Nephrology

Hypothyroidism and subclinical hypothyroidism associate with higher CKD prevalence; levothyroxine shows no clear eGFR benefit.

A meta-analysis of 46 adult studies found hypothyroidism associated with higher CKD prevalence with OR 1.94 (95% CI 1.62–2.32) and subclinical hypothyroidism with OR 1.87 (95% CI 1.55–2.27). Both non‑distinct hypothyroidism and subclinical hypothyroidism were linked to lower eGFR (SMDs approximately −0.68 and −0.99 respectively). No clear association was observed between hypothyroidism and incident CKD or ESRD in patients with existing kidney disease in pooled data. Randomized data did not show significant eGFR improvement after levothyroxine treatment, so causality and treatment benefit remain unproven. 1

Pharmacist outreach increased SGLT2 inhibitor starts in veterans with T2D and CKD.

In a VA quality improvement pseudorandomized study of 8,658 veterans with T2D and CKD, pharmacist outreach increased SGLT2 initiation (HR 1.91, 95% CI 1.69–2.16). One‑year cumulative initiation was 33.5% with intervention versus 15.5% with usual care, and 12‑month fills were 19.6% vs 9.7%. Intervention involved mailed education and a 30‑minute pharmacist phone visit with medication prescription when appropriate. Authors note limited intervention reach, so absolute population impact depends on program scalability and patient contact rates. 2

Time‑horizon definition markedly alters dynamic prediction performance in kidney transplantation.

A systematic review (171 articles) and analysis of 2,523 transplant recipients show prognosis metrics differ by horizon type: sliding versus final horizons. For a 5‑year sliding horizon, discrimination rose slightly with later landmarks and calibration was reasonable at early landmarks. For an 11‑year final horizon, discrimination was high early but calibration underestimated early and overestimated later predictions. Reporting the chosen time horizon is essential before comparing or applying dynamic prediction models clinically. 3