Swapnil Hiremath 🍁🇨🇦

@hswapnil

Nephrologist = kidney doctor MD, MPH Professor, University of Ottawa/Ottawa Hospital 🇨🇦 He/Him/His #NephJC co-creator; @FreelyFiltered.bsky.social pod panelist; KICR EiC: opinions personal

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Swapnil Hiremath 🍁🇨🇦@hswapnil· 18d

From @priscillasmith.bsky.social et al in @kireports.bsky.social The ORCHARD-BEET feasibility trial of….🫜in HDP www.kireports.org/article/S246... shows giving beetroot juice is safe, well tolerated and recruitment is possible Hope they do the larger trial! (Not everyone likes it:)

Adherence data were available for 24 of 30 participants in the dietary nitrate arm and was recorded as number of missed beetroot juice shots from consent to delivery collected at 2nd trimester, 3rd trimester and 6-week postpartum visits. There were zero missed shots reported in 7/24 (29.2%), one to twenty missed shots in 10/24 (41.7%), more than twenty missed shots in 5 /24 (20.8%) and full discontinuation prior to delivery in 2/24 (8.3%). Reported reasons for missed shots were taste, nausea, reflux, ran out of supply while inpatient or on holiday, anxious about combination with other medications, anxious about pink urine and forgot to take. No participants stopped or missed shots due to physician decision or SAE.

Swapnil Hiremath 🍁🇨🇦@hswapnil· 18d

Shifting from dialysis care to preventing kidney failure - now that we do have tools to do that! The Thailand experience in @kireports.bsky.social www.kireports.org/article/S246... Can’t rely on MDs, have to broaden screening to make a difference? @sbrimble.bsky.social #NephSky

Figure 1 Thailand’s prevention-focused CKD strategy, shifting from dialysis-centered care to population-level prevention through multisectoral collaboration—emphasizing early screening, salt reduction, multidisciplinary care, and equitable access to essential medicines. Abbreviation: CKD, chronic kidney disease; FPs, family physicians; GPs, general physicians; NGO, non-governmental organization; VHVs, village healthcare volunteers.

Swapnil Hiremath 🍁🇨🇦@hswapnil· 18d

In an unfortunate revision, the CDA says we should use lencanemab (with conditions) in Alzheimer’s @picardonhealth.bsky.social with some wisdom here: apple.news/A9Ykirj_JRx-... CDA rec: www.cda-amc.ca/sites/defaul... What a waste of money - and public resources if this goes through

“Yet, in Canada, every decision seems to be made in splendid isolation, with no attention paid to the big picture.
To be eligible for treatment with lecanemab a patient must have a diagnosis of mild cognitive impairment or mild dementia owing to Alzheimer’s. (The wait time to see neurological specialists in Canada is up to a year.) Genetic testing is required because people with two copies of the gene variant APOE4 are not eligible. (It’s not a routine screening test.) The drug is infused every two weeks in a hospital setting. Patients also require regular MRI scans. (The wait time for MRIs can be months.)
It is debatable whether the system could administer this drug effectively. The CDEC also says the drug should be funded for six months, and discontinued if the disease progresses to moderate dementia. But our system is terrible at saying “no.”
The gift of care for people with Alzheimer’s disease
Lecanemab costs about $30,000 a year.
The CDEC calculated that, even with strict conditions, funding lecanemab would cost provincial drug plans $66-million in the first year, and $485-million by year three.
Is that the best way to spend public dollars for dementia care? Or ”

Excerpt From
“Opinion: How do you judge the real value of a new Alzheimer’s drug?”
André Picard
The Globe and Mail
https://apple.news/A9Ykirj_JRx-vxLSHW0zYdA
This material may be protected by copyright.

Swapnil Hiremath 🍁🇨🇦@hswapnil· 19d

What an awful tragic story retractionwatch.com/2026/07/23/e... And in @science.org www.science.org/content/arti... Parents scraped $860000 for N: 1 trial, child dies of TMA, scientists publish ‘success’ paper in Nature in mice 🐁 www.nature.com/articles/s41...

After 3 days, Mei developed a fever, a common reaction to AAVs that was expected to last for a couple days. Qiu swung by as her fever began to wane. He assured Jason and Linda that their daughter’s condition would soon improve. As they walked him to the elevator, he announced—excitedly—that the Nature paper had been accepted with revisions. Then he added that Mei’s treatment would make an even bigger splash: the first brain-directed gene-editing therapy.

Mei did not improve. Because she hadn’t urinated since the infusion—a sign that her kidneys had been seriously injured—her doctors had limited her fluid intake, and she became desperately thirsty. The platelets in her blood also dropped to dangerous levels. It was the exact sequence of symptoms that the consent form had warned the family about.

But nowhere did the form explicitly indicate that any of this could end in death, nor did that come up during any conversations with Qiu or the other doctors, Jason and Linda say. “Death should always be mentioned in a first-in-human trial,” says Greely, the bioethicist.

Doctors took Mei for a full-body CT scan and then rushed her to the intensive care unit. Her brave face had begun to crack. “Mom, I want to go home,” she told her mother, before vanishing into the ward.

Over the next 24 hours, Jason and Linda sat in the waiting room with their elderly parents. Qiu, who had returned upon hearing of Mei’s problems, seemed unable to process it. He was still with the family the next morning when a doctor emerged to tell them Mei had died. Qiu was in shock, Jason recalled.

So was the family. They stood by Mei’s body and caressed her one last time.

TWO DAYS LATER, the hospital’s ethics board convened an emergency meeting and concluded Mei’s death was “definitely related” to the treatment, according to its report. The cause of death: thrombotic microangiopathy.

Swapnil Hiremath 🍁🇨🇦@hswapnil· 19d

It’s a Sri Lankan herbal medicine Al we have is a picture 🤷🏽‍♂️

Swapnil Hiremath 🍁🇨🇦@hswapnil· 21d

IMO they are descriptive articles; I am not sure as written are of interest for readers Perhaps they could publish them together as a supplement? They do need better external peer review as well & editing to tighter up the writing. Same as for original editorial which now has 135K

Swapnil Hiremath 🍁🇨🇦@hswapnil· 21d

Interesting chart of the day Student loan default rates in US apnews.com/article/stud... h/t @jackiantonovich.bsky.social

Data current through March 2026. Number of defaulted borrowers calculated by combining borrowers delinquent by 271-360 days and borrowers delinquent by over 360 days. Payment pause includes the pause implemented by the CARES act as well as the yearlong on-ramp period that moved loans to forbearance status after 90 days of missed payments.
Source: The office of Federal Student Aid

Red line was going down with pause on payments - and is going straight up in last 18 months

Swapnil Hiremath 🍁🇨🇦@hswapnil· 22d

To Mars and beyond! Don’t know it Meant Mars like the color 🔴 😏 stocks.apple.com/symbol/SPCX

Swapnil Hiremath 🍁🇨🇦@hswapnil· 22d

a young teenager with hypertension, case studies from @nejm.org enough info in table 1 to make a diagnosis! www.nejm.org/doi/full/10....

lab values showing
hypokalemia
elevated ESR/CRP

Swapnil Hiremath 🍁🇨🇦@hswapnil· 24d

Excellent read from @iwashyna.bsky.social voices.nejm.org/doi/full/10.... I still struggle with this, as a PGY29 #MedSky

At a less acute level, Alice was struggling with the question of how much of the scut work she should do and how much to delegate to the intern. When was doing the scut work giving her intern time to think and learn? And when was it interfering with the intern’s learning by depriving them of their experience? In other words, when is sitting back and letting someone else do the tedious work of hospital care “growth,” and when is it “exploitation”?
Even more poignantly, Alice was asking how much she should let her trainees do things differently than she would. The interns are, after all, doctors. Surely they can organize their notes in their own way.

Swapnil Hiremath 🍁🇨🇦@hswapnil· 26d

The less AKI was an improvement in creatinine number - and if you look at the actual componente of the intervention that actually happened from the supplement, a lot of things don’t add up And biomarkers didn’t change - not sure stopping RASi to make creatinine better is a good thing!

Swapnil Hiremath 🍁🇨🇦@hswapnil· 28d

Cool case in @ckj-era.bsky.social Mass spec reveals NSAIDs in herbal supplement (which caused granulomatous AIN) academic.oup.com/ckj/article/...

Figure 2:Example of mass spectrometry analysis of the main compound in one of the traditional medicine products: (A) GC–MS chromatogram, with time on the x-axis and signal intensity on the y-axis. The peak centered at 23.40 min indicates that a compound elutes from the GC column at 23.40 min. (B) Top: Spectrum of the compound eluting at 23.40 min, with each vertical bar representing an ion fragment; bottom: comparison with the reference spectrum of the molecule proposed by the library (mefenamic acid). (C) LC–HRMS chromatogram. The peak centered at 13.413 min indicates that a compound elutes from the LC column at 13.413 min. (D) Top: The HRMS MS1 spectrum of the compound eluting at RT 13.413 min, providing the exact neutral molecular mass [M + H]+ of the compound; bottom: the HRMS MS2 spectrum of the compound eluting at RT 13.413 min, enabling structural identification and comparison with a collection of reference MS2 spectra associated with identified molecules (here mefenamic acid). (E) Composition of all compound identified in high-resolution mass spectrometry. GC–MS: gas chromatography–mass spectrometry; LC–HRMS: liquid chromatography–high-resolution mass spectrometry; RT: retention time.

Swapnil Hiremath 🍁🇨🇦@hswapnil· Jul 10

compare this with the almost flat GFR slope from interim telitacicept data (while we await atacicept aka Trutakna data) www.nephjc.com/news/2026/sh... from @nephromommy-akshu.bsky.social

Swapnil Hiremath 🍁🇨🇦@hswapnil· Jul 10

GFR slope with Atrasentan alone (top panel) not that impressive anymore in the age of -tacicepts for IgAN www.thelancet.com/journals/lan... Atrasentan + Flozin (middle panel) not that bad

Figure 2 Change from baseline to week 136 in eGFR in the atrasentan and placebo group in the main stratum (A), SGLT2 inhibitor stratum (B), and pooled strata (C)

Swapnil Hiremath 🍁🇨🇦@hswapnil· Jul 9

Interesting nugget from the @wsj.com podcast on polymarket shenanigans - prediction markets are gambling - so most people lose money - 0.1% users make most of the profits: hedge funds and trading firms making informed/analysed bets www.wsj.com/podcasts/the...

Katherine Long: No. No. Most people lose money on Polymarket.

Ryan Knutson: Who does win money on Polymarket?

Katherine Long: Almost nobody. Previously we reported that 70% of Polymarket users lose money. That's based on Caitlin's incredible data analysis.

Ryan Knutson: Caitlin found that about two-thirds of the profits on Polymarket go to 0.1% of users. And those users tend to be small hedge funds and trading firms that are informed by reams of data. Meanwhile, the average better who's losing money looks a lot like the people in those fake videos.

Caitlin Ostroff: The primary audience for people to gamble, whether it's sports betting or prediction markets, is young men.

Swapnil Hiremath 🍁🇨🇦@hswapnil· Jul 8

The aftermath

Can’t hide the disgust

See the second from left - others have a reasonable poker face to hide their feelings

Swapnil Hiremath 🍁🇨🇦@hswapnil· Jul 8

Everyone enjoying the anticipation of drinking Brussel champagne 🥂

The nephrology boot camp
Toasting to some flavored urea 🥂

Swapnil Hiremath 🍁🇨🇦@hswapnil· Jul 8

The bladder is often scarred or shrunk in ESRD here’s a first in human feasibility report of a combined kidney bladder transplant www.thelancet.com/journals/lan... in @thelancet.com

Figure 2. Back-table preparation of the vascularised composite bladder allograft, creating a single arterial inflow and a single venous outflow supplying the entire bladder

Swapnil Hiremath 🍁🇨🇦@hswapnil· Jul 8

See this @jamainternalmed.com teachable moment for more jamanetwork.com/journals/jam... #potassium #nephsky

Table. Foods With Higher and Lower Potassium Levels by Region and Ethnicitya

Swapnil Hiremath 🍁🇨🇦@hswapnil· Jul 8

Do you know the potassium content of this fruit?

Swapnil Hiremath 🍁🇨🇦@hswapnil· Jul 8

Graphical representation of of Brown Econ undergrad cheating www.insidehighered.com/news/faculty... h/t @jacobtlevy.bsky.social and @sjshancoxli.liberalcurrents.com #AI #LLM

Graph showing difference between midterm (LLM aided) versus final (unaided) scores

Swapnil Hiremath 🍁🇨🇦@hswapnil· Jul 8

another episode of @freelyfiltered.bsky.social @kidneyboy.bsky.social @medpeedskidneys.bsky.social and Natalie Freidin with Prof Fernando Fervenza This will be a must listen!

Swapnil Hiremath 🍁🇨🇦@hswapnil· Jul 3

Happening today at @uottawa.ca the Nephrology Bootcamp - this year's edition will have Brussel Champagne on the menu 🥂 Inspired by @kidneyboy.bsky.social #NephSky

Swapnil Hiremath 🍁🇨🇦@hswapnil· Jul 3

The second issue of the journal is live! @theisn.org @arvindcanchi.bsky.social Thanks to the authors, and our reviewers! Everything open access to read: www.kicasereports.org/issue/S3117-... #KICR

Swapnil Hiremath 🍁🇨🇦@hswapnil· Jul 3

As ridiculous as CKD staging is, we have nothing on this thing of utter beauty www.ahajournals.org/doi/10.1161/... We are all stage A HF! Flozinate everyone. GDMT on the drinking water. #medsky #cardiosky /s

Swapnil Hiremath 🍁🇨🇦@hswapnil· Jun 29

Funny story on AI/LLM based cheating at Brown undergrad econs english.elpais.com/education/20...

The course, which he has been teaching for years, is not an easy one: it typically attracts few students, but very good ones. He has never had more than 30 students enrolled at a time, and on some occasions he had only eight. This semester, probably because of the new evaluation system, 86 students signed up for the class. The results of the midterm exam, which was administered on March 5, were extraordinary, with an average score of 96 out of 100. Forty students scored a perfect 100. The people who corrected the exams warned him about several irregularities. “Some answers contained unusual passages that coincided with results obtained after running the questions through ChatGPT,” he says.

Serrano did not void the midterm exam, but warned students that the final one, which counted for 50% of the final grade, would be held in-person. He also said that if the grade distribution was not similar to the midterm, only the final exam would be taken into account. The average score dropped to 48 out of 100. Of the 89 students who did the midterm exam, only 59 showed up for the final one. And of the 27 who did not show up, 22 had scored a perfect 100 in the midterm exam.

Swapnil Hiremath 🍁🇨🇦@hswapnil· Jun 19

What we cannot dialyse Nicely written @ajkd.bsky.social www.ajkd.org/article/S027...

Swapnil Hiremath 🍁🇨🇦@hswapnil· Jun 17

Fixing non-adherence in hypertension is hard, exhibit 3: www.sciencedirect.com/science/arti... (RCT in Lancet Prim Health) Ex 1: journals.lww.com/jhypertensio... Ex 2: academic.oup.com/ajh/article/...

Table 2. Primary and secondary outcomes (adjusted analysis)

Swapnil Hiremath 🍁🇨🇦@hswapnil· Jun 17

Happening tomorrow! Adrianna Douvris, our former fellow and now completing her post-doc, on kidney organoids #NephGR

Swapnil Hiremath 🍁🇨🇦@hswapnil· Jun 16

Can someone confirm? Science snitch on Insta (www.instagram.com/reel/DZlOQEi...) mentions potassium salt (= either KCl or K-substituted 25-75 KCl/NaCl) in Cheetos ingredients - likely US only as the FDA OK’d potassium salt nomenclature a few years ago