Freely Filtered, a NephJC Podcast

NephJC covered the meta-analysis FINE HEARTS But Freely Filtered covered FINEARTS-HF the RCT of finerenone in heart failure with preserved ejection fraction

We rarely get feed back on episodes of Freely Filtered. That is until we screw up. And our episode on the PRAECIS trial did not go smoothly. One of our experts got called into the hospital and then when she came back for a one-on-one with Joel it turns out she had no experience with the test. Our bad. So we went back and re-recorded a podcast. So join us as we re-examine the newly FDA-approved blood test looking at the ratio of soluble fms-like tyrosine kinase 1 (sFlt-1) to placental growth factor (PlGF) for the diagnosis of severe preeclampsia. The PRAECIS trial.

We had a great NephJC get together. We recorded the whole event and packaged it into a podcast. Musical entertainment Tim Yau (@Maximal_Change) Too Sweet by Hozier Fairy Tale of New York by written Jem Finer and Shane MacGowan. Hear it performed by the Pogues. Interview of Tom Mueller Tom Mueller author of How to Make a Killing Jade Teakall @jmteakell Graham Abra @GrahamAbra NephMadness logo reveal NephJC Kidneys NephJC blog post NephJC Manuscript of the Year: Flow accepted by Meg Jardine Manjula Kurella Tamura, winner of the 2015 NephMadness, oh and author of NEJM manuscripts and subject of a NYT article. NephJC Visual Abstract of the Year: Corina Teodusiu, creator of the Flozinator logo NephJC Social Justice Award: ISN petition to the WHO on Kidney Health Most Engaged Scientist Award: Michelle Rheault Rookie of the Year: Milagros Flores MVP: Christina Popa NephJC Founders Award: Joshua Waitzman Nathan Hellman Social Media Project of the Year: Edgar Lerma and the ASN Visual Abstract Team More Music with Tim Saginaw, Michigan as performed by Johny Cash Betty, written by Taylor Swift The Kidney Connection Freely Filtered Kidney Week Draft Previous drafts 2021 ASN Kidney Week Draft 2022 ASN Kidney Week Draft 2023 ASN Kidney Week Draft List of all the simultaneous publications from Kidney Week 2024 Sophia: SMART Trial (Link goes to the new KidneyCompass podcast that interview lead author Hiddo Heerspink Jordy’s editorial in the European Heart Journal. Link Josh: APPLAUSE Alternative Complement Pathway Inhibition with Iptacopan in IgA Nephropathy in the NEJM APPLAUSE results announcement at The World Congress of Neophrology in Buenos Aries Iptapocan is a factor B inhibition Jordy: POISE-3 with simultaneous publication in KI Mentions she wanted to pick KAT-AKI because she worked with Perry Wilson. Per Nayan, Amit Garg is the Beyonce of Nephrology Accord Trial (NEJM) Joel: HSK21541 for Pruritus Correction link to source (graph) Nayan: FINEARTS-HF with simultaneous publication in JACC BARACH-D: Low-dose spironolactone and cardiovascular outcomes in moderate stage chronic kidney disease: a randomized controlled trial (Nature Medicine) Swapnil comes out as a SpiroStan TOPCAT funny business PATHWAY-2 Trial (NephJC coverage) Swap: K Bath and cardiac arrhythmia with simultaneous publication in Kidney International CAST: A study that rocked the cardiology world and became the poster child for evidence-based medicine (Link) Tubular Secretions Swap: Late breaking and high impact sessions Nayan: Intro to… Joel: Student poster on blood pressure technique Jordy: The Penguin. A couple of mentee posters Sophie: Tracks her sessions on paper. Josh: Quiz and Questionaire with JC Velez, Bea Concepcione, Anna Burgner, Roger Rodby.

Nefecon, coated budesonide, is the first drug labelled for IgA nephropathy and the approval path, 9-month reduction in proteinuria followed by 2 year GFR data set the stage for the GN renaissance we are currently living through.

On May 24th, at the ERA meeting in Stockholm Sweden (this will not be the last GLP1ra talk at Stockholm), Vlado Perkovic presented the previously spoiled results of FLOW. In addition to simultaneous publication in the NEJM, it made the front page in newspapers around the world. As one headline writer said, “Is there anything Ozempic can’t do?”

Nothing terrifies nephrologists, quite like the consult from labor and delivery. And one of the most vexing questions is, “Is this preeclampsia or proteinuric CKD or a lupus flare?” Perhaps a newly approved blood test will be able to shed light on this clinical conundrum. The ratio of soluble fms-like tyrosine kinase 1 (sFlt-1) to placental growth factor (PlGF) has appeared predictive of severe preeclampsia. The PRAECIS trial evaluated this is a prospective manner. Join the filtrate as we do a truly incompetent job discussing this study.

FSGS is hard and the data sucks. But here comes sparsentan fresh off its win in the PROTECT trial for IgA Nephropathy. Can it pull another rabbit out of the hat for patients that suffer from FSGS or are we doomed to forever treating our patients with Acthar® Gel?

Beep Beep. Hey intern the patient’s blood pressure is 160/95. Do you want to do something. No. The answer is no. But honestly we have all been guilted into ordering some clonidine or god forbid some IV hydralazine. Stop it. Just stop it. Join the filtrate as we dissect a recent study looking at this issue with the lead author.

NephMadness prides itself on not repeating topics. Most topics don’t get revisited for years after a single appearance. But one region stands alone. One region is making its fourth appearance in the 12 year history of NephMadness! That region is Animal House! Modern medical education doesn’t go to the comparative physiology well very often. So when we do, it is always fresh and exciting. Join the Filtrate as we explore the fascinating world of the Gila Monster and Mourning Dove.

So this one has been on the hard drive gathering dust for quite awhile. There were significant technical problems (in other words, Joel screwed up. But the episode is now complete and despite some obvious stutters, it turned out pretty good.)

The fluids wars have been going back and forth and now have another big win. This time in transplant.

On Friday of #KidneyWk, at the City Winery in Philadelphia, The Filtrate collaborated with The Curbsiders to do a live show in front of dozens of fans. Freely Filtered is proud to get to play a role in one of these moments. Amit Garg, friend of the Pod, invited Freely Filtered into the tent to record a podcast on his High Impact and Late Breaking Clinical Trial for simultaneous release with his presentation. Here is that podcast… How do we move the needle on living donor transplants? The EnAKT LKD Cluster Randomized Clinical Trial takes its shot

We love Kidney Week and the quintessential event at Kidney Week is the Late Break and High Impact Clinical Trial Sessions. Here we see the cutting edge of science revealed. We get to be first when years of work are revealed to the world. And one of the coolest ways for a study to be revealed is with simultaneous publication in a high-impact journal. Freely Filtered is proud to get to play a role in one of these moments. Amit Garg, friend of the Pod, invited Freely Filtered into the tent to record a podcast on his High Impact and Late Breaking Clinical Trial for simultaneous release with his presentation. Here is that podcast… How do we move the needle on living donor transplants? The EnAKT LKD Cluster Randomized Clinical Trial takes its shot

Inaxaplin is a small molecule that is in trials for APOL1 associated kidney disease. Genome guided medicine comes to nephrology.

Another dogma shredding trial about diuretics, this time torsemide goes up against king furosemide and its ability to prevent rehospitalization and CV events.

Another dogma shredding trial about diuretics, this time hydrochlorothiazide ability to reduce symptomatic kidney stone events and kidney stone growth gets put under the knife.

Welcome to the NephMadness PodCrawl The idea behind a podcrawl is for a variety of podcasts to coordinate on timing and topic to push a theme and get each other’s listeners to explore all of the podcasts. One of the first goals behind NephMadness was to build a community and in the early years of Twitter, NephMadness was central to the formation of #NephTwitter and defining the ethos that makes our online community kind, intelligent, vibrant, and interesting. The NephMadness Podcrawl hopes to inspire and grow the nephrology podcast community in the same way. For 2023, our second year,  the PodCrawl has assembled the Avengers of Medical Pods! * The Curbsiders gets the skinny on mineralcorticoid receptor antagonists * Core IM will be covering Kidney Transplant in their classic Five Pearl format * The CardioNerds will be covering the effect of Heart Failure Devices on Kidney Health * Freely Filtered will try to understand thrombotic microangiopathy * ISN Global Kidney Care goes deep on IgA nephropathy * The Cribsiders look at transitions, first the Peditrics to Adult nephrology transition and then from living to death with palliative nephrology  * Fellow on Call will be covering Onconephrology * And finally, The Nephron Segment looks at Transgender Health and CKD 8 podcasts. 1 for each region in this year’s NephMadness   Go to NephMadness.com/podcrawl to get links to all of the shows.

MYTEMP is the largest dialysis trial. 15000 patients, 4.3 million dialysis treatments. We bring in lead PI Amit Garg to help break it down the trial and its implications.

For years there has been a growing dogma that if you stop the Renin Angiotensin inhibition when the GFR gets low you can delay dialysis. STOP ACE put the dogma to the test. The results are...meh.

EMPA-Kidney is the last of the big three to report their Kidney Endpoints SGLT2i trial (CREDENCE for Cana, DAPA-CKD for Dapa, and now EMPA-Kidney for Empa) and it answers some questions that, amazingly, were still unanswered.

After a 2 year hiatus, Kidney Week returned with a great meeting, even if it was in Orlando. Relive some of the highlights with the Filtrate.

Freely Filtered 051: ADVOR turns the practice of sequential nephron blockade on its head by blocking the proximal tubule before the loop of Henle. Does it work? Join The Filtrate as we dissect the latest diuretic RCT.

The Filtrate looks at a trial that tries to dissect the bumps in creatinine we regularly see with Pip/Tazo. Is it AKI or pseudonephrotoxicity?

The Filtrate look at the latest contribution to Fluid Wars, this one looking at late resuscitation.

SODIUM-HF is the largest and longest RCT done looking at sodium restriction heart failure. The top line results show no effect but the more you look at the study the more problematic it is. The Filtrate take it to task.

TESTING is the latest IgA nephropathy trial and it is the comeback kid of nephrology trials. From a trial that was halted because of excess adverse events to a safe and effective therapy with just a few tweeks. Amazing turn around. Join the Filtrate as we put TESTING to the test with study author Sean Barbour.

The Guideline Draft is back! This time the 2022 ISPD Peritonitis Guidelines are on the clock! The Filtrate are joined by PD junky Jade Teakall and guideline author, Jeff Perl.

The SSaSS study is a landmark study in the study of sodium and its effect on blood pressure and mortality. Join the Filtrate as they do a deep dive.

The University of Alabama with Revicor have made a better pig. Better for transplanting. And they transplanted a pair of these into a brain dead patient. The filtrate discuss the case report with transplant surgeon, Josh Mezrich.

Freely Filtered is excited to be the final PodCast of the first NephMadness PodCrawl and we are covering the best region of NephMadness, Animal House!

Minimal change disease has classically been described as having negative immunofluorescence and to not be antibody mediated. But here comes Dr Weins with a fresh study smashing this orthodoxy. She proposes anti-nephrin antibodies as the etiologic agent driving minimal change disease.

Voclosporin is a new calcineurin inhibitors with reliable pharmacokinetics, i.e. no more therapeutic drug monitoring, and it was able to improve complete renal remission in lupus nephritis. But all that glitters is not gold. Join us as we dig deep into the landmark AURORA1 trial.

The KDIGO 2021 Hypertension Guidelines. We mixed things up and went with a Fantasy Football-style draft. Pick your favorite guideline, and remember not to take a kicker or a defense until the last rounds.

Nephrology has been the recent beneficiary of a handful of studies examining the impact of the timing of the initiation of dialysis in AKI. One of these trials, AKIKI, now has a genuine sequel. In 2016 AKIKI was the first multi-center RCT examining early initiation of dialysis versus late initiation of dialysis and showed that early initiation not only did not improve patient outcomes but resulted in a significant number of patients receiving dialysis that would have recovered kidney function without intervention had they only been randomized to the late arm. Now five years later we are reviewing the sequel which asks the next logical question, “If delayed dialysis is as good as early dialysis is even later dialysis equivalent or better?”

Episode 035: The COVID-19 Pandemic changed everything and last fall the ASN set out to document how it affected our nephrology fellows. The ASN Workforce Committee adapted the Annual Fellow Survey to assess how the pandemic affected nephrology fellows in terms of burn out, education, and enthusiasm for the specialty.

Episode 034: A newly expanded filtrate assembled to discuss the tricky CONFIRM Trial recently published in the NEJM. We are assisted by Elliot Tapper, noted hematologist and member of #LiverTwitter.

On April 6, 2021 Fibrogen announced that the analysis of the cardiovascular outcomes was adjusted after the data was unblinded. When the data was reanalyzed without this adjustment roxadustat is less impactful. Importantly for this NephJC discussion, the previously impressive MACE and MACE+ advantage for incident dialysis is no longer found. Roxadustat remains non-inferior in all outcomes, though the confidence intervals have widened.

Animal House was one of the most exciting regions of NephMadness. We explore this region with the Selection Committee Member as well as the author to unlock the secrets of Animal House.

Roxadustat is the first HIF stabilizer up for FDA approval. There have been a number of roxa publications and today we took at the two most recent. One is a pooled analysis of incident dialysis patients: roxa versus epoetin alpha. And The second is a pre-dialysis CKD study of roxa versus placebo. Roxa represents well, but devils in the details. Join the filtrate as we go deep on roxa!

The DAPA program busted SGLT2i out of the diabetes paradigm by showing that dapagliflozen improved heart failure and CKD outcomes in a patients with or without diabetes.

The Filtrate welcome Dawn Caster and Alfred Kim to discuss lupus nephritis, B-cell biology and a new option for LN, belimumab.

The Filtrate welcome Anna Burgner and hypertension legend George Bakris to discuss the opera and RCT, Fidelio.

The filtrate welcome Drs. Katherine Tuttle and Ian de Boer to discuss the first KDIGO diabetic kidney disease guideline.

The filtrate welcome Drs. Vandana Dua Niyyar and Sophia Ambruso to discuss the recent paper in the NEJM, "Drug-Coated Balloons for Dysfunctional Dialysis Arteriovenous Fistulas."

The filtrate welcome Drs. Morgan Grams and Talar Kharadjian to discuss the recent paper in Annals of Internal Medicine: Conversion of Urine Protein-Creatinine Ratio or Urine Dipstick Protein to Urine Albumin-Creatinine Ratio for Use in Chronic Kidney Disease Screening and Prognosis: An Individual Participant-Based Meta-analysis

The Freely Filtered team welcomes Katalin Susztak to talk about the recent pair of studies that examined the use of allopurinol to prevent the progression of CKD. It didn't work.

The Freely Filtered team welcome Susan Steigerwalt and Brian Byrd to talk about the recent study published in Annals of Internal Medicine that looks for hyperaldosteronism in patients with high salt intake and suppressed renin.

The Freely Filtered team welcome Paul Welling and Sadiya Kahn to talk about the recent study published in Circulation that does a careful and detailed analysis on the diuretic and the changes in the neural-hormonal effects of a two-week, placebo-controlled, cross-over trial of empagliflozen.

Just the boys from Freely Filtered are on tonight. Matt, Joel, and Swap are joined by Josh Waitzman and Harold Feldman.

The Freely filtered crew plus David J Cohen and Keith Bellovich discuss the futility of cardiac maths in CKD patients with positive stress tests as well as the latest in COVID-19.

The Filtrate do a deep dive in idiopathic membranous and mouse models, lots of mouse models.

The Filtrate wrestle with the implication of a study that was abandoned early but still managed to be positive.

The Filtrate discuss the new international risk-prediction tool for IgA Nephropathy

The Filtrate discuss the Steve Coca's retrospective analysis on the speed of hypernatremia correction.

The Freely Filtrate go deep and long on the landmark CREDENCE trial.

Association of Nonsteroidal Anti-inflammatory Drug Prescriptions With Kidney Disease Among Active Young and Middle-aged Adults