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hswapnil.medsky.social
Swapnil Hiremath 🍁🇨🇦
@hswapnil.medsky.social
5.5K followers 3.1K following 3.5K posts
Nephrologist = kidney doctor
MD, MPH
Professor, University of Ottawa/Ottawa Hospital 🇨🇦
He/Him/His
#NephJC co-creator, @FreelyFiltered.bsky.social pod panelist
#NephSky
https://www.swapnilhiremath.com
Posts Replies Media Videos
hswapnil.medsky.social
Happening tomorrow!

Imlifidase for highly sensitized kidney transplant candidates

Dominique Bertrand from Rouen

#NephGR #NephSky
splash
November 13, 2025 at 1:40 AM
hswapnil.medsky.social
Even in the Albuminuria as Surrogate papers pubmed.ncbi.nlm.nih.gov/30635226/ from 2019, the lack of change in Albuminuria despite remission with IS in GN was noticeable (eg Albuminuria = scarring sometimes and not active disease)

3/
From lancet MA showing with immunosuppression in GN, clinical outcome may happen despite lack of Albuminuria lowering
November 12, 2025 at 3:30 PM
hswapnil.medsky.social
Pasta 🍝 tariffs?

In the @wsj.com apple.news/AGRDGheVXS_G...

And private equity (which own the US pasta makers) in involved
The department said it was punishing them because they were “uncooperative” with its investigation, citing problems with their documentation including untranslated Italian words, undefined acronyms and failure to provide requested information. It applied the hefty tariff to all 13 Italian companies based on the assumption that the behavior of La Molisana and Garofalo is representative of the group as a whole.  The outraged Italians say they responded just as in past reviews, and that what has changed is that the Commerce Department has suddenly become stricter.  People with knowledge of the case also say the Commerce Department assigned new analysts to scrutinize the filings who had little understanding of Italian accounting practices, leading the agency to view the companies as noncooperative. The Trump administration didn’t respond to questions about the analysts on the case.  “This is the first time in 30 years that we are encountering this kind of intransigence,” said Massarelli, who is working on the antidumping cases. “It is absolutely not true that we weren’t collaborative. Mistakes can happen, in good faith.” 
November 10, 2025 at 11:05 AM
hswapnil.medsky.social
And the causes of death are heart failure, sudden death, infections- how would fish oil impact those in such a huge way?

It is all a bit puzzling

See @nephroseeker.medsky.social beautiful VA till then

#KidneyWk
PISCES VA
November 9, 2025 at 11:49 AM
hswapnil.medsky.social
Will we get more simultaneous publications this year than last year at #KidneyWk?

We had 16 last year

@brendonneuen.bsky.social
@nephroseeker.medsky.social

Will thread all later - but the #NephJC blog will have them all
Last year tally
November 8, 2025 at 11:19 PM
hswapnil.medsky.social
And in the evening
- a CAR T in refractory SLE
- a PKD trial
- increasing PD in Vets
- Povetacicept in IgA
- TESTING Longterm term data
- what do the AHA/ACC BP guidelines mean?

#KidneyWk
LBRO
November 8, 2025 at 2:11 PM
hswapnil.medsky.social
Today’s LBCTs and late breaking science!

Morning:
- an Alport trial!
- Telitacicept
- REGENCY biopsy data
- Vitamin R updated in Membranous
- another sibeprenlimab slice
- Balcinrenine + Dapa in CKD

#KidneyWk
LBCT session
November 8, 2025 at 2:11 PM
hswapnil.medsky.social
And paper 3 from @cervantes-lily1.bsky.social

On adaptation of the Navigate Kidney intervention in @kireports.bsky.social

www.kireports.org/article/S246...

#KidneyWk
Figure 1 ADAPT steps. CHW, community health worker; CSC, community steering committee.
November 8, 2025 at 1:24 AM
hswapnil.medsky.social
In the afternoon another late breaking oral session among other things at 4:30 pm

@brendonneuen.bsky.social
Lorundrostat
A new oral GLP1
REMODEL to understand sema mechanism
GBD kidney disease with @paddymark.bsky.social
And
@cervantes-lily1.bsky.social !

#KidneyWk
LBRO 2
November 7, 2025 at 10:39 AM
hswapnil.medsky.social
Today’s trials at #KidneyWk

In the morning a LBCT session at 10:30

featuring
PISCES (fish oil in dialysis!)
LIBERATE in AKI
Another AKI alerts from @fperrywilson.bsky.social
A Transplant trial
GLP1 and a Flozin analyses

And
HIT 1
November 7, 2025 at 10:39 AM
hswapnil.medsky.social
These are the

ERA 2024 (Stockholm)
And
ERA 2025 (Vienna) stats

Inching close to typical #KidneyWk numbers (~ 12000 usually, will see what is reported for 2025 Houston)
ERA 2024 ERA 2025
November 7, 2025 at 12:46 AM
hswapnil.medsky.social
large cohort study of
CDK 4/6
BRAF
EGFR
VEGF
and other cancer treatments

#OncoNephrology #NephSky #KidneyWk

jamanetwork.com/journals/jam... from Shuchi Anand et al from @stanfordmedicine.bsky.social
The subdistribution hazard ratios for progressive kidney dysfunction are shown for each drug group compared with their respective propensity score–matched cohort. The blue dots represent the hazard ratio and 95% CIs. Due to wide confidence intervals, MET inhibitors results reported in the text and not displayed here. MET inhibitors are included in overall treated group. Model is adjusted for hypertension, diabetes, ischemic heart disease, congestive heart failure, chronic obstructive pulmonary disease, cirrhosis, age, sex, race, body mass index, and eGFR before drug start. ALK indicates anaplastic lymphoma kinase; BRAF, B-Raf proto-oncogene, serine/threonine kinase; CDK4/6, cyclin dependent kinase 4 or 6; EGFR, endothelial growth factor receptor; ERBB2, human epidermal growth factor receptor 2; PARP, poly(adenosine diphosphate-ribose) polymerase; VEGFR, vascular endothelial growth factor receptor.
November 6, 2025 at 10:30 PM
hswapnil.medsky.social
Don’t forget the late breaking research oral session at 4:30 pm in Grand Ballroom C this afternoon

@jaykoyner.bsky.social
Hiddo again
Sankar Navaneethan
James Burton
@areefishani.bsky.social
And more!

#KidneyWk
November 6, 2025 at 6:33 PM
hswapnil.medsky.social
Eli Lilly continuing to hit it out the park

Selective amylin agonist as an alternative to GLP1RAs? #eloralintide

www.thelancet.com/journals/lan... in @thelancet.com

(Yeah I know it’s #KidneyWk but what do we do till Houston wakes up!)

cc @rnflex.bsky.social
Figure 2. Change in bodyweight (A) Mean percent change in bodyweight from baseline to week 48, shown as observed means and bars indicating SEs. The model-based estimates of the mean percent change in bodyweight and differences among treatment groups at week 48 with the corresponding p values (efficacy estimand only) and 95% CIs are shown in (B) (efficacy estimand) and (D) (treatment-regimen estimand); bars indicate SEs. Multiplicity adjustment was not performed, and p values should be interpreted as exploratory. (C) shows the percentage of participants with bodyweight reductions of at least 5%, 10%, 15%, 20%, 25%, and 30% from baseline to week 48. The percentage of participants is annotated above each bar, calculated with the use of Rubin's rules by combining the percentages of participants who met the thresholds in imputed datasets. *The model-based estimates and 95% CIs from a mixed model repeated measures analysis for the efficacy estimand are shown on the right, denoted by 48.
November 6, 2025 at 1:54 PM
hswapnil.medsky.social
Guess some of these guys don’t work with Flozinators like @christosargyrop.bsky.social or @kidneyboy.bsky.social to feel that all we do is ‘supportive care’

Nephrologists please stop being mere dialysis-ologists

SMH

#NephSky
Poor experience in fellowship
November 6, 2025 at 12:44 PM
hswapnil.medsky.social
One of these figures is not like the other 🤔

#NephSky
Fellows bitching about workload and poor compensation Stating pay ~ 250Κ Base salary by hospital/academia
November 6, 2025 at 12:44 PM
hswapnil.medsky.social
Salient points:
~ 10% H visas
~ 25% J visas

Overall
~ third South Asian
~ 40% women

#NephSky #KidneyWk
Table 1
November 6, 2025 at 12:44 PM
hswapnil.medsky.social
#KidneyWk attendees

Please check out your outgoing flights

Both Houston airports included in list of flight reductions

Full list:
abcnews.go.com/US/flight-ca...
List of airports with flight reductions
November 6, 2025 at 11:41 AM
hswapnil.medsky.social
Machine perfusion is better than just cold storage for kidneys

10 year follow up of the original 2009 trial in the @nejm.org

www.nejm.org/doi/full/10....

#NephSky #KidneyWk
Graft survival over 10 years
November 5, 2025 at 10:37 PM
hswapnil.medsky.social
Trials coming out already!

jamanetwork.com/journals/jam...

Rituximab better than placebo in FRNS/SDNS

Duh.

#KidneyWk #NephSky
Visual abstract
November 5, 2025 at 8:33 PM
hswapnil.medsky.social
From @carolyntan.bsky.social

This is a work of art

Have to agree that amlodipine and gabapentin/pregabalin often lead to heart failure misdiagnosis

#MedSky #PharmSky

h/t @davidjuurlink.bsky.social and @jbrianbyrd.bsky.social
Description of a prescription cascade, when an initial prescription for pregabalin or amlodipine causes leg oedema leading to addition of furosemide which causes urinary incontinence. This leads to a RX for Solifenacin which causes cognitive decline and a prescription for Don Pascale. The subsequent anorexia and an insomnia leads to mirtazapine prescription and a hip fracture from a fall. This of course leads to many other cascades, including delirium, haloperidol and levodopa, risedronate, and pantoprazole, or iron and constipation with peg.
November 4, 2025 at 11:31 PM
hswapnil.medsky.social
Oooh - this is a dangerous recall

KCl 20 mmol labelled as 10 mmol from the overwrap

#nephsky #pharmsky #emimcc

www.fda.gov/safety/recal...
TOPIC: 20 mEq Potassium Chloride Injection by Otsuka ICU Medical: Recall - Due To Overwrap Mislabeled As 10 mEq Potassium Chloride Injection AUDIENCE: Patient, Health Care Professional, Pharmacy ISSUE: Otsuka ICU Medical is recalling for a MISLABELED lot of POTASSIUM CHLORIDE Inj. 20 mEq, NDC 0990-7077-14. The OVERWRAP label of lot 1030613, Expiration Date: 09-30-2026 may incorrectly identify the product as POTASSIUM CHLORIDE Inj. 10 mEq with NDC 0990-7074-26. Otsuka ICU Medical has identified this discrepancy due to a manufacturing issue. The dosage is correctly printed on the labeling affixed to the product bag which is not visible when the 10 mEq OVERWRAP is in place. This notification details the issue and the required steps for you to perform. If the incorrect dosage on the 10 mEq overwrap is used instead of the correct 20mEq dosage printed on the product, an overdose of potassium chloride is possible. Overdose of potassium chloride can lead to hyperkalemia. Hazards of severe hyperkalemia after large intravenous overdoses causes neuromuscular dysfunction including muscle weakness, ascending paralysis, listlessness, vertigo, mental confusion, hypotension, cardiac dysrhythmias, or death from cardiac arrest. Premature infants, patients on chronic parenteral nutrition, patients who have a history of cardiac arrythmias, patients with chronic renal insufficiency, patients who have acute renal failure, patients on potassium-sparing diuretics—all are at risk for adverse and potentially fatal outcomes. The affected product lot was manufactured on 15 April 2025 and distributed in the United States between 23 May 2025 through 26 August 2025. Otsuka ICU Medical LLC has not received reports of adverse events associated with this issue to date.
November 4, 2025 at 12:01 PM
hswapnil.medsky.social
Natural history of RRT from the ERA registry

The visual abstract in this case tells a lot

academic.oup.com/ndt/advance-...

@ndt-era.bsky.social #NephSky
Visual abstract Sad story reflecting that most people start with HD and most of them die
November 4, 2025 at 1:39 AM
hswapnil.medsky.social
It’s funny to have Cochrane & WHO do such work

This recently dropped news.gallup.com/poll/696599/...

It’s mind boggling that there is no push to accelerate access to these drugs
Drop in US obesity rates
November 3, 2025 at 11:23 PM
hswapnil.medsky.social
And more from WSJ

apple.news/AVFxtD7xOTBG...

Just does seem like a personal vendetta - which is par for course for this admin, so his firing seems a more principled stance

#Voclosporin #FDA
he unusual LinkedIn post followed years of antagonism from Tidmarsh directed at Aurinia board chair Kevin Tang, who once pushed Tidmarsh out of a chief executive role at a different company, the lawsuit alleged.  Tang, a pharmaceutical investor, and Tidmarsh first clashed in 2019 when, according to the lawsuit, Tang asked Tidmarsh to resign as CEO from La Jolla Pharmaceutical, where Tang was board chair. Tidmarsh stepped down, and a company press release from the time said Tidmarsh was leaving to “pursue other interests.” Tang declined to comment. Over the next several years, Tidmarsh sent a series of spiteful messages to Tang and his business associates, the lawsuit said. “You will be exposed,” he wrote in one text message to Tang quoted in the complaint. “Are you enjoying failure? Get used to it,” he wrote in another message included in the complaint. Tidmarsh met Makary at a conference last October and helped prepare Dr. Jay Bhattacharya for his confirmation as National Institutes of Health director, he said in an FDA video this year. He was “working with the new FDA,” he said in a LinkedIn post in November, to remove from the market desiccated thyroid extracts, a product critical to another company led by Tang, American Laboratories Holdings. “I’m not powerless,” he told Tang in another message in December, according to the complaint. Tidmarsh had previously worked as a director at American Laboratories from 2015 to around 2019. Between 2018 and 2025 the company paid him more than $22.5 million, according to the lawsuit. In August, after Tidmarsh started work at the FDA, the agency warned patients away from the thyroid extracts and said it would take action against the products. That same month, according to the complaint, Tidmarsh’s personal lawyer, Galda, emailed Tang: “It is my understanding,” he wrote, that American Laboratories “may have issues that require” extending for another 10 years an agreement between the company and Tidmarsh. Under the agreement, Tidmarsh had been receiving payments from the company for past services, and when he joined the FDA rerouted those payments to a limited liability corporation benefiting his sons to comply with ethics rules, according to an email included in the complaint
November 3, 2025 at 5:03 PM