Nephrology

CREDENCE post-hoc supports continuing canagliflozin when eGFR falls below 20

Among 4401 CREDENCE participants with diabetic CKD, 10.1% developed eGFR <20 ml/min/1.73 m² during follow-up. These patients had markedly higher absolute risk of the primary kidney–cardiovascular composite outcome than those who remained above this threshold. Canagliflozin reduced the primary outcome risk both in patients who did and did not cross <20 ml/min/1.73 m², with no significant interaction. Adverse events were higher in those with very low eGFR overall but similar between canagliflozin and placebo regardless of eGFR decline. Findings support continuing SGLT2 inhibition in advanced diabetic CKD until dialysis or transplantation, absent other contraindications. 1

Prospective AKI cohort: IV contrast did not impair renal recovery or outcomes

This prospective observational study followed 481 hospitalized adults with AKI undergoing CT with or without intravenous contrast. After inverse probability weighting, 7-day renal recovery was not worse with contrast and was numerically higher than in non-contrast patients. Secondary outcomes, including 72-hour improvement, dialysis requirement, length of stay, and in-hospital mortality, were similar between groups. Higher AKI stage and acute tubular injury, not contrast exposure, predicted poorer renal recovery. Data support using contrast-enhanced CT in selected AKI patients when diagnostic yield is critical, with careful clinical judgment. 2

Desidustat achieves substantial hemoglobin gains in non-dialysis CKD anemia

In this phase III double-blind trial, 152 anemic non-dialysis CKD patients were randomized to desidustat or placebo. By weeks 7–9, desidustat increased hemoglobin from about 89 g/L to 106 g/L, whereas placebo hemoglobin slightly decreased. Mean hemoglobin difference versus placebo was roughly 18 g/L, with higher response rates and better target-range maintenance on desidustat. Treatment-emergent adverse event rates were comparable between groups over nine weeks. Desidustat rapidly corrected anemia and reduced hepcidin early, supporting HIF-PHI use as an ESA alternative pending long-term safety data. 3

Ethanol lock therapy improves salvage of infected tunneled hemodialysis catheters

This randomized trial enrolled 84 hemodialysis patients with suspected or confirmed tunneled catheter-related bloodstream infection. Patients received intravenous antibiotics alone or plus 70% ethanol lock therapy instilled into the catheter. Day-7 catheter salvage was higher with ethanol locks than antibiotics alone (78.6% vs 57.1%; P = .035). CRBSI recurrence by day 60 was significantly lower with ethanol (20.5% vs 53.7%; P = .002), with more frequent fever resolution. Adverse events were infrequent and mild, supporting ethanol locks as a practical adjunct in catheter salvage protocols. 4