nephronking

He worked with us in the Renal Department in Aintree University hospital @LivHospitals. Saddened by this tragic news. A great Dr, dad and colleague. May his soul RIP. 🙏

#MedTwitter #NephTwitter 🩸KDIGO has updated their anemia management guidance for the first time in a decade! Come discuss 2/24/26 at 9 pm EST on BlueSky Check out the VA by Shellie Fravel nephjc.com/news/2026/2/23…

🗞️ The Dyspnea Clinic: a new emerging interdisciplinary medical concept @ESC_Journals @GiuseppeGalati_ @AmrAbdin10 @HanCardiomd bit.ly/4qNv19J

🧬 50 Pearls on GLP-1 Receptor Agonists & Next-Gen Incretins (Based on The Lancet Review, Nauck et al., 2026 ) 1️⃣ GLP-1 RAs revolutionized T2DM therapy 🎯 2️⃣ Strong HbA1c reduction with low hypoglycemia risk ⚡ 3️⃣ Weight loss is a class effect 📉 4️⃣ CVOTs confirm CV safety ❤️ 5️⃣ Several agents reduce MACE significantly 🫀⬇️ 6️⃣ Liraglutide, semaglutide, dulaglutide → proven CV benefit 🏆 7️⃣ Tirzepatide non-inferior vs dulaglutide for MACE 🔄 8️⃣ Stroke risk reduction consistent across trials 🧠⬇️ 9️⃣ MI risk modestly reduced 💥⬇️ 🔟 All-cause mortality reduced in meta-analysis 📊⬇️ 1️⃣1️⃣ SELECT trial: semaglutide reduced MACE in obesity without T2DM 🎉 1️⃣2️⃣ CV benefit independent of glucose lowering 🔬 1️⃣3️⃣ GLP-1 RAs improve BP & lipids 🩺 1️⃣4️⃣ Anti-inflammatory vascular effects described 🔥⬇️ 1️⃣5️⃣ Albuminuria reduction consistent 🧪⬇️ 1️⃣6️⃣ Slows eGFR decline 📉 1️⃣7️⃣ FLOW trial: semaglutide ↓ kidney failure risk 🧂 1️⃣8️⃣ Kidney benefits partially independent of HbA1c 🧠 1️⃣9️⃣ Direct renal GLP-1 receptor expression documented 🧬 2️⃣0️⃣ Immune modulation may mediate renal protection 🛡️ 2️⃣1️⃣ Higher doses needed for obesity vs T2DM ⚖️ 2️⃣2️⃣ Semaglutide 2.4 mg > liraglutide 3 mg for weight loss 💪 2️⃣3️⃣ Tirzepatide > semaglutide for weight reduction 🔥 2️⃣4️⃣ Weight regain common after discontinuation ↩️ 2️⃣5️⃣ HFpEF improves symptomatically with GLP-1 therapy ❤️‍🩹 2️⃣6️⃣ Reduced HF hospitalization risk 🏥⬇️ 2️⃣7️⃣ MASLD regression documented 🍔➡️🫀 2️⃣8️⃣ Fibrosis progression reduced in MASLD trials 🧵 2️⃣9️⃣ Tirzepatide approved for OSA 😴 3️⃣0️⃣ OA knee symptoms improved with weight loss 🦵 3️⃣1️⃣ Progression from prediabetes ↓ up to 93% 🚫🍬 3️⃣2️⃣ Dual GIP–GLP-1 agonism enhances efficacy 🧪 3️⃣3️⃣ Triple agonists under development 🚀 3️⃣4️⃣ Glucagon–GLP-1 agonists ↑ energy expenditure 🔥 3️⃣5️⃣ Amylin–GLP-1 combos show major weight effects ⚖️⬇️ 3️⃣6️⃣ Retatrutide → 20%+ weight loss 🔥🔥 3️⃣7️⃣ Small-molecule oral GLP-1 (orforglipron) emerging 💊 3️⃣8️⃣ GI adverse events remain class-limiting 🤢 3️⃣9️⃣ Slow titration improves tolerability 🐢 4️⃣0️⃣ Lean mass reduction noted — clinical impact uncertain 🏋️ 4️⃣1️⃣ Rare optic neuropathy signal reported 👁️ 4️⃣2️⃣ No consistent dementia prevention proven 🧠❓ 4️⃣3️⃣ Parkinson’s disease data mixed 🔄 4️⃣4️⃣ Substance use disorder research ongoing 🍷🚬 4️⃣5️⃣ Real-world data confirm CV protection 🌍 4️⃣6️⃣ Hypoglycemia mainly with SU co-use ⚠️ 4️⃣7️⃣ No intrinsic nephrotoxicity signal 🚫🧂 4️⃣8️⃣ Adherence influenced by GI tolerability 📉 4️⃣9️⃣ Dose escalation strategy crucial 🎯 5️⃣0️⃣ Incretin era reshaping cardiometabolic medicine entirely 🌍🔥 #lancet

Guideline-recommended preventive management in metabolic and renal disease: a paradigm shift for all healthcare professionals to maintain ‘normal’ cardiac function A tiered strategy—preventing dysfunction in at-risk individuals and, when prevention fails, detecting NT-proBNP exceeding 125 pg/mL, prompt imaging, and rapid GDMT initiation—offers a far more effective and cost-efficient alternative to our current late-stage, treatment-focused paradigm #Cardiology #MedTwitter #CardioTwitter #HeartHealth #Healthcare @mvaduganathan @hvanspall @DrMarthaGulati @gcfmd @ESC_Journals @ehj_ed @EJHFEiC @AndrewJSauer @AnastasiaSMihai @Hragy @ShelleyZieroth @biljana_parapid academic.oup.com/eurheartj/arti…

REVIEW: Hypertension in Patients With End-Stage Kidney Disease Requiring Dialysis: Bridging the Divide Between Evidence and Practice ahajrnls.org/4cbBPdR

Residual lipid risk in atherosclerotic cardiovascular disease. Read this State-of-the-Art review published in #EHJ 👉 ow.ly/GsMo50YkwIX @RoccoMontone @ehj_ed

the kidneys function as a dynamic biological operating system that continuously regulates fluid balance, electrolytes, blood pressure, acid–base status, oxygen delivery, and hormonal signaling. They do not simply remove waste. They decide what the body can safely tolerate.

BAFF and APRIL represent pre-HIT 1 in #IgAN #Nephpearls Antigen-driven immune activation within lymphoid tissues leads to the release of BAFF and APRIL, which bind to those receptors and promote B-cell survival and production of IgA Evidence now supports this as the earliest stage, or pre-HIT 1, in the evolving multi-hit model in IgAN 👉🏼 pubmed.ncbi.nlm.nih.gov/38362118/

😎 GLP-1s, Longevity & the Truth: Pills Help, but Doctors + Habits Win (Inspired by: “Are GLP-1s the first longevity drugs?” — Nature Biotechnology) 🚀 1. Are GLP-1s longevity drugs? Maybe… partially… in some people. But the real longevity stack still looks suspiciously like: 🌞 sunlight 😴 sleep 🚶 daily movement 💪 lifting weights (“the closest thing to a youth serum”) 🍽️ fasting / caloric control 🍏 low sugar, real foods 😌 stress reduction — supported and supervised by actual Physicians/MDs, not TikTok biohackers. GLP-1s alone? Great for symptoms. Not enough for systems. 🧬 2. Lifestyle is biology’s original medicine… but it works best with medical strategy The paper reminds us that aging = 🔥 damage vs. 🔧 repair Healthy habits lower damage. Medical management enhances repair, manages risks, monitors biomarkers, and modulates physiology in ways no lifestyle trick can. 👉 The winning formula = Medicine + Lifestyle, not one or the other. Think “Ferrari + driver,” not just a shiny engine. 🧪 3. GLP-1s shine in people with metabolic disease For obesity and type 2 diabetes, GLP-1s improve: ❤️ heart disease 🧠 brain aging 🫁 sleep apnea 🦵 osteoarthritis 🪙 all-cause mortality in some trials That’s impressive. But for healthy or low-risk people? 👉 Evidence almost nonexistent 👉 Long-term trials missing 👉 Risks harder to justify That’s where physician oversight matters most. Dosing, timing, combinations, biomarkers — this is real medicine, not “inject-and-forget”. 💪 4. Weight training: the unsexy, unbeatable longevity drug GLP-1s preserve muscle poorly unless training is added. And losing muscle is basically speed-running the aging process. Doctors who know what they’re doing will ALWAYS pair: 💉 GLP-1 → appetite/metabolism support with 🏋️ Strength training → muscle, mitochondria, insulin sensitivity, bone health One without the other? → Long-term fail. 💉 5. The real “incendiary” truth Longevity will not come from: ❌ a magic drug ❌ a secret supplement ❌ a celebrity protocol It will come from: ➡️ physician-led metabolic management + ➡️ consistent, data-driven, sane habits GLP-1s, metformin, senolytics, anti-inflammaging drugs — they’re tools. Not replacements. 🧨 6. Final provocation If people want to live longer, healthier lives, the solution isn’t “GLP-1 vs. lifestyle.” It’s: GLP-1 + lifestyle + medical supervision + resistance training. The future of longevity is clinical + behavioral, not pharmacological-only. 💬 Your turn Are we ready to accept that the real longevity revolution is: Doctors + muscles + biology, …with GLP-1s in the supporting role? Or are we still hoping for a syringe to solve adulthood? 😏💉🔥

Functional and Prognostic Implications of Different Iron Deficiency Definitions in Heart Failure: Insights From HEART-FID Patients with HF demonstrate wide variability in fulfillment of various diagnostic criteria for ID. Despite ferritin <100 ng/mL being the most common ID criteria met in HEART-FID, Tsat and iron and their changes over time, more than ferritin, were related to functional capacity, hemoglobin levels, and prognosis #Cardiology #MedTwitter #CardioTwitter #HeartHealth #Healthcare @mvaduganathan @hvanspall @DrMarthaGulati @AndrewJSauer @ankeetbhatt @AnastasiaSMihai @biljana_parapid @Hragy @gcfmd @gcfmd @GMCRosano jacc.org/doi/10.1016/j.…

Should nephrologists further implement genetic testing in patients with CKD? In this #ASNJASN study of adult CKD management, genetic testing showed diagnostic and clinical utility in the year following the reporting of test results. Read more: kidney.pub/JASN0913

🩸 SGLT2 inhibitors protect kidneys at all stages Meta-analysis of 70,000+ participants across 10 RCTs SGLT2 inhibitors ⬇️ CKD progression risk by 38% Effective regardless of eGFR or albuminuria, even in stage 4 CKD or minimal albuminuria. 💪 Consistent kidney protection across diabetes, CKD, and heart failure. #SGLT2i #Nephrology #CKD #CardioRenal #T2D #EvidenceBasedMedicine jamanetwork.com/journals/jama/… @brendonneuen @mvaduganathan @DLBHATTMD @JavedButler1 et al

New state of the art review examines the current evidence comparing the efficacy and safety of aspirin vs P2Y12 inhibitors in reducing cardiovascular events in patients with atherosclerotic disease. doi.org/10.1093/eurhea… #asprin #DAPT #cardiotwitter, @ESC_Journals, @escardio

Move to Remember: The Role of Physical Activity and Exercise in Preserving and Enhancing Cognitive Function in Aging—A Narrative Review mdpi.com/2308-3417/10/6…

🚨 New publication alert 🙌Our last manuscript is published in @ATHjournal : “Lipid-Lowering Therapies in Chronic Kidney Disease: A Call to Action.” 👉Key highlights: 1⃣CKD is a major and independent risk factor for ASCVD. 2⃣CKD patients are still underrepresented in LLT trials. 3⃣Current recommendations rely on extrapolated data from non-CKD populations. 4⃣It’s time to move from exclusion to inclusion — we need dedicated and inclusive studies for advanced CKD. 5⃣A coordinated effort from clinicians, researchers, industry, and regulators is essential. 👆 “It’s time to bring CKD patients from the margins to the center of cardiovascular prevention.” 🔗atherosclerosis-journal.com/article/S0021-… 👉Grateful to @JaimeMazonRuiz for his leadership and for inviting me to join this important collaboration @society_eas

For decades, people with atrial fibrillation were told to avoid caffeine The DECAF RCT (PMID: 41206802) just flipped that idea on its head a bit: 1 cup/day of caffeinated coffee for 6 months after AF cardioversion (setting their heart rhythm "normal," essentially) reduced recurrence vs abstinence (47% vs 64%) Low/modest adenosine blockade did not provoke, and may be protective here. pubmed.ncbi.nlm.nih.gov/41206802/

Low NT-proBNP ≠ low risk in obesity-related HFpEF/HFmrEF. 🔥 @mvaduganathan 🔥 fresh press New participant-level pooled analysis from 4 global trials (I-PRESERVE, TOPCAT, PARAGON-HF, DELIVER; n = 14,750; 50% women; mean BMI 30 kg/m²) shows that higher BMI is nonlinearly associated with lower NT-proBNP—yet risk remains high. Key findings 1. Every doubling of baseline NT-proBNP → 40% higher adjusted rate of CV death or HF hospitalization (HR 1.40). 2. The NT-proBNP–risk relationship is blunted as BMI rises, but not eliminated (P_interaction = 0.008). 3. For the same absolute risk (≈5 events/100 person-years, no AF), NT-proBNP was ~3× lower in BMI ≥ 35 vs < 35 kg/m² (≈158 vs 450 pg/mL). 4. At a single “trial-style” NT-proBNP threshold, absolute risk ranged from 3.5 to 7.3 per 100 person-years across BMI strata. Fixed natriuretic peptide cutoffs can underestimate risk in patients with higher BMI. Obesity-specific thresholds—or at least BMI-aware interpretation—are needed for clinical care, quality pathways, and trial eligibility. Don’t let a “reassuringly low” NT-proBNP delay diagnosis or decongestion in HFpEF/HFmrEF with obesity. Main take home point: Interpret NT-proBNP through the lens of BMI (especially ≥35 kg/

Rethinking our approach to NTproBNP for HFpEF with obesity. jacc.org/doi/10.1016/j.… Provocative and fascinating study by @mvaduganathan et al. For any NTproBNP (esp when lower), obese HFpEF pts have worse HF prognosis than less obese HFpEF. jacc.org/doi/10.1016/j.…

Correspondence: Cold Perfusion vs. Static Cold Storage of Deceased-Donor Kidneys — at 10 Years nej.md/4hDQNK4 #Surgery #Nephrology