Ah that’s basically what you said, sorry I misread the first time.
July 16, 2025 at 10:10 PM
Ah that’s basically what you said, sorry I misread the first time.
@rnflex.bsky.social my hope is that with all the new ones in the pipeline, they all become cheaper (especially a single receptor target like semaglutide) and more accessible.
July 16, 2025 at 10:09 PM
@rnflex.bsky.social my hope is that with all the new ones in the pipeline, they all become cheaper (especially a single receptor target like semaglutide) and more accessible.
Does he have two Adam’s apples?
June 7, 2025 at 5:35 PM
Does he have two Adam’s apples?
This is a great slide, thank you for this. Do you know the status of dexfadro? Is it going to get a phase 3 or has it been abandoned? I searched around and couldn’t find any indication either way.
#NephJC
#NephJC
May 28, 2025 at 2:57 AM
This is a great slide, thank you for this. Do you know the status of dexfadro? Is it going to get a phase 3 or has it been abandoned? I searched around and couldn’t find any indication either way.
#NephJC
#NephJC
Reposted by Rob Weber
Theoretically:
- it targets the primary issue in many patients- unregulated aldosterone production.
-avoid effect of further elevated Aldo during MRA treatment
Obvs -avoid gynecomastia and off-target effects of Spiro.
For other MRAs it has always been difficult to push dose high enough.
#NephJC
- it targets the primary issue in many patients- unregulated aldosterone production.
-avoid effect of further elevated Aldo during MRA treatment
Obvs -avoid gynecomastia and off-target effects of Spiro.
For other MRAs it has always been difficult to push dose high enough.
#NephJC
May 28, 2025 at 1:54 AM
Theoretically:
- it targets the primary issue in many patients- unregulated aldosterone production.
-avoid effect of further elevated Aldo during MRA treatment
Obvs -avoid gynecomastia and off-target effects of Spiro.
For other MRAs it has always been difficult to push dose high enough.
#NephJC
- it targets the primary issue in many patients- unregulated aldosterone production.
-avoid effect of further elevated Aldo during MRA treatment
Obvs -avoid gynecomastia and off-target effects of Spiro.
For other MRAs it has always been difficult to push dose high enough.
#NephJC
Reposted by Rob Weber
May 28, 2025 at 1:43 AM
Totally. Someone should do the economic analysis. Spiro is dirt cheap, I’m sure these new ones will be out of control. Osilidrostat is not even selective (blocks both aldo and cortisol) and it costs our hospital something like $100,000 a year.
May 28, 2025 at 2:14 AM
Totally. Someone should do the economic analysis. Spiro is dirt cheap, I’m sure these new ones will be out of control. Osilidrostat is not even selective (blocks both aldo and cortisol) and it costs our hospital something like $100,000 a year.
There was this spiro study where only CKD 3B was enrolled. Based on intention to treat analysis, no difference between placebo and spiro 25 because many could not tolerate the spiro. In my mind this and worse GFR is where ASIs could be helpful.
www.nature.com/articles/s41...
www.nature.com/articles/s41...
Low-dose spironolactone and cardiovascular outcomes in moderate stage chronic kidney disease: a randomized controlled trial - Nature Medicine
A randomized controlled trial involving patients with stage 3b chronic kidney disease from primary care reported that in contrast to reported cardiorenal protective effects of nonsteroidal mineralocor...
www.nature.com
May 28, 2025 at 2:11 AM
There was this spiro study where only CKD 3B was enrolled. Based on intention to treat analysis, no difference between placebo and spiro 25 because many could not tolerate the spiro. In my mind this and worse GFR is where ASIs could be helpful.
www.nature.com/articles/s41...
www.nature.com/articles/s41...
In RALES (spiro trial for HF, only 25 mg) 10% gynecomastia, in EPHESUS (eplerenone) 0.5%.
May 28, 2025 at 2:06 AM
In RALES (spiro trial for HF, only 25 mg) 10% gynecomastia, in EPHESUS (eplerenone) 0.5%.
I’m not sure….as far as I know, the blood vessel and cytokine effect is still mediated by MR in mice and in cells. Theoretically spiro should block it. I’m can’t tell you I know the clinical data on this though.
May 28, 2025 at 2:00 AM
I’m not sure….as far as I know, the blood vessel and cytokine effect is still mediated by MR in mice and in cells. Theoretically spiro should block it. I’m can’t tell you I know the clinical data on this though.
Are they still toxic if you block their receptor?
May 28, 2025 at 1:55 AM
Are they still toxic if you block their receptor?
Whenever I’ve interacted with Dr. Coleman (usually in a rapid or code situation) she is invariably a force of measured calm and moving things in the right direction. She’s a gem in our hospital.
April 17, 2025 at 8:56 PM
Whenever I’ve interacted with Dr. Coleman (usually in a rapid or code situation) she is invariably a force of measured calm and moving things in the right direction. She’s a gem in our hospital.
The remaining 10% being genetic/familial causes (which would also be bilateral….)
pubmed.ncbi.nlm.nih.gov/30255616/
pubmed.ncbi.nlm.nih.gov/30255616/
Diagnosis and treatment of primary aldosteronism: practical clinical perspectives - PubMed
Primary aldosteronism (PA), the most common form of secondary hypertension, can be either surgically cured or treated with targeted pharmacotherapy. PA is frequently undiagnosed and untreated, leading...
pubmed.ncbi.nlm.nih.gov
April 15, 2025 at 12:28 AM
The remaining 10% being genetic/familial causes (which would also be bilateral….)
pubmed.ncbi.nlm.nih.gov/30255616/
pubmed.ncbi.nlm.nih.gov/30255616/
According to Bill Young at Mayo (in various recent reviews) he says it’s the opposite: 60% bilateral, 30% unilateral. I’ve scoured his references though and I’m unsure from what data he is pulling that from.
Anecdotally, that matches with what I’ve seen in clinic.
Anecdotally, that matches with what I’ve seen in clinic.
April 15, 2025 at 12:26 AM
According to Bill Young at Mayo (in various recent reviews) he says it’s the opposite: 60% bilateral, 30% unilateral. I’ve scoured his references though and I’m unsure from what data he is pulling that from.
Anecdotally, that matches with what I’ve seen in clinic.
Anecdotally, that matches with what I’ve seen in clinic.