Swapnil Hiremath 🍁🇨🇦
@hswapnil.medsky.social
Nephrologist = kidney doctor
MD, MPH
Professor, University of Ottawa/Ottawa Hospital 🇨🇦
He/Him/His
#NephJC co-creator; @FreelyFiltered.bsky.social pod panelist; KICR EiC
https://www.swapnilhiremath.com
MD, MPH
Professor, University of Ottawa/Ottawa Hospital 🇨🇦
He/Him/His
#NephJC co-creator; @FreelyFiltered.bsky.social pod panelist; KICR EiC
https://www.swapnilhiremath.com
Pinned
If you are a nephrology or kidney disease or renal professional or interested in the field - make sure you have liked/followed/pinned the nephrology feed
bsky.app/profile/did:...
Thanks again to @richardferro.xyz for creating & updating this! It’s a one-stop shop for nephrology needs
#NephSky
bsky.app/profile/did:...
Thanks again to @richardferro.xyz for creating & updating this! It’s a one-stop shop for nephrology needs
#NephSky
Update
Link changed (will not change again)
So if you liked/pinned the old feed, please do it again!
bsky.app/profile/did:...
#NephSky
Link changed (will not change again)
So if you liked/pinned the old feed, please do it again!
bsky.app/profile/did:...
#NephSky
Reposted by Swapnil Hiremath 🍁🇨🇦
T2e
Turning to kidney function — the most consistent physiologic effect.
Using iohexol clearance, dapagliflozin caused an acute dip in measured GFR.
The placebo-adjusted mGFR decline was:
– 4.2 ml/min/1.73 m² at 1 week
– 3.5 ml/min/1.73 m² at 12 weeks
#NephJC
Turning to kidney function — the most consistent physiologic effect.
Using iohexol clearance, dapagliflozin caused an acute dip in measured GFR.
The placebo-adjusted mGFR decline was:
– 4.2 ml/min/1.73 m² at 1 week
– 3.5 ml/min/1.73 m² at 12 weeks
#NephJC
February 11, 2026 at 2:36 AM
T2e
Turning to kidney function — the most consistent physiologic effect.
Using iohexol clearance, dapagliflozin caused an acute dip in measured GFR.
The placebo-adjusted mGFR decline was:
– 4.2 ml/min/1.73 m² at 1 week
– 3.5 ml/min/1.73 m² at 12 weeks
#NephJC
Turning to kidney function — the most consistent physiologic effect.
Using iohexol clearance, dapagliflozin caused an acute dip in measured GFR.
The placebo-adjusted mGFR decline was:
– 4.2 ml/min/1.73 m² at 1 week
– 3.5 ml/min/1.73 m² at 12 weeks
#NephJC
Reposted by Swapnil Hiremath 🍁🇨🇦
T2f
Creatinine-based eGFR showed directionally similar changes, closely mirroring the early hemodynamic dip seen in native-kidney SGLT2i trials.
Crucially, this GFR dip was not accompanied by harm:
❌ No excess AKI
❌ No biochemical instability
❌ No signal for acute rejection
#NephJC
Creatinine-based eGFR showed directionally similar changes, closely mirroring the early hemodynamic dip seen in native-kidney SGLT2i trials.
Crucially, this GFR dip was not accompanied by harm:
❌ No excess AKI
❌ No biochemical instability
❌ No signal for acute rejection
#NephJC
February 11, 2026 at 2:37 AM
T2f
Creatinine-based eGFR showed directionally similar changes, closely mirroring the early hemodynamic dip seen in native-kidney SGLT2i trials.
Crucially, this GFR dip was not accompanied by harm:
❌ No excess AKI
❌ No biochemical instability
❌ No signal for acute rejection
#NephJC
Creatinine-based eGFR showed directionally similar changes, closely mirroring the early hemodynamic dip seen in native-kidney SGLT2i trials.
Crucially, this GFR dip was not accompanied by harm:
❌ No excess AKI
❌ No biochemical instability
❌ No signal for acute rejection
#NephJC
Reposted by Swapnil Hiremath 🍁🇨🇦
T1b
Participants were stable kidney transplant recipients, ≥6 months post-transplant.
Initially restricted to patients with diabetes, eligibility was later expanded to non-diabetic recipients after publication of DAPA-CKD. #NephJC
Participants were stable kidney transplant recipients, ≥6 months post-transplant.
Initially restricted to patients with diabetes, eligibility was later expanded to non-diabetic recipients after publication of DAPA-CKD. #NephJC
February 11, 2026 at 2:19 AM
T1b
Participants were stable kidney transplant recipients, ≥6 months post-transplant.
Initially restricted to patients with diabetes, eligibility was later expanded to non-diabetic recipients after publication of DAPA-CKD. #NephJC
Participants were stable kidney transplant recipients, ≥6 months post-transplant.
Initially restricted to patients with diabetes, eligibility was later expanded to non-diabetic recipients after publication of DAPA-CKD. #NephJC
Reposted by Swapnil Hiremath 🍁🇨🇦
T0b
The dominant drivers of late graft failure and death are:
❤️ Cardiovascular disease (Death with a functioning graft) ⛔ Progressive graft failure from immune and non-immune injury. #NephJC
The dominant drivers of late graft failure and death are:
❤️ Cardiovascular disease (Death with a functioning graft) ⛔ Progressive graft failure from immune and non-immune injury. #NephJC
February 11, 2026 at 2:08 AM
T0b
The dominant drivers of late graft failure and death are:
❤️ Cardiovascular disease (Death with a functioning graft) ⛔ Progressive graft failure from immune and non-immune injury. #NephJC
The dominant drivers of late graft failure and death are:
❤️ Cardiovascular disease (Death with a functioning graft) ⛔ Progressive graft failure from immune and non-immune injury. #NephJC
Reposted by Swapnil Hiremath 🍁🇨🇦
T0i
So here comes the quintessential, key unanswered question:
👉 Do SGLT2 inhibitors exert similar, altered, or entirely different physiologic effects in kidney transplant recipients—and more importantly are they safe? 📉 📈
#NephJC
So here comes the quintessential, key unanswered question:
👉 Do SGLT2 inhibitors exert similar, altered, or entirely different physiologic effects in kidney transplant recipients—and more importantly are they safe? 📉 📈
#NephJC
February 11, 2026 at 2:15 AM
T0i
So here comes the quintessential, key unanswered question:
👉 Do SGLT2 inhibitors exert similar, altered, or entirely different physiologic effects in kidney transplant recipients—and more importantly are they safe? 📉 📈
#NephJC
So here comes the quintessential, key unanswered question:
👉 Do SGLT2 inhibitors exert similar, altered, or entirely different physiologic effects in kidney transplant recipients—and more importantly are they safe? 📉 📈
#NephJC
Reposted by Swapnil Hiremath 🍁🇨🇦
Reposted by Swapnil Hiremath 🍁🇨🇦
T0g
However, kidney transplant recipients have been excluded from all major SGLT2i outcome trials—creating a major evidence gap. For better (overly cautious) or worse, we have limited safety and efficacy data for renal transplant patients. #NephJC
However, kidney transplant recipients have been excluded from all major SGLT2i outcome trials—creating a major evidence gap. For better (overly cautious) or worse, we have limited safety and efficacy data for renal transplant patients. #NephJC
February 11, 2026 at 2:13 AM
T0g
However, kidney transplant recipients have been excluded from all major SGLT2i outcome trials—creating a major evidence gap. For better (overly cautious) or worse, we have limited safety and efficacy data for renal transplant patients. #NephJC
However, kidney transplant recipients have been excluded from all major SGLT2i outcome trials—creating a major evidence gap. For better (overly cautious) or worse, we have limited safety and efficacy data for renal transplant patients. #NephJC
Reposted by Swapnil Hiremath 🍁🇨🇦
T0h
Transplanted kidneys are physiologically distinct from native kidneys.
Denervated, exposed to calcineurin inhibitors, and characterized by altered sodium handling and vascular tone are just a few of the significant differences.
Can you think of others?
#NephJC
Transplanted kidneys are physiologically distinct from native kidneys.
Denervated, exposed to calcineurin inhibitors, and characterized by altered sodium handling and vascular tone are just a few of the significant differences.
Can you think of others?
#NephJC
February 11, 2026 at 2:14 AM
T0h
Transplanted kidneys are physiologically distinct from native kidneys.
Denervated, exposed to calcineurin inhibitors, and characterized by altered sodium handling and vascular tone are just a few of the significant differences.
Can you think of others?
#NephJC
Transplanted kidneys are physiologically distinct from native kidneys.
Denervated, exposed to calcineurin inhibitors, and characterized by altered sodium handling and vascular tone are just a few of the significant differences.
Can you think of others?
#NephJC
Reposted by Swapnil Hiremath 🍁🇨🇦
⚡INTRODUCTION: ⚡
T0a
Welcome to #NephJC !
Let’s start with the big picture.
Transplantation remains the best RRT for survival and quality of life. Yet long-term graft survival has plateaued, with ~50% graft loss by 10 years.
T0a
Welcome to #NephJC !
Let’s start with the big picture.
Transplantation remains the best RRT for survival and quality of life. Yet long-term graft survival has plateaued, with ~50% graft loss by 10 years.
February 11, 2026 at 2:07 AM
⚡INTRODUCTION: ⚡
T0a
Welcome to #NephJC !
Let’s start with the big picture.
Transplantation remains the best RRT for survival and quality of life. Yet long-term graft survival has plateaued, with ~50% graft loss by 10 years.
T0a
Welcome to #NephJC !
Let’s start with the big picture.
Transplantation remains the best RRT for survival and quality of life. Yet long-term graft survival has plateaued, with ~50% graft loss by 10 years.
Reposted by Swapnil Hiremath 🍁🇨🇦
📰Check out the insightful summary by Sai vani Yellampalli Dr SaiVani Yellampalli
Bogdan Agavriloaei Bogdan Agavriloaei and me Akshaya Jayachandran
#NephJC
www.nephjc.com/news/...
To INFINITI and Beyond: SGLT2 Inhibitors in Kidney Transplant Patients — NephJC
Bogdan Agavriloaei Bogdan Agavriloaei and me Akshaya Jayachandran
#NephJC
www.nephjc.com/news/...
To INFINITI and Beyond: SGLT2 Inhibitors in Kidney Transplant Patients — NephJC
February 11, 2026 at 2:02 AM
📰Check out the insightful summary by Sai vani Yellampalli Dr SaiVani Yellampalli
Bogdan Agavriloaei Bogdan Agavriloaei and me Akshaya Jayachandran
#NephJC
www.nephjc.com/news/...
To INFINITI and Beyond: SGLT2 Inhibitors in Kidney Transplant Patients — NephJC
Bogdan Agavriloaei Bogdan Agavriloaei and me Akshaya Jayachandran
#NephJC
www.nephjc.com/news/...
To INFINITI and Beyond: SGLT2 Inhibitors in Kidney Transplant Patients — NephJC
Reposted by Swapnil Hiremath 🍁🇨🇦
Reposted by Swapnil Hiremath 🍁🇨🇦
The simplest rule is to be kind and inclusive while you use your wit! Here are #NephJC values, summarized by Sinead Stoneman
February 11, 2026 at 2:01 AM
The simplest rule is to be kind and inclusive while you use your wit! Here are #NephJC values, summarized by Sinead Stoneman
February 11, 2026 at 2:00 AM
Reposted by Swapnil Hiremath 🍁🇨🇦
Assuming its #TulipTuesday, some Tulips from 2024 - around Parliament Hill and Major Hill’s Park
#FlowerSky 🌷
#FlowerSky 🌷
February 11, 2026 at 1:57 AM
Assuming its #TulipTuesday, some Tulips from 2024 - around Parliament Hill and Major Hill’s Park
#FlowerSky 🌷
#FlowerSky 🌷
concerns about flozinating in kidney transplant include:
- non hyperfiltration mechanism of injury (eg immunological + calcineurin induced)
- risk of infections - especially given short urinary tract + immunosuppression
we really need good data &. o extrapolation - let’s discuss tonight #NephJC
- non hyperfiltration mechanism of injury (eg immunological + calcineurin induced)
- risk of infections - especially given short urinary tract + immunosuppression
we really need good data &. o extrapolation - let’s discuss tonight #NephJC
February 11, 2026 at 1:50 AM
concerns about flozinating in kidney transplant include:
- non hyperfiltration mechanism of injury (eg immunological + calcineurin induced)
- risk of infections - especially given short urinary tract + immunosuppression
we really need good data &. o extrapolation - let’s discuss tonight #NephJC
- non hyperfiltration mechanism of injury (eg immunological + calcineurin induced)
- risk of infections - especially given short urinary tract + immunosuppression
we really need good data &. o extrapolation - let’s discuss tonight #NephJC
Reposted by Swapnil Hiremath 🍁🇨🇦
⏰30 min before the #NephJC chat
There has been limited research on SGLT2i in renal transplant recipients till date, and this is the compilation of currently available data. #NephJC
Are you pumped to know how and how well #Flozins work in transplanted patients?
Let's deep dive in a few minutes!
There has been limited research on SGLT2i in renal transplant recipients till date, and this is the compilation of currently available data. #NephJC
Are you pumped to know how and how well #Flozins work in transplanted patients?
Let's deep dive in a few minutes!
February 11, 2026 at 1:30 AM
Reposted by Swapnil Hiremath 🍁🇨🇦
Yes. That is a bog standard vaccine trial! And 43,000 people basically leaves zero doubt about efficacy AND safety.
Oral semaglutide for weight loss was just approved with 205 patients! I get that it's had many many other trials as an injection but that's some hypocritical bullshit from the FDA
Oral semaglutide for weight loss was just approved with 205 patients! I get that it's had many many other trials as an injection but that's some hypocritical bullshit from the FDA
February 11, 2026 at 12:16 AM
Yes. That is a bog standard vaccine trial! And 43,000 people basically leaves zero doubt about efficacy AND safety.
Oral semaglutide for weight loss was just approved with 205 patients! I get that it's had many many other trials as an injection but that's some hypocritical bullshit from the FDA
Oral semaglutide for weight loss was just approved with 205 patients! I get that it's had many many other trials as an injection but that's some hypocritical bullshit from the FDA
Reposted by Swapnil Hiremath 🍁🇨🇦
You know that coffee & dementia study that's going around?
It's hogwash.
For starters, it's not pre-registered (that I could find), which means it may have been the product of a fishing expedition looking for dementia associations.
But even if it's not ...
www.nytimes.com/2026/02/09/h...
It's hogwash.
For starters, it's not pre-registered (that I could find), which means it may have been the product of a fishing expedition looking for dementia associations.
But even if it's not ...
www.nytimes.com/2026/02/09/h...
2 to 3 Cups of Coffee a Day May Reduce Dementia Risk. But Not if It’s Decaf.
www.nytimes.com
February 10, 2026 at 11:24 PM
You know that coffee & dementia study that's going around?
It's hogwash.
For starters, it's not pre-registered (that I could find), which means it may have been the product of a fishing expedition looking for dementia associations.
But even if it's not ...
www.nytimes.com/2026/02/09/h...
It's hogwash.
For starters, it's not pre-registered (that I could find), which means it may have been the product of a fishing expedition looking for dementia associations.
But even if it's not ...
www.nytimes.com/2026/02/09/h...
Reposted by Swapnil Hiremath 🍁🇨🇦
First blush reading all that... absolute anti vax nonsense. Perfectly acceptable for multiple other countries.
This will have yet another chilling effect on drug development pipelines.
This will have yet another chilling effect on drug development pipelines.
February 10, 2026 at 11:51 PM
First blush reading all that... absolute anti vax nonsense. Perfectly acceptable for multiple other countries.
This will have yet another chilling effect on drug development pipelines.
This will have yet another chilling effect on drug development pipelines.
Reposted by Swapnil Hiremath 🍁🇨🇦
Look at the data! It's all over the map.
If you drink half a cup per day, your risk is a little higher than none at all.
If it's 2.5 cups, risk is 20% lower.
But if it's 4.5 cups, risk is only 13% lower.
There's no universe where this makes causal sense.
jamanetwork.com/journals/jam...
If you drink half a cup per day, your risk is a little higher than none at all.
If it's 2.5 cups, risk is 20% lower.
But if it's 4.5 cups, risk is only 13% lower.
There's no universe where this makes causal sense.
jamanetwork.com/journals/jam...
February 10, 2026 at 11:24 PM
Look at the data! It's all over the map.
If you drink half a cup per day, your risk is a little higher than none at all.
If it's 2.5 cups, risk is 20% lower.
But if it's 4.5 cups, risk is only 13% lower.
There's no universe where this makes causal sense.
jamanetwork.com/journals/jam...
If you drink half a cup per day, your risk is a little higher than none at all.
If it's 2.5 cups, risk is 20% lower.
But if it's 4.5 cups, risk is only 13% lower.
There's no universe where this makes causal sense.
jamanetwork.com/journals/jam...
Reposted by Swapnil Hiremath 🍁🇨🇦
Why are we still doing this? Why are we mining these noisy, inaccurate, confounded databases for associations so we can mislead people about what they ought to be eating?
I'd sure love to see @gidmk.bsky.social and @pwgtennant.bsky.social weigh in on this one.
I'd sure love to see @gidmk.bsky.social and @pwgtennant.bsky.social weigh in on this one.
February 10, 2026 at 11:24 PM
Why are we still doing this? Why are we mining these noisy, inaccurate, confounded databases for associations so we can mislead people about what they ought to be eating?
I'd sure love to see @gidmk.bsky.social and @pwgtennant.bsky.social weigh in on this one.
I'd sure love to see @gidmk.bsky.social and @pwgtennant.bsky.social weigh in on this one.
interesting: FDA refuses to even consider Moderna’s mRNA flu vaccine
feeds.issuerdirect.com/news-release...
the poorly chosen control group is the excuse given by VP - not sure it applies here?
would live to hear #IDSky thoughts @germhuntermd.bsky.social
feeds.issuerdirect.com/news-release...
the poorly chosen control group is the excuse given by VP - not sure it applies here?
would live to hear #IDSky thoughts @germhuntermd.bsky.social
News Release
News Release
feeds.issuerdirect.com
February 10, 2026 at 11:40 PM
interesting: FDA refuses to even consider Moderna’s mRNA flu vaccine
feeds.issuerdirect.com/news-release...
the poorly chosen control group is the excuse given by VP - not sure it applies here?
would live to hear #IDSky thoughts @germhuntermd.bsky.social
feeds.issuerdirect.com/news-release...
the poorly chosen control group is the excuse given by VP - not sure it applies here?
would live to hear #IDSky thoughts @germhuntermd.bsky.social
