TOM of this month goes to ACHIEVE trial (n=2,538), which showed that spironolactone 25 mg daily did not reduce CV events or mortality in dialysis patients, and increased risk of severe hyperkalemia #VA by @nephromommy-akshu.bsky.social. See the latest #ISNTrialWatch summary for details.

Highlights from my talk yesterday on Alport syndrome spectrum of disorders. (since no one posted it, I'll have to do it myself) Variants in type IV collagen cause a wide spectrum of disease. #KidneyWk 🧵

Zigakibart was well tolerated and cut #proteinuria by 60% while stabilizing #kidney function in #IgAN patients over 100 weeks. #nephrology #nephsky #iganephropathy docwirenews.com/post/zigakib...

The 2025 @kdigo.org IgAN guideline quietly redraws the map: new drugs, new thresholds, and a sense that the era of “supportive care only” is finally over #Nephsky #Medsky ✍️Summary by @thekidneywhisperer.bsky.social and @glomerican.bsky.social www.nephjc.com/news/igan-kd...

Wonderful ! 😇 A patient’s perspective on IgA Nephropathy ! #NephJC #Nephsky #MedSky

⏩ Next #NephJC is on IgA nephropathy @kdigo.org guideline 🎨 Nice visual summary by @roxnonna23.bsky.social www.nephjc.com/news/2025/10...

Hey this is Akshaya, nephrologist from India! We’ve traditionally been restricting protein to our CKD patients until they go on to require dialysis ! A lot of our practices are changing nowadays though. Would love to get some good-y food-y insights from this chat ! #NephJC

Check at the VA for our discussion of protein diet strategies by @msocomd.bsky.social. Is restricting protein in CKD and pushing protein in ESRD #TWDFNR? www.nephjc.com/news/2025/10...

Up next! CKD & Protein: Is Your Diet a Solution or a Silent Stressor? 🥩🔍 On October 14, we're discussing protein diets and outcomes in CKD/ESRD which still remains an enigma. ☀️📚 #NephJC pubmed.ncbi.nlm.nih.gov/40876553/ #Skytorial by @nephromommy-akshu.bsky.social Akshaya's signing off 👋

10/10 Final #NephJC thoughts 🤔💭 While the study was a success, it is still a harsh reality that there exist many barriers to even getting a transplant. Much work is needed to safely simplify the procedure and make being IS - free a reliable reality for all kidney transplant patients! #NephJC

9/10 I want more info: 👓📖 Please go through the insightful summary by Akshaya Jayachandran @nephromommy-akshu.bsky.social and Natalia Nombera @roxnonna23.bsky.social 🔖📖 🎨Beautiful visual abstract by Bogdan @thekidneywhisperer.bsky.social #NephJC www.nephjc.com/news/chimera...

8/10 #NephJC Quote of the fortnight from @brianrifkin.bsky.social 💬 Immune tolerance is nice, but unpredictable and requires constant vigilance to prevent rejection. Would modifying graft kidneys to make them less antigenic be a better bet? #NdphJC

7/10 Chat consensus? 🎬 Although the study shows that the MDR-101 regimen induces chimerism and functional immune tolerance in HLA-matched living donor KTRs leading to complete IS elimination, it is far from being widely applicable. It’s too costly and works only in highly HLA matched KTRs. #NephJC

6/10 Give me something clever to say 🤓 Here’s what caught my attention! @kidneyboy.bsky.social comparing life on dialysis vs pig transplant 🐖+ IS vs Live donor transplant 🫘and IS free! Definitely stuff worthy of a sci-fi movie! 👽

5/10 A figure paints 🖼️ 1000 words! KDQOL-SF36 data showed huge improvement in Burden of Kidney Disease and Mental Health Composite Scores at two and three years when patients were off IS. This demonstrates that even low-dose IS negatively impacts patient quality of life. 🙆💊 #NephJC

4/10 One post results 📊 75% (15/20) of KTRs achieved functional immune tolerance (IS-free for two years) using the mixed chimerism strategy with MDR-101💉 The study showed 100% patient/graft survival and zero GVHD cases over three years, with improved quality of life. 4/20 KTRs resumed IS. #NephJC

3/10 One Post Methods 👩‍🏫 Phase 3, prospective, open-label, randomized, multicenter trial - USA/Canada. Included kidney transplant recipients (KTR) from a 2-haplotype HLA-matched, living donors. Primary outcome - functional immune tolerance - staying off all IS for at least 24 months. 💊 #NephJC

2/10 What’d I miss? Transplant immunosuppression (IS) causes significant drug toxicities, infection, cancer risks & huge costs 💸. “Functional tolerance” is a state in which the recipient’s immune system accepts the graft without additional IS. It has remained the "Holy grail" of transplant! #NephJC

1/10 Welcome to #TenPostNephJC Last #NephJC we discussed tolerance induction in HLA matched 🫘 transplants with donor Hematopoietic stem cells (MDR-101). Missed the Chimeri-chat? No worries - We’re quite “tolerant” to those who missed their IS(Informative Session)! pubmed.ncbi.nlm.nih.gov/39922283/

What great cha Excellent article Fantastic write up for the summary Great chat with good turn out This is a good week for #NephJC Thanks everyone

The conditioning regimen and bespoke cell product are highly specialized and costly. How do we translate this success to resource-limited centers? Cost & logistics make MDR-101 a first-world solution for now. #NephJC

Check out the insightful summary by Dr Akshaya Jayachandran @nephromommy-akshu.bsky.social and Dr Natalia Nombera @roxnonna23.bsky.social #NephJC

Hey I'm Akshaya Jayachandran, #NephJC intern 2025, and a young Nephrologist from CMC Vellore, India. No COIs. From an economy where IS costs remain a major reason for drug noncompliance leading to graft loss, this trial - if successfully done in higher risk transplants, would be a boon!

Be like Matt. Shoot us a dime so we can keep the #FOAMed flowing

Chimerism might just be the 🔑 to immune tolerance and ending the need for immunosuppression 🚫💊after transplantation 🫘. Join the discussion 9/30/25 at 9 pm EST on Bluesky #NephSky #MedSky #NephJC www.nephjc.com/news/chimera-tolerance-njqe334

I think the general message is beyond ACHIEVE: 1. Big, rigorous trials are possible in dialysis. 2. It is more about doing than complaining about the lack of quality studies. 3. Negative studies serve us better lessons than pozitive ones #NephJC Pic from DaVinci museum in Rome. (+bonus kidneys)

Thank you Natalia 😇! #NephJC

To accompany the discussion on ACHIEVE - a short piece on ALCHEMIST & the metaanalaysis from @lonniepyne.bsky.social www.nephjc.com/news/2025/ne... #NephJC

Join us 9/2/25 at 9pm EST. We will discuss the use of spironolactone in patients on dialysis to prevent t cardiovascular outcomes and heart failure hospitalizations. Invite your friends. #NephJC #NephSky www.nephjc.com/news/achieve

Check out the ACHIEVE visual abstract by @nephromommy-akshu.bsky.social www.nephjc.com/news/2025/8/...

Hey I’m Akshaya, young Nephrologist from Vellore India - no COI ! Have treated TB empirically, and in an evidence based manner, with all kinds of evidence ! And also TB has played with my health too ! So have some first hand experience with the deadly guy ! #NephJC

Just a few hours left for the #NephJC book club ! 📒 We’re discussing “Everything Is Tuberculosis” by @johngreensbluesky.bsky.social ! Come see how he turns a disease 🦠 into a story about injustice, stigma, and hope. 🙏🏻 @hswapnil.medsky.social @kidneyboy.bsky.social @brianrifkin.bsky.social

After 2 on calls in 4 days, relax time… 🗺️Finishing 📚 for tomorrow’s #NephJC bookclub Any favorite quote?

#NephJCBookClub will be on this week Check out @kidneyboy.bsky.social take on 'Everything is TB' here www.nephjc.com/news/2025/8/... Hope @johngreensbluesky.bsky.social can join us tomorrow at 9 pm EST for the discussion #NephJC

Beautiful and meaningful poem by @nephromommy-akshu.bsky.social inspired by @johngreensbluesky.bsky.social's Everything is Tuberculosis www.nephjc.com/news/2025/8/...

Hey this is Akshaya, nephrologist from Vellore, India - and #NephJC intern. I have no COI ! And I’ve been so trained to keep it low that I feel afraid seeing any Phosphorus over 6mg/dL !! (our Upper limit is 4.5) ! Wish I could say I belonged to the “High” team!

😎Check out the VA for HiLO by @sejalplakhani.bsky.social 🆒 This should be quite the discussion, don't miss it! #NephJC #NephSky www.nephjc.com/news/2025/8/4/the-hilo-trial-visual-abstract

HiLo, HiLo it's off to work we go! ⛏️ Join us 9 pm EST 8/5/25 to discuss. #NephJC #NephSky Controlling Phos in patients on HD is a lot of work, but is it worth it? HiLo looks at hospitalization & death in low/high Phos goals. Will we finally have a RCT with answers ⁉️ www.nephjc.com/news/hilo-tr...

Neither Creatinine nor Cystatin C has won the war (Cystatin C is still probably better - but also costlier) ! They end in a truce - promising to work their differences (eGFRdiff) better ! #NephJC

Amazing Chat! A job very well done Akshaya! Have seen your passion and dedication over the past few days! Keep going! #NephJC

Late Post from your host ! 😇 Hey! I’m Akshaya Jayachandran (nephromommy-akshu.bsky.social), nephrologist from Christian Medical College Vellore, India — glad to have hosted my first #NephJC chat, with the adrenaline running high! My introduction got missed in the eGFR wars!

9/ I want more info ✅ Check out #NephJC summary by @nephromommy-akshu.bsky.social ‬ @roxnonna23.bsky.social @glomerican.bsky.social www.nephjc.com/news/egfrdiff ✅Visual abstract by @nephromommy-akshu.bsky.social @drsaivani.bsky.social www.nephjc.com/news/cricdiff

👏 Great discussion! 📅 Up Next: 8/5/25 we discuss the 📘HiLo trial- A RCT of phosphate targets for HD patients #NephJC Do we finally have data to end “the great phosphate-bypass” pubmed.ncbi.nlm.nih....#NephJC

🔍 But here’s the twist—creatinine and cystatin C don’t always agree. That gap? It might be more than just a lab quirk.

#NephJC chat in 4 hours! Tune in for "Creatining" scientific discussions rather than "C-static" silence. ⚡ Ming the eGFR gap though!🫘

Check out the VA from @drsaivani.bsky.social and @nephromommy-akshu.bsky.social on eGFRdiff in the CRIC cohort. #Nephsky #NephJC www.nephjc.com/news/cricdiff

On 7/22/25 at 9pm EST only on Bluesky! #NephSky #MedSky join us for a lively discussion. We're debating eGFRdiff (the gap that is sometimes present between the eGFR of cystatin C and creatinine). What does it mean, what causes it and what you should do about it. #NephJC www.nephjc.com/news/egfrdiff

Check the insightful #NephJC summary by @jeyakumarmeyyappan.bsky.social and @sejalplakhani.bsky.social 👉 www.nephjc.com/news/...#NephJC

And @nephjc.bsky.social, is this a COI by the way?? 😂 #nephJC

Hey all ! I’m Akshaya, from India, and part of the #nephronauts gang. Here for the CONFIDENCE #nephJC chat 😃, and also building up my confidence to finally discuss in the Chat 😂!! No COI. And happy hosting @msocomd.bsky.social! #nephJC