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Trailer 路 Why NephSpace
Why I built NephSpace, in my own voice, plus three short moments from the show. Two minutes.
About this trailer
Knowledge, transformed: easy to reach, hard to stop.
New kidney research, picked by a nephrologist: short stories to read, episodes to listen to.
Listen Latest episodes
All episodesWeekly 路 Nov 9: Dialysis or Not for the Frail Older Patient, Reading Frailty at the Chair, and How to Have the Conversation
One decision this week: dialysis, or not, for the frail older patient. The first randomized trial ever run on it, a one-minute frailty score that separates 4% from 27%, and the sentence almost nobody says out loud.
Episode notes, chapters and sourcesWeekly 路 Nov 2: SGLT2 Inhibitors and Hemoglobin, Avacopan Revoked in Europe, PD Catheter Timing and Sodium on CRRT
Your weekly digest: what a rising hemoglobin on an SGLT2 inhibitor means, why Europe revoked avacopan, and when to place the PD catheter.
Episode notes, chapters and sourcesWeekly 路 Oct 26: IgA Nephropathy's Turning Point, Access in the Very Old, SGLT2 in ADPKD and the Federal Kidney Plan
Your weekly digest: IgA nephropathy's two-year test, catheters by design in the very old, and the federal kidney plan that names nephrologists.
Episode notes, chapters and sourcesRead Latest stories
All stories
Dialysis
There are only two reasons to offer dialysis, and a framework for saying so out loud
A JASN perspective names what most of us do instead of having the conversation: we describe the machine. Alongside it, a French qualitative study shows what conservative care looks like when it is actually built.
Dialysis
A nurse's one-minute judgment separates a 3.6% from a 27% chance of dying this year
In 792 patients on maintenance dialysis, a nine-point scale rated by the nurse at the chair out-ranked a comorbidity score built for the job. The catch is in how reproducible it was.
Dialysis
For the first time, a trial randomised the decision itself
445 older people with failing kidneys were prepared for dialysis, or for a life without it. After four and a half years the two arms were separated by 78 days of quality-adjusted life, in the direction nobody predicted.
AKI and critical care
Sodium at two in the morning: how to control the rate of correction on CVVH by customizing the bags
A practical review sets out how to raise or lower the sodium in 5-liter CVVH replacement bags: the calculations, the targets, the monitoring. Its evidence base is case reports and single-center protocols, and the fear of correcting too fast on CRRT is extrapolated from elsewhere.
Dialysis
Starting PD within 30 days of placing the catheter carried about three times the risk of an early complication
In about 1,500 first PD catheters across 23 North American centers, 90-day complication rates did not differ significantly by eGFR group. But within the low-eGFR group each 1 mL/min lower carried about 10% more risk, and starting PD within 30 days of insertion carried about three times the risk.
Glomerular disease
Europe revoked avacopan after regulators called its pivotal trial's data unreliable. What now for patients doing well on it?
Europe revoked avacopan on August 4, after regulators called the ADVOCATE trial's efficacy data unreliable and weighed its liver-injury signal against it. The FDA alleges the one-year result was re-scored after unblinding; Amgen disputes it. A taskforce argues to keep access for a few.
Other
Kidney transplant recipients with polycystic kidney disease clot more, and their higher hemoglobin is part of the explanation
In two transplant cohorts totaling 5,594 recipients, venous thromboembolism was more common with ADPKD: 21.0% versus 15.1% at 10 years in the Swiss cohort. The excess was concentrated in the first two years and in men, and accounting for hemoglobin over time weakened the association.
CKD and cardiometabolic
SGLT2 inhibitors raise hemoglobin by about 0.6 g/dL. Bonus, or something to watch?
Across 85 randomized, double-blind trials and about 70,000 participants, hemoglobin rose about 0.6 g/dL more on SGLT2 inhibitors than on control. The authors call the effect small and its clinical significance unclear; the editorial leans toward benefit, with a caution about erythrocytosis.
Policy and news
The HHS Kidney Care National Plan: prevention, transplant and the dialysis market
The federal plan, released October 20, sets out what HHS should consider in kidney care, and devotes a section to how dialysis chains build financial ties with nephrologists. DaVita, Fresenius Medical Care and Kidney Care Partners responded.
Dialysis
As low as possible, as high as necessary: a patient's view of incremental PD
In CJASN's Patient Voice series, Jan van Cruchten describes starting peritoneal dialysis to protect his remaining kidney function, still making good urine more than five years in, and why the dose and the decision should be shared.