HbA1c still tracks kidney decline as well as CGM, and nafamostat for filters that clot

The edition in brief

Today's nephrology edition opens with a meta-analysis of eight mostly non-randomised studies (1,189 patients) of nafamostat for anticoagulation during continuous kidney replacement therapy (published 30 October). Compared with no anticoagulation, nafamostat was associated with longer filter life and lower mortality, without more bleeding; the mortality finding is very likely confounded. A post hoc PEXIVAS analysis in the Annals of the Rheumatic Diseases (23 September) derived a model predicting first relapse within two years of remission in ANCA-associated vasculitis with severe kidney involvement, using sex, induction agent, ANCA subtype, organ involvement and eGFR at remission (C statistic 0.71); it awaits external validation. A cluster-randomised trial of nurse-led exercise in 56 haemodialysis patients with sarcopenia found trends towards better grip strength and gait speed that did not survive correction for multiple comparisons. The pearl is the sick-day pause for kidney-sensitive drugs. The practice changer is the GRADE-CGM substudy (Journal of Diabetes and its Complications, 19 October): in 1,363 adults with type 2 diabetes, the glucose management indicator and HbA1c were similarly associated with cardiovascular events and with faster eGFR decline, whereas time in range was associated with cardiovascular outcomes but not with kidney decline. For nephrologists following diabetic kidney disease, HbA1c remains a sound marker; CGM adds detail rather than replacing it.