Podcasts about ckd

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

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

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

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

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

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning spoke with Dr. Louise Kenny, a consultant pediatric and adult congenital cardiothoracic and transplant surgeon at Freeman Hospital in Newcastle upon Tyne, England, about congenital heart transplants. Chapters 00:00 Intro 02:24 JANS 1, VECTOR Procedure 07:38 JANS 2, Combined Inflation & Cooling 08:26 JANS 3, Caring for VIP Patients 11:43 JANS 4, Country Wealth & Min Inv Correlation 12:57 Career Center 13:37 Video 1, Debranching AAV Step-by-Step 15:14 Video 2, Abramson Technique 16:59 Video 3, Min Inv Cardiac w Dr. Chitwood 18:54 Dr. Kenny, DCD-HOPE Congenital Transplant 31:58 CKD & CSA-AKI Podcast Episode 34:12 Upcoming Events 35:13 Closing They discussed the complexities surrounding congenital heart transplants, donation after brain death (DBD), and donation after circulatory death (DCD). They also explored the benefits of hypothermic oxygenated perfusion (HOPE) for children, particularly in DCD pediatrics patients, and highlighted the first case where this model was used. Additionally, they examined the future of HOPE and its potential for more complex procedures. Moreover, they discussed implanting ventricular assist devices (VAD) in children, along with what other countries are doing regarding congenital heart transplants, including ongoing studies in this field.    Joel also highlights recent JANS articles on the first human VECTOR procedure for percutaneous aorto-coronary bypass graft to prevent coronary obstruction following TAVR, combined inflation and cooling method improves lung function in uncontrolled donation after circulatory death, caring for VIP patients in cardiothoracic surgery, and the national wealth and the global spread of minimally invasive thoracic surgery.  In addition, Joel explores a step-by-step guide for debranching of aortic arch vessels through a cervical approach for aortic arch aneurysm, a master class with Horacio Abramson on the Abramson technique, and an episode of The Atrium podcast featuring host Dr. Alice Copperwheat speaking with Dr. Randolph Chitwood about the future of minimally invasive cardiac surgery. Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.) Percutaneous Aorto-Coronary Bypass Graft to Prevent Coronary Obstruction Following TAVR: First Human VECTOR Procedure  2.) Combined Inflation and Cooling Method Improves Lung Function in Uncontrolled Donation After Circulatory Death  3.) Caring for VIP Patients in Cardiothoracic Surgery: Navigating Bias, Pressure, and Protocol  4.) National Wealth and the Global Spread of Minimally Invasive Thoracic Surgery: Insights From the European Society of Thoracic Surgeons Database  CTSNet Content Mentioned  1.) Debranching of Aortic Arch Vessels Through a Cervical Approach for Aortic Arch Aneurysm: A Step-by-Step Guide  2.) Master Class: The Abramson Technique With Horacio Abramson and Joel Dunning  3.) The Atrium: The Future of Minimally Invasive Cardiac Surgery  Other Items Mentioned  1.) HOPE for Children: Successful Pediatric DCD Heart Transplantation Using Hypothermic Oxygenated Perfusion  2.) Instructional Video Competition   3.) Career Center   4.) CTSNet Events Calendar  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

0.5 CPD hoursTo find out more about the MIMS Learning Live Digital event mentioned at the start of this podcast, click here.In this episode, GP and director of the Primary Care Women's Health Society, Dr Toni Hazell, talks to Pat Anderson about specific changes to the UKMEC recommendations on contraception safety.She provides key learning points for GPs about how the changes to the UKMEC contraception safety recommendations will apply in  practice. Key issues discussed include the addition of new categories for MS and CKD, an increase in the risk category for depot contraception injections and advice on vaping.Educational objectivesAfter listening to this podcast, healthcare professionals should be better able to: Understand how UKMEC aims to protect patientsRecall how UKMEC's general risk categories translate to practiceUnderstand the latest changes to UKMEC categories and adviceReflect on how to apply the changes in practiceRecall where to seek further advice and resourcesMIMS Learning resourcesContraception learning planContraception: the basics Complex contraception scenarios part 1Complex contraception scenarios part 2Answering patients' questions on intrauterine contraceptionBest use of oral hormonal contraceptionMIMS Learning blog Hosted on Acast. See acast.com/privacy for more information.

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

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

Dr Dave catches Dr Jo up on Measles clinical signs, testing, management, complications, and vaccination advice, NSAID use in CKD and Methotrexate without folic acid. Disability Allowance updates – special food form, CGM funding considerations. Cremation Regulations exemption extended – process and applicability. Concussion Guidelines – new ANZ guidance and assessment tools. RNZCGP position statement on 12‑month prescribing – regulatory changes and practice policy guidance. ResourcesAngina Action Plan (multi‑language) Birth Trauma Screening Tool (City Birth Trauma Scale) Online learning modules for bowel screening Antibiotic stewardship (Te Whata Kura) Adult ADHD – webinar information 

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning spoke with Drs. Daniel Engelman, Medical Director of the Cardiac Surgical Critical Care & Inpatient Services at Baystate Health, Professor of Surgery at the University of Massachusetts Chan Medical School—Baystate, and President of the ERAS Cardiac Society, and Marlies Ostermann, consultant in critical care and nephrology at Guy's and St. Thomas Foundation Trust and a Director of Research for the Intensive Care Society, about chronic kidney disease (CKD) and cardiac surgery-associated acute kidney injury (CSA-AKI). Chapters 00:00 Intro 02:11 Definition & Background 10:55 Burden of CSA-AKI 12:58 Unmet Medical Need 19:47 Identification & Collaboration 26:07 KDIGO, O2 Delivery 32:15 CKD CSA-AKI Final Remarks 35:10 JANS, Success in African CT Surgery 38:49 Video, Modified Root Inclusion Technique 40:53 Closing They delve into the complexities of CSA-AKI, exploring the percentage of patients affected, defining the condition, and highlighting the overall significance of this issue. They also address creatinine as a late marker for AKI, the long-term scarring that can occur from AKI, and the critical need for thorough preoperative assessments to identify high-risk patients. Additionally, they emphasize the importance of a complete health assessment before surgery. Furthermore, they discuss the dangers of reaching stage 3 AKI, the increased costs of care once that point is reached, and what actions to take if a patient has a positive marker but appears stable. They also highlight the premature use of diuretics contributing to AKI and hyperbilirubinemia. Moreover, they consider how CKD along elevates mortality risk and the importance of developing targeted therapies in the future. Finally, they discuss approaches to reduce ischemia-reperfusion (IR) AKI and the optimization of hemodynamics, as well as potential drugs for treating AKI effectively.   Joel also highlights a recent JANS article on aligning training, patient profiles, and outcomes to redefine success in cardiac surgery in Africa. In addition, he explores the modified root inclusion technique for a fourth sternotomy with Ross/Konno after previous mechanical aortic valve replacement.   Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.) Redefining Success in Cardiac Surgery in Africa: Aligning Training, Patient Profiles, and Outcomes  CTSNet Content Mentioned  1.) Fourth Sternotomy With Ross/Konno After Previous Mechanical Aortic Valve Replacement: The Modified Root Inclusion Technique  Other Items Mentioned  1.) Career Center   2.) CTSNet Events Calendar  3.) Instructional Video Competition   Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

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

New Year, New You: Why Gut Health Matters for Kidney Patients   What does New Year, New You look like when you're living with kidney disease?   In this episode, we explore gut health and why it matters for kidney patients, including the relationship between the gut microbiome and chronic kidney disease (CKD), inflammation, diet and wellbeing.   Kidney dietitian Tadala shares practical and realistic ideas for Kidney Warriors in 2026, covering:   • gut health & kidney health • the gut microbiome • dietary restrictions in kidney disease • probiotics & prebiotics • plant diversity & fibre • slowing the progression of CKD • kidney-friendly nutrition • realistic lifestyle changes • supporting health in the new year   If you have ever wondered what can I eat with kidney disease?, does gut health matter for CKD?, or what practical steps can Kidney Warriors take?, this episode will support you.   This conversation focuses on education, empowerment and choice for people living with kidney disease, without pressure or perfection.   Next episode: A powerful Kidney Warrior story — resilience, hope and choosing to live beyond a diagnosis.     Follow Diary of a Kidney Warrior:  

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

In this episode of the Clinical Update podcast, MIMS Learning deputy editor Rhiannon looks back at a year of thought-provoking clinical education from the podcast. The episode begins with a focus on cancer diagnosis, revisiting a conversation with NHS England's Professor Peter Johnson on the success of the Lung Cancer Screening Programme. We also hear from pancreatic cancer specialist nurse Rachel Richardson about the potential for new tests to revolutionise early detection in primary care. Dr Toni Hazell provides advice on one of the most talked-about clinical areas in 2025 – weight-loss medications – highlighting specific considerations for women using these drugs. Look out for more content on obesity as part of MIMS Learning's 2026 editorial campaign.Consultant nephrologist Dr Andrew Frankel outlines the ‘three actions in 3 months' initiative — a structured approach to medicines optimisation in chronic kidney disease (CKD). Also, Dr Steve Brinksman discusses how best to identify alcohol use disorder, noting ‘we're in the harm reduction business – anything we can do to stop people developing diseases, to stop people having to go to hospital; that's worthwhile.' Finally, Dr Farnaaz Sharief shares practical resilience frameworks to help clinicians recharge at this busy time of year. Educational objectivesAfter listening to this podcast, healthcare professionals should be better able to:Describe the impact of targeted lung cancer screening Recall specific advice regarding oral contraception for patients using GLP-1 agonists for weight loss Outline the ‘three actions in 3 months' approach to optimising medication in CKDUse screening tools to effectively assess alcohol consumption in primary care Apply practical techniques to manage your energy levels and maintain resilience in clinical practice You can access the website version of this podcast, along with a list of key learning points, on MIMS Learning - and make notes for your appraisal. MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser. Please note: this podcast is presented by medical editors and discusses educational content written or presented by doctors, nurses and other healthcare professionals on the MIMS Learning website and at live events. MIMS Learning[Subscribe to MIMS Learning] Patient, Presentation, Pathway for Cancer campaignNHS England's Professor Peter Johnson on optimising early cancer diagnosisNurse specialist Rachel Richardson on pancreatic cancer risk factors and new developments in earlier detectionDr Toni Hazell on weight loss injections and women's healthPodcourse: part 2 - monitoring and management of CKD with Dr Andrew FrankelDr Steve Brinksman on supporting people with alcohol misuse in primary careDr Farnaaz Sharief on finding balance in a pressured systemFrom MIMSObesity treatments Hosted on Acast. See acast.com/privacy for more information.

Welcome to a special Christmas Day bonus episode of Diary of a Kidney Warrior Podcast, created in partnership with Kidney Care UK. In this episode, Dee is joined by returning guest Moe (Episode 144) to share heartfelt messages sent in by listeners, kidney patients, past guests, and Kidney Care UK staff.   These messages are filled with hope, encouragement, gratitude, and resilience — for anyone living with chronic kidney disease (CKD), on dialysis, waiting for a kidney transplant, or supporting a loved one through kidney failure.   You'll hear reflections on: • coping with dialysis and protecting mental health • waiting for “the call” for transplant and living with uncertainty • the life-changing gift of kidney transplantation • honouring living donors and deceased donors' families • finding strength through community and shared stories  

SGLT2 inhibitors in CKD: are they really effective in all patients?

Master guideline-based, multidisciplinary care to better identify, screen, and manage chronic kidney disease (CKD) and cardio-kidney-metabolic (CKM) patients. Credit available for this activity expires: 12/22/26 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/cardio-kidney-metabolic-collective-piecing-multidisciplinary-2025a1000zc8?ecd=bdc_podcast_libsyn_mscpedu

We love to hear from our listeners. Send us a message. On this week's episode of the Business of Biotech, Bruce Culleton, M.D., CEO at ProKidney, talks about moving from academic research to industry and the role a key mentor played in his career path. Bruce discusses his experiences as a first-time CEO at ProKidney, a late-stage autologous cell therapy biotech focused on pioneering new treatments for chronic kidney disease (CKD), the benefits of FDA's Regenerative Medicine Advanced Therapy (RMAT) designation, how delaying or avoiding kidney dialysis would be a game-changer for CKD patients, and more.  Access this and hundreds of episodes of the Business of Biotech videocast under the Business of Biotech tab at lifescienceleader.com. Subscribe to our monthly Business of Biotech newsletter. Get in touch with guest and topic suggestions: ben.comer@lifescienceleader.comFind Ben Comer on LinkedIn: https://www.linkedin.com/in/bencomer/

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

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."

CME credits: 0.25 Valid until: 19-11-2026 Claim your CME credit at https://reachmd.com/programs/cme/igan-management-into-practice-evolving-guidelines-targeted-therapies/37238/ Dr. Jürgen Floege, co-chair of the KDIGO Work Group, and Dr. Jörg Latus review the updated KDIGO 2025 guidelines for managing immunoglobulin A nephropathy (IgAN) and IgA vasculitis (IgAV), which emphasize diagnostic criteria, proteinuria-based treatment thresholds, and revised therapeutic goals. The discussion focuses on the new KDIGO proteinuria treatment goal of

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.  

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.

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.  

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 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.