Thanks and agree they are factors. But dapa/empa-CKD trials didn't exclude based on hba1c (credence used 12.5%). Hba1c has snuck into (UK) practice as an exclusion and seems unlikely that additional DKA risk of ⬆️hba1c offsets the CV benefit. I can't find analyses looking at this but maybe not done.

Sorry that's mmol/mol (UK). Equivalent to 10%

Catching up on this thread looking for data supporting SGLTi #flozin in patients with hba1c>85. My institution advises against. UKKA guidelines say need endo consent. But given frequency of CV events vs rarity of DKA, surely net benefit must favour #flozin. Do you know of any data on this?

Antihypertensive Properties of Furosemide | Circulation The antihypertensive properties of single doses of furosemide were evaluated in 113 patients. Doses over 120 mg consistently produced a fall in arterial pressure whereas smaller doses did not. Thus 20...

www.ahajournals.org/doi/abs/10.1... not directly relevant but in this study from 1960s, increasing furosemide dose increased antihypertensive effect even when diuresis did not increase. Doesn't say infusion has any less effect but does make me wonder

The New England Journal of Medicine Deferring Arterial Catheterization in Critically Ill Patients with Shock A Research Summary based on Muller G et al. | 10.1056/NEJMoa2502136 | Published on October 29, 2025 Visual representations of the patients in the trial and the treatments they were assigned. Read the full Research Summary at NEJM.org.

In the EVERDAC trial involving patients with shock, results for death at day 28 indicated that management without early arterial catheter insertion was noninferior to early catheter insertion. Full trial results and Research Summary: nej.md/3LmOO0D 

#MedSky #PulmSky

Bleeding, Clotting, and Kidney Disease in Atrial Fibrillation: Can Factor XI Inhibitors Change the Game? By. Husam Alzayer, MD, MSc, MRCPIReviewed by Sophia Ambruso, DOIntroduction Bleeding and thrombosis represent one of the many paradoxes faced by patients with kidney disease. As kidney function declin...

Check out the latest @kireports.bsky.social community blog from @husamjz.bsky.social
Anticoagulantion in ESRD patients with atrial fibrillation:
www.kireportscommunity.org/post/bleeding-clotting-and-kidney-disease-in-atrial-fibrillation-can-factor-xi-inhibitors-change-the-g

Landscape of subclinical rejection in a large international cohort of pediatric kidney transplant (kTx) recipients buff.ly/7DynrzY

Thanks for sharing. Great to read the actual paper having seen it referenced a few times (usually claiming it supports S-shaped on/off pharmacodynamics). Table 2 is relatable chaos of diuretic prescribing

Table 1: Unique medications associated with eGFRcys within cohorts of patients with their most likely indication for use

As cystatin C use becomes more common - note other drugs (not just steroids) which can have an effect

@alexchangmd.bsky.social and colleagues

www.ajkd.org/article/S027... in @ajkd.bsky.social

acetaminophen, opioids, lithium, furosemide among others

#NephSky

Measuring BP over a sweater sleeve? As accurate as the optimal method!
But using a non-validated device or leaving the arm unsupported? Expect higher readings than what’s actually seen on awake ABPM.

Underpowered pilot study, so hoping to confirm this in larger trials soon!

Reliability of Blood Pressure Measurement After Arteriovenous Fistula Closure in Kidney Transplant Recipients | Hypertension

❓ Can we measure #bloodpressure in the arm with a closed AV #fistula after kidney transplant?

✅ YES! Here is our our latest study published in Hypertension @ahajournals.bsky.social showing no significant BP difference between arms post-AVF closure

👉🏼 www.ahajournals.org/doi/10.1161/...

🧵1/9
Could we improve kidney care by rethinking who gets referred to a nephrologist?
Our latest study in @ndt-era.bsky.social suggests: yes — if we base it on predicted risk rather than fixed eGFR/ACR cutoffs.
📄 t.co/xVcR8LEnhn
#nephrology #KDIGO #KFRE #NephJC #NephSky #Nephpearls

2A/ 🚨Our topic from @KIReports: Early determination of Tacrolimus Concentration-Dose ratio identifies risk of allograft loss in kidney transplantation
There are no conflicts of interest. #Medsky #nephsky @theisn.org
www.kireports.org/article/S246...

Age- and sex-specific reference values of estimated glomerular filtration rate for European adults Kidney function, often assessed by estimated glomerular filtration rate (eGFR), declines naturally with age. However, there is a lack of eGFR reference values to describe normal and abnormal values fo...

This is such a great resource:
www.kidney-international.org/article/S008...
#nephrology #eGFR

Realistic Medicine and Value Based Health and Care Casebook The Realistic Medicine Casebook shows how teams across Scotland are putting Realistic Medicine into practice. It’s a practical guide offering inspiration and support for those adopting its principles ...

Scotland is high on incremental hemodialysis. You can read all about it if you scroll to the middle of the article, @hswapnil.medsky.social.

www.gov.scot/publications...

Confirmatory Testing for Primary Aldosteronism: A Study of Diagnostic Test Accuracy: Annals of Internal Medicine: Vol 0, No 0 Background: Confirmatory testing to verify the diagnosis of primary aldosteronism (PA) in patients who have an abnormal screening result is of uncertain benefit. Objective: To perform a blinded assess...

In the @annalsofim.bsky.social

www.acpjournals.org/doi/10.7326/... from @ucalgarymed.bsky.social team

Saline suppression test not useful in confirming primary #aldosteronism - go straight to AVS if planning Sx (and ramp up MRA to target renin if Medical management)

#NephSky #EndoSky

Procalcitonin levels in septic and nonseptic subjects with AKI and ESKD prior to and during continuous kidney replacement therapy (CKRT) - Critical Care Background Procalcitonin is a 14.5 kDa protein used clinically as a marker of sepsis and therapeutic response to antibiotic therapy. However, its utility in critically ill patients with either acute k...

Procalcitonin- the more we learn, the less we love it 💔

▪️94% of non-septic AKI pts had a Pct >0.5 prior to commencing CRRT

▪️Even using a threshold of >3.2 the specificity was only 38% 🗑️

“Pct in pts with AKI/ESRD should not be measured”

#EMIMCC

ccforum.biomedcentral.com/articles/10....

Table. Timeline of Clinic Visits and Blood Pressure Measurements

Figure. Computed tomography angiography (CTA) of subclavian artery stenosis. Axial CTA image of this patient with subclavian artery stenosis. A, Patent subclavian artery (indicated by the arrow) distal to the site of the occlusion. B, A more inferior axial image with an absence of contrast in the subclavian artery at the level of the subtotal occlusion while (C) demonstrates the most inferior and proximal to the aortic arch and re-demonstrates a patent proximal portion of the subclavian artery. This is consistent with a subtotal occlusion of the subclavian artery with distal reconstitution likely via the left vertebral artery

A one year delay in diagnosis of #hypertension!

Clear illustration of the importance of measuring BP in both arms

www.ahajournals.org/doi/10.1161/... in @ahajournals.bsky.social Hypertension

two cartoon characters with big brains are standing next to each other in front of a brick wall ALT: two cartoon characters with big brains are standing next to each other in front of a brick wall

Does the over rapid correction of hypernatraemia really cause cerebral oedema in adults❓

Most guidelines suggest a rate of correction < 10mmol/L per day, and whilst there is evidence of risk in children (with tighter, more vulnerable brains) the evidence of risk in adults is scant

1/

ASN Kidney Health Guidance on the Outpatient Management of... : Journal of the American Society of Nephrology An abstract is unavailable.

Very proud of this ASN Guidance on outpatient AKI-D care; an exceptional group of colleagues including co-chair Michael Heung. Some practical points- warm hand-off, AKI specific orders (avoid “DW”), prevent dialytrauma, active monitoring for renal recovery.

journals.lww.com/jasn/fulltex...

Figure 2. Correlation Between Total Calcium and Adjusted Calcium Measurements vs Ionized Calcium Levels

Table 2. Classification of Calcium Status by Total Calcium and Ionized Calcium

Albumin adjustment formulae for calcium continue to suck

jamanetwork.com/journals/jam...

In @jama.com network open

Before you freak reflexively order IV hydralazine for that BP of 180/90, remember that people get BPs up to 480/350 (yes that is in mmHg) while weight lifting and don't "stroke out"

pubmed.ncbi.nlm.nih.gov/3980383/

Rant #5 Please don't tell me what the PaO2 is...

Less experienced critical care staff members are frequently exercised by arterial blood gas PaO2 readings.

What is the SpO2 I genially ask? In our target range? Well that's fine then.

Staff member shifting uneasily, "but the PaO2..."

Here we go...

"Drink more water!" It's the easiest health advice around. Tired? Headache? Trying to be like Tom Brady? Just drink more water. But as a nephrologist, I get asked all the time: How much is the right amount? And the truth is... we don't really know. 🧵

Great thread from Dylan on Canada’s new diabetes guidelines.

Their guidelines say you can’t initiate SGLT2i at eGFR<20 - but I’ve just taught all our local north east England renal registrars the opposite.

Quick thread to justify why I think I’m right👇

#NephSky