Alex Chang, MD

Thank you #nephjc for the beautiful flozinator glass!

I was late to join so I suppose 2019. felt like I somehow stepped into a secret medicine speakeasy society I had no idea existed..

Blood Pressure Outcomes Following a Home Blood Pressure Monitoring Program in a Large Integrated US Health System AbstractBackground. Home blood pressure telemonitoring (HBPT) can empower patients to participate in their healthcare and reduce office BP. Evidence that B

Blood Pressure Outcomes Following a Home Blood Pressure Monitoring Program in a Large Integrated US Health System

🔗 academic.oup.com/ajh/article/... 🔓

#EditorsChoice #Free

Great BP study in VA by Holly Kramer et al showing terminal digit preference (TDP) to “0” and “8” - particularly in those with BP <140/90 (I.e. wishful thinking/recording?). More TDP ( sloppy BP measurement) correlates w/better BP control rates!
onlinelibrary.wiley.com/doi/10.1111/...

lol so true

Done!

I was just asked to evaluate AI-generated educational questions for providers (created by non-specialists for 'educational purposes'), riddled with/nonsensical issues as one might expect but looks possibly professional. Then I asked another AI to spot issues. Obviously, I think this is dumb...!

Prenatal diagnosis of fetuses with renal abnormalities: a retrospective analysis of 329 Chinese cases - Orphanet Journal of Rare Diseases Background There is no clear guidance on prenatal diagnostic testing strategies for congenital renal anomalies. Therefore, this study aims to investigate the retrospective analysis of ultrasound and genetic diagnostic results in cases of fetal renal abnormalities and to establish genotype-phenotype correlations. Methods A total of 329 fetuses with renal abnormalities that underwent prenatal diagnostic testing from January 2020 to April 2023 were recruited in this study. These cases were classified into 11 subgroups based on their ultrasound diagnosis. All cases underwent chromosomal microarray analysis (CMA) or copy number variation sequencing (CNV-seq), with subsequent whole exome sequencing (WES) conducted on select CMA/CNV-seq negative cases, subject to parental consent for further testing targeting monogenic variations. Results Of the 329 cases analyzed, CMA/CNV-seq detected chromosomal abnormalities in 31 cases, with a detection rate of 9.4% (31/329). The most common abnormality was 17q12 deletion, accounting for 29% of the positive cases (9/31) and 2.7% of the total cases (9/329). WES was conducted on 76 cases (76/298, 25.5%), revealing 16 monogenic variants, and 2 CNVs in 12 cases (15.8%). An overall positive diagnostic yield of 13.1% (43/329) was obtained in the pipeline of combinational CMA/CNV-seq and WES analysis. Ciliary genes (TMEM67, NPHP3, CEP290, BBS2, and TTC8) were frequently implicated by WES. Several genotype-phenotype correlations emerged, including (1) hyperechogenic kidneys associated with 17q12 deletion, (2) renal dysplasia, renal cysts, hydronephrosis, ectopic kidney, and renal duplication with chromosomal abnormalities, (3) unilateral renal agenesis and polycystic kidneys with monogenic variants. Conclusion This study reveals genotype-phenotype correlations in fetal renal abnormalities, informing prenatal counseling regarding diagnostic testing options and expected outcomes.

Prenatal diagnosis of fetuses w/renal abnormalities: 9.4% with chromosomal abnormalities. Most common 17q12 syndrome (large deletion encompasses HNF1B), then ciliary genes (TMEM67, NPHP3, CEP290, BBS2, TTC8). WES further revealed more diagnoses (15.8%).
ojrd.biomedcentral.com/articles/10....

Christie Thomas at University of Iowa presenting on the non-– AC GME research fellowship in nephrogenic that he started!

internalmedicine.medicine.uiowa.edu/renal-geneti...

Also McMaster U w/Lanktree medicine.healthsci.mcmaster.ca/divisions/ne...

Good question! I have a pt with C3 GN who I treated with mycophenolate and prednisone…found to have CFH pathogenic variant. then she got diabetes (BMI>40) from steroids..happy to get ozempic! Kept her on mycophenolate and albuminuria eventually went away and eGfR up, now off myco. Maybe it helped?

Great work led by Matt Lanktree on his nephrology genetics could fit into nephrology education and components of a nephrogenetics fellowship (exists at very few places)

www.seminarsinnephrology.org/article/S027...

I did a blog post about Apple's new Hypertension Detection System

pbfluids.com/2025/09/appl...

Another vitamin D trial in AKI this time, and it still does not do much 😏

The Impact of Modern Industrialized Dietary Sodium Intake on the Plasma Proteome AbstractBACKGROUND. High dietary sodium intake is associated with cardiovascular disease. We investigated the influence of sodium intake on the plasma prot

#WeekendReads

Sodium intake and Proteomic changes

academic.oup.com/ajh/advance-...

and related commentary academic.oup.com/ajh/advance-...

This is hilarious. @glaucomflecken.bsky.social

Association Between Fixed-Dose Combination Use and Medication Adherence, Health Care Utilization, and Costs Among Medicaid Beneficiaries:

Compared with multi-pill tx, combo pill tx associated with higher med adherence, fewer HTN-related ED visits, fewer hospitalizations and lower costs in Medicaid recipients. Limitations: includes prevalent and incident users and did not assess dose.
www.jacc.org/doi/10.1016/...

We’re thrilled to announce NKF's 2026 Award recipients! 🏆 Each have made a lasting impact on kidney health and patient outcomes.

Explore the full list of honorees here: bit.ly/3VincvA

Be part of the celebration at SCM26 - registration opens October 2025!

Happy gloaming!

Genetic testing and counseling for kidney disease Genetic causes of kidney disease are more common than many realize.​ ​Genetic testing looks for changes in your DNA that can cause kidney disease. Learn about the benefits of genetic testing for deter...

Very nice patient educational materials about genetic testing and counseling for kidney disease from the AKF @kidneyfund.bsky.social
www.kidneyfund.org/all-about-ki...

First nephrogenetics Geisinger multidisciplinary clinic in the books today! @kkalra.bsky.social

it looks at 30 days of data to make the call so it won;t trigger based on exercise

Some of the slides on the pro AI in HTN debate from Dr. Sau: lots of potential to use EKG, to predict incident hypertension, personalized treatment, identify those most likely to respond and benefit, improve clinical trial enrollment efficiently

AI on the brain as did introductions for the AHA AI in HTN debate!

HTN sounds less threatening…maybe their AI healthbot can tell them how to buy a validated arm BP cuff and measure their BP with appropriate technique and send the results to their pcp?

I’m imagining everyone wearing the watch will receive the notification at some point (e.g. exercising)? So great for increasing awareness!

Hypertension Notifications Building on its suite of advanced health features, Apple Watch Series 11 introduces groundbreaking hypertension notifications, which can alert users if signs of chronic high blood pressure — or hypertension — are detected.5 Hypertension is the leading modifiable risk factor for heart attack, stroke, and kidney disease, and impacts approximately 1.3 billion adults globally. It is frequently undiagnosed because it often has no symptoms, many people do not see a doctor regularly, and even during a clinical visit, it can be easily missed with a single measurement. Hypertension notifications on Apple Watch use data from the optical heart sensor to analyze how a user’s blood vessels respond to the beats of the heart. The algorithm works passively in the background reviewing data over 30-day periods, and will notify users if it detects consistent signs of hypertension. These notifications provide users with valuable insights into their health as it relates to this widespread condition simply by wearing their Apple Watch, so they can begin making potentially lifesaving behavioral changes, or start treatment to reduce their risk of serious, long-term health events. Replay video: Apple Watch Series 11 Hypertension Notifications Hypertension notifications use data from the optical heart sensor on Apple Watch to analyze how a user’s blood vessels respond to the beats of the heart. Like all of Apple’s health features, hypertension notifications are grounded in rigorous scientific validation. The feature was developed with advanced machine learning and training data from multiple studies totaling over 100,000 participants. Its performance was then validated in a clinical study of over 2,000 participants. While hypertension notifications will not detect all instances of hypertension, with the reach of Apple Watch, the feature is expected to notify over 1 million people with undiagnosed hypertension within the first year.

Hypertension notifications use data from the optical heart sensor on Apple Watch to analyze how a user’s blood vessels respond to the beats of the heart. Like all of Apple’s health features, hypertension notifications are grounded in rigorous scientific validation. The feature was developed with advanced machine learning and training data from multiple studies totaling over 100,000 participants. Its performance was then validated in a clinical study of over 2,000 participants. While hypertension notifications will not detect all instances of hypertension, with the reach of Apple Watch, the feature is expected to notify over 1 million people with undiagnosed hypertension within the first year. “Hypertension is the leading preventable cause of heart attack and stroke, yet millions remain undiagnosed,” said Harlan Krumholz, MD, SM, cardiologist and scientist at Yale University and Yale New Haven Hospital. “Making accurate detection easy and part of daily life can help people get care earlier and prevent avoidable harm.” A user’s iPhone and Apple Watch Series 11 show “Possible Hypertension” and offer more details. Hypertension notifications were developed with advanced machine learning and training data from multiple studies totaling over 100,000 participants. If users receive a hypertension notification, it is recommended that they log their blood pressure for seven days using a third-party blood pressure cuff and share the results with their provider at their next visit, which is consistent with the latest American Heart Association guidelines for the diagnosis and management of hypertension. Clearance for hypertension notifications from the FDA and other regulators is expected soon, and the feature will be available in more than 150 countries and regions — including the U.S. and the EU — this month. Hypertension notifications will be available on Apple Watch Series 9 and later, and Apple Watch Ultra 2 and later, with watchOS 26.

Hypertension Notifications Hypertension notifications use data from the optical heart sensor on Apple Watch to analyze how a user’s blood vessels respond to the beats of the heart. Like all of Apple’s health features, hypertension notifications are grounded in rigorous scientific validation. The feature was developed with advanced machine learning and training data from multiple studies totaling over 100,000 participants. Its performance was then validated in a clinical study of over 2,000 participants. While hypertension notifications will not detect all instances of hypertension, with the reach of Apple Watch, the feature is expected to notify over 1 million people with undiagnosed hypertension within the first year. “Hypertension is the leading preventable cause of heart attack and stroke, yet millions remain undiagnosed,” said Harlan Krumholz, MD, SM, cardiologist and scientist at Yale University and Yale New Haven Hospital. “Making accurate detection easy and part of daily life can help people get care earlier and prevent avoidable harm.” A user’s iPhone and Apple Watch Series 11 show “Possible Hypertension” and offer more details. Hypertension notifications were developed with advanced machine learning and training data from multiple studies totaling over 100,000 participants. If users receive a hypertension notification, it is recommended that they log their blood pressure for seven days using a third-party blood pressure cuff and share the results with their provider at their next visit, which is consistent with the latest American Heart Association guidelines for the diagnosis and management of hypertension. Clearance for hypertension notifications from the FDA and other regulators is expected soon, and the feature will be available in more than 150 countries and regions — including the U.S. and the EU — this month. Hypertension notifications will be available on Apple Watch Series 9 and later, and Apple Watch Ultra 2 and later, with watchOS 26.

The new ⌚️ will have hypertensive notifications

This doesn’t seem like a cuffless BP - but more like a notification ‘you may have hypertension, go check your BP’ ?

From www.apple.com/newsroom/202...

@jordybc.bsky.social @drwanpen.bsky.social @spjuraschek.bsky.social @daichishimbo.bsky.social?

Well, there could be an effect of the drug on cystatin c or creatinine secretion/production..we're limited by not having measured GFR. For steroids, there are a few other studies showing higher levels of cystatin C with excess glucocorticoids. Study is hypothesis-generating. Lots we don't know yet

Will note that these are associations and need more validation to understand whether findings are drug effects on cystatin C vs. related to the conditions the meds are treating!

My mom and Dr. DeepSeek In China and around the world, the sick and lonely turn to AI.

Interesting deep dive into DeepSeek providing medical advice to a kidney patient - @violazhou.bsky.social mother!

restofworld.org/2025/ai-chat...

Feat @melhoenig.bsky.social and @kidneyboy.bsky.social

#NephSky #AI #LLM

U.S. survey finds salt substitutes rarely used by people with high blood pressure Research Highlights: Despite their effectiveness in lowering sodium intake and managing blood pressure, salt substitutes were rarely used by people with high blood pressure, according to a review of a...

Honored to present my abstract poster at the AHA #hypertension25 on the prevalence of salt substitute use. Grateful that our work @drwanpen.bsky.social @giaconajohn.bsky.social
@jesslin23.bsky.social was also featured in the official AHA news release: newsroom.heart.org/news/u-s-sur...