NephSpace

Three reflexes worth rethinking. In septic shock in the emergency department, stopping the fluid and starting the vasopressor early showed no difference in days alive and out of the hospital compared with the classic fluids-first approach, with about half the extra fluid. In a blinded ICU trial, sodium bicarbonate for metabolic acidosis in shock fixed the blood gas but did not significantly lower death, dialysis or lasting kidney damage. And a review of 13 interview studies asks why so few patients start peritoneal dialysis. Each with what's new, the caveats and what it means on Monday.

Disclosure: Dr. Hussein serves on the Fresenius Medical Care US Home Medical Advisory Board; Fresenius sells peritoneal dialysis equipment. The PD segment includes our take on US payment for staff-assisted home dialysis and a bill in Congress. One author of an ASN Kidney News viewpoint discussed in the bicarbonate segment, Dr. Lenar Yessayan, reports a seat on a Fresenius Medical Care medical advisory board (the authors' own disclosure).

Chapters

• 00:00 Cold open and running order
• 01:12 Fluids or pressors in septic shock: in the ARISE FLUIDS trial (NEJM), stopping the fluid and starting the vasopressor early showed no difference in days alive and out of the hospital, with about half the extra fluid
• 07:02 Bicarbonate at 2 a.m.: the blinded SODa-BIC trial (NEJM), its editorial and two ASN Kidney News viewpoints. A better blood gas, but no significant difference in death, dialysis or lasting kidney damage
• 12:24 Why PD remains underused: an AJKD review of 13 qualitative studies finds fear, clinicians, one-session education, urgent starts and missing home support decide before the patient does
• 17:15 Close

Papers in this episode

• The ARISE FLUIDS Investigators and the ANZICS Clinical Trials Group and ACEM Clinical Trials Network. Vasopressors or Fluids in Early Septic Shock. N Engl J Med 2026;395:1387-1398. https://doi.org/10.1056/NEJMoa2516225
• The SODa-BIC Investigators and the ANZICS Clinical Trials Group. Sodium Bicarbonate for Critically Ill Adults with Metabolic Acidosis and Shock. N Engl J Med 2026;395:1062-1074. https://doi.org/10.1056/NEJMoa2600526
• Ostermann M, Cook DJ. Sodium Bicarbonate in Critical Illness — A New Chapter for the Book. N Engl J Med 2026;395 (editorial). https://doi.org/10.1056/NEJMe2610218
• Sette L. A Better Blood Gas but Not a Better Outcome: Rethinking Bicarbonate in the ICU. Kidney News 2026;18(10/11):59. https://doi.org/10.62716/kn.004282026
• Teixeira JP, Yessayan L, Tolwani A. Intravenous Bicarbonate for Metabolic Acidosis in the ICU: Improving Outcomes or Just Fixing Numbers? Kidney News 2026;18(10/11):60-61. https://doi.org/10.62716/kn.004552026
• Shankar R, et al. Barriers to and Facilitators of the Adoption of Peritoneal Dialysis: A Systematic Review of Qualitative Studies. Am J Kidney Dis 2026 (articles in press). https://doi.org/10.1053/j.ajkd.2026.07.013

Also mentioned

• H.R. 8875, Improving Home Dialysis Act of 2026 (119th Congress), mentioned in the PD segment. https://www.congress.gov/bill/119th-congress/house-bill/8875

Physician-led, AI-assisted. Dr. Wael Hussein chooses the papers, reviews and edits every script, and approves every episode. AI (Claude, by Anthropic) writes the first draft from the full text of each paper, and a separate AI check compares every number with the papers; Dr. Hussein then reviews and edits the draft before the AI hosts (ElevenLabs) voice it. Everything is summarized in our own words.

For education and information only, not medical advice. Please talk to your own physician or care team about your health. Clinicians: read the original before changing practice. Full disclaimer: nephspace.com/disclaimer. Views are the creator's own and not those of his employer. No sponsors.

nephspace.com · [email protected]

A 60-page referral, nine years of creatinine, and an AI summary waiting on two desks: the attending's and the first-year fellow's. A Kidney360 perspective says to hand drafting, summarizing and paperwork to AI first, because a clinician checks the draft. A CJASN perspective says that same drafting is how fellows learn judgment, and warns of "never-skilling". We look at what the evidence actually shows: an ambient-scribe trial in which the better of two tools saved about 20 seconds per note, trainees who accepted roughly three of every four wrong AI answers, and endoscopists who detected fewer adenomas on their own after AI arrived in their units. Then a Fight Night verdict.

The takeaway: AI can take the paperwork off a nephrologist's desk, but the safety net is still a human who knows enough to catch its mistakes, so fellows need to build that skill before they hand anything over.

Disclosure: Dr. Hussein serves on the Fresenius Medical Care US Home Medical Advisory Board. Several of the dialysis AI tools discussed come from Fresenius. He also directs quality improvement and research for nephrology fellows.

Chapters

• 00:00 Cold open, welcome and disclosure
• 01:22 The attending's desk: hand AI the paperwork first? The ambient-scribe trial and the dialysis AI tools
• 07:27 The fellow's desk: never-skilling, a hallucination-spotting test, colonoscopy deskilling, and AI practice patients
• 12:36 Who checks the checker: the ASN statement, authors' ties, and a pre-visit medication-reconciliation idea
• 15:10 Fight Night verdict and the Monday-morning change

Papers discussed

• Aiumtrakul N, Thongprayoon C, Cheungpasitporn W. Artificial Intelligence in Nephrology Practice: Practical Pathways to Improve Efficiency. Kidney360 2026 (ahead of print, open access). https://journals.lww.com/kidney360/fulltext/10.34067/kid.0000001424~artificial-intelligence-in-nephrology-practice-practical
• Fong JMN, Wang AYM. Equipping Nephrology Fellows with the Knowledge, Skills, and Attitudes for the Artificial Intelligence Era. CJASN 2026 (ahead of print). https://doi.org/10.2215/CJN.0000001239
• Lukac PJ, et al. Ambient AI Scribes in Clinical Practice: A Randomized Trial. NEJM AI 2025;2(12). https://doi.org/10.1056/AIoa2501000
• Zhou J, et al. General practice trainees' ability to tell AI hallucinations from correct answers. BMC Med Educ 2025;25:406. https://doi.org/10.1186/s12909-025-06916-2
• Garbelli M, et al. Usage of the Anemia Control Model Is Associated with Reduced Hospitalization Risk in Hemodialysis. Biomedicines 2024;12:2219. https://doi.org/10.3390/biomedicines12102219
• Chaudhuri, et al. Machine-learning-directed interventions for hemodialysis patients at imminent risk of hospitalization. NEJM Catalyst 2026;7(3) (abstract only). https://doi.org/10.1056/CAT.25.0212
• Budzyń K, et al. Endoscopist deskilling risk after exposure to artificial intelligence in colonoscopy: a multicentre, observational study. Lancet Gastroenterol Hepatol 2025;10:896-903 (abstract only). https://doi.org/10.1016/S2468-1253(25)00133-5
• Ke Y, et al. AI-induced never-skilling in medical education. Nat Med 2026;32:1997-2006 (abstract only). https://doi.org/10.1038/s41591-026-04438-y
• Tangri N, et al. Responsible Use of Artificial Intelligence to Improve Kidney Care (ASN statement). JASN 2026;37:881-890. https://doi.org/10.1681/ASN.0000000929
• Lavigne E, et al. AI-Standardized Clinical Examination Training on OSCE Performance. NEJM AI 2025;2(8) (abstract only). https://doi.org/10.1056/AIoa2500066

Physician-led, AI-assisted. Dr. Wael Hussein chooses the papers, reviews and edits every script, and approves every episode. AI (Claude, by Anthropic) writes the first draft from the full text of each paper, and a separate AI check compares every number with the papers; Dr. Hussein then reviews and edits the draft before the AI hosts (ElevenLabs) voice it. Everything is summarized in our own words; read the original before changing practice.

For education and information only, not medical advice. Please talk to your own physician or care team about your health. Full disclaimer: nephspace.com/disclaimer. Views are the creator's own and not those of his employer. No sponsors.

nephspace.com · [email protected]

A new lipid guideline makes reduced kidney function a reason for a statin; in 2024, before it arrived, most patients for whom kidney function is now the reason had no statin prescription. An editorial asks whether GLP-1 drugs belong in dialysis units before the trials are done. A review says dialysis adequacy should be measured by what it does for the heart, troponin turns out to be a moving target during a session, and an AI reads photos of fistulas. Five picks from the week of September 25, 2026, each with the background, what's new, the caveats and what it means on Monday.

Disclosure: Dr. Hussein serves on the Fresenius Medical Care US Home Medical Advisory Board. Two papers in this episode have Fresenius ties: a review with coauthors affiliated with Fresenius Medical Care that rates hemodiafiltration (Fresenius makes hemodiafiltration equipment), and an AI tool from the Renal Research Institute, which authors' disclosure forms describe as a wholly owned Fresenius subsidiary. Dr. Csaba Kovesdy, author of the GLP-1 editorial, is Dr. Hussein's department chief.

Chapters

• 00:00 Cold open and running order
• 01:37 Statins in CKD: under the 2026 ACC/AHA guideline, an eGFR of 15 to 60 is a statin indication, but statin prescriptions were lower at more advanced CKD stages (CJASN research letter, 2024 data)
• 06:18 GLP-1 drugs on dialysis: Dr. Kovesdy's CJASN editorial on a real-world study, its design limits, and the risks of malnutrition, muscle loss and hypoglycemia
• 10:17 Beyond Kt/V: an NDT review weighs dialysis strategies by their cardiovascular evidence, from hemodiafiltration to potassium and sodium tailoring
• 15:21 Troponin during dialysis: a systematic review finds troponin I can rise or fall during a single session in patients without symptoms
• 19:21 Fistula aneurysms and AI: a photo classifier flagged 25 of 26 advanced aneurysms in a first test against in-person exams
• 23:16 Close

Papers in this episode

• Kim M, et al. Lipid-Lowering Therapy in Individuals with CKD. CJASN 2026 (ahead of print, research letter). https://doi.org/10.2215/CJN.0000001218
• Kovesdy CP. Glucagon-Like Peptide-1 Receptor Agonists in Dialysis: The Evidence Grows, but Trials Must Follow. CJASN 2026 (ahead of print, editorial). https://doi.org/10.2215/CJN.0000001256
• The editorial discusses Karpinski S, et al. Glucagon-Like Peptide-1 Receptor Agonist Use and Risks of Hospitalization and Mortality in Patients with End-Stage Kidney Disease. CJASN 2026. https://doi.org/10.2215/CJN.0000001208 (figures in this episode are as the editorial reports them).
• Zoccali C, et al. Beyond Kt/V: Redefining Dialysis Adequacy as Targeted Cardiovascular Risk Reduction. Nephrol Dial Transplant 2026 (advance article). https://doi.org/10.1093/ndt/gfag223
• Jørgensen JF, et al. The Intradialytic Changes in Cardiac Troponin I — A Systematic Review. Semin Dial 2026 (open access). https://doi.org/10.1111/sdi.70049
• Dong Z, et al. Cloud-Based AI Application for Classifying Arteriovenous Hemodialysis Vascular Access Aneurysms. CJASN 2026 (ahead of print, open access). https://doi.org/10.2215/CJN.0000001231

Physician-led, AI-assisted. Dr. Wael Hussein chooses the papers, reviews and edits every script, and approves every episode. AI (Claude, by Anthropic) writes the first draft from the full text of each paper, and a separate AI check compares every number with the papers; Dr. Hussein then reviews and edits the draft before the AI hosts (ElevenLabs) voice it. Everything is summarized in our own words.

For education and information only, not medical advice. Please talk to your own physician or care team about your health. Clinicians: read the original before changing practice. Full disclaimer: nephspace.com/disclaimer. Views are the creator's own and not those of his employer. No sponsors.

nephspace.com · [email protected]

I want to keep up with nephrology. But the new papers sit behind logins and scattered across sites, so I end up doomscrolling instead. NephSpace brings the week's kidney research and news together, out loud: one weekly episode on what's new, plus deep dives in between, made for the couch, the run and the drive to work.

Let's transform scroll time into learning time. Knowledge, transformed: easy to reach, hard to stop.

Follow on Apple Podcasts: https://podcasts.apple.com/us/podcast/nephspace/id6818364609
Spotify: https://open.spotify.com/show/13ehzk9U414PYpIZK3c4yv

Physician-led, AI-assisted. Dr. Wael Hussein chooses the papers and reviews and edits every script; the hosts are AI voices (ElevenLabs). Disclosure: Dr. Hussein serves on the Fresenius Medical Care US Home Medical Advisory Board; each episode's notes carry its own disclosures. For education and information only, not medical advice. Please talk to your own physician or care team about your health. Full disclaimer: nephspace.com/disclaimer. Views are the creator's own and not those of his employer.

nephspace.com · [email protected]

Two dialysis patients, same city, same week. One gets a new machine that filters and replaces more than 20 liters every session. The other gets the same old machine with a new filter. Both are told it's the future. Hemodiafiltration has a survival trial but needs new machines. Medium cutoff dialyzers drop into today's machines but have no survival evidence against standard dialysis. A detective story with a Fight Night verdict, including who makes, sells and funds each road.

The takeaway: Both roads clear more middle molecules, but only hemodiafiltration has shown that people live longer, and only in patients who can get the dose.

Disclosure: Dr. Hussein serves on the Fresenius Medical Care US Home Medical Advisory Board. Fresenius makes and sells the 5008X hemodiafiltration machine discussed in this episode. The episode names the industry ties of the review authors and of everyone quoted.

Chapters

• 00:00 Cold open and disclosure
• 01:11 The mystery: what middle molecules are, and why clearing them might matter
• 02:47 Road one, change the treatment: CONVINCE, its quality-of-life and cost papers, and the JASN review
• 08:36 Road two, change the filter: Theranova, ELISIO-HX and the medium cutoff evidence
• 11:47 The showdown: MOTheR, the head-to-head trial
• 15:13 Follow the money: who makes, sells and funds each road
• 16:49 Fight Night verdict and the Monday-morning change

Papers discussed

• Blankestijn PJ, et al. Hemodiafiltration: Clinical Practice of Today and a Look into the Future. JASN 2026 (ahead of print). https://doi.org/10.1681/ASN.0000001282
• Healio | Nephrology, September 24, 2026. Q&A with DaVita's chief medical officer on medium cutoff dialyzers. https://www.healio.com/news/nephrology/20260924/qa-recent-fda-approval-prompts-expansion-of-medium-cutoff-dialyzers
• Blankestijn PJ, et al. Effect of Hemodiafiltration or Hemodialysis on Mortality in Kidney Failure (CONVINCE). N Engl J Med 2023;389:700-709. https://doi.org/10.1056/NEJMoa2304820
• Rose M, et al. CONVINCE quality-of-life results. Kidney Int 2024;106:961-971. https://doi.org/10.1016/j.kint.2024.07.014
• Schouten AEM, et al. CONVINCE cost-utility analysis. Kidney Int 2025;107:728-739. https://doi.org/10.1016/j.kint.2024.12.018
• Vernooij RWM, et al. Haemodiafiltration versus haemodialysis for kidney failure: an individual patient data meta-analysis of randomised controlled trials. Lancet 2024;404:1742-1749 (abstract only). https://doi.org/10.1016/S0140-6736(24)01859-2
• Kandi M, et al. Clinical Outcomes With Medium Cut-Off Versus High-Flux Hemodialysis Membranes: A Systematic Review and Meta-Analysis. Can J Kidney Health Dis 2022;9. https://doi.org/10.1177/20543581211067087
• MOTheR trial (Theranova expanded hemodialysis vs online hemodiafiltration), presented at the ERA Congress, June 2026, not yet peer-reviewed. Healio, June 18, 2026. https://www.healio.com/news/nephrology/20260618/expanded-hemodialysis-noninferior-to-online-hemodiafiltration
• National Kidney Foundation. Medium Cut-Off Dialyzers for Expanded Hemodialysis: A Clinical Update. https://www.kidney.org/professionals/medium-cut-dialyzers-expanded-hemodialysis

Company and provider statements cited (promotional sources, labeled as such on air)

• Vantive, June 8, 2026 (MOTheR and CONCORDIA). https://www.globenewswire.com/news-release/2026/06/08/3308370/0/en/vantive-highlights-late-breaking-high-clinical-impact-data-at-era-indicating-hdx-therapy-is-a-practical-alternative-to-online-hemodiafiltration.html
• Fresenius Medical Care, June 2026, "High-Volume Hemodiafiltration Remains the Benchmark for Survival Evidence in Dialysis". https://freseniusmedicalcare.com/en/media/insights/blog/high-volume-hemodiafiltration-remains-the-benchmark-for-survival/
• DaVita newsroom, August 5, 2026. https://newsroom.davita.com/davita-scales-expanded-hd-to-target-middle-molecules/
• U.S. Renal Care, July 30, 2026. https://www.prnewswire.com/news-releases/us-renal-care-drives-innovation-in-dialysis-with-increased-availability-of-medium-cut-off-dialyzers-to-support-expanded-hemodialysis-302839595.html
• Healio perspective, February 24, 2026, "Middle molecule moment" (Chan and Sonti). https://www.healio.com/news/nephrology/20260224/middle-molecule-moment-hemodiafiltration-and-expanded-hemodialysis-transform-us-dialysis

Also cited by name: Baxter's August 2020 Theranova authorization announcement, Nipro's July and August 2026 ELISIO-HX releases, and Fresenius's 2025 and 2026 releases on the 5008X rollout.

Physician-led, AI-assisted. Dr. Wael Hussein chooses the papers, reviews and edits every script, and approves every episode. AI (Claude, by Anthropic) writes the first draft from the full text of each paper, and a separate AI check compares every number with the papers; Dr. Hussein then reviews and edits the draft before the AI hosts (ElevenLabs) voice it. Everything is summarized in our own words; read the original before changing practice.

For education and information only, not medical advice. Please talk to your own physician or care team about your health. Full disclaimer: nephspace.com/disclaimer. Views are the creator's own and not those of his employer. No sponsors.

nephspace.com · [email protected]

Two ways to clear more middle molecules arrive in US dialysis units at once. A urine dipstick can show whether patients are taking their SGLT2 inhibitor. Two papers disagree about who should let AI write the notes. Nine picks from the week of September 21, 2026, each with the story, the numbers and a take.

Disclosure: Dr. Hussein serves on the Fresenius Medical Care US Home Medical Advisory Board. Fresenius sells hemodiafiltration machines, which are discussed in this episode.

Chapters

• 00:00 Cold open and running order
• 01:10 Hemodiafiltration: a JASN review makes the case for high-volume HDF as the global default, and how to prescribe it
• 05:06 Medium cutoff dialyzers: Nipro's ELISIO-HX is cleared in the US and DaVita is scaling it up. What the interview shows, and what it doesn't
• 08:13 Obinutuzumab: FDA approval for preventing relapse in frequently relapsing or steroid-dependent childhood-onset nephrotic syndrome, from age 2 into adulthood
• 11:08 Nephrology and CKM syndrome: an AJKD perspective on shifting the specialty from organ failure to prevention
• 13:59 Atherosclerosis in CKD: a CJASN review of mechanisms, risk prediction and the treatment menu
• 17:54 GLP-1 receptor agonists in CKD: a case-based CJASN "How I Treat" piece
• 21:03 The dipstick adherence check: glucosuria on routine urinalysis as a marker that patients are taking their SGLT2 inhibitor
• 24:31 AI in practice: where AI can take paperwork off the nephrologist's desk
• 27:44 Fellows and AI: training for the AI era without "never-skilling"
• 30:24 Close

Papers and news in this episode

• Blankestijn PJ, et al. Hemodiafiltration: Clinical Practice of Today and a Look into the Future. JASN 2026 (ahead of print). https://doi.org/10.1681/ASN.0000001282
• Healio | Nephrology, September 24, 2026. Q&A with DaVita's chief medical officer: recent FDA approval prompts expansion of medium cutoff dialyzers. https://www.healio.com/news/nephrology/20260924/qa-recent-fda-approval-prompts-expansion-of-medium-cutoff-dialyzers
• Healio | Nephrology, September 25, 2026. FDA approves obinutuzumab (Gazyva) for idiopathic nephrotic syndrome. Background in this segment also came from FDA-approval coverage in Contemporary Pediatrics and HCPLive and from Genentech's trial release, not only from the Healio report. https://www.healio.com/news/nephrology/20260925/fda-approves-gazyva-for-idiopathic-nephrotic-syndrome-in-pediatric-patients
• Sridhar VS, Levin A. AJKD perspective on the nephrologist's role in cardiovascular-kidney-metabolic syndrome. AJKD 2026 (ahead of print). https://www.ajkd.org/article/S0272-6386(26)01125-X/fulltext
• Correa S, Cuningham JW, Mc Causland FR. Atherosclerotic Cardiovascular Disease in CKD: Contemporary Insights into Pathogenesis, Diagnosis, and Management. CJASN 2026 (ahead of print). https://doi.org/10.2215/CJN.0000001199
• Cheung DS. GLP-1 Receptor Agonists in CKD: A Case-Based Discussion of Translating Evidence into Practice. CJASN 2026 (ahead of print). https://doi.org/10.2215/CJN.0000001252
• Li Z, et al. Glucosuria as a Marker of Adherence to Sodium-Glucose Cotransporter 2 Inhibitors and Clinical Outcomes in Real-World Practice. JASN 2026 (ahead of print). https://doi.org/10.1681/ASN.0000001252
• Aiumtrakul N, Thongprayoon C, Cheungpasitporn W. Artificial Intelligence in Nephrology Practice: Practical Pathways to Improve Efficiency. Kidney360 2026 (ahead of print, open access). https://journals.lww.com/kidney360/fulltext/10.34067/kid.0000001424~artificial-intelligence-in-nephrology-practice-practical
• Fong JMN, Wang AYM. Equipping Nephrology Fellows with the Knowledge, Skills, and Attitudes for the Artificial Intelligence Era. CJASN 2026 (ahead of print). https://doi.org/10.2215/CJN.0000001239

Physician-led, AI-assisted. Dr. Wael Hussein chooses the papers, reviews and edits every script, and approves every episode. AI (Claude, by Anthropic) writes the first draft from the full text of each paper, and a separate AI check compares every number with the papers; Dr. Hussein then reviews and edits the draft before the AI hosts (ElevenLabs) voice it. Everything is summarized in our own words; read the original before changing practice.

For education and information only, not medical advice. Please talk to your own physician or care team about your health. Full disclaimer: nephspace.com/disclaimer. Views are the creator's own and not those of his employer. No sponsors.

nephspace.com · [email protected]