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)

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 (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 Hiremath@hswapnil.medsky.social

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.

The Filtrate

Joel Topf @kidneyboy.bsky.social‬

Swapnil Hiremath @hswapnil.medsky.social

Nayan Arora captainchloride.bsky.social

Sopia Ambruso @sophia-kidney.bsky.social

Special Guests

Brendon Neuen @brendonneuen.bsky.social Associate Professor and Program Lead, Renal and Metabolic at The George Institute for Global Health. Nephrologist and Director of Kidney Trials at Royal North Shore Hospital.

Neuen has had three prior appearances on Freely Filtered: EMPA Kidney, DUPLEX and Sparsentan in FSGS, FLOW and Semaglutide

Muthiah Vaduganathan @mvaduganathan on X. Cardiologist at Brigham and Women's Hospital and Harvard Medical School. Assistant Professor of Medicine.

Editing by

Joel Topf

The Kidney Connection written and performed by Tim Yau

Show Notes

DONATE to NephJC!

Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes NEJM | NephJC Summary

FIDELIO Bakris et al, NEJM 2020 | NephJC Summary; subgroup throws doubt on efficacy of finerenone in patients on flozins

FIGARO Pitt et al, NEJM 2021; subgroups clearly shows finerenone works, flozins or not

NEJM editorial (wrongly) saying do not use Flozins unless on RASi 

Don’t use dual RAS blockade ONTARGET Yusuf et al, NEJM 2008; VA NEPHRON-D Fried et al NEJM 2013

Why we cannot study finerenone in HFrEF (RALES Pitt et al NEJM 1999) 

Muthu is jealous of GFR slope and albuminuria surrogate endpoints and wants to borrow them for HFpEF (Inker et al EHJ 2025)

Combination therapy and CV outcomes in hypertension (Wang et al JAMA Card 2024 on low dose combinations and BP; Egan et al Blood Pressure 2022 review of topic) 

CONFIRMATION HF trial registry entry (Finerenone and Empagliflozin in hospitalized patients with HF)

23:20: Nayan and Swap miss a chance to say ‘de-flozination’ to discuss stopping a flozin which would allow a patient to be included in the trial 

Finerenone is a CYP3A4 substrate (Heinig et al Clin Pharmacokinetics 2023); Useful list of CYP3A4 inducers and inhibitors 

Everyone should get an ABPM (Bugeja et al CMAJ 2022)

EASiKIDNEY study design 

Albuminuria mediates CKD benefits with Finerenone (Agarwal et al Ann Intern Med 2023)

GFR slope and Albuminuria and the FDA (Taylor et al eClin Med 2025) 

Dapagliflozin and Eplerenone combination crossover trial (Provenzano et al JASN 2022)

Joel gets promoted! (PBFluids reflection) 

Bluesky NephJC Chat discussion on ‘renal remission’ 

Withdrawal of Finerenone and worse outcomes from FINEARTS (Vaduganathan et al JACC 2025)

Combination therapies Analysis from Brendan and Muthu (Neuen et al Circulation 2024)

Do not use KFRE when GFR > 60 (KDIGO Practice Point 2.2.4: Note that risk prediction equations developed for use in people with CKD G3–G5, may not be valid for use in those with CKD G1–G2) 

Finerenone vs Spironolactone trial in Primary Aldosteronism (Hu et al Circulation 2025)

FIND CKD trial design (Heerspink et al NDT 2025) 

FINE-ONE trial design (Heerspink et al Diab Res Practice 2023) 

Tubular Secretions

Nayan keeping his chin up as Yankees lose and Mariners follow (MLB Playoffs)

Sophia’s adventures with Beekeeping (Royal Jelly?) 

Brendon loves listening to ‘Susan’ by Raye 

Muthu is back into Taekwondo 

Swap is still reading Martha Wells (Witch King on GoodReads)

Joel will be hiking the Laugavegur trail in Iceland