Your weekly digest: IgA nephropathy's two-year test, catheters by design in the very old, and the federal kidney plan that names nephrologists.
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.
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.
A global scoping review of 12 hemodialysis guideline documents found that only four gave guidance a clinician could act on, and only one, from 2007, covered measurement, dose and monitoring in full.
The PUSH trial paid, coached and texted people with kidney stones to drink more, and stone events didn't fall. A Kidney International commentary argues the trial tested a behavioral strategy, not water: urine volume barely separated between the groups.
In a 50-patient randomized, placebo-controlled pilot in polycystic kidney disease, empagliflozin was well tolerated, but total kidney volume grew about 10% a year on the drug, against about 5% on placebo. A secondary outcome in a small trial, but the investigators say it should give us pause.
In OASIS, a randomized trial in people 70 and older with limited life expectancy, catheters needed fewer access procedures than fistulas. In a trial in women, a bioengineered vessel was usable in under two months, against more than five for a fistula. Both are conference abstracts so far.
Two drugs approved on proteinuria reported their two-year kidney function results in NEJM. On sibeprenlimab, the eGFR on average didn't fall; atacicept was about five points a year better than placebo. The same week, the FDA gave ravulizumab an accelerated approval on proteinuria.
Your weekly digest: the ICU dialysis trial that stopped early, where ICU fluid really comes from, and a bike in the dialysis chair.
In a small Sydney study, cardiac output rose as new fistulas matured, and patients whose output didn't rise by at least 15% had more than four times higher NT-proBNP. Exploratory and hypothesis-generating.
In a Portuguese cohort of 741 hemodialysis patients followed for about three years, those who cycled at least about 90 minutes a week during dialysis had about a third of the adjusted risk of death of those who declined. Lighter exercisers did no better than decliners.
The IMPROVED feasibility study offered deprescribing of gabapentin and other potentially inappropriate medications to older adults in 10 dialysis clinics. Seventeen of 41 patients approached agreed to try; symptoms returned in some, without serious events.
AKI and critical care
In a 41-country cohort of 2,454 ventilated adults, resuscitation made up about one liter in six of the fluid given in the first three days after intubation. Maintenance and the carrier fluid for drugs and line flushes made up about a third each.
AKI and critical care
The trial set out to show intermittent hemodialysis was no worse than continuous therapy and couldn't. Patients who started on intermittent hemodialysis had higher 90-day mortality, and the trial stopped at about half its planned size. The size of the gap is uncertain; its direction is harm.
Weekly
Your weekly digest: fluids or pressors for septic shock, bicarbonate at 2 a.m., and what's really holding back PD.
Dialysis
An AJKD review of 13 interview studies finds fear of infection, clinicians' influence, one-session education, urgent starts and missing help at home steer patients toward hemodialysis.
AKI and critical care
In 500 ICU patients on vasopressors with metabolic acidosis, sodium bicarbonate did not significantly lower the risk of death, dialysis or lasting kidney damage at 30 days. An NEJM editorial and two ASN Kidney News viewpoints take it to the bedside.
AKI and critical care
In ARISE FLUIDS, 963 adults with septic shock in the emergency department had a median of 76 days alive and out of the hospital whether the fluid stopped and the vasopressor started early or not. Pulmonary edema was reported less often; dialysis use was similar.
Deep Dive
A 60-page referral, nine years of creatinine, and an AI summary waiting on two desks: the attending's and the first-year fellow's. A Kidney360 perspective says to hand drafting, summarizing and paperwork to AI first, because a clinician checks the draft. A CJASN perspective says that same…
Weekly
Five new papers for the commute, the run or the couch: a statin gap in CKD, GLP-1 drugs on dialysis, the heart on dialysis, troponin on the move, and an AI for fistulas.
Dialysis
In 120 hemodialysis patients, a cloud-based image model distinguished advanced from non-advanced aneurysms, judged against in-person assessment, with an AUROC of about 0.91. The authors call it a proof-of-concept screening aid that still needs real-world testing.
Dialysis
Across 28 small studies of patients without symptoms, troponin I was above the 99th percentile on average before and after dialysis, and changes during a session did not follow a consistent direction.
Dialysis
A narrative review in NDT weighs hemodiafiltration, medium cutoff dialyzers, potassium and sodium tailoring, incremental and frequent dialysis by their cardiovascular evidence, and asks for trials matched to each mechanism.
Dialysis
Dr. Csaba Kovesdy reads a new real-world study of GLP-1 receptor agonists in kidney failure closely, and flags malnutrition, muscle loss and hypoglycemia as dialysis-specific concerns.