Any time I say hydralazine is trash a cardiologist slips into my DMs to defend. #NephJC I prefer to not torture patients if I can avoid it. (P.S. I love “whydralazine” 🤣)
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Hashtag
#NePhJC
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Thanks for being aboard to #NephJC Flight ✈️
Final call for applications is near ⏳
Fasten your seatbelt… and don’t miss your chance to apply 😉
Until next time @NephJC this was your nephron @dramiliflores.bsky.social ✍️
www.nephjc.com/news/nephjc-...
#TenPostNephJC #NephTwitter #NephSky
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👉 So… is it time to trash hydralazine #NephJC? 🗑️
#TenPostNephJC #NephSky #medsky
➡️ Up next (05/06/26): TRPC6 inhibition in FSGS, a phase 2 trial of BI 764198
pubmed.ncbi.nlm.nih.gov/41616795/
Join us www.nephjc.com
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Want more info #NephJC #NephTwitter #NephSky
link to the NephJC blog @nephroseeker.medsky.social @dramiliflores.bsky.social
link to VAs @divyaa24
www.nephjc.com/news/hydrala...
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8/10
Does this study close the gap?
👉 If risk is not increased, does this support hydralazine use?
👉 Why does this debate persist, when in many settings hydralazine use is unnecessary? Why-dralazine?
#TenPostNephJC #NephJC #NephSky #MedSky
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7/10
Not significant results when accounting for competing risk of death
👉 Would this change your prescribing?
👉 Do you trust ICD-coded vasculitis?
#NephJC #TenPostNephJC #NephSky #MedSky
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6/10
Give me something clever to say about additional analyses, by Eric Weinhandl #NephJC
#TenPostNephJC #NephSky #MedSky
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5/10
A figure paints🖼️ a 1000 words!
Cumulative incidence curves show early separation, but overall risk remains low.
👉 Absolute difference is small
👉 Curves stay close over time
What do you think? #TenPostNephJC #NephJC #NephSky #MedSky
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4/10
1 post results 📊
💊 Hydralazine was associated with higher
vasculitis risk ➡️ 0.8%
🆚 ACEi/ARB ➡️ 0.5%
🧮 Absolute risk difference: +0.3%; HR 1.19 (95% CI 1.04–1.37)
#TenPostNephJC #NephJC #NephSky #MedSky
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3/10
1 post methods
📍 Retrospective cohort at Ontario from 1/2008 - 12/2021, >66y
📍 🆕 hydralazine (40,748) vs 🆕 ACEi/ARB users (542,388)
📍Outcome: any new vasculitis diagnosis (ICD-10) using propensity score across 21 covariates
#TenPostNephJC #NephJC #NephSky #MedSky
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2/10
What’d I miss?
Hydralazine is used for resistant HTN & HF. It may drive autoimmunity: apoptosis of primed neutrophils, NET disruption, and loss of tolerance ➡️ immune complex–mediated injury 💥 Prescribing it? 🤔
#TenPostNephJC #NephJC #NephSky #MedSky
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Still ordering hydralazine? 🤔
Beyond case reports, this large cohort compares hydralazine vs ACEi/ARB to estimate real-world vasculitis risk, will this 📉 bias & clarify the answer
Read more 👇
pubmed.ncbi.nlm.nih....
#TenPostNephJC #NephJC
#NephSky #MedSky
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10 minutos to #nephJC
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Hydralazine, a 1950s drug still used at the edges of modern care. Cheap? Available?
Signal of benefit… shadowed by decades of immune toxicity signals
15 min to #TenPostNephJC #NephJC #NephSky #MedSky
pubmed.ncbi.nlm.nih.gov/6786464/
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Hydralazine is most classically associated with which serologic pattern in ANCA vasculitis?
25 min #TenPostNephJC #Nephsky #MedSky #NephJC
A. High-titer PR3-ANCA
B. High-titer MPO-ANCA
C. ANCA− / anti-GBM+
D. anti-dsDNA antibodies
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A. I am not convinced how a 3X effect in crude becomes a 1.2x effect after PS weighting black box
B. As we say in the summary, there are no good reasons to use hydralazine anyways. So small risk:zero benefit = infinite risk:benefit ratio.
#NephJC
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