The draft order: Sophia Ambruso Nayan Arora Swapnil Hiremath AC Gomez Joel Topf Editor Nayan Arora Show Notes Previous drafts: 2021 KDIGO Hypertension —Joel, Sophia, Swap, Nayan, Josh 2021 ASN Kidney Week Draft—Joel, Sophia, Swap, Nayan, Jennie 2022 The ISPD Peritonitis Guideline— Joel, Sophia, Swap, Nayan 2022 ASN Kidney Week Draft—Joel, Sophia, Swap, Nayan 2023 ASN Kidney Week Draft—Joel, Sophia, Swap, Nayan, AC, Josh 2024 KDIGO CKD Clinical Practice Guideline —Joel, Sophia, Swap, Nayan, Josh, AC The guideline The NephJC discussion Part 1 | Part 2 First Round Sophia’s Pick 3.7.1 We recommend treating patients with type 2 diabetes (T2D), CKD, and an eGFR ≥20 ml/min per 1.73 m2 with an SGLT2i (1A). Not Nayan’s Pick 3.7.3: We suggest treating adults with eGFR 20 to 45 ml/min per 1.73 m2 with urine ACR 10% can be used to determine the timing of multidisciplinary care in addition to eGFR-based criteria and other clinical considerations. Practice Point 2.2.3: A 2-year kidney failure risk threshold of >40% can be used to determine the modality education, timing of preparation for kidney replacement therapy (KRT) including vascular access planning or referral for transplantation, in addition to eGFR-based criteria and other clinical considerations. Swap’s Pick 3.15.1.1: In adults aged ‡50 years with eGFR 1.3 g/kg body weight/d) in adults with CKD at risk of progression. 3.3.1.2: In adults with CKD who are willing and able, and who are at risk of kidney failure, consider prescribing, under close supervision, a very low–protein diet (0.3–0.4 g/kg body weight/d) supplemented with essential amino acids or ketoacid analogs (up to 0.6 g/kg body weight/d). 3.3.1.3: Do not prescribe low- or very low–protein diets in metabolically unstable people with CKD. AC’s Pick 3.9.1: In adults with T2D and CKD who have not achieved individualized glycemic targets despite use of metformin and SGLT2 inhibitor treatment, or who are unable to use those medications, we recommend a long-acting GLP-1 RA (1B). Swapnil’s Pick Practice Point 5.4.1: Initiate dialysis based on a composite assessment of a person’s symptoms, signs, QoL, preferences, level of GFR, and laboratory abnormalities. IDEAL Trial: A Randomized, Controlled Trial of Early versus Late Initiation of Dialysis NEJM Timing of dialysis initiation to reduce mortality and cardiovascular events in advanced chronic kidney disease: nationwide cohort study NephJC Nayan’s Pick Practice Point 1.1.4.2: Use tests to establish a cause based on resources available (Table 6b). Sophia’s Pick Practice Point 1.1.1.2: Following incidental detection of elevated urinary albumin-to-creatinine ratio (ACR), hematuria, or low estimated GFR (eGFR), repeat tests to confirm presence of CKD. Joel’s cystatin C Tweet The cystatin C guideline recommendation 1.1.2.1: In adults at risk for CKD, we recommend using creatinine-based estimated glomerular filtration rate (eGFRcr). If cystatin C is available, the GFR category should be estimated from the combination of creatinine and cystatin C (creatinine and cystatin C– based estimated glomerular filtration rate [eGFRcr-cys]) (1B). Nayan’s additional thoughts. He is not a fan of Practice Points 3.6.4 and 3.6.5 Practice Point 3.6.4 Continue ACEi or ARB therapy unless serum creatinine rises by more than 30% within 4 weeks following initiation of treatment or an increase in dose. and Practice Point 3.6.5: Consider reducing the dose or discontinuing ACEi or ARB in the setting of either symptomatic hypotension or uncontrolled hyperkalemia despite medical treatment, or to reduce uremic symptoms while treating kidney failure (estimated glomerular filtration rate [eGFR] 15 ml/min per 1.73 m2). Tubular Secretion Swap The Murderbot Diaries by Martha Wells Nayan Searching for Hobey Baker Narrated by David Duchovny AC Rosie Revere, Engineer Sophia Bassnectar How to fix the Apple Music automatically playing when you connect to bluetooth. Joel T