David W retweeted
1/10 #NephJC #TenPosts
🫘 Intermittent HD or continuous RRT for critically ill patients with AKI?
⚖️ For years, trials suggested similar outcomes. Does the choice of modality affect survival?
💥 The ICRAKI trial challenges previous evidence
nejm.org/doi/10.1056/NEJMoa2…
David W retweeted
ICRAKI- intermittent vs continuous RRT for AKI in the ICU? VA by @farahwehbe92
#NephTwitter #NephJC
nephjc.com/news/icraki-the-v…
David W retweeted
IHD vs CRRT again. ICRAKI was stopped early due to higher mortality with IHD. Real signal or truncation artifact? And was IHD given the way we'd give it to a patient on vasopressors? #NephJC #nephtwitter
✍️ By @rn_flex @DivyaveerSSNeph
nephjc.com/news/icraki11126
David W retweeted
#nephjc coverage of #kidneywk simultaneous publications day 1✨✨
✍️By @hswapnil @DrAkshayaJ @CristinaDeReins @dra_miliflores
nephjc.com/news/2026/10/21/k…
David W retweeted
If someone miraculously invented a drug that:
- successfully reversed obesity and most of its associated diseases
- improved longevity
- decreased the long term health costs
….and it was NOT covered by health insurance, ….
- then what would be the use of health insurance?
David W retweeted
Managing iron-deficiency anemia is a challenge in CKD. This randomized trial in #ASNCJASN found that adding lactoferrin to oral iron improved hemoglobin and iron status more than iron alone, suggesting a potentially accessible treatment strategy. kidney.pub/CJASN11204
David W retweeted
😲 The most shocking info that David (@rn_flex) highlighted in this piece was the difference in the A1C reductions between CagriSema and EloraTZP.
▪️The two amylins clearly have very different efficacy for A1C reduction. In REIMAGINE 2, Cagrilintide 2.4 mg showed a -0.8 reduction in A1C (efficacy estimand), while Elora showed reductions of -1.06 to -1.42 on its own in its T2D P2.
▪️All 5 EloraTZP arms had at least 90%% of patients hitting an A1C < 7%, and two arms had 100%, compared to 82% for CS 2.4/2.4mg.
▪️4/5 of the EloraTZP arms had 66-77% of patients reach normal glycemia (A1C < 5.7%), and the 5th (the lowest dose arm) hit 45%, while CS 2.4/2.4mg only had 20.6% achieve normal glycemia.
▪️Baseline A1C were 8.2% for REIMAGINE 2, and 8.14% for the EloraTZP P2.
The normal glycemia data for CS is pulled from their ADA presentation. I could not find it in the REIMAGINE-2 paper.
Also added the TRIUMPH-2 A1C data for retatrutide, but I should note that the baseline A1C was 7.7%.
🔥 It feels foolish to post TWO @rn_flex articles in one day, but here we are.
▪️GREAT REVIEW of the whirlwind that was Tuesday and Wednesday of EASD 2026, plus a pretty great synopsis of how wild the last 10 years have been in GLP-1s
▪️Retatrutide TRIUMPH-1 and -2 and Elora Tirz P1 & T2D P2
▪️If you want to be excited about future treatment *possibilities*, this is a great review of retatrutide and eloralintide + tirzepatide
▪️Caveat: There’s definitely still work to do in optimizing tolerability and safety, and figuring out how to report all of this back to trial readers (docs, investors, and patients)
Humor: Pretty sure there’s a dungeon and dragons/dice-based role playing game reference in there 🤦♀️, plus a classic Jurassic Park one as well 🦕.
[Yes, I’m admitting to playing a weekend or two of D&D in my foolish college years.]
the-incretins.beehiiv.com/p/…
David W retweeted
🔥 It feels foolish to post TWO @rn_flex articles in one day, but here we are.
▪️GREAT REVIEW of the whirlwind that was Tuesday and Wednesday of EASD 2026, plus a pretty great synopsis of how wild the last 10 years have been in GLP-1s
▪️Retatrutide TRIUMPH-1 and -2 and Elora Tirz P1 & T2D P2
▪️If you want to be excited about future treatment *possibilities*, this is a great review of retatrutide and eloralintide + tirzepatide
▪️Caveat: There’s definitely still work to do in optimizing tolerability and safety, and figuring out how to report all of this back to trial readers (docs, investors, and patients)
Humor: Pretty sure there’s a dungeon and dragons/dice-based role playing game reference in there 🤦♀️, plus a classic Jurassic Park one as well 🦕.
[Yes, I’m admitting to playing a weekend or two of D&D in my foolish college years.]
the-incretins.beehiiv.com/p/…
David W retweeted
Let’s look at this, shall we?
▪️The standards for inclusion only appear to require a SINGLE GLP-1 injectable SCRIPT (not a fill) prior to switch. So some people in this might not have ever taken an injectable, if they ran into insurance or cost issues.
▪️41% of those switched from Zepbound had 2.5mg as their last script before switching. Thats just the intro dose and not approved for weight loss efficacy.
▪️69% of those switching from injectable Wegovy were on 1mg or lower for their last script before switching. 1.7mg is the first dose approved for weight loss efficacy.
▪️Mean BMI change over 3 months was 1.4 and mean loss was 4kg (8.8lbs).
▪️That may be *statistically* significant, but is it that stage sort of significance patients are expecting when you say “significantly”?
▪️They don’t break out results by starting treatment AT ALL.
#PRESS: What happened when people switched from weight-loss injections to a pill?
Learn more about the findings, presented at EASD 2026, in our press release: novonordisk.com/content/nnco…
David W retweeted
Certainly its becoming less practical, and much less informative, to try to compare novel therapy to something below the best standard of care. Drop in rates of GLP-1 and the rising attrition rates in placebo confound effect sizes, make studies less interpretable and demonstrate patient need. Since the approved molecules are now abundant, should be standard of care for obesity management, and increasingly reimbursed - your point is a good one.
David W retweeted
Hey #NephJC 👋
Checkout the VA by @DivyaveerSSNeph
This week we're looking at steroid weaning strategies in adults with podocytopathies (MCD/FSGS).
💊Steroids: easy to start but hard to stop.
#NephTwitter
nephjc.com/news/starttrial
David W retweeted
@Roche notches impressive P2 data for the GLP-1R-GIPR co-co-agonist Enicepatide #T2D #weightloss roche.com/media/releases/med…
David W retweeted
🚨 The Novo Nordisk Foundation funded a very interesting trial, REACT, that is being presented this weekend as part of #ESC2026. The related paper is: “Prevalence of Silent Atherosclerosis across Adult Life.”
It found, that among adults with no known atherosclerotic cardiovascular disease:
▪️Atherosclerosis was identified in 57.1% of participants, with presence varying by age and sex
▪️In the 18-29 group, silent atherosclerosis was detectable 8.7% of
men and 6.7% of women
▪️This increased to 34.6% of men and 21.3% of women 30 to 39 years old
▪️By 60-70, only 1.9% of
men and 8.1% of women had no plaque detected in any examined territory
Their imaging looked for atherosclerosis (plaque) in both coronary and peripheral arteries.
I believe this is an attempt to start laying the ground work for coverage of semaglutide and CagriSema as a preventative CVD measure (prior to an adverse CV event) in a broader population, just as Medicare Bridge and BALANCE are enabling coverage for seniors with pre-diabetes, even though that’s not actually an FDA indication for weight loss GLP-1s at this time.
David W retweeted
1/10
#NephJC #TenPostNephJC #NephTwitter
Can just 4 doses of an SGLT2i prevent AKI after cardiac surgery? The MERCURI-2 trial put dapagliflozin to the test. But is the benefit a treat or a trick?🫀💊
Read the article 👇
pubmed.ncbi.nlm.nih.gov/4253…
David W retweeted
Here’s our (@NephJC’s) 🔥 fiery review of the MERCURI-2 trial ! What to say, the limitations seem limitless ! 😅
Probably one of the first trials I’ve read where Urine output takes up more space and value than Creatinine in the AKI equation.
Summary by @rn_flex and @DrBarbaTeba (the girl with the 🐈⬛s)
@DrPallaviPrasad @brian_rifkin @CristinaDeReins @jmteakell @assad_sm @kidney_boy @hswapnil @dra_miliflores
Dapagliflozin cuts AKI after cardiac surgery - MERCURI-2 says so. But dig into the data, and it's mostly an urine output story, not a kidney protection one
✍️ #NephJC summary by @rn_flex and @DrBarbaTeba
#nephtwitter #medtwitter
nephjc.com/news/2026/8/18/me…
David W retweeted
Dapagliflozin cuts AKI after cardiac surgery - MERCURI-2 says so. But dig into the data, and it's mostly an urine output story, not a kidney protection one
✍️ #NephJC summary by @rn_flex and @DrBarbaTeba
#nephtwitter #medtwitter
nephjc.com/news/2026/8/18/me…
David W retweeted
Excited for SGLT2 inhibitors to prevent AKI in CV surgery patients? So were we... until we got past the title.
This week we're talking about "that JAMA paper "🙃
#NephJC #NephTwitter
Here's the VA by @ManoleaA
nephjc.com/news/2026/8/17/me…
David W retweeted
1/10
#NephJC #TenPostNephJC
Bicarbonate is an ICU drug that almost everyone has an opinion on.
The physiology is attractive, but evidence isn’t.
SODa-BIC asks if IV bicarb changes outcomes in ICU pts with metabolic acidosis on vasopressors.
📄 pubmed.ncbi.nlm.nih.gov/4228…
David W retweeted
🖌️Check out the #visualabstract for the SODa-BIC trial by @danyrcal
#NephJC
nephjc.com/news/2026/8/3/sod…
David W retweeted
$NVO ZEUS reveals that IL6i in patients w/ hsCRP 2+ AND ASCVD AND CKD does not drive 3P MACE reduction
Should also note that majority of patients in ZEUS had hypertension, diabetes, and a significant fraction had HF.
Zilti (humanized mAb against IL6 ligand) drops hsCRP > 80% (more than IL1beta inhibition in CANTOS). Of course, hsCRP is non-specific and a marker of risk not causal.
Without the full details, which will be shared soon, it's hard to speculate. I do not think the results of this trial should be extrapolated to assume that inflammatory axis blockade in CVD is not going to work.
My thoughts include:
1. Will upstream inhibition result in CVOT success?
2. Is the infection risk too high w/ IL6i?
3. Will offering inflammatory axis blockade in patients with HIGH residual inflammation but without as many comorbidities / comorbidity intensity offset the AEs associated with this process?
4. Does moving to a small molecule improve performance?
5. Does expansion to 4P-MACE or other composite endpoints that allow for detection of more events improve relevant clinical signal?
6. HF? other CVD indications but not ASCVD
Highly anticipated Zeus trial of anti-inflammatory therapy for cardiovascular risk reduction arrives. Ziltivekimab didn't reduce major adverse cardiovascular events risk (hazard ratio, 0.99; 95% confidence interval, 0.88 to 1.11). See press release. novonordisk.com/content/nnco…
