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Nephrology Journal Club

@nephjc.bsky.social
2.9K followers 130 following 3.3K posts

A twice monthly nephrology journal club that used to meet on Twitter. Hashtag #NephJC www.nephjc.com

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Nephrology Journal Club @nephjc.bsky.social · 03/10/2026
Can tolvaptan keep up with 3% saline? This within-subject study in healthy volunteers delivered a surprising answer - and a few eyebrow-raising physiology twist. Dive in #NephJC ✍️ by @drsaivani.bsky.social www.nephjc.com/news/tolvapt...
nephjc.com
Raising sodium: can tolvaptan rival 3% hypertonic saline? — NephJC
Testing Tolvaptan versus 3% saline and the rate of rise of serum sodium in healthy volunteers.
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Nephrology Journal Club @nephjc.bsky.social · 30/09/2026
11/10 ➡️Up next on 10/13: Survival benefit of deceased donor kidney transplantation versus continued dialysis: international target trial emulation | The BMJ www.bmj.com/content/394/... Join us www.nephjc.com/
nephjc.com
NephJC
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Nephrology Journal Club @nephjc.bsky.social · 30/09/2026
10/10 START questions the default "longer = better" steroid assumption. A 2-month taper looks to be a reasonable place to START post-remission for many steroid-sensitive patients. However, simplicity and a one-size-fits-all strategy, is not an option.
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Nephrology Journal Club @nephjc.bsky.social · 30/09/2026
9/10 I want more info: nephjc.com/news/startst... www.nephjc.com/news/starttr... www.nephjc.com/news/startsp... Andreea Manolea, Farah Wehbe, David White
nephjc.com
Why Can’t I Quit You: Steroid Tapering in Adults with Podocytopathies (START) — NephJC
This week, we will discuss the best schedule for tapering steroids in adult patients with podocytopathies (MCD/FSGS).
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Nephrology Journal Club @nephjc.bsky.social · 30/09/2026
8/10 ⚠️ #NephJC Consensus 💡Underpowered (94/114 target, ~75% power), open-label, 2 center trial, wide margin (CI compatible w/ ~14 extra relapses/100 pts short-course), and FSGS trended toward favoring the longer taper underpowered subgroup 💡Hypothesis-generating only
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Nephrology Journal Club @nephjc.bsky.social · 30/09/2026
7/10 Question 2 #NephJC #NephTwitter Q: Can MCD & FSGS receive similar steroid taper regimens? A: Probably not! We need a more adequately powered trial to answer this, especially with FSGS which remains more treatment resistant & steroid resistance may be disease defining
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Nephrology Journal Club @nephjc.bsky.social · 30/09/2026
6/10 Question 1 #NephJC #Nephsky or #NephTwitter Q: Should we stop steroids quickly in all podocytopathies? A: Probably not, but this gives us evidence that we should explore this further in larger trial, as less steroids has less AE exposure, but also without more relapses
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Nephrology Journal Club @nephjc.bsky.social · 30/09/2026
5/10 A Picture is worth 1000 words 💉 The payoff: cumulative prednisolone roughly halved on the short course 1750mg vs 3430mg and as the KM graph shows ♻️Relapse free survival was essentially the same ⚡AEs were also less in short course arm
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Nephrology Journal Club @nephjc.bsky.social · 30/09/2026
4/10 One post results ✅ Primary outcome: 12-mo relapse-free remission (ITT): 63.3% short vs 57.8% standard ✅Risk diff +5.5%, lower CI −14.3% clears the −25% margin (P=0.001) ✅Per-protocol analysis confirmed it too
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Nephrology Journal Club @nephjc.bsky.social · 30/09/2026
3/10 One post methods 👥 118 screened → 94 randomized (49 short-course, 45 standard) after hitting remission. 👶Young cohort (mean age 32), MCD/FSGS almost evenly split, ~55% treatment-naive ‼️Noninferiority margin −25% points reflecting how sparse adult data on steroid taper duration
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Nephrology Journal Club @nephjc.bsky.social · 30/09/2026
2/10 What did I miss? 📋 Open-label noninferiority RCT, 2 centers in India (2021–2023) 💊Adults with biopsy-proven MCD or FSGS who hit remission (proteinuria <0.5g/d) on prednisolone were randomized to a 2-month vs 4-month taper
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Nephrology Journal Club @nephjc.bsky.social · 30/09/2026
1/10 #NephJC #TenPosts #NephSly 🫘💊 START your steroids! A question we ask constantly but adult RCT data rarely answers after remission in steroid-sensitive MCD/FSGS, how long should the prednisolone taper actually be? 🧵 www.sciencedirect.com/science/arti...
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Nephrology Journal Club @nephjc.bsky.social · 28/09/2026
Steroids are useful (and have bad side effects) in patients with podocytopathies. Starting is easy, but stopping can be challenging. Are longer courses of steroids better for longer remissions? How quickly do you taper? 🐇🐢 #NephSky #NephJC www.nephjc.com/news/startsteroidtaper
nephjc.com
Why Can’t I Quit You: Steroid Tapering in Adults with Podocytopathies (START) — NephJC
This week, we will discuss the best schedule for tapering steroids in adult patients with podocytopathies (MCD/FSGS).
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Nephrology Journal Club @nephjc.bsky.social · 28/09/2026
El Resumen Visual, gracias @dramiliflores.bsky.social #NephSky #NephJC ¿Cuánto debe durar la reducción gradual de esteroides tras la remisión de una podocitopatía? www.nephjc.com/news/startspanish
nephjc.com
START: El Resumen Visual — NephJC
¿Podemos reducir el uso de esteroides tras la remisión?
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Nephrology Journal Club @nephjc.bsky.social · 28/09/2026
Hey #NephJC 👋 Checkout the VA by @divyaveerssneph.bsky.social This week we're looking at steroid weaning strategies in adults with podocytopathies (MCD/FSGS). 💊Steroids: easy to start🟢 but hard to stop 🛑. #NephSky www.nephjc.com/news/starttrial
nephjc.com
START: The Visual Abstract — NephJC
Can steroid tapering be shorter after remission in adults with sensitive podocytopathy?
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Nephrology Journal Club @nephjc.bsky.social · 15/09/2026
📣Hey #NephSky We just passed 5000 #NephJC Newsletter subscribers Will you be 5001? Also, we can now be found at LinkedIN. So, if you are tired of "the bad place", but don't want to miss the latest, you can follow us there as well! www.nephjc.com/news/nephjc-on-linkedin
nephjc.com
NephJC on LinkedIn — NephJC
NephJC is now more than twelve years old- and it’s amazing to see how far a simple idea has grown. We started with a handful of nephrologists on Twitter (yeah, we still call it that) choosing a paper ...
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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 13/09/2026
You want a ticket to the hottest event of #KidneyWk? www.nephjc.com/news/2026/9/... Consider a donation to the fall #NephJC pledge drive
nephjc.com
2026 NephJC Night in Denver — NephJC
On FRIDAY night, October 23rd, NephJC will host another legendary NephJC Night during ASN Kidney Week
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Nephrology Journal Club @nephjc.bsky.social · 14/09/2026
⏳ Just a bit over one month until #KidneyWk And yes... the legendary #NephJC party is happening again 🎉 🩵Join us, meet the crew, and meet people from across the world 👇Grab your ticket and come be part of the magic www.nephjc.com/news/2026/9/...
nephjc.com
2026 NephJC Night in Denver — NephJC
On FRIDAY night, October 23rd, NephJC will host another legendary NephJC Night during ASN Kidney Week
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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 14/09/2026
recording another episode of @freelyfiltered.bsky.social with special guests @jaykoyner.bsky.social and Rahul Ganatra of @thecurbsiders.bsky.social @kidneyboy.bsky.social @sophia-kidney.bsky.social and Vipin Varghese
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Nephrology Journal Club @nephjc.bsky.social · 08/09/2026
One week to go until #SummerBookClub As Long as the Lemon Trees Grow by Zoulfa Katouh We will have a live chat! Tuesday 9/15/26 at 9pm EST only on Twitter #NephJC #NephSky 📚There's still time to read it and come discuss
static.klipy.com
Simmering Lemon Slices for Syrup
ALT: Simmering Lemon Slices for Syrup
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Nephrology Journal Club @nephjc.bsky.social · 08/09/2026
#NephJC runs on community magic ✨ We choose to stay free and independent and give back to our community for 12yrs 🩵 If our blogs, podcasts, or visuals have helped you, your donation keeps us going - and might get you into the coolest #KidneyWk party www.nephjc.com/news/2026/9/...
nephjc.com
NephJC 2026 Fall Pledge Drive — NephJC
Help keep NephJC a vital, original, and unbiased source of medical education.
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Nephrology Journal Club @nephjc.bsky.social · 02/09/2026
11/10 Up next, we will have a live #NephJC chat! Book Club- As Long as the Lemon Trees Grow by Zoulfa Katouh Join us on Twitter 9pm EST 9/15/26, just like the good old days Hope to see you there.
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Nephrology Journal Club @nephjc.bsky.social · 02/09/2026
10/10 Final thoughts 🌟AI clearly can improve reasoning in nephrology 🌟There`s a gap between AI performance & AI-assisted human performance 🌟AI doesn`t replace nephrologists — but nephrologists who know how to work with AI may have an advantage Thread by @ancast13
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Nephrology Journal Club @nephjc.bsky.social · 02/09/2026
9/10 Want More? 📚 Read the full NephJC discussion 🔗 www.nephjc.com/news/ai-diag... 👀 Check out this great VA by @kiddokidney.bsky.social 🔗https://www.nephjc.com/news/refine-the-visual-abstract
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Nephrology Journal Club @nephjc.bsky.social · 02/09/2026
8/10 #NephJC Consensus ✅ Randomized ✅ Nephrology-specific ✅ Complex multimodal cases 🎯AI assistance improved diagnostic accuracy 🎯GPT-5 alone outperformed AI-assisted docs 🎯AI-induced diagnostic errors were rare 🎯 Promising results, but vignette performance ≠ real-world
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Nephrology Journal Club @nephjc.bsky.social · 02/09/2026
7/10 Question #2 Should AI in nephrology be viewed as a differential-diagnosis generator for clinician verification or an autonomous tool? Do we need better AI models, AI literacy and workflow design? Or do we need better guidelines in using AI in real-world clinical practice?
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Nephrology Journal Club @nephjc.bsky.social · 02/09/2026
6/10 Question #1 If GPT-5 alone had 77.1% accuracy, why did AI-assisted docs only reach 57.5%? When AI was correct & clinicians were initially wrong, more than half still did not adopt the correct diagnosis - why? Would the benefit persist with real-time, interactive LLM?
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Nephrology Journal Club @nephjc.bsky.social · 02/09/2026
5/10 A figure paints 1000 words 🌟The benefit of AI support was remarkably consistent. 👀 🌟GPT-5 assistance improved Top-3 diagnostic accuracy across specialty, experience, certification status, gender, and prior AI use, with no significant subgroup interactions.
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Nephrology Journal Club @nephjc.bsky.social · 02/09/2026
4/10 1️⃣ Post Results 🤖 AI improved diagnostic accuracy: 🔹 Top-3 accuracy: 37.2% ➡️57.5% with AI; aOR 2.8 ( P<0.001) 🔹 AI group accuracy: 25.4% ➡️57.5% after GPT-5 suggestions With AI: 🔹 47.8% of incorrect diagnoses were corrected ⚠️ 1.5% of correct responses became incorrect
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Nephrology Journal Club @nephjc.bsky.social · 02/09/2026
3/10 1️⃣ Post Methods 🔹 Prospective, randomized 1:1- AI-assisted vs standard diagnostic reasoning 🔹 97 docs, 10 complex vignettes 🔹 Participants listed top-3 differential diagnoses + confidence 🔹 AI arm: received pre-generated GPT-5 suggestions & could revise their answers
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Nephrology Journal Club @nephjc.bsky.social · 02/09/2026
2/10 What’d I miss? There isn`t much evidence supporting the use of LLMs in realistic clinical settings, especially in nephrology. No previous randomized trial has tested whether LLM assistance can actually improve diagnostic accuracy in complex nephrology cases.
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Nephrology Journal Club @nephjc.bsky.social · 02/09/2026
1/10 #NephJC #TenPostNephJC Validation of an AI model is difficult. 🤖 Enter the REFINe trial (Reasoning Enhancement With Feedback From a Generative AI in Nephrology), a RCT of large language model (LLM) -assisted diagnostic accuracy in nephrology. www.kireports.org/article/S246...
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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 30/08/2026
The latest @freelyfiltered.bsky.social pod is live www.nephjc.com/freelyfilter... Prof Fervenza with @medpeedskidneys.bsky.social Nat and @kidneyboy.bsky.social Must listen for GN fans
nephjc.com
FF96 MAJESTY, or Mentor Two — NephJC
From 2-year delay to simultaneous publication the journey from MENTOR to MAJESTY
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Nephrology Journal Club @nephjc.bsky.social · 30/08/2026
We'd like to think REFINe tested AI with clinicians, not against them, and accuracy jumped from 37% to 58%, but 1/2 of correct AI nudges were ignored #NephJC 🙌 Teamwork by @ancast13.bsky.social @assadsm.bsky.social @kiddokidney.bsky.social @danyrcal.bsky.social www.nephjc.com/news/ai-diag...
nephjc.com
REFINe-ing AI’s Role in Nephrology Diagnosis — NephJC
This week, we will discuss the use of LLMs for the diagnosis of complex nephrology cases. Can AI help nephrologists nail the correct diagnosis?
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Nephrology Journal Club @nephjc.bsky.social · 30/08/2026
El resumen visual de REFINe (acerca de inteligencia artificial) 🤖🦾 @dramiliflores.bsky.social #NephTwitter #NephJC www.nephjc.com/news/refine-el-resumen-visual
nephjc.com
REFINE: El Resumen Visual — NephJC
¿Puede la IA mejorar la toma de decisiones clínicas en nefrología?
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Nephrology Journal Club @nephjc.bsky.social · 30/08/2026
🤖AI is everywhere 🤖 You will be assimilated! Can the current LLMs help nephrologist diagnose complex nephrology cases? Right out of Sci-Fi movie, it is the REFINe study. VA by @kiddokidney.bsky.social #NephSky #NephJC www.nephjc.com/news/refine-the-visual-abstract
nephjc.com
REFINe: The Visual Abstract — NephJC
Can AI boost clinical decision-making in nephrology?
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Nephrology Journal Club @nephjc.bsky.social · 30/08/2026
Early pressors in ARISE FLUIDS didn't quite arise to the occasion, except for slashing pulmonary edema ✍️ #NephJC short by @dramiliflores.bsky.social www.nephjc.com/news/2026/8/...
nephjc.com
ARISE FLUIDS: Early vasopressors or more fluids in early septic shock? — NephJC
Once a patient with septic shock has received the first liter, what comes next? ARISE FLUIDS reshapes the ED shock strategy before 30 mL/kg: more fluid or earlier vasopressors?
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Nephrology Journal Club @nephjc.bsky.social · 26/08/2026
🚨A New #NephJC short 🩳 The first trial in pregnancy and CKD in 30 years - ORCHARD BEET 🌳 Aiming to test feasibility of nitrate administration in pregnant women with CKD by @nephroseeker.medsky.social #NephSky www.nephjc.com/news/orchard-beet
nephjc.com
Dietary nitrate supplementation in CKD pregnancy — NephJC
First trial in pregnancy and CKD after 30 years - aiming to test feasibility of nitrate administration in pregnant women with CKD
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Nephrology Journal Club @nephjc.bsky.social · 25/08/2026
In our Stone Era 🪨 (PUSH/NO STONE) Maybe we don't have a ➕ RCT, but that doesn't exclude usefulness at the patient level 🤷‍♂️. Listen to the experts on the subtleties of stone treatment, don't be a 🥤nihilist. #NephSky www.nephjc.com/freelyfiltered/2026/8/push www.nephjc.com/freelyfiltered/60/nostone
nephjc.com
FF95 The PUSH trial. Push it real good! — NephJC
PUSH Water to prevent kidney stones…or not
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Nephrology Journal Club @nephjc.bsky.social · 21/08/2026
When our patients start HD, everything gets filtered, except the debate on beta-blocker dialyzability Read #NephJC short about the new target emulation trial, suggesting the non-dialyzables may be doing some heavy MACE-lifting ✍️By @drpallaviprasad.bsky.social nephjc.com/news/targetr...
nephjc.com
Is this the end of the beta-blocker debate in hemodialysis? — NephJC
This week, we will discuss
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Nephrology Journal Club @nephjc.bsky.social · 19/08/2026
11/10 ➡️Up next 01/09/2026: Randomized Controlled Trial of Large Language Model–Assisted Diagnostic Accuracy in Nephrology (KI Report-June 2026) Thread by: @farahwehbe92.bsky.social Join us www.nephjc.com/
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Nephrology Journal Club @nephjc.bsky.social · 19/08/2026
10/10 Final thoughts💡 Always look past the primary endpoint headline! KDIGO is useful, but you must understand drug physiology to read it. MERCURI-2 nearly halved KDIGO AKI, but whether SGLT2is prevent AKI beyond oliguria remains unsettled. The peri-op 👑is still up for grabs.
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Nephrology Journal Club @nephjc.bsky.social · 19/08/2026
9/10 I want more info: Dive into the full breakdown of why we think this trial is "too sweet to be true"on the NephJC blog by @rnflex.bsky.social and @drbarbateba.bsky.social www.nephjc.com/news/2026/8/... and check out the VAs! by @manoleaandreea.bsky.social www.nephjc.com/news/2026/8/...
nephjc.com
Too sweet to be true? Prophylactic SGLT2 inhibitors before cardiac surgery — NephJC
MERCURI-2 reports that dapagliflozin cuts postoperative AKI after cardiac surgery, but the headline result is mostly a urine-output story, not a creatinine one. That matters: urine output after surger...
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Nephrology Journal Club @nephjc.bsky.social · 19/08/2026
8/10 #NephJC Consensus🤝 ✅Strong RCT, ⬇️KDIGO 2012 AKI ⚠️UOP driven, not Cr ⚠️Underpowered for MAKE30; no biomarkers, narrow cohort AKI "win" is UOP driven, not proven nephron protection. Flozins remain undefeated! Promising—not practice-changing, yet
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Nephrology Journal Club @nephjc.bsky.social · 19/08/2026
7/10 Q2❓Practice Changing? Big effect, clean safety – but 97% White, 76% male, and none used SGLT2i at baseline. 1️⃣ Enough to change peri-op practice? 2️⃣ Reassuring safety- or do the null Cr signal + limited generalizability make you hold off?
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Nephrology Journal Club @nephjc.bsky.social · 19/08/2026
6/10 Q1❓ Cr AKI unchanged while UOP AKI fell sharply. Authors argue flozins aren't diuretic after dose 1. 🔎But eGFR dropped MORE with dapa (−7.4 vs −1.75) ? Fits volume loss 1️⃣ Renoprotection, or osmotic diuresis gaming KDIGO? 2️⃣ Stress hyperglycemia driving the UOP?
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Nephrology Journal Club @nephjc.bsky.social · 19/08/2026
5/10 A figure paints🖼️ a 1000 words! Look closer: 🧪”Cr only” AKI was identical (~14% vs ~15%). 🚽”Urine output only” AKI: 21% vs 48% The entire "benefit" of Dapa came from patients peeing more & avoiding the KDIGO UOP threshold. So what exactly are we preventing? 👀
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Nephrology Journal Club @nephjc.bsky.social · 19/08/2026
4/10 Results📊 Headline: Dapa cut AKI from 52%➡️ 28% RR 0.54 (95% CI 0.45–0.65), P<.001➡️ a 46% RRR after just 4 doses🤯 Safety: similar AEs; only 1 DKA case Stage 3 AKI was rare, no differences in MAKE30/MACE30/stay length. But wait..where did that benefit actually come from?👇
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Nephrology Journal Club @nephjc.bsky.social · 19/08/2026
3/10 Methods 🛠️ 🇳🇱 Multicenter, double-blind RCT (n=784) 👥Elective cardiac surgery 💊Dapa 10 mg vs placebo 🗓️Day −1➡️ POD2 (4 doses) 🎯1°outcome: KDIGO AKI ≤ 7days (Cr or UOP) Cohort: 97% White, 76% male, median eGFR 80. 12% T2D. Not our typical high-risk CKD population.
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Nephrology Journal Club @nephjc.bsky.social · 19/08/2026
2/10 What'd I miss?🧐 We usually hold flozins pre-op to avoid ketoacidosis. However, post-op AKI hits up to 50% of patients! MERCURI-2 flipped the script: could 4 perioperative doses of Dapa (day before to POD 2) prevent AKI? Too sweet to be true? Keep reading👇
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