Carl Öberg MD PhD

On the occasion of the #InternationalWomensDay
@pd-perls.bsky.social and I chat with three extraordinary women in #peritonealdialysis on a new special episode of the #PDExchange #podcast
Podcast Link
Spotify - spoti.fi/3DxBOli
Apple - apple.co/3pboqwa

@ispd.org @pdi-journal.bsky.social

Excited to participate in the upcoming PD Meeting in Kiel which is the 1st International Meeting on Cellular and Molecular Peritoneal Dialysis Research! Join us to explore cutting-edge research, network with experts, and advance peritoneal dialysis care. pdmeeting.skip-sh.de

Clinical, Experimental and Theoretical Studies of Solute and Water Removal in Peritoneal Dialysis

Giedre’s excellent thesis is now available for download at Lund University: portal.research.lu.se/en/publicati...
Brings tears to the eyes of a true Peritoneal Dialysis Nerd 🎓🎓🎓

Clinical, Experimental and Theoretical Studies of Solute and Water Removal in Peritoneal Dialysis

Giedre's excellent thesis is now available for download at Lund University: portal.research.lu.se/en/publicati...

Brings tears to the eyes of a true PD-nerd 🎓🎓🎓

#NephJC One of the slides from @bhallaresearch.bsky.social at #ISNWCN

Primary aldosteronism is an elephant in the room, encountered at all stages of HTN, and even with normotension.

Brown, et al, 2020

A neoantigen vaccine generates antitumour immunity in renal cell carcinoma - Nature A phase I trial of a neoantigen-targeting personalized cancer vaccine led to durable and polyfunctional T cell responses and antitumour recognition, and was associated with no recurrence in patie...

Some good news - a vaccine to prevent kidney cancer returning.

It’s a small sample at this stage, but there were zero cases of recurrence.

Clazakizumab, an IL-6 inhibitor, improves iron metabolism & may reduce ESA use in dialysis

✅ ↓ Hepcidin (~44%)
✅ ↑ TSAT (up to 19%)
✅ ↓ ESA dose uptitration

P3 trial (n=2,200) ongoing for CV outcomes.

Our findings now in JASN @asnpublications.bsky.social : journals.lww.com/jasn/citatio...

Both as I understand it. HyperK is the major safety concern + CKD4-5 pts were excluded in all major trials RALES, EPHESUS etc. = lack of solid evidence showing that the benefits outweigh potential risks in these patients.

1/ 📢 New research alert: The creatinine-cystatin C (Cr/CysC) ratio is shown to predict mortality and technique failure in anuric peritoneal dialysis (PD) patients. This marker might improve patient risk stratification. #RenalFailure #DialysisCare #ClinicalResearch

Open-label, Randomized, Controlled, Crossover Trial on the Effect of #Dapagliflozin in Patients with Autosomal Dominant Polycystic Kidney Disease #ADPKD Receiving #Tolvaptan

#VisualAbstract by @md_abdulqader83

www.kireports.org/ar...

👍 In Sweden, sodium bicarbonate pills are 1000 mg and contain ~12 mEq of bicarbonate.

So, the answer is: Yes, theoretically, you could survive on Baltic Sea water—but only if you follow a strict, low-salt diet to avoid dehydration. Without careful control of dietary salt, the kidneys would quickly be overwhelmed, leading to fluid loss and dehydration. 🌊💧❗️

Here’s the catch: drinking 2 liters of Baltic Sea water (14 g of salt) leaves little room for dietary salt. A typical diet adds another 10–12 g/day, pushing the total salt intake to 24–26 g, exceeding the kidneys' ability to excrete salt efficiently (~10–12 g/L in urine) and lead to dehydration. ⚠️💧

So, let’s revisit the Baltic Sea. Its water contains ~7 g/L of salt, much lower than regular seawater. If you drink 2 L per day, that would be a salt intake of 14 g/day. Surprisingly, not far off from the average Swedish daily salt consumption of 10–12 g/day. Could this be feasible for survival? 🤔💧

First, regular seawater has a salt concentration of ~35 g/L. Consuming seawater leads to dehydration because the kidneys can only produce urine with a maximum salt concentration of 10-12 g/L. So for every liter of seawater consumed, 3-3.5 liters of urine is needed to excrete all the excess salt. 🚫💧

💡 "Can you survive by drinking water from the Baltic Sea?" 🌊💧
A student asked me an interesting question: You can’t survive on seawater (~35 g/L salt), but the Baltic Sea surrounding Sweden only has 7 g/L. Could that be low enough for survival? Let’s dive in. 🧵✨

By shedding light on this mechanism, our study may help pave the way for optimized dialysis strategies in the future. For a complete overview of our study design and findings, read more here: doi.org/10.1177/0896...

The data we gathered supports the idea of a transcellular route for glucose movement—with evidence indicating that GLUT1 is central to this process. This builds on our previous observations and adds a new layer of understanding to how peritoneal dialysis works.

Forest plot showing 95% confidence intervals for UF rate, free water transport, diffusion capacity (MTAC) for 18F-deoxyglucose ([18-F]-DG), and MTACs for glucose, creatinine, urea and potassium.

Additional studies with indinavir (GLUT4-blocker) had no effect on FDG diffusion, leading us to conclude that the observed effects were likely the result of GLUT1-inhibition.

Both pan-GLUT-inhibition with phloretin and GLUT1:GLUT4-inhibition with ritonavir reduced plasma to dialysate diffusion capacities (MTACs) for 18-F-deoxyglucose.

In our study, we not only found that phloretin reduced FDG transfer, supporting our hypothesis of transcellular transfer, but also a significant reduction using GLUT1:GLUT4-blocker ritonavir.

Three hypotheses for plasma to dialysate diffusion of 18-F-deoxyglucose (18F-dg). Reduced diffusion of 18F-dg is reduced during GLUT-inhibition for indicate transcellular transfer.

We hypothesized that the observed reduction in glucose absorption due to pan-GLUT-blocker phloretin was either due to a reduction in 1. trans-cellular glucose transfer and little trapping 2. cellular absorption and trapping in peritoneal cells, 3. para-cellular glucose transfer.

Diffusion capacities (MTACs) for 18-F-deoxyglucose (FDG) and glucose during experimental PD. The direction of diffusion for glucose is from dialysate to blood, while the diffusion of FDG occurred in the opposite direction, from blood plasma to dialysate.

Here, we tracked the journey of glucose across the peritoneal membrane studying both conventional glucose and radiolabeled glucose (18-F-deoxyglucose) in the opposite direction (plasma→dialysate). Diffusive transport capacities for glucose were similar regardless of the direction of transport.

Phloretin Improves Ultrafiltration and Reduces Glucose... : Journal of the American Society of Nephrology ally contribute to mass transfer are not fully understood. Intraperitoneal administration of phloretin, a nonselective blocker of facilitative glucose transporters (GLUTs), reduced glucose absorption ...

We previously showed that the pan-GLUT inhibitor phloretin reduced glucose absorption and increased UF, implicating facilitative glucose transporters. However, it was unclear if transport occurred via absorption or transcellular pathways, or which GLUTs were involved. doi.org/10.1681/ASN.2022040474

Our recent study shows that glucose can cross peritoneal cells via a trans-cellular route during peritoneal dialysis, with evidence pointing to GLUT1 as playing a key role. This thread 🧵outlines the design and findings of the study. doi.org/10.1177/0896...

@pdi-journal.bsky.social @ispd.org @pd-perls.bsky.social
Original Article - journals.sagepub.com/doi/full/10....
Editorial - @johannmorelle.bsky.social @carloberg.bsky.social journals.sagepub.com/doi/full/10....

VA - @jmteakell.bsky.social

Enhancing individual glomerular filtration rate assessment: can we trust the equation? Development and validation of machine learning models to assess the trustworthiness of estimated GFR compared to ... Background Creatinine-based estimated glomerular filtration rate (eGFR) equations are widely used in clinical practice but exhibit inherent limitations. On the other side, measuring GFR is time consum...

Can we trust eGFR results? The answer of IA !
bmcnephrol.biomedcentral.com/articles/10....
trustekfcegfr.shinyapps.io/GFR_shiny_La...

Thanks to the EKFC!
Thanks to Antoine Lanot

🎓📢📢 My PhD student Giedre Martus will publicly defend her doctoral thesis:

"Clinical, Experimental and Theoretical Studies of Solute and Water Removal in Peritoneal Dialysis"

📅 March 6, 2025, at 1:00 PM CET
📍 Alwall House, SUS Lund (and via Zoom: lu-se.zoom.us/j/61103791502)

Will Xylocore® be the magic ELIXIR for peritoneal dialysis?

@ispd.org @pdi-journal.bsky.social @drnikhilshah.bsky.social @pd-perls.bsky.social @mlambie.bsky.social

Editorial: journals.sagepub.com/eprint/ENYAN...

Original article: journals.sagepub.com/doi/10.1177/...

🎉 Huge congratulations to the team, and especially to Martin Björk! Hard to believe this study started as his master’s thesis—and he did much of the work on his own. 👏 Impressive achievement!

Dose-Response Relationship of Phloretin Therapy on Water... : Kidney360 has shown to improve water transport and lower glucose absorption in experimental peritoneal dialysis. However, the dose-response relationship remains unknown, and we therefore performed a dose-respon...

🚨 New Research Alert! 🚨
Can phloretin (from apple trees 🍏) enhance peritoneal dialysis?

Our study shows potent effects on:
✅ Improving ultrafiltration
✅ Reducing glucose absorption via GLUT inhibition
✅ Clear dose-response relationship in experimental
models

bit.ly/KID0717