¿Los inhibidores de bomba de protones (IBP) realmente causan daño renal? Abro hilo 🧵 x/10

Nephrobnoxious (adj.): The irresistible urge to correct “dehydrated” to “volume depleted,” even when everyone in the room knows exactly what was meant. Usually accompanied by a five-minute explanation of total body water versus effective arterial blood volume. H/T @Jwaitz

La pregunta ya no es si la diálisis peritoneal funciona en la LRA. La evidencia dice que sí. La verdadera pregunta es: ¿por qué seguimos utilizándola tan poco? Ventajas: -Mayor estabilidad hemodinámica -No requiere acceso vascular ni anticoagulación sistémica -Menor riesgo de bacteriemia asociada a catéter -Útil en estados de hipercoagulabilidad y entornos con recursos limitados

Create a fake, made up condition 🙄 Now write guidelines with ho-hum pedestrian take home messages 🤦‍♂️ What’s next? CKM staging? …..wait a minute - they got that already 🤣

You’ve never heard of it, but you very well may have it. Medical bodies develop the first guidelines to treat cardiovascular-kidney-metabolic syndrome, which likely affects 90% of Americans. on.wsj.com/4uleU53

Sodium zirconium cyclosilicate (SZC) (Lokelma) and acidosis

The 2026 ACC CKM guideline gives us a 4-step risk AHA PREVENT Equations Step 1️⃣ Calculate: PREVENT-HF, PREVENT-ASCVD & PREVENT-CVD Step 2️⃣ Personalize: 30-yr risk, risk enhancers Step 3️⃣ Reclassify: biomarkers, TTE, CAC if uncertain Step 4️⃣ Shared decision-making for treatment

📌2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation & Management of Cardiovascular-Kidney-Metabolic Syndrome #CaReME #CRM #Guidelines #PositionPaper

Published today, the first-ever clinical practice guideline on cardiovascular-kidney-metabolic (CKM) syndrome from the American Heart Association and @ACCinTouch. The focus of this clinical practice guideline is to create a living, working document that provides current knowledge in the field of CKM syndrome aimed at all practicing cardiologists, endocrinologists, nephrologists, and primary care and specialty clinicians who manage these patients. ✍🏼 @ChiadiNdumele @HeartDocSadiya @kardiologykazi @noshreza @virani_md @biykemb @NutritionHF @mandeepbajaj65 @KatherineTuttl8 @RangaswJ @lisaVWMD @KBreathettMD @EmoryFamMed @ShoaClarke @mad_sters @jmortonmd @sripalbangalore @AnumSaeedMD

Repeat kidney biopsy in patients with ANCA associated vasculitis and suspected kidney relapse doi.org/10.1093/ckj/sfag026

🧵1/10 Obesity in CKD - part III/III This #ERA26 symposium challenged us to think beyond weight loss &BMI ⚖️, and also to reflect on the impact of the increasing 🌍 consumption of Ultraprocessed Foods (UPFs)🍔🍟🥤. #ChallengeYourThinking #CKD #Obesity 🪑 Ziad Massy @MassyZiad 🪑 Inga Arune Bumblyte

Thin Glomerular Basement Membrane #GBM Phenotypes With no Identified Pathogenic #COL4A3/A4/A5 #Variant #VisualAbstract by @deniise_am kireports.org/article/S2468-… @CzarneckiLab

Systematic Review and Meta-Analysis of #ICU #Scoring Systems Performance in Patients with Pre-Existing #KidneyDisease #VisualAbstract by @Cteodosiu kireports.org/article/S2468-…

New editorial in Kidney News from Dr Weerasiri Finally, an RCT in Hyponatremia Management: A “HIT” or a Miss? kidneynews.org//view/journal…

Los que continuaron iSGLT2 (dapagliflozina) durante diálisis, se asociaron a ↓53% y ↓67% todas las causas de muerte y las no cardiovasculares, respectivamente PostHoc del DAPA-CKD CKJ 2026 academic.oup.com/ckj/advance…

#ERA26 ICI related Nephritis

1️⃣ Naomi Clyne – The role of exercise training on cardiovascular risk factors and heart disease in severe #ERA26 ➡️ Key messages: 🔹Exercise is far more than physical activity: skeletal muscle acts as an endocrine organ, releasing myokines with systemic anti-inflammatory and cardiometabolic effects. 🔹Physical inactivity is a major CV risk factor across all #CKD stages, while even modest increases in activity are associated with improved outcomes. 🔹Exercise should be viewed as a therapeutic intervention, adaptable to each patient’s functional capacity. 📊 Key data: 🔹 #CVD accounts for 58% of deaths in CKD stage 5 and KRT patients. 🔹 As little as 15 minutes/day (90 min/week) of physical activity is associated with 🔽 mortality risk (HR 0.87). 🔹 In the EXCITE trial, 6 months of home-based exercise improved hospitalization-free survival in dialysis patients. 🔹 In the DiaTT trial, 12 months of intradialytic exercise reduced hospital days from 12.8 to 10.9 days/patient (p=0.036). 🔹 In RENEXC, resistance training reduced albuminuria from 98 to 64 g/mol after 12 months (p<0.001). 💡 Take-home messages: 🔹Exercise is medicine. Even small doses can improve outcomes, reduce hospitalizations and potentially slow disease progression in CKD patient

Y se ve en la práctica , el beneficio es mínimo en paciente con normopeso. Y peor aún en pacientes con ERC y proteinuria leve. Fine y iSglt2 tienen más impacto en mayor peso y mayor proteinuria.

🚨 #FINDCKD results #ERA26 🔹 Finerenone slowed CKD progression in non-diabetic CKD 🔹 Primary endpoint met (total eGFR slope) 🔹 Significant reduction albuminuria (~37% vs placebo) 🔹 56% achieved ≥30% UACR reduction vs 24% placebo 🔹 Reduced composite kidney-CV events(HR 0.77)

Is this a game changer for nephroprotection?

For a cleaner picture look at the REMODEL trial: watermark02.silverchair.com/… Here patients with "typical diabetic kidney disease" were biopsied and they found: * No IgA * No AIN * No ATI