Weekly · Nov 2: SGLT2 Inhibitors and Hemoglobin, Avacopan Revoked in Europe, PD Catheter Timing and Sodium on CRRT

A rising hemoglobin on an SGLT2 inhibitor: bonus, or warning sign? A meta-analysis of 85 randomized trials in JAMA puts the average rise at about 0.6 g/dL and calls its clinical significance unclear, while its editorial leans toward benefit. We read it alongside a small study of patients on SGLT2 inhibitors at altitude, where the clots clustered in those whose hemoglobin rose most, and a JASN study showing that kidney transplant recipients with polycystic kidney disease clot more, which its authors think is at least partly explained by their own higher hemoglobin. Then a first for our field: Europe revoked avacopan in August, after regulators concluded that data-integrity problems made its pivotal trial's efficacy data unreliable and that its liver-injury signal weighed against it. The FDA alleges the trial's one-year result was re-scored after unblinding; the New England Journal of Medicine retracted the paper at its academic authors' request, and the company disputes the account. Also: a registry study of when to place the peritoneal dialysis catheter, where starting within 30 days carried about three times the risk of an early complication; and a practical review of how to control the rate of sodium correction on CVVH by customizing the replacement bags.

Disclosure: Dr. Hussein serves on the Fresenius Medical Care US Home Medical Advisory Board. The peritoneal dialysis catheter segment concerns dialysis practice; that study was funded by the Canadian Institutes of Health Research with support from the International Society for Peritoneal Dialysis North American Chapter, the Ontario Renal Network, Vantive Healthcare and Medtronic, and several of its authors report ties to dialysis companies, including Vantive Healthcare and Fresenius Medical Care. Authors of the JAMA meta-analysis and of the JASN transplant study report relationships with companies that market SGLT2 inhibitors and other kidney drugs, and the authors of the JAMA editorial report consulting relationships with anemia drug companies. In the avacopan segment, the FDA's allegations about the ADVOCATE trial are contested by Amgen, which markets the drug in the United States; a hearing has been requested and the matter is unresolved. The European authorization was held by CSL Vifor. The NDT editorial's conflict-of-interest statement declares none, while its acknowledgments record that its senior author's institution has received unrestricted research grants from GlaxoSmithKline, CSL Vifor and Novartis for his investigator-initiated studies, and consulting fees from AstraZeneca, Alexion, GSK, Novartis, Otsuka, Roche, Sobi and CSL Vifor for his consultancies. Full disclosures are in each paper. These disclosures were not read on air this week.

Chapters

• 01:28 Hemoglobin on SGLT2 inhibitors: bonus or warning? · Read the stories: 1, 2
• 08:19 Avacopan revoked in Europe · Read the story
• 14:54 When to place the PD catheter · Read the story
• 17:44 Sodium on CVVH · Read the story

Papers in this episode

• Yang Y, Yang C, Wang Y, et al. Sodium-Glucose Cotransporter 2 Inhibitor Use and Levels of Hemoglobin, Markers of Iron Metabolism, and Erythropoiesis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. JAMA. Published online October 24, 2026. Link
• Eckardt KU, Koury MJ. Increased Hemoglobin With Sodium-Glucose Transporter 2 Inhibitors — A Consistent Extra Benefit? JAMA. Published online October 24, 2026. Link
• Aoun M, Madero M, Fernández Yepez AK, et al. Impact of Altitude on Hemoglobin Response to Sodium-Glucose Cotransporter 2 Inhibitors in CKD: The SGaLTItude Study. Kidney360. Published online August 4, 2026. Link
• Bais T, Alnaim AA, Tegzess E, et al. Risk of Venous Thromboembolism in Kidney Transplant Recipients with Autosomal Dominant Polycystic Kidney Disease. J Am Soc Nephrol. Published online October 26, 2026. Link
• Teng YKO, et al., for the ERN RITA Autoimmune Vasculitis Taskforce. Avacopan across borders: regulatory divergence and treatment dilemmas for ANCA-associated vasculitis. Nephrol Dial Transplant. Published online October 26, 2026. Link
• Dhoot A, Quinn RR, Clarke A, et al. Association of Estimated GFR at the Time of Peritoneal Dialysis Catheter Insertion With Dialysis-Related Complications. Am J Kidney Dis. Published online October 26, 2026. Link
• Alrashidi FS. Updated Management of Sodium Disorders During Continuous Venovenous Hemofiltration. Semin Dial. Published online October 29, 2026. Link

Also mentioned

• Rubin EJ. Retraction: Jayne DRW et al. Avacopan for the Treatment of ANCA-Associated Vasculitis, N Engl J Med 2021;384:599-609. N Engl J Med. Published online June 29, 2026. Link
• US Food and Drug Administration, Center for Drug Evaluation and Research. Tavneos (avacopan): proposal to withdraw approval; notice of opportunity for a hearing. April 27, 2026. Link
• Chapman GB, Pugh D, Dhaun N. From ADVOCATE to ADVOGATE: Is This the End of Avacopan? Arthritis Rheumatol. Published online 2026. Link
• The Lancet Rheumatology. The end for avacopan. Lancet Rheumatol. 2026;8(8):e587. Link
• Spasovski G. Hyponatraemia — treatment standard 2024. Nephrol Dial Transplant. 2024;39(10):1583-1592. Link

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Physician-led, AI-assisted. Dr. Wael Hussein chooses the papers, reviews and edits every script, and approves every episode. AI (Claude, by Anthropic) writes the first draft from the full text of each paper, and a separate AI check compares every number with the papers; Dr. Hussein then reviews and edits the draft before the AI hosts (ElevenLabs) voice it. Everything is summarized in our own words. For education and information only, not medical advice. Please talk to your own physician or care team about your health. Clinicians: read the original before changing practice. See our disclaimer. Views are the creator's own and not those of his employer. No sponsors.