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Bypass surgery continues to be the laboratory where we test the most innovative ideas on the prevention of AKI The Filtrate Joel Topf @kidney_boy Swapnil Hiremath @hswapnil.medsky.social Vipin Varghese Sophia Ambruso Special Guests Rahul Ganatra Deputy Editor NEJM Clinician. https://clinician.nejm.org/editors/AU3406 Jay Koyner Professor of Medicine, University of Chicago. https://www.uchicagomedicine.org/find-a-physician/physician/jay-koyner Editing Vipin Varghese The Kidney Connection written and performed by Timothy Yau Show Notes Back to the Future: https://youtu.be/BDuZqYeNiOA?is=r-RE2DgIDBazRAlW Amino Acids for AKI: The PROTECTION Study NephJC: Trial by Combat: Do Amino Acids provide PROTECTION to the Kidneys? In 2016 the FDA posted a warning that SGLT2i could induce AKI. This Nature Reviews Nephrology explores possible mechanisms for the AKI: Acute kidney injury from SGLT2 inhibitors: potential mechanisms https://www.nature.com/articles/nrneph.2016.159 But by 2019 the SMART-C Collaboration was looking at the risk of AKI in the large RCTs and found Flozins to be protective: SGLT2 inhibitors for the prevention of kidney failure in patients with type 2 diabetes: a systematic review and meta-analysis. https://www.thelancet.com/journals/landia/article/PIIS2213-8587(19)30256-6/abstract If you are actually looking for the best data you should look at the updated meta-analysis from 2025 which extends the findings to patients with and without diabetes and to patients with and without CKD: SGLT2 Inhibitors and Kidney Outcomes by Glomerular Filtration Rate and Albuminuria https://pmc.ncbi.nlm.nih.gov/articles/PMC12595549/ 2012 KDIGO AKI Guidelines: https://kdigo.org/wp-content/uploads/2016/10/KDIGO-2012-AKI-Guideline-English.pdf The 2025/2026 AKI Draft guidelines: https://kdigo.org/wp-content/uploads/2026/03/KDIGO-2026-AKI-AKD-Guideline-Public-Review-Draft-March-2026.pdf Meta-analysis of frusemide to prevent or treat acute renal failure https://www.bmj.com/content/early/2005/12/31/bmj.38902.605347.7C Euglycemic Diabetic Ketoacidosis: A Potential Complication of Treatment With Sodium–Glucose Cotransporter 2 Inhibition https://diabetesjournals.org/care/article-abstract/38/9/1687/37246/Euglycemic-Diabetic-Ketoacidosis-A-Potential Topic of this podcast, the MERCURI-2 trial: Dapagliflozin and Acute Kidney Injury Following Cardiac Surgery https://jamanetwork.com/journals/jama/article-abstract/2852324 | NephJC: Too sweet to be true? Prophylactic SGLT2 inhibitors before cardiac surgery https://www.nephjc.com/news/2026/8/18/mercuri2 MERCURI-1 Pilot trial is described here. Looks like it was only published as a pre-print. The first link provides a glimpse at MERCURI-3 https://abrahamhulst.com/research/mercuri-1/ https://www.medrxiv.org/content/10.1101/2024.03.27.24304998v1.full.pdf Vipin Varghese used to believe in the urinalysis: Diagnostic Utility of Serial Microscopic Examination of the Urinary Sediment in Acute Kidney Injury https://pubmed.ncbi.nlm.nih.gov/35373012/ MERCURI-2 in ClinicalsTrials.gov: proMoting Effective Renoprotection in Cardiac sURgery Patients by Inhibition of SGLT-2 (MERCURI-2)   https://clinicaltrials.gov/study/NCT05590143 Roger Rodby’s 4 favortite equations in Nephrology from Channel Your Enthusioasm: https://pca.st/episode/abff985f-6a87-41f9-bcc9-80b8a85c2441?t=3257.0 IDEAL ICU Timing of Renal-Replacement Therapy in Patients with Acute Kidney Injury and Sepsis https://www.nejm.org/doi/full/10.1056/NEJMoa1803213?referrer=https%3A%2F%2Fwww.google.com%2F Rethinking the definition of oliguria: Identification of an optimal threshold to define oliguria in critically ill patients: an observational study https://pubmed.ncbi.nlm.nih.gov/37254158/ Editorial on MERCURI-2 in JAMA by Wolfgang Winkelmayer and  Glenn Chertow https://jamanetwork.com/journals/jama/fullarticle/2852331          Tubular Secretion Swapnil Spider Noire Amazon Prime Sophia Bernadoodle via Starlight Bernadoodle https://starlightbernedoodles.com Rahul Derry Girls on Netflix Vipin Tennis Cincinnati Open and the US Open. The death of the one handed backhand. Jay Slow Horses on Apple TV and Adults on Hulu Joel Silo season three. Mountain biking.

The Filtrate Joel Topf @kidney_boy Swapnil Hiremath @hswapnil.medsky.social Natalie Freidin Program director at Medical University of South Carolina AC @medpeedskidneys.bsky.social Special Guests Fernando Fervenza Professor of Medicine, The Mayo Clinic Editing Vip Vergues The Kidney Connection written and performed by Timothy Yau Show Notes MENTOR NephJC | NEJM | Freely Filtered episode 7 PLA2r in 2009 M-Type Phospholipase A2 Receptor as Target Antigen in Idiopathic Membranous Nephropathy NEJM MAJESTY NephJC | NEJM Obinutuzumab or Tacrolimus in Primary Membranous Nephropathy Giuseppe Remuzzi discovers rituximab works in primary membranous. Rituximab for idiopathic membranous nephropathy The Lancet 2002 Fervenza’s 15-person study of Rituximab treatment of idiopathic membranous nephropathy Kidney International 2008. Larry Beck’s NEJM PLA2r study M-Type Phospholipase A2 Receptor as Target Antigen in Idiopathic Membranous Nephropathy NEJM 2009 2011 (not 2010) JASN paper where using banked serum from two prior rituximab studies in membranous nephropathy, Beck and Fervenza showed that declines in anti-PLA2R antibodies preceded reductions in proteinuria and predicted subsequent clinical remission, establishing the concept that immunologic remission precedes clinical remission. Rituximab-Induced Depletion of Anti-PLA2R Autoantibodies Predicts Response in Membranous Nephropathy PubMed The National Institute of Animal Health…a Fervenza fiction Robert A. Star, M.D. NIH Daniel C. Cattran, M.D. NephCure Tubular Secretions Swap do not go to see Mandalorian and Grogu or Supergirl AC doing nothing Natalie The Wealth Ladder by Nick Maggiulli (amazon) Fernando South Portugal and GlomCon Hawaii Joel The Boundary Waters Canoe Area

The Filtrate Joel Topf@kidney_boy Vipin [email protected] Nayan Arora @captainchloride Special Guests David Goldfarb Professor of Medicine, NYU (COI) Megan Prochaska Assistant professor of medicine at University of Chicago John Asplin Medical Director Consultant LithoLink (Twitter) Editing Anna Gaddy The Kidney Connection written and performed by Timothy Yau Show Notes Kidney Treks, University of Chicago. For medical students. The Push Trial: Prevention of urinary stones with hydration: a randomised clinical trial of an adherence intervention NephJC Short | The Lancet Charlie Pak trial showing increased urine volume reduced risk of kidney stones. Evidence justifying a high fluid intake in treatment of nephrolithiasis PubMed The Borghi Trial: Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study PubMed Medical Management of Kidney Stones: AUA Guideline (2026) Weird little trial Asplin mentioned with amlodipine. But it was actually verapami. By Kemal Sarical: The effect of calcium channel blockers on stone regrowth and recurrence after shock wave lithotripsy PubMed Borghi’s other giant study in kidney stones: Comparison of Two Diets for the Prevention of Recurrent Stones in Idiopathic Hypercalciuria NEJM The No Stone Trial: Hydrochlorothiazide and Prevention of Kidney-Stone Recurrence NephJC | NEJM Gary Curhan epidemiologic data from the Nurses Health Study and the Health Professionals Follow-up Study: Twenty-four-hour urine chemistries and the risk of kidney stones among women and men PubMed Gary Curhan epidemiologic data on sugar sweetened beverages and risk of kidney stones. Soda and other beverages and the risk of kidney stones PubMed Eric Topol’s tweet:NephJC in 2014 on the ACP Kidney Stone Guidelines NephJC Goldfarb’s scathing editorial on said guidelines, not on NephJC as I said but, on Fred Coe’s website at the University of Chicago. Link Tubular Secretions Nayan: Shrinking on Apple TV Wikipedia David: The deaths of Sonny Rollins (Wikipedia) and James Blood Ulmer (Wikipedia) Megan: Sri Lanka for travel (National Geographic) Vipin: Memory Eternal: Living with Grief as Orthodox Christians (Amazon) John: A History of Rock Music in 500 Songs (Link) Patty Smith’s memoir, Just Kids (Amazon) Joel: This is How You Lose The War by Amal El-Mohtar and Max Gladstone (Amazon) for the second time, and Acquired PodCast (Link)

The Filtrate Joel Topf kidneyboy.bsky.social Swapnil Hiremath @hswapnil.medsky.social Natalie Freidin Program director at Medical University of South Carolina Sophia Ambruso @sophia_kidney AC @medpeedskidneys.bsky.social Special Guests Carla Nester, Professor of Medicine, Professor of Pediatrics, University of Iowa. Senior author of Valiant Editing Natalie Freidin The Kidney Connection written and performed by Timothy Yau Show Notes Trial of Pegcetacoplan in C3 Glomerulopathy and Immune-Complex MPGN NEJM | NephJC Tubular Secretions Swapnil: City of Last Chances by Adrian Tchaikovsky (Amazon) Natalie: Heated Rivalry, the books by Rachel Reid Carla: Rowing and gold fiber embroidery AC: Audiobooks, that are appropriate for children: The Giver and Tuck Everlasting Sophia: Greeking Out podcast and the Wheel of Time by Robert Jordan (Wikipedia) Joel: This is How You Lose The War by Amal El-Mohtar and Max Gladstone (Amazon)

The Filtrate Joel Topf kidneyboy.bsky.social Swapnil Hiremath @hswapnil.medsky.social Pedro Teixeira @nephcrit.bsky.social Special Guests Ewout J. Hoorn, Professor of Medicine Erasmus MC, Netherlands. One of the primary authors. Harish Seethapathy, Assistant physician at Massachusetts General Hospital Editing Vipin Verghese The Kidney Connection written and performed by Timothy Yau Show Notes A Randomized Trial of Targeted Hyponatremia Correction in Hospitalized Patients in NEJM Evidence, in PubMed, in NephJC Seethapathy: Severe Hyponatremia Correction, Mortality, and Central Pontine Myelinolysis in NEJM Evidence MacMillan: Osmotic Demyelination Syndrome in Patients Hospitalized with Hyponatremia in NEJM Evidence SALSA: Risk of Overcorrection in Rapid Intermittent Bolus vs Slow Continuous Infusion Therapies of Hypertonic Saline for Patients With Symptomatic Hyponatremia: The SALSA Randomized Clinical Trial in JAMA Internal Medicine SALT 1 and 2: Tolvaptan, a Selective Oral Vasopressin V2-Receptor Antagonist, for Hyponatremia in NEJM Hyponatremia registry: Current treatment practice and outcomes. Report of the hyponatremia registry in Kidney International The Richard Sterns’ article on the lower mortality with more severe hyponatremia: Mortality and Serum Sodium: Do Patients Die from or with Hyponatremia? in CJASN The European Hyponatremia Guidelines: Clinical practice guideline on diagnosis and treatment of hyponatraemia in The European Journal of Endocrinology The American Hyponatremia Guidelines: Diagnosis, Evaluation, and Treatment of Hyponatremia: Expert Panel Recommendations in American Journal of Medicine Treating hyponatremia: damned if we do and damned if we don't by Tom Berl in Kidney International Prospective (clamp) versus reactive (rescue) DDAVP in hyponatremia: Safety and efficacy of proactive versus reactive administration of desmopressin in severe symptomatic hyponatremia: a randomized controlled trial in Nature Scientific Reports and as covered in PBFluids Helbert Rondon’s RCT of urea Urea for Chronic Hyponatremia on ClinicalTrials.gov Tubular Secretions Swapnil: Catfishing on CatNet: A Novel by Naomi Kritzer (Amazon) Harish: Disney Cruise Edward: Flesh: A Novel (Booker Prize Winner) by David Szalay (Amazon) Pedro: Scrubs reboot (IMDB) Joel: KIDNEYcon

The Filtrate Joel Topf kidneyboy.bsky.social Special Guests Dr. Samir Parikh, President of the American Society of Nephrology Prof. Donal Reddan, President, Irish Nephrology Society Prof. Catherine Godson Editing Joel Topf The Kidney Connection written and performed by Timothy Yau Show Notes Tubular Secretions Joel Topf, the Dublin Port Greenway Link Catherine Godson: never heard of the Dublin Port Greenway Samir Parikh: Trinity College Dublin and specifically the Eavan Boland Library, named after the Irish poet. Donal Reddan: Something about rugby

The Filtrate Joel Topf kidneyboy.bsky.social Pedro Teixeira @nephcrit.bsky.social Nayan Arora @captainchloride.bsky.social Anna Gaddy @annagaddy.bsky.social Swapnil Hiremath @hswapnil.medsky.social and on LinkedIn Special Guests Ian McCoy, MD @NephroNinja study author and UCSF Chi-yuan Hsu Senior author and Chief of the Division of Nephrology at UCSF Samuel Silver Associate Professor at Queens University in Canada Editing Vipin Verghese and Joel Topf Show Notes NephJC Discusion: Dialyze Less, Recover More? AKI’s Chance to Get LIBERATE-D Manuscript: A Conservative Dialysis Strategy and Kidney Function Recovery in Dialysis-Requiring Acute Kidney InjuryThe Liberation From Acute Dialysis (LIBERATE-D) Randomized Clinical Trial JAMA | PubMed Ben’s pilot study: RAD-AKI Pilot study: Recovery After Dialysis-Requiring Acute Kidney Injury (RAD-AKI) (ClinicalTrials.gov) STARRT-AKI NephJC Editorial in JAMA: A-E-I-O-U and Sometimes Why—Dialysis in Acute Kidney Injury (JAMA) What Is Dialytrauma? (Nephrology Times) How Fragile Are the Results of a Trial? The Fragility Index (PubMedCentral) Shiffl Trial: Daily Hemodialysis and the Outcome of Acute Renal Failure (NEJM) AKIKI: Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit (NEJM) AKIKI2: How Late it was, How Late! (NephJC) Sam Silver’s study: Promoting Kidney Recovery After Acute Kidney Injury Receiving Dialysis (Recover-AKI) (ClinicalTrial.Gov) Marie Kondo (Wikipedia) Tubular Secretions Swap: The smutty dragon novels of novels of Rebecca Yarros (Wikipedia) Specifically The Empyrean series Anna: Brisket recipes Pedro: The Naked Gun (Wikipedia) with Liam Neeson Ian: ASN Kidney Health Guidance on the Outpatient Management of Patients with Dialysis-Requiring Acute Kidney Injury (PubMed) he really doesn’t get Tubular Secretions. Nayan: Tilt: A Novel by Emma Pattee (Amazon) Chi: The Year of Magical Thinking by Joan Didion (Wikipedia) and Innovations in Nephrology (Springer Nature) Sam: Monopoly Super Electronic Banking Board Game (Amazon) Joel: Song Sung Blue (Wikipedia)

The Filtrate Joel Topf (kidneyboy.bsky.social) AC (@medpeedskidneys.bsky.social)NephMadness Anna Gaddy (@AnnaGaddy) Vipin Verghese (@vipvargh.bsky.social) Natalie Freidin Program director at Medical University of South Carolina Special Guests Anna Vinnikova (@kidneywars.bsky.social) Long time game maker for NephMadness and Associate Professor at Virginia Commonwealth University Autumn Harris Associate Professor of Veterinary Medicine at NC State Sarah Street MD PhD Assistant Professor of Medicine at Virginia Commonwealth University Editing Joel Topf Show Notes Animal House scouting report Autumn Harris on Team Cat Cheese!

I know 2026 feels like it ihas been here for months, but only a few weeks ago we were celebrating the nephrology accomplishments of 2025. The New Filtrate came together to review the year.The Filtrate Joel Topf‍ ‍@kidneyboy.bsky.social‬ (COI) Swapnil Hiremath @hswapnil.medsky.social and on LinkedIn Editor in Chief of Kidney International Case Reports Anna Gaddy (@AnnaGaddy) Winner of NephJC Rookie of the Year 2020 Nayan Arora (@CaptainChloride.bsky.social) AC (@medpeedskidneys.bsky.social) Vipin Verghese (@vipvargh.bsky.social) co-winner of NephJC Engaged Scientist of the Year in 2021 Brian Rifkin (@brianrifkin.bsky.social) Co-Editor in Chief NephJC. Winner of NephJC Rookie of the Year 2021 Cristina Popa (@NephroSeeker) Co-Editor in Chief NephJC. Wwinner of NephJC Rookie of the Year 2022 and MVP 2023 Editing and Show Notes by Anna Gaddy and Joel Topf The Kidney Connection written and performed by Tim Yau Show Notes Top Stories in Nephrology 2025 (NephJC) First Top sories in Nephrology 2010! (Renal Fellow Network) Links to all of the Top Stories in Nephrology, hosted on NephJC since 2017 (NephJC) 1. IgA Nephropathy VISIONARY: Sibeprenlimab in IgA Nephropathy — Interim Analysis of a Phase 3 Trial (NEJM) ORIGIN 3: A Phase 3 Trial of Atacicept in Patients with IgA Nephropathy (NEJM) APPLAUSE-IgA Alternative Complement Pathway Inhibition with Iptacopan in IgA Nephropathy (NEJM) Aliza M. Thompson, MD, MS (ASN) 2. Lupus Nephritis REGENCY: Efficacy and Safety of Obinutuzumab in Active Lupus Nephritis (NEJM) 3. Nobel prize winner and peripheral immune tolerance 4. Xenotransplantation 5. GLP1ra Revolution Remodel REMODELing mechanistic trials for kidney disease: a multimodal, tissue-centered approach to understand the renal mechanism of action of semaglutide (Kidney International) SURPASS-CVOT Tirzepatide vs. Dulaglutide Is Associated with Reduced Major Kidney Events in Patients with Type 2 Diabetes, CVD, and Very High-Risk Kidney Diseases (Kidney Week abstract in JASN) Poll: 1 in 8 Adults Say They Are Currently Taking a GLP-1 Drug for Weight Loss, Diabetes or Another Condition, Even as Half Say the Drugs Are Difficult to Afford (KFF survey) 6. GDMT implementation in CKD: lessons learnt from CONFIDENCE and MIRO-CKD Confidence Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes (NEJM) MIRO-CKD Balcinrenone in combination with dapagliflozin compared with dapagliflozin alone in patients with chronic kidney disease and albuminuria: a randomised, active-controlled double-blind, phase 2b clinical trial (The Lancet) 7. Flozin Meta analysis SMART-C. SGLT2 Inhibitors and Kidney Outcomes by Glomerular Filtration Rate and Albuminuria. A Meta-Analysis (JAMA) SMART-C. Effects of Sodium Glucose Cotransporter 2 Inhibitors by Diabetes Status and Level of Albuminuria. A Meta-Analysis (JAMA) 8. Paradigm Shift: Aiming for CKD Remission 9. Fish Oil and Dialysis PISCES Fish-Oil Supplementation and Cardiovascular Events in Patients Receiving Hemodialysis (NEJM) 10. Decline in Dialysis Patients in the United States USRD 2025 Annual Data Report (USRDS) Tubular Secretion Swapnil Hiremath Alien Earth on FX Hulu (Wikipedia) AC A Christmas Carol by Charles Dickens (Wikipedia) and The Muppet Christmas Carol (Wikipedia) Anna Monty Don (Wikipedia) Nayan Back Street Boys at The Sphere (Wikipedia) Brian Marty Supreme (Wikipedia) Cristina The Yellow Tie (Wikipedia) Vipin Stranger Things, good for a four year old? (Wikipedia) Joel Crash Course: The Universe with Katie Mack and John Green (Apple PodCasts)

The Filtrate Joel Topf‍ ‍@kidneyboy.bsky.social‬ (COI) Sophia Ambruso @sophia-kidney.bsky.social Swapnil Hiremath @hswapnil.medsky.social and on LinkedIn Special Guests Jonathan Barratt Professor of Renal Medicine, University of Leicester Google Scholar (COI: all the companies) Editing and Show Notes by Nayan Arora @captainchloride.bsky.social The Kidney Connection written and performed by Tim Yau Show Notes Proteinuria Reduction as a Surrogate End Point in Trials of IgA Nephropathy (Aliza Thompson, 2019 PubMed) The number, quality, and coverage of randomized controlled trials in nephrology (PubMed 2004) A Randomized, Controlled Trial of Rituximab in IgA Nephropathy with Proteinuria and Renal Dysfunction (PubMed 2017) BLISS Belimumab in lupus nephritis (NephJC | PubMed) The Phase 2 trial of atacicept A phase 2b, randomized, double-blind, placebo-controlled, clinical trial of atacicept for treatment of IgA nephropathy (PubMed) The phase 3 trial of atacicept, the subject of this podcast A Phase 3 Trial of Atacicept in Patients with IgA Nephropathy (PubMed | NephJC) The use of Gd-IgA1 in the Testing Trial Role of Systemic Glucocorticoids in Reducing IgA and Galactose-Deficient IgA1 Levels in IgA Nephropathy (PubMed) If you can’t get enough Jon Barratt, take a look at his grand rounds at The University of Ottawa. Updates to the KDIGO Guidelines for the treatment of IgA nephropathy, with Prof Jonathan Barratt (YouTube) Tubular Secretion Swapnil Hiremath Pluribus on Apple TV (Wikipedia) Jon Barratt Lynyrd Skynyrd (Wikipedia) Slow Horses (Wikipedia) on AppleTV Joel Topf the new ASN

The Filtrate Joel Topf‍ ‍@kidneyboy.bsky.social‬ (COI) Pedro Teixeira @nephcrit.bsky.social Ana Gaddy @AnnaGaddy Nayan Arora @captainchloride.bsky.social Special Guests David Goldfarb Professor of Medicene, NYU (COI) Editing by Pedro Teixeira The Kidney Connection written and performed by Tim Yau Show Notes BICARBICU 2018 (Lancet) BICARBICU-2 2025 (JAMA) SOFA score (Wikipedia) Sodium bicarbonate administration for metabolic acidosis in the intensive care unit: a target trial emulation (PubMed) Effect of sodium bicarbonate on intracellular pH under different buffering conditions (PubMed) Evaluating the clinical and cost-effectiveness of Sodium Bicarbonate administration for critically ill patients with Acute Kidney Injury (MOSAICC) (ICNARC Site) SODium BICarbonate for Metabolic Acidosis in the ICU (SODa-BIC) (ClinicalTrials.gov) Surviving Sepsis Campaign Guidelines 2021 (Website) Tubular Secretions Nayan: Louise Penny, The Black Wolf (Amazon) Anna: Broom Gate: A Curling Scandle (CBC) Pedro: One Battle After Another! (Wikipedia) David: Patti Smith (Wikipedia) Bonus pick: Kids Rarely Read Whole Books Anymore. Even in English Class. (NYT) Joel: Boys in the Boat by Daniel James Brown (Film Wikipedia | Book Wikipedia)

The Filtrate Joel Topf‍ ‍@kidneyboy.bsky.social‬ (COI) Swapnil Hiremath @hswapnil.medsky.social and on LinkedIn Pedro Teixeira @nephcrit.bsky.social Special Guests Charmaine E Lok, MD Professor of Medicine at the Faculty of Medicine, University of Toronto Editing and Show Notes by Joel Topf The Kidney Connection written and performed by Tim Yau Show Notes Fish-Oil Supplementation and Cardiovascular Events in Patients Receiving Hemodialysis NEJM | NephJC What works in hemodialysis? Iron: PIVOTAL Trial (NEJM) Hemodiafiltration: CONVINCE (NEJM) That’s the whole list Earlier work on vascular access, The FISH Trial: Effect of fish oil supplementation on graft patency and cardiovascular events among patients with new synthetic arteriovenous hemodialysis grafts: a randomized controlled trial JAMA Eskimo myth: "Fishing" for the origins of the "Eskimos and heart disease" story: facts or wishful thinking? (PubMed) Dialysis patients have low levels of fish oil in their body (PubMedCentral) Positive trial in non-dialysis patients: REDUCE-IT Negative trial of fish oil in non-dialysis patients: STRENGTH ACC does not recommend FISH Oil for primary or secondary prevention of CV events (ACC) Poisson distribution (Wikipedia) Ocean Nutrition Canada (Wikipedia) Ocean Nutrition was bought by DSM (Press Release) DSM merged with Firmenich (Press Release) Vanguard feasibility trials (PubMed) Freezing fish oil caps will eliminate the fishy aftertaste (Pharmacists Letter) The study also received a philanthropic donation from Mr. Alexander Epstein (UHN Research) Selection Bias, Interventions and Outcomes for Survivors of Cardiac Arrest (PubMedCentral) Effectiveness of fish oil in controlling inflammation in adult patients undergoing hemodialysis: A systematic review and meta-analysis (PubMed) Tubular Secretions Swapnil Hiremath: Michael Clayton (IMDB) Pedro: Fifa World Cup Soccer coming to North America with Portugal! (FIFA) Charmaine: New Puppy, Rose. It’s a Barbet (Wikipedia) Joel Topf: The Dark Forrest by Liu Cixin (Wikipedia)

The Filtrate Joel Topf‍ ‍@kidneyboy.bsky.social‬ (COI) Sophia Ambruso @sophia-kidney.bsky.social Swapnil Hiremath @hswapnil.medsky.social and on LinkedIn Special Guests Jonathan Barratt Professor of Renal Medicine, University of Leicester Google Scholar (COI: all the companies) Editing and Show Notes by Nayan Arora @captainchloride.bsky.social The Kidney Connection written and performed by Tim Yau Show Notes Proteinuria Reduction as a Surrogate End Point in Trials of IgA Nephropathy (Aliza Thompson, 2019 PubMed) The number, quality, and coverage of randomized controlled trials in nephrology (PubMed 2004) Updated here (PubMed | NephJC discussion) A Randomized, Controlled Trial of Rituximab in IgA Nephropathy with Proteinuria and Renal Dysfunction (PubMed 2017) BLISS Belimumab in lupus nephritis (NephJC | PubMed) The Phase 2 trial of atacicept A phase 2b, randomized, double-blind, placebo-controlled, clinical trial of atacicept for treatment of IgA nephropathy (PubMed) The phase 3 trial of atacicept, the subject of this podcast A Phase 3 Trial of Atacicept in Patients with IgA Nephropathy (PubMed | NephJC) Christos’ Bluesky post: https://bsky.app/profile/christosargyrop.bsky.social/post/3m5bsujwg3s2q The use of Gd-IgA1 in the Testing Trial Role of Systemic Glucocorticoids in Reducing IgA and Galactose-Deficient IgA1 Levels in IgA Nephropathy (PubMed) If you can’t get enough Jon Barratt, take a look at his grand rounds at The University of Ottawa. Updates to the KDIGO Guidelines for the treatment of IgA nephropathy, with Prof Jonathan Barratt (YouTube) Tubular Secretion Swapnil Hiremath Pluribus on Apple TV (Wikipedia) Jon Barratt Lynyrd Skynyrd (Wikipedia) Slow Horses (Wikipedia) on AppleTV Joel Topf the new ASN

The Filtrate Joel Topf‍ ‍@kidneyboy.bsky.social‬ Sophia Ambruso @sophia-kidney.bsky.social Nayan Arora @captainchloride.bsky.social Special Guests Brian Rifkin @brianrifkin.bsky.social Anna Gaddy @AnnaGaddy Editing and Show Notes by Joel Topf The Kidney Connection written and performed by Tim Yau Show Notes Brian Rifkin and Cristina Popa ascend to co-editors in chief of NephJC. Paresh Jadav receives the first NephJC Champion award. Dr. Jadav hosted the NephJC night and saved NephJC thousands of dollars. It makes a huge difference in our fund raising. Thank you. Also a big thank-you to Jade Teakell for buying the cowboy hats! The first pick of the draft, by Sophia is Fish oil for dialysis: Fish-Oil Supplementation and Cardiovascular Events in Patients Receiving Hemodialysis (NEJM)The second pick, by Brian is FINE-ONE (Bayer Press release) Rajiv Agarwal’s mediation analysis to show how much of finerenone’s beneficial renal effects are captured by the reduction proteinuria: Impact of Finerenone-Induced Albuminuria Reduction on Chronic Kidney Disease Outcomes in Type 2 Diabetes : A Mediation Analysis (PubMed) Anna has the third pick and it goes to Katherine Tuttle and the REM0DEL Trial: REMODELing mechanistic trials for kidney disease: a multimodal, tissue-centered approach to understand the renal mechanism of action of semaglutide (Science Direct) Nayan goes off-board and picks a poster by a med student (backed by Testani) Mechanism and Effects of Manipulating Chloride Homeostasis in Stable Heart Failure (ClinicalTrials.gov) For the final pick in the draft Joel went with a little Lilly on Lilly violence: Tirzepatide vs. Dulaglutide Is Associated with Reduced Major Kidney Events in Patients with Type 2 Diabetes, CVD, and Very High-Risk Kidney Diseases (JASN) Bring out your dead…What’s left on the draft board. Liberate-D A Conservative Dialysis Strategy and Kidney Function Recovery in Dialysis-Requiring Acute Kidney Injury: The Liberation From Acute Dialysis (LIBERATE-D) Randomized Clinical Trial (JAMA) Atacicept for IgAN A Phase 3 Trial of Atacicept in Patients with IgA Nephropathy (NEJM) Lilia Cervantes crushed it with Community Health Worker Support for Hispanic and Latino Individuals Receiving Hemodialysis: The Navigate-Kidney Randomized Clinical Trial (JAMA) Tubular Secretion Brian: Late Breaking and High Impact Clinical Trials. Including Sibe! REGENCY Biopsy Data. Sophia: Flying Home. No, really it’s the Electrolyte Quiz Joel: The Poster Session, the Quiz Session, and Nayan: Flying to AHA to talk about dual-heart-kidney-transplant Anna: Kidney STARS! and Melanie Hoenig’s session on potassium

The Filtrate Joel Topf‍ ‍@kidneyboy.bsky.social‬ Swapnil [email protected] AC @medpeedskidneys.bsky.social Special Guest Mike Walsh Associate Professor in the Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University as well as a Scientist at the Population Health Research Institute and a nephrologist at St. Joseph’s Healthcare Hamilton where he is the Chair of the Clinical Nephrology Research Group. Editing and Show Notes by Sophia Ambruso The Kidney Connection written and performed by Tim Yau Show Notes ALCHEMIST (NephJC Shorts, Rossignol et al Lancet 2025) AC is in her 83rd year of med-peds fellowship. Joel’s monologue brings us all down. Prophylactic ICD therapy doesn’t improve sudden cardiac death or all-cause mortality in HD patients in the ICD2 trial (Jukema JW et al. Circulation 2019) Initiation with statins do not impact MACE endpoints or atherosclerotic events (4D AURORA trial Fellstrom BC et al. NEJM 2009 & SHARP trial Baigent C et al. Lancet 2011) Mike tries to liven up the mood by mentioning positive outcomes with iron therapy in heart failure with the PIVOTAL trial (Macdougall IC et al. NEJM 2018) TOPHAT trial revealed treatment with spironolactone in HFpEF did not affect MACE outcomes. (Pitt B et al. NEJM 2014) NephTrials ‘Run-in periods in clinical trials: What can we ACHIEVE?’ SPIN D trial - spironolactone dose finding trial in ESRD (Charytan DM et al. Kidney Int 2018) Mike shares the human experience of the trial after being instructed to end the trial prematurely and being told they have “answered their question” Study in Japan - spironolactone predominantly benefits male over females (cannot find this) Male vs female benefit not observed in ACHIEVE despite Mike’s initial hypothesis Swap compares and contrasts ACHIEVE, ALCHEMIST & Meta-analysis (Pyne L et al. Lancet 2025) Mike discusses how nonadherence to spironolactone impacted the intention to treat outcomes in the trial. What is a high risk of bias for dummies? Mike, Swap & Joel ponder future nsMRA or ASI trials hemodialysis? Tubular secretions Swap is probably stalking Martha Wells by now, has moved on from Witch King, now onto Queen Demon on Good Reads AC is adding to her brood, 2 dogs (Snickers & Harper), 1 child Dungeon Crawler Call -  a science fantasy book series by Matt Dinniman (on goodreads), which he lovingly referred to as complete nerd trash. Joel is binging on the series Task on HBO max, featuring Mark Ruffalo as FBI agent. NephJC is having its annual fundraiser (get your tickets here) at ASN. Providing a party shuttle that is leaving every 30 minutes from the conference center. As always, it will feature a live podcast recording covering the ASN late breaking, high impact clinical trials. Swap describes the high impact model at ASN this year - go big or go home.