9/10 Want More? 📚 Read the Comprehensive NephJC Blog by @kiddokidney.bsky.social & @ancast13.bsky.social 🔗 www.nephjc.com/news/soda-bic 🎨 Check out the Beautiful Visual Abstract by @danyrcal.bsky.social 🔗 www.nephjc.com/news/2026/8/...

5/10 📷 Figure is worth 1000s words 💡Bicarbonate did exactly what you'd expect 👍⬆️ pH, bicarbonate & base excess 👎Yet the curves for patient-centred outcomes never separated We tend to assume (naively) that correcting physiology should improve outcomes, SODa-BIC disproves it❌

4/10 One Post Results MAKE30 Score with💉Bicarbonate ➡️ 40.2% & with 💧Placebo ➡️39.4%. ⚖️Absolute difference 1.2% (95% CI − 7.1 to 9.4, P=0.78). 🎯No difference in 1°outcome. 🎯No signal for⬇️mortality. 🎯No⬇️in KRT & No difference in kidney dysfunction.

3/10 One Post Methods Pragmatic, adaptive, double blind RCT 🧑‍🤝‍🧑500 adults, 55 ICUs, 7 countries Included: pH <7.30, on vasopressors Excluded: eGFR <30, DKA, major bicarb loss, on KRT 💉 : Protocolized bicarb infusion targeting pH ≥7.30 and BE ≥0 up to 5 hrs 🎯1° outcome: MAKE30

2/10 ⁉️What’d I miss? We've been here before. Early trials corrected pH, but not outcomes. BICAR-ICU hinted at mortality benefit in patients with severe AKI. BICAR-ICU2 failed to reproduce that benefit.❌ 💉So are we treating the patient? Or just making the blood gas look better?

1/10 #NephJC #TenPostNephJC 💉Bicarbonate is an ICU drug that almost everyone has an opinion on. The physiology is attractive, but evidence isn’t. 🥼SODa-BIC asks if IV bicarbonate improves outcomes in ICU pts with metabolic acidosis on vasopressors. 📄 pubmed.ncbi.nlm.nih.gov/42283370/

🖌️ Echa un vistazo al #resumenvisual del ensayo SODa‑BIC realizado por @danyrcal.bsky.social #NephJC www.nephjc.com/news/2026/8/...

Summer's almost over 😎 #NephSky We know you've been waiting 🏖️ #NephJC Summer Book Club, 9/15/26 discussion! Salama Kassab was a pharmacy student in Syria. Now she helps the wounded who flood through the doors. Set amid the Syrian Revolution, a story of hope, love & possibility.

Question 2 🤔Where does finerenone fit into practice? eGFR slope reduction was modest, but UACR reduction was robust. Still expensive/not-covered/limited access for many patients. 🫀Is cardiac benefit driven by mild increase in potassium? 7/10

A figure paints🖼️ a 1000 words! The 2° composite kidney-CV outcome (≥57% eGFR decline, kidney failure, HF hospitalization, or CV death) favored finerenone. Finerenone: 13.9% vs. Placebo16.9% HR: 0.77 (95% CI 0.60–0.99; p = 0.04), driven largely by CV death 5/10

One Post Results Finerenone successfully slowed the rate of eGFR decline! Total eGFR slope: -3.3 vs. -4.0 mL/min/1.73 m²/year. This represents a statistically significant treatment benefit of 0.7 mL/min/1.73 m²/year (p < 0.001). 4/10

#NephJC #TenPostNephJC FIND-CKD asks: Can we extend nsMRA cardiorenal benefits to the massive population with CKD without diabetes? Let’s FIND out! 🔍 Read the article 👇: pubmed.ncbi.nlm.nih.gov/42246672/ 1/10🧵

5/10 A figure paints a 1000 words The TRACK trial demonstrated that low-dose rivaroxaban offers no cardiovascular protection while increasing bleeding risk in patients with advanced CKD, highlighting the need for CKD-specific cardiovascular therapies. None of the subgroups showed any benefits.

4/10 1 post results 🩸Low-dose rivaroxaban did not reduce major adverse cardiovascular events vs placebo (22.6% vs 20.7%; HR 1.09, 95% CI 0.87–1.36; P=0.46). 🩸Increased major bleeding (8.8% vs 6.0%; HR 1.51, 95% CI 1.02–2.22; P=0.04)

3/10 1 post methods 🩸1458 patients with CKD stage 4-5 including those on dialysis across 90 centres in 12 countries 🩸Participants received rivoraxaban 2.5 mg BID or placebo 🩸Median follow up was 1.7 years. 🩸Primary outcome: MACE; Safety outcome: major bleeding

2/10 What was the study 🩸TRACK was a randomized, placebo-controlled study that studied whether rivaroxaban could safely ⬇️major CV events in pts with advanced CKD or ESKD, who were at ⬆️ CV risk 🩸The study also evaluated the associated risk of major bleeding

#NephJC #TenPostNephJC. #NephSky 1/10 Patients with CKD have ⬆️ CVD & bleeding risks but are often excluded from antithrombotic trials, creating a 🔑 evidence gap. Can low dose rivaroxaban safely improve CV outcomes? pubmed.ncbi.nlm.nih.gov/42240165/

Meeting number 2 is in the books. 🧑‍🏫We reviewed how to blog, create a VA, create a post thread and promote on Insta. So many ways to learn and teach #NephJC #NephSky @dramiliflores.bsky.social @drpallaviprasad.bsky.social @nephroseeker.medsky.social @hswapnil.medsky.social @brianrifkin.bsky.social

🦵Had our Kick-off meeting today to welcome a new class of #NephJC interns (year 12 and counting). 👁️Keep an eye out for new blog and VA creators. See if you can Catch'em All🎣 #NephSky #MedSky @hswapnil.medsky.social @kidneyboy.bsky.social @nephroseeker.medsky.social @dramiliflores.bsky.social

MENTOR gave durable remission MAJESTY hints deeper depletion may do even better So who earns first line 👀 OBI or rituximab? Next #NephJC ➡️ Jul 7: TRACK Trial Join us www.nephjc.com Great #ERA26, signing off @dramiliflores.bsky.social #TenPostNephJC #NephTwitter

#NephJC Consensus From GEMRITUX, MENTOR, STARMEN, RI-CYCLO & MAJESTY- the signal remains consistent: ✅ Anti-CD20 therapy works ✅ Remissions are durable ✅ Relapses are lower than CNIs Check out anti-CD20 trials in pMN by @nephroseeker.medsky.social 👇 #NephJC #TenPostNephJC #NephTwitter #NephSky

6/10 Not all proteinuria is created equal Patients receiving TAC were substantially more likely to require rescue immunosuppressive therapy during follow-up. Remission with OBI was not only more frequent, it was more durable #NephJC #TenPostNephJC #NephSky

5/10 A figure paints 🖼️ 1000 words! At Week 104, complete remission occurred in: 👑 Obinutuzumab ➡️ 37% 📉 Tacrolimus ➡️ 6% Results were consistent across all subgroups #NephJC #TenPostNephJC #NephSky

4/10 Who were the patients? 👥 📍Mean age 50 years 📍78% PLA2R positive Some patients appeared to have eGFR and proteinuria values outside the inclusion criteria at baseline; could this reflect changes between screening and randomization? 🤔 #NephJC #TenPostNephJC #NephSky

3/10 One Post Methods 📚 🎲Phase III, randomized, open-label trial 📍 142 adults with high-risk primary membranous nephropathy 🎯Primary outcome: complete remission at week 104 #NephJC #TenPostNephJC #NephSky

2/10 What'd I miss? 👀 📍Obinutuzumab: type II anti-CD20 monoclonal antibody, depletes B cells 📍Tacrolimus: ⬇️ T lymphocytes through FK50-binding protein 📍MAJESTY asks: 👑 Can OBI outperform TAC in durable remission while preserving kidney function? #ChatGPT #NephJC #TenPostNephJC #NephSky

1/10 With the incredible wave of glomerular disease and trials showcased at #ERA26, it's time for membranous nephropathy to take the stage Could deeper B-cell depletion finally claim the throne? 👑 Read the article 👇 pubmed.ncbi.nlm.nih.gov/42246654/ #NephJC #TenPostNephJC #NephSky

10/10 Final thoughts: ✈️🚉🚗 we made it to #ERA26, sorry we're a little late on the posts! @nephroseeker.medsky.social Renal biopsy in diabetics is still a gold standard to rule out NDKD and improve the survival in diabetic patients… Up next, LBCT from #ERA26 Join us at nephjc.com

5/10 A figure paints a thousand words 🎨🖌️ The indication for biopsy predicts likelihood of DN, NDKD and the co-existence of the two.

4/10 1 post results: Cohort 1- Diabetic Nephropathy DN = 41.2% DN & DKD = 22.9% NDKD = 35.9% Overall, 58.8% of NDKD in all biopsies 🤔perhaps biopsy is done when NDKD indications are present Higher chronicity in biopsy—lower incidence of NDKD