Kidney Week is over but buckle up for the American Heart Meeting starting this Saturday. One of the trials I am excited about is KARDIA-1, a phase-2 trial of zilebesiran a twice a year injection to control blood pressure. Zilebesiran uses RNA interferance to block hepatic synthesis of angiotensinogen. The idea of removing adherance from the list of causes of resistant hypertension is exciting. 

If you want to tune up for KARDIA-1, check out the phase-1 data on zilebesiran that was published in the NEJM in July. Can you tell how excited I am about this potential game changer?

Christos talks about the future of IgA Nephropathy therapy. I think he is right. The clinical trials are not going to give us clarity and we will need both better biomarkers and more understanding payers to do our patients right. 

Speaking of alternative antihypertensive (or in this case alternative anti-proteinuric) drugs, aldosterone synthase inhibition is on deck. In a Boehringer Ingelheim spoinsored phase-2 trial shown at Kidney Week's High Impact and Late Breaking Clinical Trial session, Kathleen Tuttle showed how BI 690517 reduced proteinuria with and without SGLT2i. 

This may be the future of anti-proteinuric trials. The Anti-proteinuric properties of SGLT2i are so important new agents need to be tested with and without them to make sure they work by a unique mechanism that is additive to these Flozins which are becokming table stakes in the war against CKD. It is amazing how fast these drugs have changed every aspect of nephrology. 

The combined BI 690517 and empagliflozin group additionally saw nice blood pressure reduction wioth modest (but measurable) hyperkalemia.

The NEJM Group sent out a link to this abstract from Kidney Week. The authors looked at the risk of sudden cardiac death in the ten days following the prescription of ondansetron compared to "other anti-emetics." The headline was that ondansetron increased the risk of sudden cardiac death by 45% (95% CI 1.08 1.93). But looking at the absolute risk tells a story with a different slant. The risk of SCD with ondansetron was around 0.06%. The Number needed to harm was 1,672. Alternatives to ondansetron may be safer, but ondansetron looks pretty safe.