Nephrology Journal Club

INFINITI: The Visual Abstract — NephJC SGLT2i have reshaped cardiorenal care, but kidney transplant recipients have mostly been left out of the story. INFINITI starts to close that gap, testing the safety and physiology of dapagliflozin in...

Here is the VA for the INFINITI study of SGLT2i in transplant patients by @glomerican.bsky.social #NephSky #Flozins #Flozination

www.nephjc.com/news/2026/2/8/infiniti-the-visual-abstract

INFINITI: El Resumen Visual — NephJC Los iSGLT2 han revolucionado la protección cardiorrenal, pero los trasplantados renales han quedado fuera de la historia. El ensayo INFINITI empieza a cerrar esa brecha. ¿Flozinaran igual los iSGLT2 e...

And in honor of Bad Bunny's win at the Super Bowl 🏆,
here is the INFINITI VA en Espanol #NephSky
www.nephjc.com/news/2026/2/8/infiniti-el-resumen-visual

To INFINITI and Beyond: SGLT2 Inhibitors in Kidney Transplant Patients — NephJC This week, we aim for an INFINITe allograft lifespan. or flozination in kidney transplant.

Hey #NephSky
2/10/26 at 9 pm EST we'll discuss
#Flozinating into the Future & Beyond...
SGLT2i in kidney transplant recipients.
What's the latest evidence of risk/benefit?
Do #Flozins act mechanistically the same in de-innervated kidneys?
Come chat.
www.nephjc.com/news/inifinti-flozins-transplant

To say it took a while is an understatement, because #NephJC has been around for 11 years (and still counting)...

🥁 We opened an Instagram account, so if you're around, can follow and interact 👣💞

#NephSky #Medsky

Up next on #NephJC we will be unpacking SGLT2i in transplant recipients👇

journals.lww.com/cja...

#NephJC
Massive thanks as well to our mentors Brian Rifkin Cristina Popa Milagros Flores

Huge thanks to the hardworking team Clemens Weber Shellie Fravel, PharmD Marc Soco Jeyakumar Meyyappan #NephJC

If you want to support #NephJC and get some cool merch, check out
www.nephjc.com/merch...

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Up next on #NephJC we will be unpacking SGLT2i in transplant recipients👇

journals.lww.com/cja...

T3n

Bottomline?
In ICD patients with mild–moderate CKD, raising plasma K safely cut arrhythmias, HF/arrhythmia hospitalizations, and death

But is it practice-changing… or still a “wait and see”? 🤔#NephJC

T3m

✅Strengths: Strong recruitment, adjudicated endpoints
⚠️Limitations: Single country, ICD-only patients, eGFR <30 excluded, <50% reached K⁺ target, unclear separation of MRA vs K⁺ effects #NephJC

T3l

POTCAST interventions are widely available
🍌 diet
💊 MRAs
🧂 KCl supplements
💧 reducing K⁺-losing diuretics
<50% hit the target but ~75% stayed on therapy… enough to improve outcomes #NephJC

T3k

If K is the answer for arrhythmias, maybe it’s time to rethink “normal” ranges for high-risk patients Hyperkalemia risk exists in those w/ CKD but careful monitoring keeps high-normal K safe-ish #NephJC

T3j

Could the benefits of ACEi/ARBs, ARNIs, MRAs, and beta-blockers be partly just potassium doing its thing?
They do nudge K⁺ up a bit…

Let’s hear your thoughts 💭 #NephJC

T3i

It seems like nephrologists are somehow quietly saving cardiology
And yes, I’m talking about the pillars of HF management 😏👀#NephJC

T3h

Interestingly, benefits weren’t limited to HF patients
👉~40% of participants without HF also showed improved outcomes!

And potassium may be the unifying mechanism 💥#NephJC

T3g

Traditionally, this K rise was seen as a side effect, needing close observation and possible intervention,
but POTCAST suggests it might actually contribute to the benefit #NephJC

T3f

In the landmark MRA trials (RALES, EPHESUS, EMPHASIS-HF, FINEARTS-HF), patients taking MRAs for HF had improved survival, including fewer sudden cardiac deaths #NephJC

T3e

POTCAST showed us that this modest increase translated into:
⚠️fewer arrhythmias, hospitalizations, and deaths…
And this is despite less than half of participants reaching the exact target.
So what is the exact target? #NephJC

T3d

This study show us that physiology supports a rise from 4.0 to 4.3 mmol/L which leads to:
⚡Fewer hypokalemia episodes
🫀Stabilized resting potential
🔋Fewer ICD shocks & arrhythmias #NephJC

T3c

Most of the benefit came from fewer ICD therapies (shocks or pacing) and documented ventricular tachycardia. Effects were consistent across subgroups & independent of the drug used #NephJC

T3b

Most of the benefit came from fewer ICD therapies (shocks or pacing) and documented ventricular tachycardia. Effects were consistent across subgroups & independent of the drug used #NephJC

T3a

This study suggests that a small dietary & treatment-induced increase in K⁺ (~0.3 mmol/L) lowered the risk of arrhythmias, ICD therapy, CV hospitalizations, and death in high-risk ICD patients #NephJC

T3: Discussion

Feeling the K rush? We’ve charged through the results… now let’s talk
Is aiming for high-normal potassium the real shock therapy for arrhythmias? #NephJC

T2l #NephJC

Safety endpoints
⚠️ High-normal K⁺ = no extra hospitalizations or deaths
⚠️ Creatinine barely budged (~0.1–0.2 µmol/L)

Seems reassuring! #NephJC

T2k

Discontinuations: 67 participants stopped meds due to side effects:
⚠️ 27% MRA
⚠️ 34% K⁺ supplements
⚠️ 39% both
Although, the side effects were manageable #NephJC

T2j

Only 41.5% reached the target 4.5–5.0 mmol/L
Reasons: max dose reached, declined meds, protocol limits, or other factors

📈Mean K⁺ rose to 4.36 mmol/L, a difference of only 0.3 treatment vs control
Is it really K⁺ driving the results? #NephJC

T2i

Among the 572 high-normal K⁺ participants who completed dose adjustment (median 85 days), some used MRA, K⁺ supplements, both, or neither #NephJC

T2h

Hospitalizations:
🏥Unplanned hospitalization for arrhythmias: 6.7% vs 10.7%, HR 0.63
🏥Unplanned HF hospitalization: 3.5% vs 5.5%, HR 0.64


High-normal K⁺ seems protective #NephJC