Understand your kidneys. Improve your metabolic health.

For years, a kidney drug with good trials behind it had one hole in the evidence: every trial was done in people with diabetes. FIND-CKD closed it, and 1,584 adults with chronic kidney disease and no diabetes now have a randomized answer. Every month I take the newest research in kidney health and metabolic health and tell you, in plain English, what the evidence can actually cash. Strong study, you will hear it. Small, early, or paid for by the company selling the drug, you will hear that too. Tonight is 6 studies from the last 6 weeks, kidney health first and the wider metabolic world second, with 4 stops to take your questions live in the chat. What you will learn: - Why finerenone slowed kidney decline by 0.7 millilitres per minute per year without diabetes, and why the trial's potassium number is a floor rather than a ceiling - Who FIND-CKD actually studied: more than half had a named glomerular disease, entry required a potassium of 4.8 or lower, and polycystic kidney disease was excluded - What the JAMA follow-up found in the 903 people with IgA nephropathy, FSGS or membranous nephropathy, and why a prespecified subgroup is still not a trial - Why evening fasted exercise burned more fat and was followed by 547 more calories eaten over 24 hours - The cholesterol particle most people have never had measured, why statins raise it by about 11 percent, and the one blood test worth asking for - The honest record of the CETP drug class, including the one that cut heart attacks and was never sold - What happened when a randomized trial took 90 minutes of sleep a night from people who were already sleeping enough, and why that is not the same claim as getting 90 minutes more CHAPTERS 00:00 The 547-calorie result 01:47 What tonight covers, and how to ask a question 03:03 Kidney background: ACE inhibitors, SGLT2, finerenone 04:36 FIND-CKD, and who was allowed into it 06:09 The slope result, and what 0.7 buys over 10 years 08:32 The potassium tradeoff 10:43 Your questions, round one 14:43 Who was actually in that trial 17:48 Why a prespecified subgroup is not a trial 19:31 Three questions for your next appointment 21:06 Your questions, round two 25:13 Exercise timing, and both results being true 27:20 Fat burned is not fat lost 30:34 Your questions, round three 34:34 Lipoprotein(a), and why statins do not fix it 38:41 Lowering a number is not preventing an event 41:33 A liver trial that failed, and the arm that won 45:53 Your questions, round four 49:53 The members-only live 51:03 The sleep trial, and the 17 minutes nobody picks 56:03 One idea, and the one action for this week WATCH NEXT IgA Nephropathy: 5 Steps to Protect Your Kidneys Now https://www.youtube.com/watch?v=pe8A9tyikLs KEY REFERENCES Finerenone in Persons with Chronic Kidney Disease without Diabetes (FIND-CKD). New England Journal of Medicine. 2026;395(6):533-545. PMID: 42246672. Finerenone in Patients With Chronic Kidney Disease Due to Glomerular Diseases. JAMA. 2026;336(3):224-235. PMID: 42246414. Effects of exercise timing and metabolic state on post-exercise energy intake and appetite. American Journal of Clinical Nutrition. 2026;124(3):101439. PMID: 42471222. Obicetrapib and lipoprotein(a) levels in patients at high cardiovascular risk. European Heart Journal. 2026;47(26):3404-3414. PMID: 42183881. Zalfermin co-administered with semaglutide in fibrosis and cirrhosis due to MASH. Lancet Gastroenterology and Hepatology. 2026;11(9):797-811. PMID: 42456707. Prolonged Short Sleep and Its Effect on Body Weight and Composition. Annals of Internal Medicine. 2026. PMID: 42407080. ────────────────────────────── Become a member. The reason people join is the members-only live AMA every month, the fourth Thursday at 6 PM Pacific, next on August 27, where I spend real time on your questions on camera in a smaller room. Members also get every new video 48 hours before it goes public, members-only community posts, and a member badge. https://www.youtube.com/@SeanHashmiMD/join?utm_campaign=membership Subscribe for evidence-first health each week: https://www.youtube.com/@SeanHashmiMD?sub_confirmation=1 ────────────────────────────── Get these monthly roundups in writing, with every citation and the member-live schedule: 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 #CKD #Lipoproteina

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