Oral orforglipron passes its cardiovascular safety test in a population with heavy CKD, and one geriatric review is not enough for frail kidney patients

The edition in brief

ACHIEVE-4 randomised 2,749 adults with type 2 diabetes, overweight or obesity and established cardiovascular disease or CKD (37.6% had CKD) to oral orforglipron or insulin glargine. Over a median two years, major adverse cardiovascular events occurred in 4.2% versus 5.0% (HR 0.84, 0.59–1.20), meeting non-inferiority. Gastrointestinal adverse events affected 62.1% versus 14.2%, while clinically significant hypoglycaemia was lower (6.8% vs 19.2%). Deaths were 1.4% versus 3.2%. A Kidney International commentary on the GOAL trial notes that a single outpatient comprehensive geriatric assessment did not improve goal attainment in older people with CKD and frailty, and argues for other models of person-centred care. A randomised trial of 181 patients having percutaneous nephrolithotomy found lung ultrasound-guided fluid management reduced extravascular lung water and postoperative hypoxaemia compared with CVP-guided care. In mice, the tubular repair factor SOX9 was induced after AKI only in males, through androgen signalling. The pearl covers volume depletion and AKI with GLP-1 receptor agonists.