VictorHugoG.Johnson

Attending Nephrologist @NefrologiaINC | Cardiorenal @geshNHS | Critical Care Nephrology @UAB_NRTC | POCUS | Music Lover | Calisthenics

[VictorHugoG.Johnson @vikouerMD]

Un día en la mejor unidad de HDF del país

Decidí explicar cómo es un día en la vida del residente de nefrología en la que yo (y muchos) consideran la mejor unidad de HDF.

🧵 🚨 🧵

[ERA - European Renal Association @ERAkidney]

1/6 🧵 #ERA26 - High impact clinical trials in Nephrology. #ChallengeYourThinking
🪑: Mario Gennaro Cozzolino @MarioCozzolin19; Kaitlin Mayne

Effects of SGLT2 inhibitors on erythropoiesis and iron homeostasis: a systematic review and meta-analysis exploring how these agents may raise Hb/Hct beyond simple hemoconcentration.
💬 Speaker: Michele F. Eisenga

[Ahmed Bennis MD 🫀 @drbennisahmed]

FIND-CKD presents the evolving treatment paradigm for diabetic vs non-diabetic CKD:
🔵 Diabetic KD: RASi + SGLT2i + Finerenone + GLP-1RA — 4-pillar approach
⚪ Non-diabetic KD: RASi + SGLT2i + Finerenone + aetiology-specific therapies + other treatments?

[Ahmed Bennis MD 🫀 @drbennisahmed]

Important iron deficiency data from ASCEND-ND (n=3,872; mean age 67y, 56% female, median eGFR 18 mL/min/1.73m²):
In advanced CKD, it’s TSAT — not ferritin — that predicts CV risk:

ferritin alone may be a misleading marker of iron status in CKD — TSAT is the driver of CV risk

[Alfonso Valle @ValleAlfonso]

¿Reduce la #finerenona el riesgo de muerte súbita en el espectro cardiometabólico-renal?
📈 ⬇️Muerte súbita: HR 0,81 (IC95% 0,67–0,98; p=0,034) a 2,9 años mediana de seguimiento

[Edgar V. Lerma 🇵🇭 @edgarvlermamd]

Treatment of chronic hyponatremia from Dr Ewout Hoorn
#Nephpearls #ERA26 🏴󠁧󠁢󠁳󠁣󠁴󠁿

[NEJM @NEJM]

Presented at #ERA26:

In adults without diabetes who had chronic kidney disease, the nonsteroidal mineralocorticoid receptor antagonist finerenone led to a slower decrease in the estimate glomerular filtration rate than placebo over 32 months. Full phase 3 FIND-CKD trial results: https://t.co/BSF1GmHFaf

@ERAkidney

[Ahmed Bennis MD 🫀 @drbennisahmed]

Don’t chase aldosterone levels to decide who gets an MRA in HFpEF.

Check renin instead.

Renin <21 mU/L → high-sodium, hypertensive phenotype → may derive outsized benefit from combo MRA + SGLT2i therapy

Precision medicine in HF is getting real. 🎯

#MedTwitter #HeartFailure

[Henry Han @HanCardiomd]

Venous vascular pharmacology: how does it contribute to #HFpEF?

This review discusses current literature on the vasoactive effects of #EDRF and #EDCF in the venous vs. arterial systems, in both preclinical and clinical models on #HFpEF

https://t.co/2jjJkp38qn

@ESC_Journals

[Juan Carlos López-Azor @jclopezazor]

Delighted to share the publication of the #EDICA study in @JCardFail

https://t.co/vjovzicGGw

In patients 🏥 with acute HF, a natriuresis/diuresis-guided decongestion strategy (@escardio guidelines) vs a weight-guided one showed:
✅ Greater 5-day NT-proBNP reduction
�� 5-day clinical decongestion
🟰 Length of stay & 30-day outcomes (🏥/☠️)
🟰 Safety & feasibility
🔎 Trend toward not sustained ⬆️ 24–48 h diuresis, weight loss, & loop-diuretic dose

Some conclussions:
1️⃣ Time matters: earlier identification of diuretic resistance improves biomarker decongestion
2️⃣ Yet this did not translate into better short-term clinical outcomes
🎯Still need to close the gap between decongestion and clinical outcomes:
Timing of assessment? Faster titration? Earlier combination diuretic therapy?

Thanks to the great collab of Cardiology - Internal Medicine - Emergency Dep

@MartaCoboMarcos @JanBiegus @esthermonteroh @fernidom @DeCastro9 @dr_pavia @segoviajavierve @ICardiacaSEC @secardiologia @CardioRenalSEC @HospiPtaHierro @Sociedad_SEMI @IcyfaSemi @SEMES_

[Ahmed Bennis MD 🫀 @drbennisahmed]

Why does sacubitril/valsartan (ARNi) work so well in HF? It hits two pathways at once 🧵

Reverse remodeling — countering the structural, electrical & energetic damage of RAS hyperactivation.
Two drugs. One pill. Complementary mechanisms.

#Cardiology #HeartFailure #ARNi

[Marta Cobo Marcos @MartaCoboMarcos]

📢Very important and timely subanalysis of CLOROTIC. The addition of Hydrochlorothiazide to loop diuretics increased📈diuretic response irrespective of baseline Cl in AHF. @ICardiacaSEC @CardioRenalSEC @IcyfaSemi

[Abdelhamed Hamdy @Abdelhamed6261]

Retatrutide
isn't just the weight loss,up to 28.3% for adults with obesity
- A noticeable decrease in blood pressure
- A 24 cm reduction in waist circumference
- A decrease in TG
- A decrease in non-HDL
- A significant improvement in hsCRP
improving overall metabolic health.

[Ahmed Bennis MD 🫀 @drbennisahmed]

🔑 The eGFR threshold matters:
• eGFR ≥45 → No survival benefit
• eGFR 30–44 → 64% ↓ mortality (HR 0.36)
• eGFR <30 → 54% ↓ mortality (HR 0.46)
If eGFR <45, re-SHKT should be the default conversation.

[Gregg Fonarow MD @gcfmd]

@drbennisahmed @SJGreene_md @JavedButler1 @UoGHeartFailure @AndrewJSauer @JamesCFangMD @HFSA @mvaduganathan @ankeetbhatt @robmentz @FudimMarat HF EF>40

Start SGLT2i+ns-MRA day 1

🎯 Rapid clinical benefits
🎯 Speedy ⬇️ in CV☠️/HF🏨
🎯 Fully additive clinical benefits
🎯 Enhanced tolerability
🎯 Defeat inertia
🎯 Improve adherence

HF won’t wait. Why should you?

[Ahmed Bennis MD 🫀 @drbennisahmed]

Bottom line: SZC didn’t beat SOC on the primary endpoint, but trends suggest potential benefit for RAASi optimization & reducing rehospitalization in high-risk CKD patients.

#Nephrology #CKD #Hyperkalaemia

[Sayed S Rahman @SayedSRahman1]

Renal Transplant Rejection :
Quick reference

PART 1/2

[Gregg Fonarow MD @gcfmd]

Among older patients 🏨 for HFrEF and eligible for quadruple therapy, those prescribed quadruple GDMT had a life expectancy up to 5.3 years ⤴️ than those prescribed 0/1

Median Survival Among Patients Hospitalized Prescribed Quadruple Medical Therapy https://t.co/OiF1V4I5QF

[Ahmed Bennis MD 🫀 @drbennisahmed]

The gap between best-case and real-world GDMT in #HFrEF is striking.
GWTG-HF 2024 vs EPIC COSMOS 2023–2025 (all HFrEF pts, 3.3M patients):
💚 Beta-Blocker: 95% vs 73%
💚 ACE/ARB/ARNI: 92% vs 67%
💚 MRA: 81% vs 36%
💚 SGLT2i: 78% vs 34%
💚 Quadruple GDMT: 68% vs 18%

[Brendon Neuen @brendonneuen]

IRON-HFpEF: Placebo-controlled RCT of IV iron in HFpEF (n=45)

- No effect on NT-proBNP or KCCQ
- But increase in RV ejection fraction and improvements in 6MWD, particularly after correcting for baseline differences

https://t.co/CJtFucE8dL

[Edgar V. Lerma 🇵🇭 @edgarvlermamd]

Hypophosphatemia During Kidney Replacement Therapy and Ventilator-Free Days: A Post-Hoc Analysis of the STARRT-AKI Trial ca. 2026 from @AJKDonline @javo_neyra @drseanbagshaw @DrRonWald
#Nephpearls #AKIinICU

👉🏼 https://t.co/uJjEDhoQB0