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Equations for estimating GFR with serum creatinine overestimate measured GFR in Blacks. The authors report new equations, without race as an inflation factor, using cystatin C and creatinine that reduced errors in estimation between Black participants and non-Black participants.

Estimating equations for the glomerular filtration rate — EKFC eGFRcr (creatinine) and EKFC eGFRcys (cystatin C) — were tested. EKFC eGFRcys was unbiased and accurate, irrespective of the inclusion of race or sex.

Aldosterone synthase controls the synthesis of aldosterone and has been a pharmacologic target for the treatment of hypertension for several decades. Selective inhibition of aldosterone synthase is essential but difficult to achieve because cortisol synthesis is catalyzed by another enzyme that shares 93% sequence similarity with aldosterone synthase. In preclinical and phase 1 studies, baxdrostat had 100:1 selectivity for enzyme inhibition, and baxdrostat at several dose levels reduced plasma aldosterone levels but not cortisol levels. In this multicenter, placebo-controlled trial, we randomly assigned patients who had treatment-resistant hypertension, with blood pressure of 130/80 mm Hg or higher, and who were receiving stable doses of at least three antihypertensive agents, including a diuretic, to receive baxdrostat (0.5 mg, 1 mg, or 2 mg) once daily for 12 weeks or placebo. The primary end point was the change in systolic blood pressure from baseline to week 12 in each baxdrostat group as compared with the placebo group. A total of 248 patients completed the trial. Dose-dependent changes in systolic blood pressure of -20.3 mm Hg, -17.5 mm Hg, -12.1 mm Hg, and -9.4 mm Hg were observed in the 2-mg, 1-mg, 0.5-mg, and placebo groups, respectively. The difference in the change in systolic blood pressure between the 2-mg group and the placebo group was -11.0 mm Hg (95% confidence interval [CI], -16.4 to -5.5; P<0.001), and the difference in this change between the 1-mg group and the placebo group was -8.1 mm Hg (95% CI, -13.5 to -2.8; P = 0.003). No deaths occurred during the trial, no serious adverse events were attributed by the investigators to baxdrostat, and there were no instances of adrenocortical insufficiency. Baxdrostat-related increases in the potassium level to 6.0 mmol per liter or greater occurred in 2 patients, but these increases did not recur after withdrawal and reinitiation of the drug. Patients with treatment-resistant hypertension who received baxdrostat had dose-related reductions in blood pressure. (Funded by CinCor Pharma; BrigHTN ClinicalTrials.gov number, NCT04519658.).

Genetically modified pig kidney xenografts were transplanted into two brain-dead human recipients. The xenografts functioned immediately and showed no evidence of acute rejection on serial biopsy over a period of 54 hours. The serum creatinine level decreased in both recipients.

Key PointsMedical Artificial Intelligence and Human ValuesAs large language models and other artificial intelligence models are used more in medicine, ethical dilemmas can arise depending on how the model was trained. A user must understand how human decisions and values can shape model outputs. Medical decision analysis offers lessons on measuring human values.A large language model will respond differently depending on the exact way a query is worded and how the model was directed by its makers and users. Caution is advised when considering the use of model output in decision making.

Among participants with type 2 diabetes and cardiovascular disease, chronic kidney disease, or both, oral semaglutide (14 mg) was associated with a lower risk of cardiovascular events than placebo after 4 years of follow-up.

The cause of von Hippel–Lindau disease is excess activity of the HIF-2α pathway. A total of 61 patients with renal cell carcinoma and other proliferative manifestations of the hypoxia-induced signaling pathway received belzutifan, which inhibits the HIF-2α pathway. Nearly half the patients with renal cell carcinoma had a response to treatment, and 98% had disease control.

In a phase 2a study, 16 participants with APOL1 nephropathy received inaxaplin, an inhibitor of APOL1 channel function. Among 13 evaluable participants, the mean reduction in proteinuria was 47.6% at week 13.

Key Clinical PointsNavigating and Communicating about Serious Illness and End of LifePartnering with patients as they navigate serious illness requires effectively communicating prognostic information while responding to the emotions generated by the conversation.Clinicians should expect, and have the skill, to engage in a continuum of conversations that allow patients to integrate prognostic information cognitively and emotionally.Patients oscillate between expressions of intense hopefulness and more realistic aspirations; this a normal and expected part of the process.Facilitating patient exploration of their hopes and worries allows them to grieve, understand their priorities, and build coping skills for living with a serious illness.As patients integrate prognostic information, clinicians should discuss what is most important to the patient given the likely illness trajectory and incorporate these goals and values into a recommendation about medical care, including care at the end of life.