One of the places we do not have robust data supporting the use of flozins is in kidney transplant recipients. At #KidneyWk, one of the oral abstract sessions included this real-world, propensity matched study of transplant recipients on and off flozins. SGLT2i use was associated with a significant reduction in graft failure, rejection, MACE, all-cause mortality, and genitourinary infections.

This was another interesting poster from Saturday. They looked at urine specimens up to a week after collection and found no loss of diagnostic utility. All that stuff you were taught about casts being delicate flowers that needed to be looked at immediately. All wrong. Oh, and if you were feeling good about yourself, the lead author is a freshman in college.

One of the concepts that is gaining acceptance in nephrology is individualizing dialysis dosing. Part of this is recognizing that patients with some measurable residual renal function may not need 3 times a week dialysis and in fact may do better with dialysis twice a week. This study crossed patients over from three times a week to twice a week and found better quality of life without adverse events. 

Anticoagulation in patients with atrial fibrillation is standard of care because despite the risk of bleeding from the intervention the reduction in strokes makes this a good decision. The problem is that dialysis patients were excluded from all of these studies and since they have a much higher risk of bleeding (uremic coagulopathy, large needles regularly being inserted into high flow blood vessels, high risk of GI bleeds) no one knows if the risk of anticoagulation justifies a presumed reduced risk of stroke.

This team from Canada and Australia is plannig an RCT to do examine this and they are enrolling three arms: coumadin, apixaban and no oral anticoagulat (OAC)! This pilot feasability study successfully enrolled around 50 patients in each arm (the primarty outcome of thios study). After six months they found 2 strokes (1 apixaban, 1 no OAC), and 27 participants had at least one bleeding event (12 warfarin, 8 apixaban, 7 no OAC) of which 8 were major (4 warfarin, 2 apixaban, 2 no OAC). Underpowered, but intriguing.

I have been tracking use of the NephJC hashtag since 2011 and every year, the nuber of people using the #KidneyWk hashtag at the conference has grown, until now. This is the second year in a row that the number of tweets has fallen.