Understand your kidneys. Improve your metabolic health.

Does your blood pressure pill hurt your kidneys? Usually it's the opposite: that early creatinine bump after starting an ACE inhibitor, ARB, or SGLT2 inhibitor is often the drug starting to protect the kidney, not damage it. The dip is the point — and quitting is the real danger. In this month's members-only live, Dr. Sean Hashmi answers the top five questions members asked all month, then takes live questions from the chat. This is general education, not personal medical advice. What you'll learn: - Why creatinine rises when a "prill," "sartan," or "flozin" starts working, and the ~30% rule that tells you it's expected - Why your creatinine swings between tests: big meat meals, creatine, dehydration, and when to ask for cystatin C - The two-minute post-meal walk and seated calf raise that blunt a blood sugar spike - Whether apple cider vinegar, cinnamon, and berberine actually do anything - ApoB and Lp(a): why a "normal" LDL can still hide real risk - The four evidence-based pillars that slow kidney disease, even without diabetes Chapters: 00:00 Welcome to the members-only live 00:46 Why a kidney "dip" scares you (and why the dip is the point) 01:19 Ground rule: general education, not personal medical advice 02:48 Does your blood pressure pill hurt your kidneys 06:51 Why your creatinine keeps jumping around 12:26 What actually reverses insulin resistance and fatty liver 18:46 Cholesterol: is a normal LDL really safe (ApoB and Lp(a)) 23:28 This month in research: muscle mass and GLP-1 eye safety 27:05 What slows kidney disease when the usual advice runs out 29:30 The four kidney-protection pillars (works without diabetes) 35:43 Live schedule and how to join 36:00 Your questions answered live Watch Next: Your Creatinine Dropped? Here's What Actually Happened — https://www.youtube.com/watch?v=m3k0Mf6FQTY Key references: - Holtkamp FA, de Zeeuw D, Thomas MC, et al. An acute fall in estimated GFR during treatment with losartan predicts a slower decrease in long-term renal function (RENAAL post hoc analysis). Kidney Int. 2011;80(3):282-287. doi:10.1038/ki.2011.79 - Inker LA, Eneanya ND, Coresh J, et al. New creatinine- and cystatin C-based equations to estimate GFR without race. N Engl J Med. 2021;385(19):1737-1749. doi:10.1056/NEJMoa2102953 - The EMPA-KIDNEY Collaborative Group. Empagliflozin in patients with chronic kidney disease. N Engl J Med. 2023;388(2):117-127. doi:10.1056/NEJMoa2204233 - Perkovic V, Tuttle KR, Rossing P, et al. Effects of semaglutide on chronic kidney disease in patients with type 2 diabetes (FLOW). N Engl J Med. 2024;391(2):109-121. doi:10.1056/NEJMoa2403347 - Agarwal R, Filippatos G, Pitt B, et al. Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis. Eur Heart J. 2022;43(6):474-484. doi:10.1093/eurheartj/ehab777 _____________ Become a member (SELF Supporter): the hero perk is this monthly members-only Live AMA with Dr. Sean, fourth Thursday, 6 PM Pacific — plus new videos 48 hours early, members-only community posts, and a member badge. Join: https://www.youtube.com/@SeanHashmiMD/join?utm_campaign=membership The free monthly live is open to everyone on the second Thursday, 6 PM Pacific. Subscribe: https://www.youtube.com/@SeanHashmiMD?sub_confirmation=1 _____________ Get the science first, in plain language — join the newsletter: https://selfprinciple.org/newsletter Website: https://selfprinciple.org Instagram: https://www.instagram.com/seanhashmimd The information in this content is for educational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have seen in this content. The views expressed here are my own and do not represent the views of my employer or any affiliated institution. Never start, stop, or change the dose of any prescription medication without consulting your physician. #KidneyHealth #ChronicKidneyDisease #Creatinine

A meta-analysis of 22 randomized trials asked whether eating more protein harms healthy kidneys. The answer cracks a warning a lot of doctors have repeated for decades. Every month I take the newest research across kidney and metabolic health and tell you, in plain English, what the evidence can actually cash. Strong study, you'll hear it. Small, early, or paid for by the company selling the drug, you'll hear that too. Tonight is a fast tour through 15 new studies, kidney health in the first half, the broader metabolic world in the second, with two stops along the way to take your questions live in the chat. It covers the protein-and-kidneys finding, a new IgA nephropathy drug, why an SGLT2 inhibitor did not protect failing transplanted kidneys, how much of GLP-1 weight loss is muscle instead of fat, the fix that protects it, fatty liver, sleep, and a closing study that may extend kidney protection to people who don't have diabetes at all. What You'll Learn • Why high protein raised eGFR but showed no rise in creatinine and no sign of injury in people without kidney disease, and why that matters if you eat high protein for muscle or weight goals • How much of GLP-1 weight loss is muscle, not fat (lean mass was about 28 percent of total weight lost across 36 trials), and the resistance-training-plus-creatine fix that protects it • What the ALIGN trial showed for atrasentan in IgA nephropathy, and the near-miss p-value of 0.057 that keeps the result honest • Why dapagliflozin did not protect failing transplanted kidneys, even though the same drug class protects native kidneys • The first real signal that semaglutide may protect kidneys and blood pressure in people with obesity but without diabetes CHAPTERS 00:00 Opening: the 22-trial protein number 02:32 What tonight covers, and the ground rules 04:37 Kidney: does high protein harm healthy kidneys? 09:01 Semaglutide's kidney benefit and the FLOW subgroup 12:06 A new IgA nephropathy drug (ALIGN, atrasentan) 16:13 When a kidney drug misses: dapagliflozin in transplant 19:51 Quick hit: enlarged prostate and kidney stones 21:27 Read your own labs: eGFR and ACR 24:54 Your questions, round one 27:55 Metabolic health: the ultra-processed food debate 32:25 How much muscle you lose on GLP-1 drugs 35:42 The fix: creatine and resistance training 38:31 A surprise heart benefit: atrial fibrillation 40:51 Semaglutide and the brain: a seizure signal 43:10 Is weekend catch-up sleep really bad? 45:29 Fatty liver: tirzepatide versus SGLT2 inhibitors 47:58 ApoB versus LDL: the whole cholesterol picture 50:33 Your questions, round two 52:41 The finale: semaglutide without diabetes 55:17 The SELF Inner Circle 56:35 What to do this week Watch Next IgA Nephropathy: 5 Steps to Protect Your Kidneys Now https://www.youtube.com/watch?v=pe8A9tyikLs Key References • High protein intake and kidney function in adults without CKD: systematic review and meta-analysis of 22 randomized trials. Diabetes, Obesity and Metabolism. 2026. PMID: 42289790. • Lean body mass loss with GLP-1 receptor agonists and SGLT2 inhibitors: systematic review and meta-analysis of 36 randomized trials. Diabetes, Metabolism Research and Reviews. 2026. PMID: 42319968. • Creatine monohydrate plus resistance training on lean mass and strength in postmenopausal women: meta-analysis of 7 randomized trials. Journal of the International Society of Sports Nutrition. 2026. PMID: 42141930. • ALIGN trial: atrasentan in biopsy-proven IgA nephropathy, randomized controlled trial. The Lancet. 2026. PMID: 42242268. • Tirzepatide versus SGLT2 inhibitors in MASLD: real-world comparative outcomes at one and three years. Hepatology International. 2026. PMID: 42397506. • Semaglutide in obesity with chronic kidney disease or hypertension without diabetes: pooled analysis of 3 studies. La Clinica Terapeutica. 2026. PMID: 42340790. Membership Become a member: you get every new video 48 hours before it goes public, plus a second live every month, members only, on the fourth Thursday, where I spend real time on your questions in a smaller room. https://www.youtube.com/@SeanHashmiMD/join?utm_campaign=membership Subscribe Subscribe for evidence-first health each week: https://www.youtube.com/@SeanHashmiMD?sub_confirmation=1 Newsletter Get these monthly roundups in writing, with every citation and the member-live schedule: https://selfprinciple.org/newsletter Website and Social Website: https://selfprinciple.org Instagram: https://www.instagram.com/SeanHashmiMD Disclaimer The information in this content is for educational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The views expressed here are my own and do not represent the views of my employer or any affiliated institution. #KidneyHealth #Protein #GLP1

Your eGFR dropped right after starting an SGLT2 inhibitor like Jardiance or Farxiga, and you want to stop. That eGFR drop is usually the drug working. In this members live AMA I answer the five kidney questions you asked most this month. We open with the early eGFR drop on an SGLT2 inhibitor, why it is a pressure change and not kidney damage, and the point where a drop is actually a warning sign. Then a blood pressure target under 120 after age 75, how much protein to eat with chronic kidney disease while protecting muscle on a GLP-1, why your creatinine and cystatin C can disagree, and whether these drugs protect your kidneys when you are not diabetic and not overweight. What you'll learn: • Why the early eGFR dip of up to about 30 percent on an SGLT2 inhibitor is expected, and the threshold that means call your clinician • Whether a systolic target under 120 is worth it after 75, and the SPRINT numbers behind it • What 0.6 to 0.8 g/kg of protein looks like on a plate, and how resistance training protects muscle on a GLP-1 • Why creatinine and cystatin C disagree, and when to ask for the combined CKD-EPI estimate • Whether these drugs protect kidneys without diabetes, since EMPA-KIDNEY was about 54 percent non-diabetic Chapters 00:00 The drop is the point 02:00 My eGFR dropped, do I stop? 08:00 Is under 120 too low over 75? 14:00 Protein, and keeping muscle 19:00 Creatinine vs cystatin C 24:00 This month in research 26:00 Not diabetic, not overweight, do they help? 30:00 The number is not the patient Watch next, 3 Medications That Dramatically Cut Kidney Failure Risk (Most People Miss One): https://www.youtube.com/watch?v=J8qEwYUFW80 Key references: Heerspink HJL, et al. Dapagliflozin in Patients with Chronic Kidney Disease (DAPA-CKD). N Engl J Med. 2020;383(15):1436-1446. PMID: 32970396. The EMPA-KIDNEY Collaborative Group. Empagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2023;388(2):117-127. PMID: 36331190. Inker LA, et al. New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race. N Engl J Med. 2021;385(19):1737-1749. PMID: 34554658. SPRINT Research Group. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015;373(22):2103-2116. PMID: 26551272. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of CKD. Kidney Int. 2024;105(4S):S117-S314. PMID: 38490803. ------------------------------------------------------------ Members get new videos 48 hours early, plus a monthly live Q and A with Dr. Sean. Join: https://www.youtube.com/@SeanHashmiMD/join?utm_campaign=membership Subscribe: https://www.youtube.com/@SeanHashmiMD?sub_confirmation=1 ------------------------------------------------------------ Free weekly newsletter, the research on kidney and metabolic health turned into what to do this week: SELFPrinciple.org Website: SELFPrinciple.org Instagram: https://www.instagram.com/seanhashmimd The information in this content is for educational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have seen in this content. The views expressed here are my own and do not represent the views of my employer or any affiliated institution. Never start, stop, or change the dose of any prescription medication without consulting your physician. #KidneyHealth #CKD #eGFR

A new IgA nephropathy drug cut urine protein by nearly 60% in a Phase 3 trial. That's one of nine new kidney, diabetes, and brain studies I break down here. Every month I take the newest research and tell you, in plain English, what's real and what's hype. This month spans kidney health, metabolism, and how you age. Three studies made me stop, and all three have a catch, because the catch is where the truth lives. Stay to the end for my three rankings: the study most likely to change how I practice, the one you can use this week, and the one social media will blow out of proportion. WHAT YOU'LL LEARN The IgA nephropathy biologic that cut urine protein about 59% with kidney function nearly flat How electrical stimulation during dialysis added roughly 48 meters to a 6-minute walk The GLP-1 and dual-agonist weight loss drugs ranked, from semaglutide to tirzepatide to CagriSema How 62.5% of people with early type 2 diabetes hit remission with food alone The 7-day food-packaging swap that dropped urinary plastic chemicals up to 60% The exercise mix that best protects the aging brain, and the truth about supplements for women CHAPTERS 00:00 The three studies that made me stop 00:52 Why this monthly live is different 02:23 Segment 1: Kidneys 02:55 IgA nephropathy: a drug that cut urine protein ~60% (NEJM) 06:49 Holding onto muscle on dialysis: electrical stimulation (Kidney Medicine) 10:01 Low-protein diet plus exercise in CKD (Nutrients) 14:31 Segment 2: Metabolism 15:00 GLP-1 weight loss drugs, ranked (Endocrinology, Diabetes & Metabolism) 19:39 Reversing early type 2 diabetes with food (Journal of Diabetes) 22:42 Plastics: a 7-day swap that cut chemical exposure up to 60% (Nature Medicine) 27:34 The best exercise for the aging brain (Frontiers in Public Health) 29:52 Women, muscle, and supplements: what actually works (Int. Journal of Medical Sciences) 32:32 Insomnia and dementia risk (Archives of Gerontology and Geriatrics) 36:50 The recap 38:42 My three rankings for tonight 41:13 Your questions, answered live WATCH NEXT IgA Nephropathy: 5 Steps to Protect Your Kidneys Now https://www.youtube.com/watch?v=pe8A9tyikLs STUDIES AND SOURCES (journals named in the video) IgA nephropathy biologic, telitacicept, Phase 3, New England Journal of Medicine Electrical stimulation during hemodialysis, Kidney Medicine Low-protein diet plus exercise in CKD, Nutrients GLP-1 and dual-agonist weight loss drugs, Endocrinology, Diabetes & Metabolism Diet and remission of early type 2 diabetes, Journal of Diabetes Food packaging and urinary plastic chemicals, the PERTH study, Nature Medicine Exercise type and cognition in sedentary adults, Frontiers in Public Health Protein, amino acids, and creatine with exercise in women, International Journal of Medical Sciences Insomnia and dementia risk over seven years, Archives of Gerontology and Geriatrics Full citations with author, year, and PMID are in this week's free newsletter. DRUG NAMES MENTIONED Telitacicept: the IgA nephropathy biologic, blocks BLyS/BAFF and APRIL Semaglutide: Ozempic, Wegovy Tirzepatide: Mounjaro, Zepbound Cagrilintide CagriSema: cagrilintide plus semaglutide. Not yet FDA approved; Novo Nordisk filed in December 2025, FDA decision expected late 2026. Retatrutide: investigational triple agonist SGLT2 inhibitors, including empagliflozin (Jardiance) BECOME A MEMBER Members get new videos 48 hours early and a second, members-only live Q and A with me every month on the fourth Thursday. https://www.youtube.com/channel/UC9LQOhavwlGM58bIWbnXTDA/join?utm_campaign=membership SUBSCRIBE https://www.youtube.com/channel/UC9LQOhavwlGM58bIWbnXTDA?sub_confirmation=1 FREE WEEKLY NEWSLETTER Every study from these monthly reviews, written out with the full citations, in your inbox each week. https://selfprinciple.org/newsletter CONNECT Website: https://selfprinciple.org Instagram: @SeanHashmiMD The information in this content is for educational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have seen in this content. The views expressed here are my own and do not represent the views of my employer or any affiliated institution. Never start, stop, or change the dose of any prescription medication without consulting your physician. #KidneyHealth #IgANephropathy #GLP1