Mayo Clinic proceedings
Audio Summaries

The Physiological Basis of Acute GFR Decline With Renoprotective Therapies

Jun 23, 2026

The authors investigate the physiological basis for the acute decline in estimated glomerular filtration rate (eGFR) observed with renoprotective therapies, such as RAS inhibitors and SGLT2 inhibitors, which paradoxically correlate with long-term kidney protection. They explain that this decline is a hemodynamic response resulting from reduced glomerular capillary pressure, rather than nephrotoxicity, and detail the mechanisms by which these therapies regulate intraglomerular pressure. Ultimately, the review aims to clarify how these treatments can initially impair eGFR while promoting renal health in the long term.

Estimating the Cost of Poor Work Control Among Physicians in the United States

Jun 22, 2026

The authors aim to estimate the economic costs incurred by healthcare organizations due to physician turnover linked to poor work control. Their study finds that physicians with inadequate work control are significantly more likely to intend to leave their practice, leading to substantial replacement costs for organizations, estimated at $5-13 million annually for a typical group of 500 physicians. The findings suggest that enhancing work control could improve physician retention and yield financial benefits for healthcare organizations.

Association Between Angiotensin Receptor Blocker Use and Cardiovascular Outcomes Compared With Angiotensin-Converting Enzyme Inhibitors in Patients With Atherosclerotic Cardiovascular Disease: A Real-World Cohort Study

Jun 19, 2026

The authors aimed to evaluate the association between angiotensin receptor blocker (ARB) use and cardiovascular outcomes compared to angiotensin-converting enzyme inhibitor (ACEI) use in patients with atherosclerotic cardiovascular disease (ASCVD). Their findings from a large retrospective cohort study indicated that ARB users experienced a lower incidence of major adverse cardiovascular events (MACE) and individual components such as ischemic stroke and all-cause mortality compared to ACEI users. However, the authors caution that these results should be interpreted as non-causal, suggesting that differences in treatment patterns and patient characteristics may influence the outcomes.

Hyponatremia: A Mechanistic Approach to Diagnosis and Management

Jun 16, 2026

The authors aim to address the challenges in diagnosing and managing hyponatremia by proposing a mechanistic approach that prioritizes understanding the primary abnormality of excess extracellular water over traditional volume categorization. By emphasizing the underlying pathophysiological mechanisms, the review seeks to enhance diagnostic and therapeutic strategies, ultimately improving patient care in cases of hyponatremia.

Invited State of the Art Review for MCP Rethinking Obesity Beyond Body Mass Index: A Review of Body Composition and Chronic Disease Risk

Jun 15, 2026

The authors aim to evaluate the limitations of body mass index (BMI) in diagnosing obesity and assessing chronic disease risk, emphasizing the need for more accurate body composition (BC) metrics. They highlight that BMI fails to account for individual variations in fat distribution and lean mass, which can lead to misclassification of health risks. The review advocates for a transition to BC-based evaluations to enhance obesity diagnosis and improve health outcomes.

Aortic Stenosis Progression: Lessons from Multimodality Imaging

Jun 12, 2026

This review explores how multimodality imaging techniques can enhance the assessment of aortic stenosis progression, particularly in the aging population. The authors aim to highlight the clinical utility of various imaging modalities in evaluating aortic valve calcification and metabolic activity, as well as their potential as targets for clinical research aimed at slowing disease progression.

Rheumatoid Arthritis Before and Beyond the Joint: Early Recognition, Targeted Treatment, and Primary Care Co-Management

Jun 9, 2026

This review by Elena Myasoedova addresses the need for early recognition and targeted treatment of rheumatoid arthritis (RA) in primary care settings, aiming to enhance timely referrals to rheumatology and improve co-management of comorbidities. The authors explore the challenges of diagnosing early RA, particularly in seronegative cases, and emphasize the importance of a comprehensive approach that includes cardiovascular and lung health, as well as personalized treatment strategies. Ultimately, the paper advocates for a shift from reactive management of RA to proactive identification and intervention to improve patient outcomes.

Small Abdominal Aortic Aneurysm Surveillance, Management, and Outcomes

Jun 5, 2026

The authors aimed to evaluate the clinical characteristics of small abdominal aortic aneurysms (AAAs) regarding their growth patterns, rates, and associated outcomes in relation to surveillance imaging intervals. Their findings indicate that growth rate significantly influences the likelihood of repair, time to repair, and overall survival, with rapid-growth AAAs demonstrating higher rates of repair and mortality compared to slower-growing counterparts. The study highlights the importance of monitoring growth rates to inform management decisions for patients with small AAAs.

Nondialytic Care vs Dialysis Transition on Hospitalization: Outcomes in Veterans With Advanced Chronic Kidney Disease

Jun 5, 2026

The authors aimed to compare the hospitalization outcomes of veterans with advanced chronic kidney disease receiving nondialytic care versus those transitioning to dialysis. Their findings revealed that dialysis was associated with significantly higher rates of hospitalization, increased days hospitalized, and longer average length of stay compared to nondialytic care. Additionally, earlier transitions to dialysis correlated with even greater hospitalization rates, suggesting that nondialytic care may be a preferable option for managing advanced chronic kidney disease.

Integrated 24-Hour Time Use Patterns to Mediate Depression and Cardiovascular Disease Comorbidity: A Shared Lifestyle Pathway

Jun 5, 2026

The authors aimed to investigate how integrated patterns of time use behaviors—specifically sleep, work, and physical activity—affect health outcomes related to cardiovascular disease (CVD) and depression, and whether these patterns mediate the relationship between the two conditions. Analyzing data from the National Health and Nutrition Examination Survey, they found that certain favorable time use patterns significantly reduced the risks of all-cause mortality and depression, while unfavorable patterns increased these risks. Notably, these patterns mediated approximately 44% of the comorbidity between depression and major adverse cardiovascular events, suggesting the potential for personalized time use recommendations in disease prevention.