Lonnie Pyne

Will hopefully know more about phosphate levels soon from the ongoing PHOSPHATE trial.

#NephJC

www.clinicaltrials.gov/study/NCT035...

Unfortunately no. We tried to look for that based on the ACHIEVE results but the outcomes were poorly reported by sex in most trials included in the meta-analysis.

#NephJC

Not 100% sure (been awhile since I signed off on any enrolment forms for ACHIEVE), but I don't recall race/ethnicity being recorded.

#NephJC

You got it. Pragmatic choice.
Equivalent dose in ESRD to that used in CV studies.
Most common dose used in prior trials in ESRD.

#NephJC

Hi everyone. Lonnie Pyne, nephrologist from McMaster University in Hamilton, Ontario, Canada joining for #NephJC tonight.

COI - one of the authors

Safety and efficacy of steroidal mineralocorticoid receptor antagonists in patients with kidney failure requiring dialysis: a systematic review and meta-analysis of randomised controlled trials Mineralocorticoid receptor antagonists can prevent cardiovascular events in patients with heart failure and non-severe chronic kidney disease, but the…

Following #ACHIEVE our meta-analysis of RCTs of MRAs for pts receiving dialysis in @thelancet.com. Thanks to @lonniepyne.bsky.social for leading. No signal for benefit among low-risk of bias RCTs and a good demo of why we continue to need large simple trials.
www.sciencedirect.com/science/arti...

Spironolactone versus placebo in patients undergoing maintenance dialysis (ACHIEVE): an international, parallel-group, randomised controlled trial Patients undergoing maintenance dialysis for kidney failure are at substantial risk of cardiovascular morbidity and mortality. We aimed to establish i…

Proud to have worked with colleagues and friends around the world on #ACHIEVE. We're disappointed spiro didn't prevent CV death/heart failure hospitalizations, but we've shown it's possible to do publicly funded large RCTs of repurposed meds in ESKD. More to do!
www.sciencedirect.com/science/arti...

The updated meta-analysis will be published very soon along with ACHIEVE.
#ERA25

Intravenous Iron in Patients Undergoing Maintenance Hemodialysis | NEJM Intravenous iron is a standard treatment for patients undergoing hemodialysis, but comparative data regarding clinically effective regimens are limited. In a multicenter, open-label trial with blin...

First and only? Can’t be such a stickler as to ignore the PIVOTAL trial.
PIVOTAL trial effect estimate on all-cause mortality HR 0.84 (95% CI 0.71 to 1)

I do think expecting anything to improve all-cause mortality in ESRD is probably unwise.

www.nejm.org/doi/full/10....