The Pulse - July 2025

Keep your finger on it

Author

Jonathan Kooiman
August 01, 2025

The pulse is a monthly online newsletter summarizing key literature curated for the hospitalist/inpatient provider. Given the brevity, this is not meant to supplant reading primary literature independently.

Greetings Readers! The Pulse took a brief hiatus from its typical early month publication due to the summer holiday. In this monthly edition, we examine 3 practice changing studies.

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  1. Filtering the Evidence: SGLT-2s Still Clear in Advanced CKD

    Even with eGFRs circling the drain, SGLT-2 inhibitors appear to retain clinical utility. In a meta-analysis of over 38,000 patients—including 5,000 with advanced CKD (mean eGFR ~25)—SGLT-2s reduced the risk of composite renal outcomes compared to placebo (19% vs. 25%). While cardiovascular benefit waned at lower eGFRs, safety profiles remained consistent across kidney function strata. These findings reinforce that we shouldn't reflexively pull the plug on SGLT-2s in stage 4 CKD—especially in patients with albuminuria. Prescribing inertia may stem more from financial toxicity than from pharmacologic futility. Elenjickal EJ et al. Clin J Am Soc Nephrol 2025 Jun.

    Link 

    Study Type: meta-analysis of ten phase-3 RCTs of SGLT-2i in adults, including 4800 patients with eGFR <30.

  2. Rise, Shine, or Recline? Blood Pressure Meds Don’t Mind

    Turns out, the clock doesn’t tick for your antihypertensives. After much debate sparked by a spicy Spanish study suggesting bedtime dosing slashes cardiovascular events, dual Canadian studies (BedMed and BedMed-Frail) seem to prevail. Across community dwellers and nursing home residents alike, morning vs. evening timing showed no difference in preventing strokes, heart attacks, or other unwelcome cardiac guests. No safety trade-offs either — falls, fractures, and cognitive slips stayed level. Bottom line: unless you're on a diuretic (hello, midnight bathroom trips), take your meds when you’re most likely to remember them — AM, PM, or whatever works best with your routine.Thank you for reading! If you enjoyed this newsletter, please consider sharing with your colleagues. Garrison SR et al. JAMA 2025 Jun & JAMA Netw Open 2025 May.

    Link 1, Link 2

    Study Type: Canadian RCT of 3357 Canadian primary care patients with hypertension (BedMed) and 776 nursing home residents with hypertension (BedMed-FRAIL)

  3. DISCOVERY: Oxygen Lowers COPD Admissions

    Oxygen may do more than improve SaO2 and symptoms — it might also save a hospital bed or two. In this large Swedish study of 13,000 patients with chronic lung disease and severe hypoxemia, those with COPD who started long-term oxygen therapy (LTOT) saw a meaningful drop in hospitalizations (both exacerbation-related and all-cause). Sadly, patients with ILD or pulmonary hypertension didn’t see the same clear-cut benefit. While LTOT is known to extend life for COPD patients, this study helps reinforce its role in keeping patients out of the hospital, too. Khor YH et al. Thorax 2025 May

    Link

    Study Type: Longitudinal analysis of 10,134 patients in the population-based Swedish DISCOVERY cohort who started LTOT. Annualized hospitalizations compared in the year before and after initiation of LTOT.

Thank you for reading! If you enjoyed this newsletter, please consider sharing with your colleagues.