Nephrology Journal Club
@nephjc.bsky.social
A twice monthly nephrology journal club that used to meet on Twitter. Hashtag #NephJC
www.nephjc.com
www.nephjc.com
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Reposted by Nephrology Journal Club
January 28, 2026 at 2:56 AM
January 28, 2026 at 3:00 AM
Huge thanks to the hardworking team Clemens Weber Shellie Fravel, PharmD Marc Soco Jeyakumar Meyyappan #NephJC
January 28, 2026 at 2:59 AM
Huge thanks to the hardworking team Clemens Weber Shellie Fravel, PharmD Marc Soco Jeyakumar Meyyappan #NephJC
January 28, 2026 at 2:58 AM
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January 28, 2026 at 2:57 AM
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www.nephjc.com/newsl...
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January 28, 2026 at 2:56 AM
T3n
Bottomline?
In ICD patients with mild–moderate CKD, raising plasma K safely cut arrhythmias, HF/arrhythmia hospitalizations, and death
But is it practice-changing… or still a “wait and see”? 🤔#NephJC
Bottomline?
In ICD patients with mild–moderate CKD, raising plasma K safely cut arrhythmias, HF/arrhythmia hospitalizations, and death
But is it practice-changing… or still a “wait and see”? 🤔#NephJC
January 28, 2026 at 2:55 AM
T3n
Bottomline?
In ICD patients with mild–moderate CKD, raising plasma K safely cut arrhythmias, HF/arrhythmia hospitalizations, and death
But is it practice-changing… or still a “wait and see”? 🤔#NephJC
Bottomline?
In ICD patients with mild–moderate CKD, raising plasma K safely cut arrhythmias, HF/arrhythmia hospitalizations, and death
But is it practice-changing… or still a “wait and see”? 🤔#NephJC
T3m
✅Strengths: Strong recruitment, adjudicated endpoints
⚠️Limitations: Single country, ICD-only patients, eGFR <30 excluded, <50% reached K⁺ target, unclear separation of MRA vs K⁺ effects #NephJC
✅Strengths: Strong recruitment, adjudicated endpoints
⚠️Limitations: Single country, ICD-only patients, eGFR <30 excluded, <50% reached K⁺ target, unclear separation of MRA vs K⁺ effects #NephJC
January 28, 2026 at 2:54 AM
T3m
✅Strengths: Strong recruitment, adjudicated endpoints
⚠️Limitations: Single country, ICD-only patients, eGFR <30 excluded, <50% reached K⁺ target, unclear separation of MRA vs K⁺ effects #NephJC
✅Strengths: Strong recruitment, adjudicated endpoints
⚠️Limitations: Single country, ICD-only patients, eGFR <30 excluded, <50% reached K⁺ target, unclear separation of MRA vs K⁺ effects #NephJC
T3l
POTCAST interventions are widely available
🍌 diet
💊 MRAs
🧂 KCl supplements
💧 reducing K⁺-losing diuretics
<50% hit the target but ~75% stayed on therapy… enough to improve outcomes #NephJC
POTCAST interventions are widely available
🍌 diet
💊 MRAs
🧂 KCl supplements
💧 reducing K⁺-losing diuretics
<50% hit the target but ~75% stayed on therapy… enough to improve outcomes #NephJC
January 28, 2026 at 2:53 AM
T3l
POTCAST interventions are widely available
🍌 diet
💊 MRAs
🧂 KCl supplements
💧 reducing K⁺-losing diuretics
<50% hit the target but ~75% stayed on therapy… enough to improve outcomes #NephJC
POTCAST interventions are widely available
🍌 diet
💊 MRAs
🧂 KCl supplements
💧 reducing K⁺-losing diuretics
<50% hit the target but ~75% stayed on therapy… enough to improve outcomes #NephJC
T3k
If K is the answer for arrhythmias, maybe it’s time to rethink “normal” ranges for high-risk patients Hyperkalemia risk exists in those w/ CKD but careful monitoring keeps high-normal K safe-ish #NephJC
January 28, 2026 at 2:52 AM
T3k
If K is the answer for arrhythmias, maybe it’s time to rethink “normal” ranges for high-risk patients Hyperkalemia risk exists in those w/ CKD but careful monitoring keeps high-normal K safe-ish #NephJC
T3j
Could the benefits of ACEi/ARBs, ARNIs, MRAs, and beta-blockers be partly just potassium doing its thing?
They do nudge K⁺ up a bit…
Let’s hear your thoughts 💭 #NephJC
Could the benefits of ACEi/ARBs, ARNIs, MRAs, and beta-blockers be partly just potassium doing its thing?
They do nudge K⁺ up a bit…
Let’s hear your thoughts 💭 #NephJC
January 28, 2026 at 2:51 AM
T3j
Could the benefits of ACEi/ARBs, ARNIs, MRAs, and beta-blockers be partly just potassium doing its thing?
They do nudge K⁺ up a bit…
Let’s hear your thoughts 💭 #NephJC
Could the benefits of ACEi/ARBs, ARNIs, MRAs, and beta-blockers be partly just potassium doing its thing?
They do nudge K⁺ up a bit…
Let’s hear your thoughts 💭 #NephJC
T3h
Interestingly, benefits weren’t limited to HF patients
👉~40% of participants without HF also showed improved outcomes!
And potassium may be the unifying mechanism 💥#NephJC
Interestingly, benefits weren’t limited to HF patients
👉~40% of participants without HF also showed improved outcomes!
And potassium may be the unifying mechanism 💥#NephJC
January 28, 2026 at 2:49 AM
T3h
Interestingly, benefits weren’t limited to HF patients
👉~40% of participants without HF also showed improved outcomes!
And potassium may be the unifying mechanism 💥#NephJC
Interestingly, benefits weren’t limited to HF patients
👉~40% of participants without HF also showed improved outcomes!
And potassium may be the unifying mechanism 💥#NephJC
T3g
Traditionally, this K rise was seen as a side effect, needing close observation and possible intervention,
but POTCAST suggests it might actually contribute to the benefit #NephJC
Traditionally, this K rise was seen as a side effect, needing close observation and possible intervention,
but POTCAST suggests it might actually contribute to the benefit #NephJC
January 28, 2026 at 2:48 AM
T3g
Traditionally, this K rise was seen as a side effect, needing close observation and possible intervention,
but POTCAST suggests it might actually contribute to the benefit #NephJC
Traditionally, this K rise was seen as a side effect, needing close observation and possible intervention,
but POTCAST suggests it might actually contribute to the benefit #NephJC
T3f
In the landmark MRA trials (RALES, EPHESUS, EMPHASIS-HF, FINEARTS-HF), patients taking MRAs for HF had improved survival, including fewer sudden cardiac deaths #NephJC
In the landmark MRA trials (RALES, EPHESUS, EMPHASIS-HF, FINEARTS-HF), patients taking MRAs for HF had improved survival, including fewer sudden cardiac deaths #NephJC
January 28, 2026 at 2:47 AM
T3f
In the landmark MRA trials (RALES, EPHESUS, EMPHASIS-HF, FINEARTS-HF), patients taking MRAs for HF had improved survival, including fewer sudden cardiac deaths #NephJC
In the landmark MRA trials (RALES, EPHESUS, EMPHASIS-HF, FINEARTS-HF), patients taking MRAs for HF had improved survival, including fewer sudden cardiac deaths #NephJC
T3e
POTCAST showed us that this modest increase translated into:
⚠️fewer arrhythmias, hospitalizations, and deaths…
And this is despite less than half of participants reaching the exact target.
So what is the exact target? #NephJC
POTCAST showed us that this modest increase translated into:
⚠️fewer arrhythmias, hospitalizations, and deaths…
And this is despite less than half of participants reaching the exact target.
So what is the exact target? #NephJC
January 28, 2026 at 2:46 AM
T3e
POTCAST showed us that this modest increase translated into:
⚠️fewer arrhythmias, hospitalizations, and deaths…
And this is despite less than half of participants reaching the exact target.
So what is the exact target? #NephJC
POTCAST showed us that this modest increase translated into:
⚠️fewer arrhythmias, hospitalizations, and deaths…
And this is despite less than half of participants reaching the exact target.
So what is the exact target? #NephJC
T3d
This study show us that physiology supports a rise from 4.0 to 4.3 mmol/L which leads to:
⚡Fewer hypokalemia episodes
🫀Stabilized resting potential
🔋Fewer ICD shocks & arrhythmias #NephJC
This study show us that physiology supports a rise from 4.0 to 4.3 mmol/L which leads to:
⚡Fewer hypokalemia episodes
🫀Stabilized resting potential
🔋Fewer ICD shocks & arrhythmias #NephJC
January 28, 2026 at 2:45 AM
T3d
This study show us that physiology supports a rise from 4.0 to 4.3 mmol/L which leads to:
⚡Fewer hypokalemia episodes
🫀Stabilized resting potential
🔋Fewer ICD shocks & arrhythmias #NephJC
This study show us that physiology supports a rise from 4.0 to 4.3 mmol/L which leads to:
⚡Fewer hypokalemia episodes
🫀Stabilized resting potential
🔋Fewer ICD shocks & arrhythmias #NephJC
T3c
Most of the benefit came from fewer ICD therapies (shocks or pacing) and documented ventricular tachycardia. Effects were consistent across subgroups & independent of the drug used #NephJC
Most of the benefit came from fewer ICD therapies (shocks or pacing) and documented ventricular tachycardia. Effects were consistent across subgroups & independent of the drug used #NephJC
January 28, 2026 at 2:44 AM
T3c
Most of the benefit came from fewer ICD therapies (shocks or pacing) and documented ventricular tachycardia. Effects were consistent across subgroups & independent of the drug used #NephJC
Most of the benefit came from fewer ICD therapies (shocks or pacing) and documented ventricular tachycardia. Effects were consistent across subgroups & independent of the drug used #NephJC
T3b
Most of the benefit came from fewer ICD therapies (shocks or pacing) and documented ventricular tachycardia. Effects were consistent across subgroups & independent of the drug used #NephJC
Most of the benefit came from fewer ICD therapies (shocks or pacing) and documented ventricular tachycardia. Effects were consistent across subgroups & independent of the drug used #NephJC
January 28, 2026 at 2:43 AM
T3b
Most of the benefit came from fewer ICD therapies (shocks or pacing) and documented ventricular tachycardia. Effects were consistent across subgroups & independent of the drug used #NephJC
Most of the benefit came from fewer ICD therapies (shocks or pacing) and documented ventricular tachycardia. Effects were consistent across subgroups & independent of the drug used #NephJC
T3a
This study suggests that a small dietary & treatment-induced increase in K⁺ (~0.3 mmol/L) lowered the risk of arrhythmias, ICD therapy, CV hospitalizations, and death in high-risk ICD patients #NephJC
This study suggests that a small dietary & treatment-induced increase in K⁺ (~0.3 mmol/L) lowered the risk of arrhythmias, ICD therapy, CV hospitalizations, and death in high-risk ICD patients #NephJC
January 28, 2026 at 2:42 AM
T3a
This study suggests that a small dietary & treatment-induced increase in K⁺ (~0.3 mmol/L) lowered the risk of arrhythmias, ICD therapy, CV hospitalizations, and death in high-risk ICD patients #NephJC
This study suggests that a small dietary & treatment-induced increase in K⁺ (~0.3 mmol/L) lowered the risk of arrhythmias, ICD therapy, CV hospitalizations, and death in high-risk ICD patients #NephJC
T3: Discussion
Feeling the K rush? We’ve charged through the results… now let’s talk
Is aiming for high-normal potassium the real shock therapy for arrhythmias? #NephJC
Feeling the K rush? We’ve charged through the results… now let’s talk
Is aiming for high-normal potassium the real shock therapy for arrhythmias? #NephJC
January 28, 2026 at 2:41 AM
T3: Discussion
Feeling the K rush? We’ve charged through the results… now let’s talk
Is aiming for high-normal potassium the real shock therapy for arrhythmias? #NephJC
Feeling the K rush? We’ve charged through the results… now let’s talk
Is aiming for high-normal potassium the real shock therapy for arrhythmias? #NephJC
T2k
Discontinuations: 67 participants stopped meds due to side effects:
⚠️ 27% MRA
⚠️ 34% K⁺ supplements
⚠️ 39% both
Although, the side effects were manageable #NephJC
Discontinuations: 67 participants stopped meds due to side effects:
⚠️ 27% MRA
⚠️ 34% K⁺ supplements
⚠️ 39% both
Although, the side effects were manageable #NephJC
January 28, 2026 at 2:39 AM
T2k
Discontinuations: 67 participants stopped meds due to side effects:
⚠️ 27% MRA
⚠️ 34% K⁺ supplements
⚠️ 39% both
Although, the side effects were manageable #NephJC
Discontinuations: 67 participants stopped meds due to side effects:
⚠️ 27% MRA
⚠️ 34% K⁺ supplements
⚠️ 39% both
Although, the side effects were manageable #NephJC
T2j
Only 41.5% reached the target 4.5–5.0 mmol/L
Reasons: max dose reached, declined meds, protocol limits, or other factors
📈Mean K⁺ rose to 4.36 mmol/L, a difference of only 0.3 treatment vs control
Is it really K⁺ driving the results? #NephJC
Only 41.5% reached the target 4.5–5.0 mmol/L
Reasons: max dose reached, declined meds, protocol limits, or other factors
📈Mean K⁺ rose to 4.36 mmol/L, a difference of only 0.3 treatment vs control
Is it really K⁺ driving the results? #NephJC
January 28, 2026 at 2:38 AM
T2j
Only 41.5% reached the target 4.5–5.0 mmol/L
Reasons: max dose reached, declined meds, protocol limits, or other factors
📈Mean K⁺ rose to 4.36 mmol/L, a difference of only 0.3 treatment vs control
Is it really K⁺ driving the results? #NephJC
Only 41.5% reached the target 4.5–5.0 mmol/L
Reasons: max dose reached, declined meds, protocol limits, or other factors
📈Mean K⁺ rose to 4.36 mmol/L, a difference of only 0.3 treatment vs control
Is it really K⁺ driving the results? #NephJC