Deb Choudhury

History of dialysis in india and USA Saga of Philip Varughese who was the probably first trained Dialysis therapist in india as it was CMC Vellore which started dialysis in india in 1960s @Vasuragh @arvindcanchi @cmcvelloreoff @CMCNephrology @kamaldshah

This is the proverb we read in school: “For want of a nail the shoe was lost, For want of a shoe the horse was lost, For want of a horse the rider was lost, For want of a rider the battle was lost, For want of a battle the kingdom was lost, And all for the want of a horseshoe nail." It also reflects the real clinical challenge in chronic kidney disease (CKD), especially with proteinuria (protein in the urine): For want of a good drug for keeping potassium levels under control, kidneys were lost. For want of a drug to control potassium, the best medicines for reducing protein leak in urine were lost. For want of those medicines, kidney damage worsened. For want of slowing the damage, progressive decline accelerated. For want of halting the decline, permanent kidney failure was reached. And all for the want of controlling potassium levels. Medicines that powerfully protect the kidneys—such as ACE inhibitors (e.g., lisinopril, enalapril) and ARBs (e.g., losartan)—lower blood pressure inside the kidney's filters, reduce proteinuria, and slow progression to end-stage kidney disease.1 Non-steroidal mineralocorticoid receptor antagonists like finerenone also help reduce proteinuria and cardiovascular risk in diabetic kidney disease.2 However, these drugs (along with some others like spironolactone or eplerenone in certain contexts) can raise blood potassium levels (hyperkalemia), because they reduce the kidney's ability to excrete potassium or affect aldosterone signaling.3 In patients with already impaired kidney function, this risk leads some clinicians to hesitate, reduce doses, or stop these "kidney-protective" therapies altogether—potentially allowing faster damage and protein leakage to continue.4 Potassium binders can help bridge this gap by lowering potassium levels and making it easier to continue these kidney-protective therapies safely.5 Used appropriately and with monitoring, they may help preserve access to treatments that slow CKD progression rather than forcing premature dose reduction or discontinuation. Why potassium control matters here Uncontrolled high potassium is dangerous (it can affect the heart's rhythm), but fear of it sometimes means missing out on therapies that meaningfully delay dialysis or transplant. Modern management strategies to reduce potassium aim to bridge this gap. Without reliable ways to manage potassium, clinicians and patients may underuse the very drugs that preserve kidney function longest. Advances in potassium-lowering options like potassium binders have helped shift this balance, letting more people benefit from "good medicine" for proteinuria and CKD progression. This is a nuanced area of nephrology—decisions always depend on individual lab values, overall health, and close monitoring. The proverb reminds us how small, solvable pieces (like potassium control) can protect the bigger picture of kidney health. @AstraZeneca @Vasuragh @arvindcanchi #Hyperkalemia #HKisnotok #UnitedagainstHK