chronic fatigue syndrome, also called myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which is a diagnosis of exclusion after 6 months of disabling fatigue with other symptoms.Michael:The differential is massive. So, we can also group it by systems.Jordan:Let's run through the big ones.Endocrine / Metabolic Causes    • Hypothyroidism: A classic cause of fatigue. Often associated with cold intolerance, weight gain, dry skin, and constipation. May be subtle and underdiagnosed, especially in women.    • Diabetes Mellitus: Both hyperglycemia and hypoglycemia can cause fatigue. Look for polyuria, polydipsia, weight loss, or blurry vision in undiagnosed diabetes.    • Adrenal Insufficiency: Think of this when fatigue is paired with hypotension, weight loss, salt craving, or hyperpigmentation. Can be primary (Addison's) or secondary (e.g., due to long-term steroid use).Michael: Hematologic Causes    • Anemia (especially iron deficiency): Very common, especially in menstruating women. Look for fatigue with pallor, shortness of breath on exertion, and sometimes pica (craving non-food items).     • Vitamin B12 or Folate Deficiency: B12 deficiency may present with fatigue plus neurologic symptoms like numbness, tingling, or gait issues. Folate deficiency tends to present with megaloblastic anemia and fatigue.    • Anemia of Chronic Disease: Seen in patients with chronic inflammatory conditions like RA, infections, or CKD. Typically mild, normocytic, and improves when the underlying disease is treated.Michael: Psychiatric Causes    • Depression: A major driver of fatigue, often underreported. May include anhedonia, sleep disturbance, appetite changes, or guilt. Sometimes presents with only somatic complaints.    • Anxiety Disorders: Mental fatigue, poor sleep quality, and hypervigilance can leave patients feeling constantly drained.    • Burnout Syndrome: Especially common in caregivers, healthcare workers, and educators. Emotional exhaustion, depersonalization, and reduced personal accomplishment are key features.Jordan: Infectious Causes    • Epstein-Barr Virus (EBV):Mononucleosis is a well-known cause of fatigue, sometimes lasting weeks. May also have sore throat, lymphadenopathy, and splenomegaly.    • HIV:Consider it in high-risk individuals. Fatigue can be an early sign, along with weight loss, recurrent infections, or night sweats.    • Hepatitis (B or C):Can present with chronic fatigue, especially if liver enzymes are elevated. Screen at-risk individuals.    • Post-viral Syndromes / Long COVID:Fatigue that lingers for weeks or months after viral infection. Often, it includes brain fog, muscle aches, and post-exertional malaise.Important: Chronic Lyme disease is a controversial term without a consistent clinical definition and is often used to describe patients with persistent, nonspecific symptoms not supported by objective evidence of Lyme infection. Leading medical organizations reject the term and instead recognize "post-treatment Lyme disease syndrome" (PTLDS) for persistent symptoms following confirmed, treated Lyme disease, emphasizing that prolonged antibiotic therapy is not effective. Research shows no benefit—and potential harm—from extended antibiotic use, and patients with unexplained chronic symptoms should be thoroughly evaluated for other possible diagnoses.Michael: Cardiopulmonary Causes    •   Congestive Heart Failure (CHF): Fatigue from poor perfusion and low cardiac output. Often comes with dyspnea on exertion, edema, and orthopnea.    •   Chronic Obstructive Pulmonary Disease (COPD): Look for a smoking history, chronic cough, and fatigue from hypoxia or the work of breathing.    •   Obstructive Sleep Apnea (OSA): Daytime fatigue despite adequate hours of sleep. Patients may snore, gasp, or report morning headaches. High suspicion in obese or hypertensive patients.Jordan:Autoimmune / Inflammatory Causes    •   Systemic Lupus Erythematosus (SLE): Fatigue is often an early symptom. May also see rash, arthritis, photosensitivity, or renal involvement.    •   Rheumatoid Arthritis (RA): Fatigue from systemic inflammation. Morning stiffness, joint pain, and elevated inflammatory markers point to RA.    •   Fibromyalgia: A chronic pain syndrome with widespread tenderness, fatigue, nonrestorative sleep, and sometimes cognitive complaints ("fibro fog").Cancer / Malignancy    •   Leukemia, lymphoma, or solid tumors: Fatigue can be the first symptom, often accompanied by weight loss, night sweats, or unexplained fevers. Consider when no other cause is evident.Michael:Medications:Common culprits include:    ◦   Beta-blockers: Can slow heart rate too much.    ◦   Antihistamines: Sedating H1 blockers like diphenhydramine.    ◦   Sedatives or sleep aids: Can cause grogginess and daytime sedation.    •   Substance Withdrawal: Fatigue can be seen in withdrawal from alcohol, opioids, or stimulants. Caffeine withdrawal, though mild, can also contribute.Dr. Arreaza:Whenever we evaluate fatigue, we need to keep an eye out for red flags. These should raise suspicion for something more serious:    •   Unintentional weight loss    •   Night sweats    •   Persistent fever    •   Neurologic symptoms    •   Lymphadenopathy    •   Jaundice    •   Palpitations or chest painThis patient doesn't have these—but that doesn't mean we stop here.Dr. Arreaza:Those are a lot of causes, we can evaluate fatigue following 7 steps:Characterize the fatigue.Look for organic illness.Evaluate medications and substances.Perform psychiatric screening.Ask questions about quantity and quality of sleep.Physical examination.Undertake investigations.So, students, do we send the whole lab panel?Michael:Not necessarily. Labs should be guided by history and physical. But here's a good initial panel:    •   CBC: To check for anemia or infection    • TSH: Screen for hypothyroidism    • CMP: Look at electrolytes, kidney, and liver function    • Ferritin and iron studies    • B12, folate    • ESR/CRP for inflammation (not specific)    • HbA1c if diabetes is on the radarJordan:And if needed, consider:    • HIV, EBV, hepatitis panel    • ANA, RF    • Cortisol or ACTH stimulation testImaging? Now that's rare—unless there are specific signs. Like chest X-ray for possible cancer or TB, or sleep study if you suspect OSA.Dr. Arreaza:Unaddressed fatigue isn't just inconvenient. It can impact on quality of life, affect job performance, lead to mood disorders, delay diagnosis of serious illness, increase risk of accidents—especially driving. So, don't ignore your patients with fatigue!Jordan:And some people—like women, caregivers, or shift workers—are especially at risk.Michael:The cornerstone of treatment is addressing the underlying cause.Jordan:If it's iron-deficiency anemia—treat it. If it's depression—get mental health involved. But there's also: Lifestyle Support: Better sleep hygiene, light physical activity, mindfulness or CBT for stress, balanced nutrition—especially iron and protein, limit caffeine and alcoholDr. Arreaza:Sometimes medications help—but rarely. And for chronic fatigue syndrome, the current best strategies are graded exercise therapy and CBT, along with managing specific symptoms. Beta-alanine has potential to modestly improve muscular endurance and reduce fatigue in older adults, but more high-quality research is needed.SSRI: fluoxetine and sertraline. Iron supplements: Even without anemia, but low ferritin [Anecdote about low ferritin patient]Jordan:This case reminds us to take fatigue seriously. In her case, it may be multifactorial—work stress, caregiving burden, and possibly iron-deficiency anemia. So, how would we wrap up this conversation, Michael?Michael:We don't need to order everything under the sun. A focused history and exam, targeted labs, and being alert to red flags can guide us.Jordan:And don't forget the basics—sleep, stress, and nutrition. These are just as powerful as any prescription.Dr. Arreaza:We hope today's episode on fatigue has given you a clear framework and some practical tips. If you enjoyed this episode, share it and subscribe for more evidence-based medicine!Jordan:Take care—and get some rest~___________________________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:DynaMed. (2023). Fatigue in adults. EBSCO Information Services. https://www.dynamed.com (Access requires subscription)Jason, L. A., Sunnquist, M., Brown, A., Newton, J. L., Strand, E. B., & Vernon, S. D. (2015). Chronic fatigue syndrome versus systemic exertion intolerance disease. Fatigue: Biomedicine, Health & Behavior, 3(3), 127–141. https://doi.org/10.1080/21641846.2015.1051291Kroenke, K., & Mangelsdorff, A. D. (1989). Common symptoms in ambulatory care: Incidence, evaluation, therapy, and outcome. The American Journal of Medicine, 86(3), 262–266. https://doi.org/10.1016/0002-9343(89)90293-3National Institute for Health and Care Excellence. (2021). Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: Diagnosis and management (NICE Guideline No. NG206). https://www.nice.org.uk/guidance/ng206UpToDate. (n.d.). Approach to the adult patient with fatigue. Wolters Kluwer. https://www.uptodate.com (Access requires subscription)Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.

In this episode, we review the pharmacology, indications, adverse effects, monitoring, and unique drug characteristics of angiotensin receptor blockers (ARBs).  Key Concepts ARBs are equally efficacious as ACE inhibitors when used for hypertension, heart failure with reduced ejection fraction (HFrEF), chronic kidney disease (CKD) with proteinuria, and post-MI care. Some limited evidence suggests that they might be better in reducing albuminuria in patients with diabetes. ARBs are generally better tolerated than ACEi due to a lower risk of angioedema and dry cough.  While most ARBs are comparable to each other, small differences exists regarding hepatic metabolism (CYP metabolism for losartan, telmisartan, and azilsartan), degree of blood pressure lowering (generally better with azilsartan, olmesartan, valsartan, and candesartan), and additional pharmacological effects (telmisartan with PPAR-Y agonism, losartan with uricosuric effect). ARBs are contraindicated in pregnancy, those with bilateral renal artery stenosis, and those with previous angioedema to ARBs. The most common adverse effects include hypotension and hyperkalemia, but in rare cases acute renal impairment can also occur. Baseline serum creatinine and potassium should be monitored in patients taking ARBs. After initiation or dose adjustment, blood pressure, serum creatinine, and potassium should be repeated in 1-2 weeks. Signs and symptoms of hypotension as well as angioedema should be monitored throughout the treatment period.

Listener feedback on cardiac sarcoidosis, SA node ablation, surgical AF ablation, chronic kidney disease protection, and recruiting for clinical trials are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Listener Feedback EHJ paper Mathijssen et al https://doi.org/10.1093/eurheartj/ehaf338 Nordenswan et al https://www.ahajournals.org/doi/full/10.1161/CIRCEP.117.006145#tab-contributors II IST HR Case Reports https://doi.org/10.1016/j.hrcr.2025.05.017 Lakkireddy et al https://doi.org/10.1016/j.hrthm.2021.07.010 III Survival After Surgical AF ablation during CABG McClure et al https://doi.org/10.1093/europace/eux336 Schaffer et al https://doi.org/10.1016/j.athoracsur.2025.03.044 IV Finerenone with Empagliflozin in CKD and DM The Confidence Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2410659 V Recruiting for Important Trials and the Stature of EP as a Profession Two UK Cardiology Trials Struggle to Recruit Patients https://www.medscape.com/viewarticle/two-uk-cardiology-trials-struggle-recruit-patients-2025a1000ffs CRAFT HF https://clinicaltrials.gov/study/NCT06505798 BRITISH https://doi.org/10.1016/j.ahj.2023.09.008 PROFID https://profid-project.eu/profid-ehra-trial/ You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Why You Should Listen:  In this episode, you will learn about chronic kidney disease and how to address the Kidneydemic with Renology. About My Guest: My guest for this episode is Dr. Robin Rose.  Robin Rose, MD began a journey into holistic healing in her teens in the mid-sixties beginning with nutrition and botanical medicine and yoga and meditation.  Over the years her journey included time living in India and working with both village doctors and healers.  She became a health food chef and inspired many to change their habits.  Before long she was enrolled in an RN program and then a family nurse practitioner program.  Aware that the education wasn't complete, she attended University of Arizona College of Medicine; while also serving as a medical student board member for the American Holistic Medical Association.  During residency, she continued learning Chinese medicine, acupuncture, osteopathy, energy medicine, and herbal medicine.  Her main practice was in Ashland, Oregon where she served a community eager to integrate many healing modalities into the conventional setting, including innovative care in the hospital.  In the past decade after her own alarming health challenges with kidney cancer and advanced kidney disease, she became agile in regenerative medical approaches to kidney care.  She created a new specialty called Renology; a new concept of "Kidney Success" not Kidney Failure.  When she discovered peptides and especially bioregulator peptides, she led the brigade to new heights of seeing success in a field that had not embraced this kind of care.  Her recent book "Renology Peptides" is a nearly 800 page text on how to achieve this renewal of health.  Her current intention is to raise awareness of the role of kidney in wellbeing and how we can all celebrate this success.  Key Takeaways: What is the purpose of the kidneys? What symptoms are observed in chronic kidney disease? Is kidney disease a catabolic process? Is kidney disease genetic or epigenetic? What are the stages of kidney disease? What are the best tests and lab markers? What might elevations or phosphorous or potassium suggest? What is the kidney-gut axis? What is the role of endothelial health in kidney disease? What role do the mitochondria play?  How do infections and environmental toxicants contribute to kidney disease? What is the role of oxalates in kidney health? How might carbon dioxide guide treatment? Does cellular senescence play a role? What is the connection between the kidneys and the teeth? How do the limbic system and mental/emotional health impact the kidneys? What treatment intervention warrant exploration? Where do dialysis and transplantation come into the discussion? What role might peptides and peptide bioregulators play? Connect With My Guest:  RenologyIsKidneySuccess.com Interview Date: May 21, 2025 Transcript: To review a transcript of this show, visit https://BetterHealthGuy.com/Episode217. Additional Information: To learn more, visit https://BetterHealthGuy.com. Follow Me on Social Media: Facebook - https://facebook.com/betterhealthguy Instagram - https://instagram.com/betterhealthguy X - https://twitter.com/betterhealthguy TikTok - https://tiktok.com/@betterhealthguy Disclaimer:  The content of this show is for informational purposes only and is not intended to diagnose, treat, or cure any illness or medical condition. Nothing in today's discussion is meant to serve as medical advice or as information to facilitate self-treatment. As always, please discuss any potential health-related decisions with your own personal medical authority. 

Why You Should Listen:  In this episode, you will learn about chronic kidney disease and how to address the Kidneydemic with Renology. About My Guest: My guest for this episode is Dr. Robin Rose.  Robin Rose, MD began a journey into holistic healing in her teens in the mid-sixties beginning with nutrition and botanical medicine and yoga and meditation.  Over the years her journey included time living in India and working with both village doctors and healers.  She became a health food chef and inspired many to change their habits.  Before long she was enrolled in an RN program and then a family nurse practitioner program.  Aware that the education wasn't complete, she attended University of Arizona College of Medicine; while also serving as a medical student board member for the American Holistic Medical Association.  During residency, she continued learning Chinese medicine, acupuncture, osteopathy, energy medicine, and herbal medicine.  Her main practice was in Ashland, Oregon where she served a community eager to integrate many healing modalities into the conventional setting, including innovative care in the hospital.  In the past decade after her own alarming health challenges with kidney cancer and advanced kidney disease, she became agile in regenerative medical approaches to kidney care.  She created a new specialty called Renology; a new concept of "Kidney Success" not Kidney Failure.  When she discovered peptides and especially bioregulator peptides, she led the brigade to new heights of seeing success in a field that had not embraced this kind of care.  Her recent book "Renology Peptides" is a nearly 800 page text on how to achieve this renewal of health.  Her current intention is to raise awareness of the role of kidney in wellbeing and how we can all celebrate this success.  Key Takeaways: What is the purpose of the kidneys? What symptoms are observed in chronic kidney disease? Is kidney disease a catabolic process? Is kidney disease genetic or epigenetic? What are the stages of kidney disease? What are the best tests and lab markers? What might elevations or phosphorous or potassium suggest? What is the kidney-gut axis? What is the role of endothelial health in kidney disease? What role do the mitochondria play?  How do infections and environmental toxicants contribute to kidney disease? What is the role of oxalates in kidney health? How might carbon dioxide guide treatment? Does cellular senescence play a role? What is the connection between the kidneys and the teeth? How do the limbic system and mental/emotional health impact the kidneys? What treatment intervention warrant exploration? Where do dialysis and transplantation come into the discussion? What role might peptides and peptide bioregulators play? Connect With My Guest:  RenologyIsKidneySuccess.com Interview Date: May 21, 2025 Transcript: To review a transcript of this show, visit https://BetterHealthGuy.com/Episode218. Additional Information: To learn more, visit https://BetterHealthGuy.com. Follow Me on Social Media: Facebook - https://facebook.com/betterhealthguy Instagram - https://instagram.com/betterhealthguy X - https://twitter.com/betterhealthguy TikTok - https://tiktok.com/@betterhealthguy Disclaimer:  The content of this show is for informational purposes only and is not intended to diagnose, treat, or cure any illness or medical condition. Nothing in today's discussion is meant to serve as medical advice or as information to facilitate self-treatment. As always, please discuss any potential health-related decisions with your own personal medical authority.