This study in #ASNKidney360 examined depletion of the antioxidant ergothioneine in patients undergoing dialysis. They compared levels in blood from patients on peritoneal dialysis hemodialysis, and healthy controls. Read more about what they found: kidney.pub/KID1105 @grahamabra.bsky.social

New out today:

Antiproteinuric Effect of Sparsentan in Patients with Genetic-Associated FSGS Enrolled in the DUPLEX Trial

Genetic FSGS CAN be treated. journals.lww.com/cjasn/abstra...

Makes sense for all the reasons outlined as possible dialysis harms

In big busy centers my guess is the schedule overrides the more nuanced approach we’d all take if we had a small list with limited chaos

#NephJC

ASN Kidney Health Guidance on the Outpatient Management of Patients with Dialysis-Requiring Acute Kidney Injury - PubMed This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/JASN/2025_03_11_KTS_March2025.mp3

I’ll do a pitch for the ASN AKI-D guidance document here #nephjc

@nephroninja.bsky.social

pubmed.ncbi.nlm.nih.gov/40014384/

#NephJC the editorialist wondered if our control arm represented ‘unnecessary dialysis’ and was not ‘standard of care’—sounds like many at #NephJC do not feel the same way?

You swim against the tide when you pull an AKI-D patient off schedule, I don’t think the control arm was unrepresentative of practice #NephJC

Makes sense there is some ceiling of how much small solute you can allow to build up #NephJC

Is 90 day mortality the right outcome?

A good fraction of patients will have left the hospital and can’t really expect the acute in hospital AKI-D strategy to impact events outside.

#NephJC

#NephJC The traditional approach is increase in native renal function and then dialysis cessation. We proposes a different paradigm: dialysis cessation to promote increase in native renal function.

It’s always the high protein tube feeds…

and the high tacrolimus troughs…

and the high dose diuretics…

#NephJC

#NephJC it is important to point out that ‘1st day of recovery’ was defined retrospective. On that day, GFR may be very low (so not ‘recovered’ in the way many people use the word). See 2 figures below for illustration. Both these patients contributed to those Kaplan-Meier curves separating early.

T2f
Dialysis-Free Days by Day 28:
Conservative: 21 days
Conventional: 5 days
Most pronounced divergence within the first 10-12 days
Clinically, this means these patients spent most of their hospital course not needing dialysis, something no earlier AKI-D trial has demonstrated so clearly. #NephJC

There’s no difference in the in hospital death so the day 28 mortality must be driven by outside the hospital events - can’t really expect conservative acute dialysis to have an impact on this #NephJC

Totally get this but also get that the pt is in a controlled environment and with AKI-D your balancing keeping the pt safe from complications of AKI and complications from the dialysis itself

I like that the triggers were set up this way, demonstrates how much breathing room we really have

#NephJC

In our practice and others I’ve worked in there is often a lot of non-neph clinician discomfort around the red lab values and any symptom that might be uremic (AMS being a common one) and the dialysis machine is so available that withholding it often requires a lot of discussion #NephJC

T1c
#NephJC
1️⃣Conservative RRT group
RRT was done only if one of the following occurred:
✅BUN >112 mg/dL
✅Potassium >6.0 mmol/L, >5.5 after meds
✅pH <7.15 or HCO3 < 12 meq/L
✅Hypoxemia or pulmonary edema
✅Symptomatic overload
✅Clinician judgment
2️⃣ Conventional RRT was 3x/wk

T1a
Population: stable AKI-D patients with realistic renal recovery potential
Exactly the “gray zone” group we debate daily whether dialysis continuation is necessary.
👀Check out the inclusion/exclusion criteria #NephJC

Less so in the Lokelma/Veltassa era

#NephJC

Did you guys add any resources (eg APPs) to help manage this or did it just become part the standard workflow? #NephJC

Hi! I'm a nephrologist and clinical researcher at UCSF.

COI: I was one of the LIBERATE-D investigators at the UCSF site.

I made a BlueSky account today to join this discussion. #NephJC

Graham Abra

Clinical nephrologist and educator

COI Fan of the UCSF neph team!

#NephJC

#NephJC This is Chi Hsu, senior author and one of the two PI’s for LIBERATE-D. Thanks for choosing our paper. I am borrowing UCSF Nephrology Division’s BlueSky account.

Turning clinical experience into shared knowledge: ISN launches Kidney International Case ReportsTM - International Society of Nephrology

Excited about this @theisn.org initiative, especially under the leadership of @hswapnil.medsky.social as EIC. Nephrology needed this
www.theisn.org/blog/2025/12...

The Stanford African Scholars in #GlobalHealth (SASH) program is fostering innovation at a time of growing global health challenges. Through partnerships & knowledge exchange, physician-leaders from African countries gain skills & insights to improve care at home. https://stanford.io/4pt5IKq

It was really interesting researching this topic. Hope it’s useful.

That’s a close one!

#NephSky as I ask every match day, what is the deal? Endocrinology and Rheumatology (what I would consider the closest comps to nephro) are following almost of their spots while we continue to...not. Do we simply have too many spots?

Figure 1.1

Yup

Figure 1.1 in incidence rate of ESRD in the US

Seems to have slipped most people’s awareness 🤷🏽‍♂️

Totally unknown which is frustrating!