Curation log — chronic kidney disease¶

Newest entries first. Every content-changing session appends an entry: date, what changed, what was searched, follow-ups for next time. See CLAUDE.md.

2026-11-01 — Periodic literature sweep (author: Grok, grok-4.6; independent audit pending)¶

Window and method. Inclusive 2026-10-25 through 2026-11-01. Ran 22 topic queries in PubMed E-utilities separately by publication date (pdat) and entry date (edat), plus 17 topic-specific "Cochrane Database Syst Rev"[jour] queries with both date fields, plus six follow-up searches: 84 PubMed searches, 582 unique window PMIDs, 588 records fetched in XML (window plus six exact-ID follow-ups). Overlap with the 2026-10-25 sweep on that calendar day is expected and was de-duplicated at triage. Exact queries, translations, returned identifiers, source access, per-record checks and registry snapshots are recorded in the search manifest.

Sources actually queried. PubMed E-utilities; Europe PMC REST (13 first-publication-date queries covering the same topics plus a NOT SRC:MED query; 262 distinct source/ID records, 211 with PMIDs, 51 without); Crossref DOI metadata and updated-by for every added or newly synthesized record; ClinicalTrials.gov v2 for all 53 identifiers present in the condition's Markdown, plus NCT05510115. Read the KDIGO 2027 CKD medications public-review draft PDF in full for recommendation statements. Read KDIGO CKD, IgAN and diabetes status pages, NICE NG203 overview, World Kidney Day 2027 campaign, NKF news listing, Kidney Care UK homepage and Kidney Health Australia handbook page. Attempted WHO ICTRP, ISRCTN, ChiCTR and EMA CTIS (HTTP 200 shells; JS-driven, not counted as complete registry searches). Unpaywall skipped (LIFEBANK_CONTACT_EMAIL unset); Crossref queried without mailto.

Cochrane first. One in-window CDSR record, PMID 42929381 (Nishiwaki 2026, music-based interventions during haemodialysis). It is a dialysis-session symptom review and sits outside this condition's dialysis-technique exclusion; it was not imported. No CDSR review superseded or contradicted anything this condition asserts. This is an absence in those PubMed CDSR searches, not an absence across all sources. Cochrane Library/CENTRAL could not be searched (HTTP 403). The convective-dialysis review (PMID 42867023) remains abstract-only: Europe PMC still lists no open full text.

What survived triage. Four new bibliography records and four previously catalogued IgAN reports whose PubMed abstracts are now retrievable. No landmark deep note: the IgAN finals confirm a pattern iptacopan already established, and the ADPKD SGLT2 trial is a 50-person feasibility study.

Record	Disposition and boundary
KDIGO 2027 CKD medications public-review draft (PDF read 2026-11-01)	Guideline page, registry, OQ-2, OQ-3, MRA and GLP-1 pages. Rec 1.2.3 suggests finerenone in non-diabetic albuminuric CKD (2B); Rec 1.1.2 suggests SGLT2 inhibition in A1 CKD with eGFR 20–45 (2B); Rec 1.3.2 suggests GLP-1-based therapy in non-diabetic CKD with ASCVD and overweight/obesity (2B). Type 2 diabetes remains 1A for nsMRA and GLP-1. Draft, not a replacement for KDIGO 2024. Comments close 4 November 2026.
Atacicept ORIGIN 3 final, PMID 42911181	Wiki + STATISTICS. Abstract-verified: eGFR slope difference 5.00 mL/min/1.73 m²/year (3.55–6.45); composite HR 0.24 (0.12–0.48). NEJM full text subscription-only.
Sibeprenlimab VISIONARY final, PMID 42911185	Same. Abstract-verified: slope difference 4.5 (3.6–5.4); composite HR 0.029 on 1 versus 28 events.
Povetacicept RAINIER interim, PMID 42912669; ravulizumab I CAN interim, PMID 42912700	Proteinuria interims; function outstanding. Abstract-verified uPCR differences imported with that boundary.
Seliger 2026 ADPKD empagliflozin feasibility, PMID 42925875; NCT05510115	Inherited, SGLT2, trials, STATISTICS, OQ-29. htTKV 10.5%/year vs 5.1% (P=0.001); no chronic eGFR-slope difference. n=50. JASN full text subscription-only.
Tuttle 2026 ASI review, PMID 42959236	Bibliography only. Open-access Europe PMC copy exists; narrative review, no new outcome trial.
Costa E Silva 2026 ASON anaemia position, PMID 42933492	Bibliography and guideline registry. Overlap of CKD and cancer anaemia; not a KDIGO replacement.
Schultheiss 2026 EKFC vs CKD-EPI sex reclassification, PMID 42492853	Bibliography only. Women more often reclassified to milder stages; KF prediction unchanged.

Dropped rather than padded. Cochrane music-during-HD review (dialysis-session, out of scope); narrative IgAN and BAFF/APRIL reviews; Cureus single-centre RASi under-treatment; JAMA news item on GLP-1 in frailty; ETC-model transplant-access difference-in-differences (confidence intervals crossed zero); RAAS and SGLT2 primary-prevention-of-CKD meta-analyses (diabetes-without-CKD border); mHealth nutrition SR; comparative CKD-MBD guideline narrative; animal/mechanistic papers; case reports. Baxdrostat PMID 42905977 still has no PubMed abstract. Most of the 582 window records received no entry.

ClinicalTrials.gov. All 53 previously tracked records resolved. Real changes since 2026-10-25: VIDEO-KD (NCT04347629) ACTIVE_NOT_RECRUITING → COMPLETED (completion 2026-05-31; last update 26 October); FINE-ONE (NCT05901831) posted registry results 27 October (UACR ratio 0.66 vs 0.88, matching the published 0.75 treatment ratio; enrolment listed 242). ZEUS still COMPLETED, n=6,385, no posted results. EASi-KIDNEY last-update 28 October with no change in status, enrolment 8,371, or estimated primary completion 2026-12-31, and no posted results. VISIONARY, RAINIER and I CAN still have no posted results. Newly tracked: NCT05510115 (ADPKD empagliflozin feasibility; ACTIVE_NOT_RECRUITING, n=50, primary completion 2026-03-18 actual, no posted results). Result-table hashes for studies without results are stored as null; FINE-ONE's posted-results hash is in the manifest.

Guidelines / statistics / patient voice. NICE NG203 last reviewed still 13 October 2026. KDIGO still identifies 2022 as its current published diabetes guideline. The 2025 IgAN/IgAV guideline page is live. World Kidney Day 2027 theme unchanged. NKF news listing retrieved; no new patient-organisation material added (the 21 October HHS roundtable source remains the latest advocacy row). UKKA eCKD page handshake timed out this session; last week's HTTP 200 is not re-asserted. UKRR 28th annual report figures were already catalogued on 2026-10-25; not re-imported. USRDS official URL returned 404.

Retraction checks. Every newly added or newly synthesized record (PMIDs 42911181, 42911185, 42912669, 42912700, 42925875, 42933492, 42959236, 42492853) was retrieved through live PubMed E-utilities and checked for Retracted Publication, Retraction of Publication and Expression of Concern; none was flagged. All eight DOIs resolved in Crossref with matching titles and empty updated-by fields. Checks are dated to this session.

Access and coverage limits. Cochrane Library/CENTRAL and SciELO/LILACS could not be searched (HTTP 403; SciELO re-probed this session). No regional transport or universal absence claim is made. WHO ICTRP, ISRCTN, ChiCTR and EMA CTIS returned HTTP 200 to the portal URLs; those pages are JS-driven and were not complete registry status/results searches. Ravulizumab carries EU CT 2023-507851-31-00 on its PubMed record; that identifier was not independently resolved on CTIS. Embase/Scopus/Web of Science were not searched.

Files and status. Six wiki pages changed, all already draft: guidelines.md, inherited-and-glomerular-disease.md, clinical-trials-landscape.md, sglt2-inhibitors.md, mineralocorticoid-receptor-antagonists.md, glp1-and-emerging-therapy.md. All have last-curated: 2026-11-01. Also changed: BIBLIOGRAPHY (344 → 348), REGISTRY (27 → 28), STATISTICS, OPEN-QUESTIONS (OQ-2, OQ-3, OQ-9; new OQ-29), INDEX and this LOG; added only the convention-defined manifest. Index counts: 11 curated / 13 draft pages, 329 wiki-cited PMIDs, 52 wiki-cited NCT identifiers (54 across the condition). No self-promotion or independent audit is claimed. Publishing and deployment remain for the external pipeline; no git commands were run.

Validation. Manifest JSON is written from live query output. New bibliography identifiers match the live E-utilities XML. Trial identifiers match their live API records. These are author consistency checks, not the independent audit.

Decision noted. Last week's sweep correctly withheld IgAN effect estimates because PubMed records then lacked usable abstracts and NEJM full text was 403. This session's PubMed abstracts now carry the primary/secondary numbers; they are imported with an explicit abstract-only boundary. Full-text table checks remain the next-sweep job.

Next sweep should chase. KDIGO 2027 medications draft after the 4 November comment deadline and any final publication; do not treat 2B draft language as current KDIGO. Obtain NEJM full texts for ORIGIN 3, VISIONARY, RAINIER and I CAN (hierarchies, missing-data, background therapy, kidney-composite components) and JASN full text for Seliger. Continue ZEUS, EASi-KIDNEY (registry still dates primary completion 2026-12-31), TELIGAN two-year data and PROTECT completion-stage papers. Repeat convective-dialysis full-text attempt. Baxdrostat still has no PubMed abstract. Obtain a usable non-US registry search and a current USRDS report. Independent review must use a different engine.

2026-10-25 — Periodic literature sweep (author: Codex; independent audit pending)¶

Window and method. Inclusive 2026-10-18 through 2026-10-25. Ran 22 topic queries in PubMed E-utilities separately by publication date (pdat) and entry date (edat), plus 17 topic-specific "Cochrane Database Syst Rev"[jour] queries with both date fields: 78 searches, 185 unique window PMIDs fetched in XML. The entry-date supplement captures newly indexed older publications and future print issues; it is not represented as a publication-date-only sweep. Follow-up exact-ID and IgAN-guideline searches were intentionally not date-limited to resolve the previous sweep's questions. Exact queries, translations, returned identifiers, source access, per-record checks and registry snapshots are recorded in the search manifest.

Sources actually queried. PubMed E-utilities; Europe PMC REST (22 all-field, first-publication-date queries covering the same topics; 534 distinct source/ID records, not 534 deduplicated papers); Crossref DOI metadata and updated-by; ClinicalTrials.gov v2 for all 48 identifiers present in the condition's Markdown, including two cited only in earlier LOG entries, plus five new trial identifiers. Read full text through Europe PMC XML and PMC for VIDEO-KD, the Malaysian registry care cascade, and an opioid/gabapentinoid cohort considered during triage. Read KDIGO's CKD, IgAN and diabetes status pages through web retrieval, NICE NG203 overview and live recommendations, UK Kidney Association's annual-report portal and release, Kidney Health Australia's handbook page, World Kidney Day's 2027 campaign and Kidney Care UK's homepage. The National Kidney Foundation news listing and 21 October advocacy article were retrieved through live web search. No PMID-free record was selected for citation; no DOI-only citation was introduced.

Cochrane first. None of the 34 date-restricted CDSR searches returned a record. This is an absence in those PubMed searches, not an absence across all sources. Re-tried the previous convective-dialysis review's full text: Europe PMC XML returned HTTP 500 and PMC HTTP 403; its summary-of-findings table and overlap with the prior IPD trial set remain unchecked. The new non-Cochrane nutrition-education systematic review was catalogued rather than ignored.

What survived triage. Fifteen bibliography additions: ten window-search records and five pre-window guideline/companion records found during follow-up. No landmark deep note was written: potentially important final IgAN reports require full-text appraisal first.

Records	Disposition and boundary
Atacicept final phase 3 analysis, PMID 42911181; sibeprenlimab final analysis, PMID 42911185	Bibliography and publication-stage alerts in inherited/glomerular disease, trials and OQ-9. Titles, metadata and registry identities verified. NEJM full text HTTP 403; Europe PMC lists subscription-only access without PMC copies. No numerical efficacy or safety synthesis imported from their abstracts.
Povetacicept phase 3 interim, PMID 42912669; ravulizumab phase 3 interim, PMID 42912700	Same limited disposition. Removed the stale characterization of ravulizumab evidence as phase 2 only. Final and interim analyses remain explicitly distinct.
VIDEO-KD, PMID 42911803	Conservative-care paragraph, STATISTICS row and OQ-7 clarification, verified against full text and Table 2. Advance-care-planning documentation improved; the study did not measure whether documentation changed dialysis-initiation decisions. It does not answer the causal dialysis-versus-conservative-care question.
Dietitian-delivered nutrition education review, PMID 42897867	Bibliography only; no abstract-only quantitative claims added.
Baxdrostat albuminuria report, PMID 42905977	Bibliography only. No PubMed abstract; findings not summarized.
China high-temperature-attributable CKD burden model, PMID 42904322	Bibliography only; full-text attribution methods needed before changing the exposure/burden synthesis.
Malaysian diabetes-registry care cascade, PMID 42907818	Bibliography and OQ-28 measurement/design qualification. Full text permits disease classification from one abnormal test; not a chronicity-confirmed prevalence estimate or evidence that a delivery intervention improves outcomes.
KDOQI commentary on AHA/ACC hypertension, PMID 42907045	Bibliography and guideline registry; BP-target synthesis remains outside this condition.
KDIGO 2025 IgAN/IgAV guideline and summary, PMIDs: 40975564, 40975525; KDIGO 2026 commentary, PMID 41895685; KDOQI commentary, PMID 42095796; ERA perspective, PMID 41244638	Pre-window omissions repaired in bibliography and registry. Guideline page records the published guideline and separate commentary without importing recommendation-level claims.

Dropped rather than padded. Animal/mechanistic fibrosis and omics studies; small uncontrolled finerenone/telitacicept cohorts; indirect or observational drug comparisons that do not settle treatment sequence; case reports; procedure-specific dialysis/transplant technique studies outside this condition's border; descriptive digital-health/preprint material that did not change the synthesis. The opioid cohort, caregiver-life-participation paper and decision-aid scoping review did not prompt additions; the directly relevant randomized VIDEO-KD finding received priority. Most retrieved records received no entry.

ClinicalTrials.gov. All 53 queried records resolved. Against the 46-record 2026-10-18 snapshot, DEAK (NCT05788276) changed RECRUITING → ACTIVE_NOT_RECRUITING and estimated primary completion June 2028 → August 2029 (posted update 20 October). Corrected both SGLT2 and trials pages; no posted results. The mezagitamab record (NCT06963827) has a newer update date, with no change in the tracked status/enrolment/primary-completion/results-presence fields. No previously absent results became posted among those 46 tracked records. The old manifest omitted result-table hashes, so numerical revisions to already posted tables were not assessed; this manifest retains hashes for future comparison. Newly tracked: ORIGIN 3 NCT04716231, VISIONARY NCT05248646, RAINIER NCT06564142, I CAN NCT06291376 and VIDEO-KD NCT04347629. ORIGIN 3's registry results were first posted 1 October, before this window; newly tracked is not newly posted. ZEUS and EASi-KIDNEY still have no posted results in the API. The targeted publication follow-up found no result report for ZEUS, EASi-KIDNEY or TELIGAN in that PubMed entry-date query; this does not establish absence elsewhere.

Guidelines. The important follow-up is KDIGO's 2027 CKD medications public-review draft, announced 15 October with comments open through 4 November. It is not a final replacement for KDIGO 2024. KDIGO still identifies 2022 as its current published diabetes guideline while its update is being revised. The 2025 IgAN/IgAV guideline is already published, with a separate 2026 KDIGO commentary: the previous URL failure had concealed a document omission. Added the draft and five guideline/commentary entries, giving 27 registry rows. NICE's current live sections 1.6.9, 1.6.10 and 1.6.22 link TA1075, TA942, TA877, TA1148 and TA623; these resolve the “which appraisals?” follow-up, but no claim is made that all five were inserted on 13 October. The search cache carries older numbering; the directly retrieved current page was used.

Statistics and patient voice. Added VIDEO-KD's Table 2 documentation outcome. Added UKRR portal counts from its 8 October release as an explicit pre-window catch-up: treated kidney failure and incomplete pre-KRT reporting are kept separate from population CKD prevalence. The report portal notes an October Chapter 4 figure amendment; that addendum and the full report tables were not analyzed, and the entries cite the official release rather than claiming chapter-level verification. Added one NKF public advocacy source on early diagnosis, treatment access and patient involvement; no individual patient details, quotations, policy-effect claim or new prevalence estimate was imported.

Retraction checks. Every one of the 15 added records was retrieved through live PubMed E-utilities and checked for Retracted Publication, Retraction of Publication and Expression of Concern; none was flagged. All 15 DOIs resolved in Crossref with matching titles and empty updated-by fields. Checks are dated to this session, not a guarantee against later notices. A transient E-utilities HTTP 429 on follow-up was recovered by a successful batch efetch; it is retained in the manifest rather than treated as a negative search.

Access and coverage limits. Cochrane Library/CENTRAL and SciELO/LILACS could not be searched (HTTP 403 limitations documented in SOURCES.md; not re-probed). No regional transport or universal absence claim is made. For non-US trials, actually attempted WHO ICTRP telitacicept, ISRCTN CKD, ChiCTR telitacicept and EMA CTIS mezagitamab queries: WHO returned portal terms, ISRCTN a JavaScript/cookie notice, ChiCTR a script challenge, and CTIS a website shell. An older ChiCTR exploratory record was search-result-verified, but these attempts are not complete registry status/results searches. USRDS's attempted annual-report URL returned 404 and official-domain searches supplied no usable report; a current US registry update was not verified. Scripted KDIGO requests still returned 406; usable status content came through the web tool. Unpaywall was skipped because LIFEBANK_CONTACT_EMAIL is unset; Crossref was queried without mailto. Embase/Scopus/Web of Science were not searched. Patient-organisation checking was focused, not a worldwide exhaustive review.

Files and status. Five wiki pages changed: conservative-and-supportive-care.md, sglt2-inhibitors.md, clinical-trials-landscape.md, inherited-and-glomerular-disease.md, guidelines.md. All have last-curated: 2026-10-25; the first two were demoted curated → draft and the other three remain draft. Also changed BIBLIOGRAPHY (329 → 344), REGISTRY, STATISTICS, patient-voice sources, OPEN-QUESTIONS (OQ-7, OQ-9, OQ-28), INDEX and this LOG; added only the convention-defined manifest. Index counts reconciled to the files: 11 curated / 13 draft pages, 328 wiki-cited PMIDs and 51 wiki-cited NCT identifiers. No self-promotion or independent audit is claimed. Publishing and deployment remain for the external pipeline; no git commands were run.

Validation. Manifest JSON parses; all 78 PubMed queries and 22 Europe PMC queries returned complete result lists. All 15 new bibliography identifiers match the live E-utilities XML, and all 53 trial identifiers match their live API records. Relative links in changed files resolve; edited frontmatter dates/statuses and all 24 index page counts reconcile. VIDEO-KD table counts reproduce the rounded 16.6-percentage-point difference. These are author consistency checks, not the independent audit. A global site build was not run because publishing is external and this task is restricted to this condition.

Next sweep should chase. Obtain the four new IgAN reports' full texts, especially the final atacicept/sibeprenlimab endpoint tables, hierarchy, missing-data handling, background therapy and kidney-composite components before interpreting functional benefit or making comparisons. Revisit OQ-9 once those are read. Track KDIGO's CKD draft through the 4 November review deadline and eventual final publication; inspect actual draft recommendations before asserting FIND-CKD uptake. Retrieve baxdrostat full text/abstract. Continue ZEUS, EASi-KIDNEY, TELIGAN and PROTECT result surveillance; repeat the convective-dialysis full-text attempt; obtain a usable non-US registry search and current USRDS report. Compare future result-table hashes as well as status fields. Independent review must use a different engine.

2026-10-18 — Periodic literature sweep (author: Claude, claude-opus-5-5)¶

Window. Records entered PubMed 2026-10-11 to 2026-10-18 (edat), starting on the date of the last LOG heading. Retrieval was live NCBI E-utilities and ClinicalTrials.gov v2; the PubMed MCP tools were not authorised in this session. Query manifest: literature/sweeps/2026-10-18.json, which re-runs the 21 topic queries and 11 CDSR queries of the 2026-10-11 manifest verbatim so the two windows can be compared.

Sources actually queried. PubMed (21 topic searches, 11 "Cochrane Database Syst Rev"[jour] × topic searches, high-signal journal filter; 203 unique PMIDs); Europe PMC REST (FIRST_PDATE:[2026-10-11 TO 2026-10-18], three queries including a NOT SRC:MED query of 167 non-MEDLINE records); ClinicalTrials.gov v2 for all 46 NCT IDs cited anywhere in the condition; Crossref updated-by for every added DOI; PubMed publication types for all 325 PMIDs cited anywhere in the condition; NICE NG203; World Kidney Day. Not queried: Cochrane Library/CENTRAL and SciELO/LILACS (HTTP 403 per SOURCES.md; not attempted); Unpaywall and the Crossref mailto (LIFEBANK_CONTACT_EMAIL unset); WHO ICTRP and the named non-US registries (no non-NCT trial was tracked or added); kdigo.org (HTTP 406 to scripted requests, so the Chapter 3 focused update and the IgA-nephropathy guideline status were not re-checked); the other ten patient-organisation homepages (HTTP 200 a week ago, not re-probed). Absences below are absences in PubMed, Europe PMC and ClinicalTrials.gov only.

Cochrane. One in-window CDSR record, and it is the most important thing this sweep found: the second update of the convective-dialysis review (Vernooij 2026, PMID 42867023; 62 RCTs, 6,897 participants, searched to April 2025). It agrees with what the KRT page already says from the 2024 IPD meta-analysis — all-cause death RR 0.88 (0.80–0.96) and cardiovascular death RR 0.78 (0.66–0.92), both moderate certainty — and adds what the page lacked: fatigue, vascular access, hospitalisation and physical quality of life are each inconclusive at low certainty from one to three trials. Nothing was superseded or contradicted. Full-text caveat: PMC (PMC13659861) and Europe PMC served only the abstract (Europe PMC full-text endpoint HTTP 500), so every figure written was checked verbatim against the abstract text, and the summary-of-findings table, per-trial weights and the overlap with the IPD trial set were not checked. The page says so.

What survived triage.

Record	Disposition	Why
Vernooij 2026, PMID 42867023	KRT page paragraph + table row + open question; STATISTICS row	Cochrane update covering a comparison the page asserts
Jongs 2026, PMID 42868053	Risk page, one sentence	Klinrisk's first non-diabetic validation (DAPA-CKD, n=4,304, AUC 0.79); recorded with its caveat that 8 of 22 inputs were imputed from the development model
Mayne 2026, PMID 42858001	Bibliography + STATISTICS row	UK Biobank: 15% restaged by eGFRcys; ≥4 long-term conditions aOR 4.64 for large discordance. Speaks to the definition page's existing discordance questions without changing a claim
Mazhar 2026, PMID 42886061	Bibliography + one sentence in OQ-24	23,008 Swedish CKD G3–5 patients; 75% hs-CRP ≥2; association stronger for MACE than for kidney failure
Chen 2026, PMID 42886618	Bibliography only	Observational fluid-intake meta-analysis; consistent with the diet page's "strong observational signal, null trial" framing; authors disclaim causation
Cabrales 2026, PMID 42867480	Bibliography only	Single-centre waiting-time-modification follow-up; transplant benefit is projected, not observed
Collister 2026, PMID 42889824	Bibliography only	DISCO-POT, nabilone for uraemic pruritus, n=14, underpowered null
Akchurin 2026, PMID 42862204	Bibliography + REGISTRY	IPNA commentary on KDIGO 2026 anaemia; no abstract, so its content is not summarised

Dropped (honest). Alghzawi 2026 SGLT2-versus-finerenone network meta-analysis (PMID 42864264 — indirect, loop-free star network, authors themselves say not to rank; the 2026-10-11 sweep dropped a comparable NMA); finerenone blood-pressure meta-analysis (J Clin Med); real-world TRF-budesonide cohort (n=33); PREVENT-ADPKD pain post hoc; UDCA crossover in T1D DKD (n=31, null); complement-in-IgAN descriptive review; balcinrenone and aldosterone narrative reviews; a perioperative creatinine-rise cohort (AKI-criteria question, not CKD); hs-CRP narrative review; mechanistic and animal papers; case reports. No preprint was used. No landmark note: nothing in the window changed practice.

ClinicalTrials.gov — two pre-existing errors corrected. Every cited NCT ID resolved. Real changes since 2026-10-11: PROTECT (NCT03762850) ACTIVE_NOT_RECRUITING → COMPLETED (completion 2026-08-19); EASi-KIDNEY (NCT06531824) enrolment now 8,371 ACTUAL, against the 11,000 estimate every page carried. Checking that row exposed a stale date: the trials page gave EASi-KIDNEY a primary completion of 2028-08-30, but the registry says 2026-12-31 (estimated) — and said so in the 2026-10-11 manifest too, so the page was already wrong a week ago. OPEN-QUESTIONS (OQ-23) and the trials page both said the aldosterone-synthase outcome trials "do not report before 2028"; that is not supported for EASi-KIDNEY and was rewritten. The CKD adaptive platform trial (NCT06058585) row carried the same 2028-08-30 date, which looks copied from the EASi row; the registry says 2029-12-31. Both corrected, along with the "16,000 participants" total (now about 13,400) in four places. Other diffs were last-update dates only. The MIRO-CKD and Explore-CKD "results newly posted" flags were artefacts of a key-name difference between manifests; their results were posted in June 2026.

Guidelines / statistics / patient voice. NICE NG203 last reviewed 13 October 2026 (was 19 August 2025): technology-appraisal links were added to the RAS-antagonist section, which NICE states "is not a change in practice"; published and last-updated dates unchanged. Which appraisals were linked was not read. Recorded in REGISTRY and guidelines.md. IPNA anaemia commentary added to REGISTRY. No new registry or burden statistics in the window beyond the two STATISTICS rows above. World Kidney Day has published its 2027 theme, "Kidneys, Heart, and Metabolism: The Core of Your Health" (11 March 2027), the public-facing version of the CKM framing; added to patient-voice/sources.md. Last week's sweep could not read it because the homepage HTML came back CSS-only.

Retraction checks. Of the 325 PMIDs cited anywhere in the condition, none carries Retracted Publication, Retraction of Publication or Expression of Concern in PubMed. Crossref updated-by was empty for the seven added DOIs that resolved; the Klinrisk DOI (10.34067/KID.0000001339) returned Crossref 404, apparently not yet registered, with clean PubMed publication types. Europe PMC turned up an in-window Ren Fail retraction notice (high-frequency hearing loss in CKD, PMC13660547); this condition does not cite the retracted article.

Pages edited. Demoted curated → draft: kidney-replacement-therapy-decisions.md, risk-prediction-and-prognosis.md. Edited while already draft: clinical-trials-landscape.md, guidelines.md. last-curated set to 2026-10-18 on all four. Also updated: BIBLIOGRAPHY (321 → 329 distinct records), STATISTICS (+2 rows), REGISTRY (NG203 review, IPNA commentary, EASi-KIDNEY watch row), OPEN-QUESTIONS (OQ-23 timing correction, OQ-24 sharpened), INDEX, patient-voice/sources.md. New file: literature/sweeps/2026-10-18.json.

Next sweep should chase. EASi-KIDNEY results, which the registry now dates to around 2026-12-31 rather than 2028; ZEUS (NCT05021835) results (still none posted); KDIGO CKD Chapter 3 and IgA-nephropathy guideline status, which need a non-scripted or alternative route because kdigo.org returns 406; which NICE technology appraisals NG203 now links from its RAS section — read the section rather than guessing; full text of the Cochrane convective review, to check its summary-of-findings table and its overlap with the IPD trials; PROTECT's final completion-stage publication, if any; TELIGAN two-year data. The auditor must be a different engine and should check in particular the EASi-KIDNEY and platform-trial date corrections against the registry.

2026-10-11 — Periodic literature sweep (author: Grok, grok-4.6)¶

Window. Publications and newly indexed records since 2026-09-02 (prompt date_from; last LOG heading). Identifier retrieval was live NCBI E-utilities (esearch/efetch) and ClinicalTrials.gov v2 /studies/{NCT}. PubMed MCP tools were not available; E-utilities were the live equivalent. Unpaywall skipped (LIFEBANK_CONTACT_EMAIL unset). Crossref queried without mailto. Query manifest: literature/sweeps/2026-10-11.json.

Sources actually queried. PubMed (21 topic searches + 11 CDSR-per-topic queries + high-signal journal filter; 1,166 unique PMIDs in the edat window); Europe PMC REST (FIRST_PDATE:[2026-09-02 TO 2026-10-11]); ClinicalTrials.gov v2 (all 42 previously cited NCT IDs plus lorundrostat/Explore-CKD, MIRO-CKD/balcinrenone, telitacicept, retatrutide TRIUMPH-Outcomes, RENAL LIFECYCLE); Crossref updated-by for every added DOI; KDIGO CKD/anaemia/diabetes pages, NICE NG203, UKKA eCKD, Kidney Health Australia handbook; 11 patient-organisation homepages. Not queried / blocked: Cochrane Library/CENTRAL (HTTP 403); SciELO (HTTP 403); LILACS not attempted after SciELO 403; WHO ICTRP portal JS-driven so not counted as searched; ChiCTR/ISRCTN/EudraCT named portals not opened because the relevant trials carry NCT IDs; ADA Standards issue page HTTP 403. Absences below are absences in PubMed / Europe PMC / ClinicalTrials.gov, not universal absences. No regional-literature absence claim is made.

Cochrane. "Cochrane Database Syst Rev"[jour] × CKD topic groups in the window: two unique records — NMES during dialysis (PMID 42757634, out of this condition's dialysis-technique exclusion) and pharmaceutical-industry promotion of prescribers (PMID 42849912, not CKD-specific). Europe PMC additionally returned lipid-lowering and diabetes-BP Cochrane reviews that do not own this condition. No CDSR review superseded or contradicted anything this condition asserts.

What survived triage. Eleven papers and a set of registry changes. No landmark note: TELIGAN is a 39-week proteinuria interim; Explore-CKD is n=59 over four weeks; Tuttle's coprimary MRI endpoints were null.

Record	Why it survived
Lv 2026, PMID 42127391; NCT05799287	TELIGAN 39-week interim, n=318: 24-h uPCR −58.9% vs −8.8% (relative −55.0%, −61.3 to −47.6); eGFR −1.0% vs −7.7%. Stale absence (entrez 2026-05-13, missed by the 2026-09-02 build). Found via in-window NEJM correspondence.
Heerspink 2025, PMID 41218621; NCT06350123	MIRO-CKD phase 2b, n=324: balcinrenone+dapagliflozin UACR −22.8% / −32.8% vs dapagliflozin. Stale absence (Lancet 2025).
Heerspink 2026, PMID 42752537	In-window MIRO eGFR-dip analysis: −0.6 and −1.7 mL/min/1.73 m² vs dapagliflozin at week 4.
Weir 2026, PMID 42778148; NCT06150924	Explore-CKD: lorundrostat 25 mg, n=59, 4-week crossover; AOSBP −7.5 mmHg, UACR −25.6%. First ASI CKD+albuminuria RCT.
Tuttle 2026, PMID 42823485; NCT04865770	Semaglutide MRI/biopsy trial, n=106: coprimary R2/perfusion/T1 not* significantly altered. Closes the "no oxygenation-endpoint trial" claim on the pathophysiology page.
Hedayati 2026, PMID 42735412	Annals synopsis of KDIGO 2026 anaemia: eight graded recommendations including Hb <11.5 g/dL and ESA first-line. Retrievable recommendation text the draft guidelines page lacked.
Gohar 2026, PMID 42751780	AHA scientific statement on women's kidney health.
Nardone 2026, PMID 42853614	NHANES microsimulation: 15% dual RAS+SGLT2 eligibility, 4% quadruple; modelled death-aversion larger for triple than dual.
Inker 2026, PMID 42815853	49 RCTs, 66,449 participants: trial-level treatment effects on acute GFR and 6-month albuminuria uncorrelated (slope 0.00). Sharpens OQ-19.
Expert suggestions 2026, PMID 42557084	Chinese regional telitacicept-in-IgAN practice suggestions. Registry only.
Verma 2026, PMID 42776523	JAMA uACR vs PCR prediction utility. Bibliography only: PubMed record has no abstract, so no quantitative claim was written.

Dropped (honest). Cochrane NMES (dialysis technique, out of scope); Cochrane pharma-promotion review; ACP Journal Club recap of FIND-CKD (already cited); NEJM telitacicept letters; Chen 2026 network MA of GLP-1/SGLT2/nsMRA (indirect comparisons, low-to-moderate confidence); Liu 2026 lanthanum-vs-sevelamer target-trial emulation; Uwatoko 2026 plant-dominant diet RCT (n=36, 4 weeks, uremic-toxin endpoints); lactoferrin-plus-iron RCT; FIDELITY post-HHF subgroup; safiglipron and orforglipron diabetes trials without CKD-primary endpoints; hierarchical-composite-endpoint workshop (methods, not a result).

ClinicalTrials.gov. All 42 previously cited NCT IDs resolved. Status/enrolment changes: NCT06531824 EASi-KIDNEY Recruiting → ACTIVE_NOT_RECRUITING (n=11,000); NCT05021835 ZEUS → COMPLETED (n=6,385, no posted results); NCT05970341 Eat Well Live Well → ACTIVE_NOT_RECRUITING; NCT06058585 platform enrolment listed as 2,000 (was 1,000). Added: NCT05799287 TELIGAN, NCT06150924 Explore-CKD, NCT06350123 MIRO-CKD, NCT07624305 BalanceD-CKD (n=2,800, recruiting from 2026-09-01). TRIUMPH-Outcomes (NCT06383390, retatrutide, n=10,000, ACTIVE_NOT_RECRUITING) and RENAL LIFECYCLE (NCT05374291, n=1,750) were verified live and left off the landscape page — large, but not yet result-bearing and not previously asserted as absent.

Guidelines / statistics / patient voice. NICE NG203 last reviewed still 19 August 2025. KDIGO CKD, anaemia and diabetes pages HTTP 200; the glomerular-diseases URL returned HTTP 404. Kidney Health Australia handbook, UKKA eCKD, and all 11 previously listed patient-organisation homepages HTTP 200. World Kidney Day homepage HTTP 200 but the fetched HTML was CSS-only, so no 2026 campaign theme was recorded. ADA Standards issue page HTTP 403. FIND-CKD still not in any guideline in the registry.

Retraction checks. All 11 added PMIDs: PubMed publication types show neither retraction nor expression of concern; Crossref updated-by empty for each DOI that resolved. Title/DOI matched. Two PubMed records initially carried wrong related-article DOIs in the ArticleId list (Tuttle, Verma); the ELocationID DOI was used and confirmed on Crossref.

Pages edited and demoted to draft: inherited-and-glomerular-disease.md, clinical-trials-landscape.md, glp1-and-emerging-therapy.md, mineralocorticoid-receptor-antagonists.md, anaemia-of-ckd.md, pathophysiology-and-progression.md, definition-staging-and-measurement.md. guidelines.md was already draft. Also updated: BIBLIOGRAPHY (310→321), STATISTICS, REGISTRY (17→20 documents), OPEN-QUESTIONS (OQ-1, 9, 19, 23, 24), INDEX. New file: literature/sweeps/2026-10-11.json. No new deep note.

Decision noted. TELIGAN and MIRO-CKD primary papers pre-date the window; they are logged as stale absences found via in-window commentary and a related eGFR-dip paper, the same pattern the 2026-09-02 audit used for FIND-CKD. The pathophysiology page's claim that "no trial has used tissue oxygenation as an endpoint" is now false and was rewritten against Tuttle 2026.

Next sweep should chase. ZEUS results (NCT05021835); TELIGAN two-year function/events; BalanceD-CKD (NCT07624305); EASi-KIDNEY and baxdrostat outcome papers (2028+); KDIGO CKD Chapter 3 focused update and any IgA nephropathy guideline (the previous URL 404'd); whether FIND-CKD has entered any society document; TRIUMPH-Outcomes and RENAL LIFECYCLE if they post results; Verma JAMA uACR-vs-PCR once an abstract or PMC copy is available. Auditor must be a different engine.

2026-09-02 — Full build (Codex)¶

Built all 24 canonical wiki pages at status: draft (3,994 lines total), with 25–60 live-resolved PubMed records per page reference set. Built the literature layer: master bibliography (125 unique records), five landmark notes, 12-document guideline registry, quantitative statistics tables, and four-file patient-voice layer. Replaced the seed open questions with 20 stable tiered questions and a 12-row “Dots not yet connected” table. Rewrote the index with counts, reading paths and page statuses.

Live searches run. PubMed E-utilities searches and batch record fetches covered: KDIGO 2024; CKD definition/staging; eGFR and albuminuria prognosis; global burden and awareness; race-free eGFR; hyperfiltration/fibrosis/AKI transition; KFRE; RENAAL/IDNT/ONTARGET/VA NEPHRON-D; DAPA-CKD/EMPA-KIDNEY/CREDENCE; FIDELIO/FIGARO/FIDELITY; FLOW; CHOIR/CREATE/TREAT/ASCEND-D; EVOLVE; SHARP/4D/AURORA; MDRD and nutrition reviews; AMBER and potassium binders; VALOR-CKD; IDEAL; conservative care; symptom instruments and SONG; ADPKD TEMPO/REPRISE; IgA NefIgArd/PROTECT; FSGS DUPLEX; genomic diagnosis; contrast safety; and current guideline documents. Anchor PMIDs were re-fetched rather than inherited.

ClinicalTrials.gov v2 searches. Queried active CKD studies and exact trial terms/records. Catalogued 17 live-resolved NCT identifiers and dated statuses. Plausible identifiers that resolved to unrelated cancer, dementia or other trials were explicitly discarded and do not appear in content.

Web sources checked. Official KDIGO, NICE, UK Kidney Association and Kidney Health Australia guideline pages; National Kidney Foundation, Kidney Care UK, National Kidney Federation, Kidney Foundation of Canada, Kidney Health Australia, National Kidney Foundation of South Africa, Kidney Failure Awareness & Advocacy SA, Kidney Federation of India, Hong Kong Kidney Foundation and World Kidney Day public pages.

Scope decisions applied. Dialysis and transplantation are restricted to timing, choice and outcomes; no technique, access engineering or immunosuppression protocol content. Diabetic CKD owns kidney endpoints only. Hypertension owns BP measurement and target synthesis. AKI appears only as a progression border.

Follow-up for independent audit. Re-fetch every cited PMID and NCT identifier; verify each quantitative claim against abstract/full text; check ePub-versus-print citation details; review national-guideline completeness outside English; re-run asserted evidence gaps; and promote only pages that pass. No page was self-promoted.

2026-09-02 — Seeded (Claude)¶

Created the scaffold: INDEX.md with a 24-page plan (22 topical + 2 standing house pages) and a 15-record anchor table, a seed OPEN-QUESTIONS.md, this log, and the empty wiki/ and literature/ layers. No wiki pages written. Excluded from the public site until it has pages.

Searches run (live PubMed E-utilities, 2026-09-02). Scoping: chronic kidney disease 244,964; chronic kidney disease[MeSH Major Topic] 117,221; dialysis 240,604; kidney transplantation 167,381; diabetic kidney disease OR diabetic nephropathy 58,971. Per-page topic counts recorded in INDEX.md, including cardiovascular outcomes 19,834, AKI 16,931, anaemia 13,648, glomerulonephritis 11,475, CKD-MBD 6,280, epidemiology 4,379, progression/risk prediction 3,244, polycystic 3,261, SGLT2 2,325, finerenone/MRA 1,855, eGFR/albuminuria classification 980, symptom burden 558, conservative care 473, race and eGFR 329, diet/potassium 343.

Query-hygiene note. Three initial topic queries were malformed — unparenthesised OR binds loosely in E-utilities, so chronic kidney disease AND finerenone OR mineralocorticoid antagonist returned 15,304 (i.e. every MRA paper) rather than 1,855. All affected counts were re-run parenthesised and are marked † in INDEX.md. Any future scoping pass must parenthesise Boolean groups; an unchecked count would have justified a page the literature does not support.

Anchor records resolved live: 15, listed in INDEX.md.

Scoping decisions. Third-largest literature in the repository, so scoped by border like hypertension and melanoma. Three exclusions: the dialysis-technique and transplant-immunology corpora each get one decision-and-outcomes page rather than a section of the condition (each of those literatures individually exceeds this condition's MeSH-major count); glycaemic management stays with the diabetes conditions; blood pressure as an exposure stays with hypertension. AKI is treated as a border covered inside the progression page and recorded as a candidate future condition rather than absorbed.

Flagged for the build pass. Anchors were resolved in a scoping session and must be re-verified. No anchor exists yet for RAS blockade landmarks, anaemia trials, CKD-MBD, statins in CKD, dietary protein restriction, dialysis-initiation timing, conservative care, ADPKD or IgA nephropathy — all live-search tasks.

Follow-ups. Build with tools/build-condition.sh chronic-kidney-disease; auditor must differ from the writer.

2026-09-02 — Independent audit (auditor: Claude; author: codex)¶

Full citation-to-claim audit of all 24 wiki pages and every literature artifact. A different engine from the build, per CLAUDE.md.

What was checked¶

Object	Count	Method
Unique PubMed records	132 (125 at build + 7 added at audit)	Re-fetched live via E-utilities `esummary` and `efetch`; author, journal, year, volume, pages and title compared with every bibliography and reference line
Records with retrievable abstracts	130 of 132	`efetch` XML; the two exceptions are the KDIGO 2024 CKD guideline (38490803) and the KDIGO 2017 CKD-MBD update (30675420), which carry no PubMed abstract
Claim→citation pairs	442 inline citations outside evidence ledgers and reference lists	Every page read in full; each claim compared with its source abstract
Numeric claim lines	59	Every effect size, confidence interval, sample size, percentage and follow-up duration checked digit-by-digit against the abstract
ClinicalTrials.gov records	20 (17 catalogued + 3 added)	v2 API; title, status, phase, enrolment and dates re-verified
Non-journal URLs	15 (11 patient organizations + 4 guideline pages)	Re-requested; all returned HTTP 200; NICE, UKKA and Kidney Health Australia page text re-read
Asserted absences re-searched	7	Fresh PubMed searches on finerenone outside type 2 diabetes, combination/factorial CKD trials, semaglutide in CKD without diabetes, conservative-management RCTs

Errors found and fixed¶

1. Stale absences — the most consequential finding. Seven records published before the build date were missed, and six pages asserted gaps that had already closed:

FIND-CKD has reported. mineralocorticoid-receptor-antagonists.md said "Evidence for non-diabetic CKD … remains incomplete" and clinical-trials-landscape.md listed the trial as merely COMPLETED with publication "to be tracked". Heerspink 2026 (PMID 42246672, N Engl J Med 2026;395:533-545) randomized 1,584 adults with CKD and no diabetes: total eGFR slope difference 0.7 mL/min/1.73 m²/year (95% CI 0.3–1.1), composite kidney-or-cardiovascular HR 0.77 (0.60–0.99), hyperkalaemia 17.0% vs 13.3%.
The INFINITY pooled analysis exists (Neuen 2026, PMID 42248158, Lancet): 14,574 participants across FIDELIO-DKD, FIGARO-DKD and FIND-CKD; kidney composite HR 0.76 (0.68–0.86), kidney failure alone 0.85 (0.74–0.99), all-cause death 0.88 (0.79–0.99).
A randomized combination trial exists. diabetic-kidney-disease.md said "randomized evidence for the full combination and sequence is absent" and clinical-trials-landscape.md said "the major missing design is factorial or strategy randomization". CONFIDENCE (Agarwal 2025, PMID 40470996) randomized 779 people 1:1:1 to finerenone, empagliflozin or both; combination lowered uACR 29% more than finerenone alone (ratio 0.71, 0.61–0.82) and 32% more than empagliflozin alone (0.68, 0.59–0.79) at day 180. Its prespecified secondary analysis (PMID 41493296) found combination did not mitigate hyperkalaemia versus finerenone alone. Claims rewritten to say precisely what remains missing: an outcome-powered trial across all four classes.
Finerenone has type 1 diabetes evidence (FINE-ONE, PMID 41780000): 242 participants, uACR 25% lower than placebo at six months (ratio 0.75, 0.65–0.87). The table row reading "T2D only" was corrected.
A glomerular-disease analysis exists (Neuen 2026, PMID 42246414, JAMA): prespecified exploratory FIND-CKD subgroup, 903 participants, eGFR slope difference 0.73 (0.22–1.24), kidney failure or ≥40% eGFR decline HR 0.74 (0.57–0.97).
Semaglutide's kidney signal now extends beyond diabetic CKD (Mann 2026, PMID 42567173): SELECT + FLOW + SOUL pooled, 30,787 participants, kidney composite HR 0.84 (0.77–0.91).
Three new NCT records verified live and added: NCT05254002 (CONFIDENCE), NCT05901831 (FINE-ONE), plus the FIND-CKD publication link on NCT05047263.

2. Systematic study-design mislabelling — 194 rows across all 24 pages. The per-page "Evidence ledger" assigned each record a design descriptor; 41 of 125 records carried the wrong one, in the direction that most misleads about evidence strength. CREDENCE (PMID 30990260, on 15 pages), AMBER (9 pages), ONTARGET (7), VA NEPHRON-D (7), NefIgArd, BEACON, HALT-PKD, CHOIR, AURORA, ASCEND-D, NEUTRALIZE and the FIDELITY stage-4 analysis were all labelled "Observational or conceptual evidence; association is not treatment effect" — every one is a randomized trial. Five meta-analyses (including Tangri 2016 and the Inker 2019 IPD meta-analysis) were labelled observational; two editorials and a KDIGO controversies conference were labelled as primary evidence; and four modelling studies plus four consensus/Delphi exercises were labelled "Intervention study", including Neuen 2024, which is an actuarial projection, and Geroldinger 2023, which is a retrospective cohort. All corrected against PubMed publication types with hand adjudication, and two new categories added for modelled projections and consensus exercises.

3. Pseudo-citations in per-page open questions — 120 instances. All 24 pages carried an identical five-question boilerplate block, each question tagged with a citation the source does not support: a question about minimum outcome sets was attributed to Hostetter 1981, a 1981 rat micropuncture study; a surrogate-validation question to Wen 2014, a paper on race-specific relative risks; a competing-death question to Tangri 2016, a KFRE validation. Tangri 2016 was cited this way on eight pages without appearing in those pages' reference lists at all. All 24 blocks were replaced with page-specific questions grounded in that page's verified sources, cross-linked to the OQ IDs in OPEN-QUESTIONS.md.

4. Wrong number. kidney-replacement-therapy-decisions.md stated IDEAL's "median start was 9.0 versus 7.2". The trial reported median time to initiation of 1.80 versus 7.40 months; 9.0/7.2 is a different quantity and appeared without units. Replaced with the abstract-verified figures, plus mortality 37.6% vs 36.6% over median 3.59 years. The condition's own landmark note (cooper-2010-ideal.md) already had it right.

5. Direction of effect misrepresented. diet-and-nutrition.md said later syntheses find "small or uncertain effects" of protein restriction, citing Yan 2018. That meta-analysis of 19 trials (2,492 participants) actually found kidney failure OR 0.59 (0.41–0.85) and ESRD OR 0.64 (0.43–0.96) — a significant positive result. Rewritten to present MDRD's null primary endpoint and the meta-analysis's positive one as the live contradiction they are, rather than collapsing both into "small".

6. Overstatements corrected against source. - causes-and-aetiology.md and inherited-and-glomerular-disease.md used Benson 2020 to support genomic testing resolving uncertain diagnoses. That study found a molecular diagnosis in 2 of 50 (4%) unselected biopsy referrals and concluded testing is most valuable when a heritable form is already suspected. The yield and the authors' own qualification were added. - mineralocorticoid-receptor-antagonists.md said the FIDELITY stage-4 subgroup "retains benefit". The paper reports that the kidney composite violated the proportional-hazards assumption, with protection only to about two years and inconsistent direction thereafter; the cardiovascular HR was 0.78 (0.57–1.07), crossing 1.0; hyperkalaemia was 26% vs 13%. Stated accordingly. - ras-blockade-and-blood-pressure.md attributed increased acute kidney injury and hyperkalaemia jointly to ONTARGET and VA NEPHRON-D. ONTARGET's renal paper reports neither; it reports a worse composite renal outcome (HR 1.09, 1.01–1.18) and steeper eGFR decline. The AKI and hyperkalaemia rates come from VA NEPHRON-D alone. Split and quantified. - mineral-and-bone-disorder.md said Xu 2022 found "limited evidence for patient-important benefit". Its outcome was radiologic calcification, not patient-important endpoints; it found data insufficient or conflicting for calcification itself, with magnesium and sodium thiosulfate the only consistent signals across 77 trials of median size 50 and median duration 12 months. - symptom-burden-and-patient-experience.md said a standardized life-participation measure "was developed"; the SONG workshops endorsed SONG-LP by consensus and stated explicitly that piloting and validation in non-KRT CKD remain outstanding. - pathophysiology-and-progression.md said the remnant-nephron model "established" that hyperfiltration becomes injurious; Hostetter 1981 is a rat micropuncture study whose own conclusion is that hyperfiltration "may" be maladaptive. Softened, with the species and study design made explicit. - conservative-and-supportive-care.md attributed Wongrakpanich's HR 0.53 to all 11,515 participants; it comes from a subset (age ≥65, eGFR <15, models adjusted for age and comorbidity). Qualified.

7. Wrong PMID on a landmark note. literature/notes/empa-kidney-2023.md attributed the acute-dip and chronic-slope figures to the 2023 primary paper (PMID 36331190). They are from the 2024 prespecified secondary analysis (PMID 38061371). Corrected, with a note recording the change.

8. Unsupported non-journal claims. The guidelines registry stated the Kidney Health Australia handbook was published in 2024 and "endorsed as an accepted clinical resource by Australian professional bodies listed on the official page". The live page states neither; its only endorsement text is Kidney Health Australia's Deductible Gift Recipient charity status, which is unrelated. Both claims removed from the registry and from wiki/guidelines.md. By contrast, the NICE NG203 dates (published 25 Aug 2021, updated 24 Nov 2021, reviewed 19 Aug 2025), its supersession chain, and the UKKA eCKD Guide's February 2024 update were all confirmed word-for-word from the live pages and are now recorded with that precision.

9. Design mischaracterization in the patient-voice layer. Schade van Westrum 2025 was described as qualitative; it is a nationwide descriptive survey of 414 patients. Replaced with its actual findings (94.7% often fatigued; 86.3% ranked it top-three; 32.1% never or rarely discuss it with a physician; 67.8% untreated).

10. Reference-list gaps. Nine PMIDs were cited in page bodies without appearing in those pages' reference lists. All added. Every page now passes a cited↔referenced consistency check in both directions, and all 132 bibliography "cited by" lists were regenerated from the actual reference sections.

Density improvements made while verifying¶

Where a claim was correct but thin, the verified numbers were added rather than left as adjectives: 4D and AURORA event rates and confidence intervals, RENAAL's 16%/25%/28% risk reductions, ASCEND-D's co-primary results, CHOIR's HR 1.34 and CREATE's HR 0.78, BEACON's HR 1.83 for heart failure, Tangri 2016's C-statistic of 0.90 across 31 cohorts and 721,357 people, Grams 2023's finding that added slope and comorbidity variables did not improve the KFRE, MDRD's full two-study design, and the DAPA-CKD diabetes/no-diabetes slope interaction (2.26 vs 1.29, p-interaction 0.0049) that the page had flattened into "relative effects were consistent". STATISTICS.md gained 14 rows for the newly found trials and four new caveats; its "Change in CKD deaths +41.5%" row was relabelled, since that figure is the all-age mortality rate change, and the age-standardised rate change was not significant.

Promotion result¶

22 of 24 pages promoted to curated. Every citation on them resolves, matches the paper claimed, and supports the claim made, after the fixes above.

2 held at draft, with the reason stated on the page and in INDEX.md:

guidelines.md — its substance is a synthesis of what guideline documents recommend, and its two central sources (PMIDs 38490803 and 30675420) have no PubMed abstract, so those characterizations could not be checked against retrievable source text this session. Everything about the documents as documents — dates, supersession, URLs, PMIDs — was verified live.
red-flags-and-safety-concerns.md — the trial-derived "surrogate traps" material is fully verified, but the opening diagnostic red-flag list and the medication-reconciliation guidance rest on the same non-retrievable KDIGO full text.

Both need a pass by an agent with access to the guideline PDFs rather than their PubMed records.

For the next sweep¶

OQ-2 is now largely answered and OQ-1 narrowed; both were rewritten rather than deleted, and the residual gaps stated. Re-read them before opening new questions in this area.
Watch for the FIND-CKD-era evidence entering guidelines: no document in the registry post-dates it, so guidance restricting non-steroidal MRA to diabetic CKD currently reflects its evidence cycle rather than the trial base.
The finerenone literature moved substantially between the build and this audit on the same day. Search windows for this condition should not assume the last sweep date is recent enough.
Structural note for whoever next edits these pages: the "Decision and interpretation matrix", "What can and cannot be concluded" and "Research-design checklist" blocks are byte-identical across all 24 pages and contribute roughly 40 lines per page of non-page-specific text. They are not errors and were left alone, but they inflate the line counts and should be either differentiated per page or consolidated into one shared methods page.

2026-09-02 — Literature-deepening pass (Claude)¶

Purpose. The condition was structurally complete but sourced narrowly: 24 pages, 167 lines and 27 distinct citations per page, but only 130 distinct PubMed records across the whole condition — roughly 5 per page — because the same small pool of records was recycled across many pages, largely through the byte-identical "Evidence ledger" blocks. Reference conditions run 15–24 distinct records per page. The instruction for this pass was to widen the evidence base, not to lengthen pages with the same references.

Result.

Measure	Before	After
Distinct PubMed records across the condition	130	306
Distinct records per page (total ÷ 24)	5.4	12.8
Distinct ClinicalTrials.gov records	19	41
Total wiki lines	4,030	5,377
Mean lines per page	168	224
Pages at `status: draft`	2	24
Records in BIBLIOGRAPHY.md	132	306
Lines in STATISTICS.md	96	292
Documents in guideline REGISTRY.md	12	17

Every one of the 306 PMIDs and all 41 NCT IDs was resolved live in this session — PMIDs through PubMed E-utilities esearch/esummary/efetch, NCT IDs through the ClinicalTrials.gov v2 API. A final verification pass re-resolved all 306 in a single esummary call (306 requested, 306 returned, no errors) and requested each NCT record individually (41 of 41 returned HTTP 200). No citation in this pass was written from memory; every claim with a number was written from the abstract or record text retrieved in this session.

What was deepened, page by page¶

Each page received sections built from searches run specifically for that page's topic, not from the shared pool. Representative additions:

definition-staging-and-measurement (25→43 records) — within-person variability arithmetic (creatinine CV 5.4% versus random-spot uACR 50.6%), creatinine–cystatin C discordance prevalence and prognosis in 861,000 people, CKD-EPI versus EKFC head-to-head P30 and bias, the age-adaptation controversy with both sides quantified, PCR/dipstick conversion performance, surrogate-endpoint performance for both eGFR slope and albuminuria, the AKD construct, and the eGFR-C monitoring study.
epidemiology-and-burden (26→37) — GBD 2023 replacing GBD 2017 as the current estimate (788 million adults, 14.2%, ninth leading cause of death), Hill's stage-specific pooled prevalence, lifetime risk of treated kidney failure, the sex gradient reversing between prevalence and progression, screening ICERs with sensitivity to SGLT2 inhibitor efficacy, workforce capacity, and ambient heat as a measured exposure in DAPA-CKD.
pathophysiology-and-progression (28→39) — human single-nephron GFR and nephron number, the human kidney cell atlas and its 28 injury states, G2–M arrest and TASCC biology, the hypoxia circuit, local complement, AKI→CKD quantified from two syntheses whose estimates differ three-fold, and the two urate trials that closed the urate hypothesis.
causes-and-aetiology (29→40) — APOL1 with absolute risks by genotype, exome-sequencing yield by phenotype category, aristolochic acid, heat-exposed occupational cohorts with biomarker data, PPI and lithium effect sizes, obesity-related glomerulopathy, MGRS, sickle cell trait, and biopsy-proven CKDu.
race-and-the-egfr-equation (25→34) — reclassification magnitudes in three different populations, the masked high-risk subgroup, oncology trial-eligibility exclusion, the OPTN waiting-time modification and its 32% uptake, APOL1 in living donors, and the paediatric CKiD analysis that isolates the creatinine mechanism.
Therapy pages — pooled class effects (13-trial and 8-trial SGLT2 meta-analyses), the AKI-reduction paradox, participant-level safety data, sotagliflozin, transplant physiology, cost-effectiveness; FIGARO, the finerenone mediation analysis, two negative spironolactone trials, FINEARTS-HF kidney outcomes, FIDELIO hyperkalaemia; SELECT kidney outcomes, GLP-1-on-SGLT2 additivity, endothelin antagonism, HIF-PHI safety, tirzepatide versus dulaglutide; REIN and its follow-up, benazepril, STOP-ACEi, SPRINT, chlorthalidone, and the 285,124-participant blood-pressure IPD meta-analysis.
Complication pages — TREAT, PIVOTAL and its infection analysis, FIND-CKD iron, daprodustat heart failure; EVOLVE, LANDMARK, PRIMO and the Cochrane binder review as four negative results with three competing explanations; SHARP versus AURORA, ISCHEMIA-CKD, CKM staging, anticoagulation, coronary calcification; UBI versus VALOR-CKD, fruit-and-vegetable alkali, DIAMOND, DIALIZE-Outcomes, RAASi discontinuation.
inherited-and-glomerular-disease (26→35) — TEMPO 3:4 and REPRISE, DUPLEX as a surrogate counterexample, MENTOR, and the IgA nephropathy pipeline including iptacopan's conversion of a proteinuria signal into an eGFR slope and kidney-failure benefit; plus voclosporin, belimumab and avacopan.
Decision and experience pages — PD-versus-HD from day 0 and day 90, FHN Nocturnal and its post-trial mortality signal, incremental initiation, haemodiafiltration, MyTEMP, transplantation versus waitlist, the two Cochrane modality reviews; the Dutch conservative-care cohort with hospital-free days; global symptom-burden prevalence, SONG-HD fatigue, difelikefalin, two exercise trials, depression treatment, sleep disorders, dialysis withdrawal.
guidelines (36→47) — the 2026 AHA/ACC/ADA/ASN CKM syndrome guideline (published in duplicate), ADA Standards §11 with its annual cycle, the KDIGO 2013 lipid guideline and its deliberate abandonment of LDL targets, the ERBP commentary on KDIGO 2026 anaemia, and an explicit treatment of grading-system incompatibility and cycle length as sources of disagreement.
clinical-trials-landscape (32→36 records, 19→41 NCTs) — the shift to combination-on-background-SGLT2 (EASi-KIDNEY at 11,000 and baxdrostat/dapagliflozin at 5,000), the first nephrology adaptive platform, and a 12-trial table of the glomerular-disease pipeline showing that proteinuria is carrying almost all of it.

Controversies added with citations on both sides¶

Age-adapted versus fixed CKD definition; population-specific versus race-free EKFC Q-values; whether race-free eGFR helped or harmed access; AKI as cause versus revealed low reserve; whether correcting acidosis slows CKD (open-label positive versus blinded-but-unseparated null); albuminuria surrogacy validated in IgA nephropathy and refuted in FSGS; steroidal versus non-steroidal MRAs as one class or two; why LDL lowering works before dialysis and not on it; the FINEARTS-HF acute dip counted as kidney events; hydration and urate as observationally strong and causally null; potassium restriction versus plant-forward dietary patterns; ESA versus HIF-PHI first-line positioning.

Literature layer¶

BIBLIOGRAPHY.md was rebuilt programmatically from the wiki reference sections, so every record's "cited by" list is now derived from the pages rather than maintained by hand. 306 records across the ten existing topic sections; pre-existing citation text was preserved verbatim.
STATISTICS.md gained nine new tables — updated global burden, measurement variability and equation performance, age-adaptation and screening economics, surrogate-endpoint performance, mechanism and progression, aetiology, pooled therapy class effects, complications and replacement, symptoms and glomerular disease, safety and negative results — and nine new entries in the closing conflicts section.
REGISTRY.md gained five documents, four per-guideline entries, six disagreement rows (including grading-system incompatibility and revision cadence) and five watch-list rows.
OPEN-QUESTIONS.md — OQ-3, OQ-5 and OQ-9 were rewritten with the new evidence and their residual gaps restated rather than being deleted; eight new questions were added (OQ-21 to OQ-28) covering the age-adapted definition, acidosis correction, aldosterone synthase inhibition, anti-inflammatory therapy, sickle cell trait counselling, the failure of observationally-derived targets, pregnancy in prognostic models, and the delivery constraint. The "dots not yet connected" table gained eight junctions (D13–D20).

Deliberately left alone¶

The five landmark notes in literature/notes/ were not touched. They are deep notes on DAPA-CKD, EMPA-KIDNEY, race-free eGFR, IDEAL and FLOW; none of the new material supersedes them, and CONVENTIONS reserves notes for papers that changed practice or opened a field. Candidates from this pass for future notes: the GBD 2023 CKD analysis (PMID 41213283), the APPLAUSE-IgAN 24-month result (PMID 41910396), and the 285,124-participant blood-pressure IPD meta-analysis (PMID 42035778).
The patient-voice layer was not modified. It is a non-journal layer with its own ethics rules and verification method (organizations verified by fetching their sites with access dates); re-verifying it was outside the scope of a literature-deepening pass and partially updating it would have left the access dates inconsistent.
The shared boilerplate blocks — "Decision and interpretation matrix", "Evidence ledger", "What can and cannot be concluded" and "Research-design checklist" — were left in place on every page. The previous audit flagged them as byte-identical across all 24 pages and recommended consolidating or differentiating them. That recommendation stands and was not acted on here because it is a structural change, not a sourcing one, and this pass was explicitly about substance rather than structure. Note that the "Evidence ledger" tables are the main reason the pre-existing per-page citation counts looked adequate while the distinct-record count was low: they list records that the page body does not use.
Existing verified content was extended, never replaced. No previously verified claim, citation or section was deleted from any page.

Errors found and fixed during this pass¶

My own editing helper silently dropped appended reference lines. The script computed the set of "already present" PMIDs after inserting the new body text, so every new reference was skipped as a duplicate. This was caught when the bibliography rebuild reported 130 records instead of 306. A repair script then appended the 215 missing reference lines across all 24 pages, ordered by first appearance in each page body, and a verification pass confirmed that every inline PMID now appears in its page's ## References section with no duplicate numbering.
Citation lines for six records were written with incomplete or guessed locator details before the exact record had been retrieved (Canaud 2019, Portilla 2025, Smeijer 2024, Song 2025, McCoy 2025, Ndumele 2026 JACC). Each was re-fetched and corrected. The abstract fetcher was patched to emit the ELocationID pii when a record has no conventional pagination, so that particular guess cannot recur. Four of the six had to be corrected twice, because the first correction was applied before the reference-line bug above was found and therefore matched nothing.
One pre-existing bibliography entry from the original build carried a paraphrased rather than actual title (PMID 36316605, recorded as "SGLT2 inhibitors in advanced CKD: systematic review and meta-analysis"; the real title is "Effects of sodium-glucose co-transporter-2 inhibitors on kidney, cardiovascular, and safety outcomes in patients with advanced chronic kidney disease: a systematic review and meta-analysis of randomized controlled trials"). It was corrected in the bibliography and on all nine pages that carried it.
Whole-corpus citation verification. After the repairs, all 1,177 citation lines across the 24 pages and the bibliography — 306 distinct records — were checked programmatically against their PubMed XML on journal abbreviation, publication year, volume, and title-word overlap. Zero mismatches remain. This checks that each line describes the record it names; it does not check that the record supports the claim it is cited for, which is the re-audit's job.
One trial acronym ("CAPTIVATE") was written for NCT06058585 without evidence from the registry record and was removed.

Status and what the next agent should do¶

All 24 pages are set to status: draft. A different engine must re-audit. The audit should prioritise:

The quantitative claims added in this pass — every effect size, confidence interval, sample size and percentage — against the source abstracts. There are several hundred of them.
The 215 reference lines appended by the repair script: confirm each matches the PMID it is paired with, since they were written from a mapping file rather than re-derived per page.
The two pages whose pre-existing draft reason is unresolved (guidelines.md, red-flags-and-safety-concerns.md): both still rest partly on KDIGO full text with no retrievable PubMed abstract, and both would benefit from an agent with access to the guideline PDFs.
Assertions of absence — "no trial has", "no guideline specifies", "no study has measured" — appear frequently in the new material because the pass deliberately surfaced gaps. Stale absences are the most common real error; each should be re-searched.

For the next sweep¶

The distinct-record density is now 12.8 per page against a reference range of 15–24. Further widening is possible but should be driven by page-specific gaps rather than by the metric; the pass stopped adding where additional citations would not have supported anything a reader needed.
The IgA nephropathy pipeline is moving fastest of any area here: six agents in phase 3, none comparative, almost all with proteinuria primary endpoints. Expect this section to need revision at every sweep.
The two aldosterone synthase inhibitor outcome trials (NCT06531824, NCT06742723) do not report before 2028 but are the largest bet in the current pipeline; the watch list tracks them.
GBD 2023 has superseded GBD 2017 for CKD burden. The two use different age denominators and are not a time series — a caveat now recorded in STATISTICS.md that any future sweep should preserve.

2026-09-02 — Independent audit of literature-deepening additions (auditor: Codex; author: Claude)¶

Audited the new material added by Claude's literature-deepening pass on all 24 pages that it returned to status: draft. The change boundary was reconstructed without repository history: the union of the pre-existing evidence ledgers is exactly 130 PMIDs, matching the logged pre-deepening corpus, while the post-deepening wiki contained 306. The pass therefore added 176 distinct PubMed records and 215 per-page reference lines.

Verification performed¶

Object	Count	Method
Deepening-pass PubMed additions	176 distinct records	Re-fetched through live PubMed E-utilities; identifier, title, author, journal and year checked against the claim and reference line
Appended per-page reference lines	215	Checked against the live records; all resolved to the paper named
New claim lines using appended records	409	Read against retrieved abstracts/record text; 315 contained quantitative content and were checked for value, direction, endpoint, population and follow-up context
Current wiki PubMed corpus after corrections	310 distinct records	Final live batch `efetch`: 310 requested, 310 returned
Current ClinicalTrials.gov corpus after corrections	42 NCT records	Every identifier requested individually from the live v2 API; 42 returned
Asserted evidence gaps	19 targeted search strategies	Fresh PubMed `esearch`/`esummary` plus ClinicalTrials.gov searches where the register was the relevant source

Errors and padding removed¶

Wrong order of magnitude. epidemiology-and-burden.md and overview.md called lifetime risk of treated kidney failure “roughly two orders of magnitude” below CKD prevalence. The cited values are 3.14% in men and 1.42% in women versus 14.2% adult prevalence — about fourfold and tenfold lower, respectively, and not directly commensurable because populations and methods differ. Corrected in both places.
Stale transplant absence. sglt2-inhibitors.md and clinical-trials-landscape.md said transplant evidence stopped at a 52-person physiology study and that no outcome trial was recruiting. Live searches found a 208-person 12-month randomized trial in chronic allograft dysfunction (PMID 42102257) and the recruiting 330-person DEAK chronic-slope trial (PMID 42315275; NCT05788276). The pages now state that randomized evidence exists but remains surrogate-based and is not powered for graft failure, cardiovascular events or mortality.
Stale comparative-trial absence. The IgA-nephropathy material said none of the agents was comparative. A 65-person randomized crossover trial compared ambrisentan, henagliflozin and their combination (PMID 41949916). The gap is now stated precisely: no phase 3 comparative clinical-outcome trial establishes sequence.
New potassium-liberalisation evidence omitted. A 16-person randomized crossover pilot tested a potassium-rich fruit/vegetable/nut diet in advanced CKD with sodium zirconium cyclosilicate rescue (PMID 42636918). Added with its two hyperkalaemia events and explicit limits: six weeks, selected patients, biochemical feasibility rather than clinical benefit.
Pipeline overstatement. “Every large CKD outcome trial” was said to place SGLT2 inhibition in both arms, although the same table included SGLT2-versus-placebo and non-SGLT2 designs. Narrowed to the three largest general-CKD phase 3 programmes to which the statement applies.
Historical overstatement. The IgA-nephropathy page said the field had no disease-specific licensed therapy in 2023. Removed; disease-specific approval preceded that date.
Missing context. AURORA 1 quoted the voclosporin response as 41% against only “significantly fewer” controls. Added the meaningful comparator: 23% (40/178), OR 2.65 (1.64–4.27).
Citation padding and cross-study rhetoric. Removed the uncited inference that G1–G3 prevalence means patients “feel well”; removed rankings of intensive glycaemic control and bariatric surgery against unrelated drug trials; removed the claim that sodium-restriction effects were “comparable to adding a drug”; changed statistical albuminuria mediation from causal language; removed causal claims from achieved haemodiafiltration dose, the FINEARTS-HF acute dip and the urate trials; and removed a transplant hazard-ratio ranking across unlike study designs. These citations supported the underlying numbers but not the rhetorical conclusion attached to them.
Additional precision fixes. The heat analysis is now framed as an exposure requiring prospective testing rather than an established modifiable cause; HIF-PHI placebo-versus-ESA asymmetry is not assigned a mechanism; CKD incident-risk development-cohort incidence is not presented as population risk; BMI attenuation is not quantified as causal mediation; earlier CKD-MBD biochemical trials are distinguished from absent patient-important-outcome trials; and the exercise heading and adherence explanation were de-hyped.

Citation breadth and promotion¶

The deepening pass did widen the evidence base rather than merely lengthen pages with the landmark set: 130 distinct wiki PMIDs before deepening (5.4 distinct condition records per page) → 306 after Claude's pass (12.8 per page) → 310 after this audit's four corrective records (12.9 per page). The 176-record widening is substantive, although 12.9 remains below the 15–24 reference-condition range logged by the author; further additions should remain gap-driven rather than metric-driven.

22 pages promoted to status: curated. guidelines.md and red-flags-and-safety-concerns.md remain draft for the pre-existing unresolved reason: central recommendation and red-flag claims depend on KDIGO full text not present in the PubMed records, so those statements still require direct guideline-PDF verification. All body/reference PMID sets match, reference numbering is consecutive, no duplicate reference number exists, and no unresolved [unverified] marker remains on the 22 promoted pages.