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Sean Hashmi, MD

Sean Hashmi, MD

Understand your kidney numbers and metabolic health. I'm Dr. Sean Hashmi, a board-certified kidney and obesity medicine specialist. I explain the research behind your lab results, food choices and daily habits in plain English.

I'm the founder of SELF Principle, a nonprofit built around Sleep, Exercise, Love and Food.

Free weekly newsletter: https://selfprinciple.org/newsletter/
Website: https://www.seanhashmimd.com/

For education only, not personal medical advice.

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  • 20 episodes
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  • August 2 · 14 min

    Dialysis Timing: What Actually Decides When You Start

    Three people can have the exact same kidney number, and completely different futures. One needs dialysis this year. One never will. Nephrologist Dr. Sean Hashmi breaks down the biggest myth in kidney care: that a single eGFR number decides when you need dialysis. There is no eGFR threshold that automatically triggers dialysis, according to a 2024 review in JAMA. What actually decides timing is a combination of symptoms, fluid status, blood acid level, and potassium, not a single lab value. Dr. Hashmi walks through the landmark IDEAL trial, a randomized study of 828 people that found starting dialysis early bought no survival benefit at all, and explains why preparing early and starting early are two completely different things. He closes with the one medication class proven to slow kidney decline, and a simple two-column tracking method to bring to every appointment. References: Flythe JE, Watnick S. Dialysis for chronic kidney failure: a review. JAMA. 2024;332(18):1559-1573. Cooper BA, Branley P, Bulfone L, et al. A randomized, controlled trial of early versus late initiation of dialysis. N Engl J Med. 2010;363(7):609-619. Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al. Dapagliflozin in patients with chronic kidney disease. N Engl J Med. 2020;383(15):1436-1446. The EMPA-KIDNEY Collaborative Group. Empagliflozin in patients with chronic kidney disease. N Engl J Med. 2023;388(2):117-127. Want the evidence without the hype? Sign up for the free weekly newsletter at selfprinciple.org/newsletter. The information in this content is for educational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have seen in this content. The views expressed here are my own and do not represent the views of my employer or any affiliated institution. Never start, stop, or change the dose of any prescription medication without consulting your physician. Practice kindness and gratitude.

  • July 26 · 12 min

    This Sign Means Your Kidneys Are Already Damaged

    Your kidneys can lose more than half their function and never once make you feel sick. Nephrologist Dr. Sean Hashmi walks through the real warning signs of kidney disease, including the ones almost everyone misses because they blame them on something else. Fewer than one in 20 people with early kidney disease are aware they have it, because kidneys are built with so much spare filtering capacity that blood tests can look normal while damage quietly continues underneath. Dr. Hashmi covers the eight warning signs to watch for as a cluster, from swelling and foamy urine to washed-out fatigue and itchy skin, the visible signs on your ankles, eyes, and nails and why they show up late, and the sign people miss completely: rising blood pressure. He also explains why diabetes and high blood pressure cause about half of all kidney disease with zero symptoms, and the two simple tests, a blood test for creatinine and a urine albumin-to-creatinine ratio, that catch kidney damage years before any symptom appears. References: Gong J, Vaduganathan M, Wadhera RK. Chronic kidney disease prevalence and awareness among US adults. JAMA Cardiol. 2026;11(1):77-81. Romagnani P, Agarwal R, Chan JCN, et al. Chronic kidney disease. Nat Rev Dis Primers. 2025;11(1):8. Kalantar-Zadeh K, Jafar TH, Nitsch D, Neuen BL, Perkovic V. Chronic kidney disease. Lancet. 2021;398(10299):786-802. KDIGO CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024;105(4S):S117-S314. Want the evidence-based breakdowns in writing? Sign up for the free weekly newsletter at selfprinciple.org/newsletter. The information in this content is for educational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have seen in this content. The views expressed here are my own and do not represent the views of my employer or any affiliated institution. Practice kindness and gratitude. Dr.Sean

  • July 20 · 15 min

    Do Proton Pump Inhibitors Cause Kidney Disease?

    Do heartburn pills like omeprazole really damage your kidneys? Nephrologist Dr. Sean Hashmi breaks down what the actual research found, how big the risk really is, and who carries it versus who barely does. Large observational studies do show a higher rate of chronic kidney disease in people who take proton pump inhibitors daily for years, roughly 26 to 50 percent higher depending on the study. But that number is smaller than it sounds once it's anchored in real numbers, and every one of these studies is observational, meaning it cannot prove the pill itself is the cause rather than the reasons someone was prescribed it in the first place. Dr. Hashmi explains the research trap called confounding by indication, the one kidney injury from these drugs that is not a myth, and why dose and time, not the single pill, are what actually drive the risk. He also covers the safe, planned way to taper off a proton pump inhibitor without acid rebound, and who genuinely needs to stay on one. References: Lazarus B, et al. Proton pump inhibitor use and the risk of chronic kidney disease. JAMA Intern Med. 2016;176(2):238-246. Ang SP, et al. Association between proton pump inhibitor use and risk of incident chronic kidney disease. Biomedicines. 2024;12(7):1414. Rajan P, et al. The association between proton pump inhibitor use and the risk of adverse kidney outcomes. Therap Adv Gastroenterol. 2022;15:17562848221074183. Praga M, González E. Acute interstitial nephritis. Kidney Int. 2010;77(11):956-961. Want the evidence-based breakdowns in writing? Sign up for the free weekly newsletter at selfprinciple.org/newsletter. The information in this content is for educational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have seen in this content. The views expressed here are my own and do not represent the views of my employer or any affiliated institution. Never start, stop, or change the dose of any prescription medication without consulting your physician. Practice kindness and gratitude. Dr.Sean

  • July 19 · 11 min

    Can Kidney Disease Be Reversed? Here's What Really Happens

    Can kidney disease be reversed? A five-year study in PLOS Medicine found that about one in five people with kidney disease saw their numbers return to the normal range. Nephrologist Dr. Sean Hashmi explains what that finding actually means, and why it is different from the "reverse it naturally" promises flooding your feed. You cannot regrow kidney filters that have scarred or died, and chronic kidney disease has no cure. But the two numbers that define kidney health, your filtering score and the protein in your urine, can genuinely improve. Dr. Hashmi walks through the four things the evidence says actually move those numbers: controlling blood pressure and blood sugar, the two medication classes proven in the DAPA-CKD and EMPA-KIDNEY trials to slow kidney decline, treating fixable underlying causes, and a plant-predominant, low-salt eating pattern. He also flags the supplement claims that can push potassium or phosphorus to dangerous levels, and addresses the popular claim that blood pressure medications harm the kidneys. References: Shardlow A, et al. Chronic kidney disease in primary care: outcomes after five years. PLoS Med. 2016;13(9):e1002128. Heerspink HJL, et al. Dapagliflozin in patients with chronic kidney disease. N Engl J Med. 2020;383(15):1436-1446. The EMPA-KIDNEY Collaborative Group. Empagliflozin in patients with chronic kidney disease. N Engl J Med. 2023;388(2):117-127. Kalantar-Zadeh K, et al. Chronic kidney disease. Lancet. 2021;398(10299):786-802. Want the evidence-based breakdowns in writing? Sign up for the free weekly newsletter at selfprinciple.org/newsletter. The information in this content is for educational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have seen in this content. The views expressed here are my own and do not represent the views of my employer or any affiliated institution. Never start, stop, or change the dose of any prescription medication without consulting your physician. Practice kindness and gratitude. Dr. Sean

  • July 15 · 14 min

    Silent Kidney Stone: Should You Watch It or Treat It?

    Roughly one in twenty CT scans done for something unrelated turns up a silent kidney stone, and "just watch it" is the advice most people hear afterward. Dr. Sean Hashmi, a board-certified nephrologist, walks through what long-term data actually says happens to a silent stone left alone: the risk of a real problem climbs from about 3% at one year to 19% at three years and 31% at five years in a long-term UK cohort, yet close to six in ten stones followed this way for more than five years never needed anything done. He explains which two facts, stone size and location, predict almost everything that follows, why fluid is the one habit that actually helps, why the flush and tonic remedies flooding social media cannot dissolve a real stone, and what a June 2026 meta-analysis of six randomized trials found when researchers compared treating a stone early against watching it: lower odds of a later stone and less than half the risk of eventually needing surgery, without more complications. He also answers two listener questions, one about a stone that grew to 18 millimeters after years of missed follow-up, and one about a newly found 1.5-millimeter stone with no blockage. References: Darrad et al., BJU International, 2018 (PMID 29675983); Kang et al., Journal of Urology, 2013 (DOI 10.1016/j.juro.2012.11.113); Tuo et al., World Journal of Urology, 2026 (DOI 10.1007/s00345-026-06536-5). Want the research translated like this every week? Subscribe free at selfprinciple.org/newsletter. The information in this content is for educational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have seen in this content. The views expressed here are my own and do not represent the views of my employer or any affiliated institution. Practice kindness and gratitude.

  • July 12 · 16 min

    Can Food Really Lower Your Creatinine? What Actually Protects Your Kidneys

    Can food really lower your creatinine? Right now your feed is full of morning drinks and five-food lists that promise it will. Here is the part they leave out: you can move your creatinine number tonight without helping your kidneys at all. In this episode, Dr. Sean Hashmi separates what moves the number from what actually protects your kidneys. Creatinine is not a toxin your kidneys struggle to push out. It is a waste product your muscles make at a steady rate, and your lab number reflects two things at once, how much muscle you carry and how well you filter. A single cooked meat meal can raise your measured creatinine for hours, because cooking meat turns some creatine into creatinine that you absorb directly. Researchers showed this in Diabetes Care in 2014. So skipping meat before a blood draw can drop the number while nothing about your kidneys has changed. Dehydration nudges it up too, and the eGFR on your report is an estimate calculated from a formula, not a direct measurement. Detox teas do nothing. Your kidneys already filter about 180 liters a day. Even forcing water was tested directly in the CKD WIT trial, published in JAMA in 2018, and after a full year, drinking more water did not slow kidney function decline. A few food changes do genuinely help a little: cutting inorganic phosphate additives, cutting sodium, and a plant-forward, Mediterranean-style pattern, which is what the KDIGO 2024 guidelines point toward. What actually decides whether someone ends up on dialysis is not a food. It is the medicines with real trial evidence, especially SGLT2 inhibitors, tested in EMPA-KIDNEY and DAPA-CKD, and for people with type 2 diabetes and kidney disease, the GLP-1 drug semaglutide, which cut major kidney events by 24 percent in the FLOW trial. Alongside that, controlling blood pressure and blood sugar protects your kidneys over a decade more than any food list. Ask your doctor one question: given my numbers, am I a candidate for an SGLT2 inhibitor? The information in this content is for educational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have seen in this content. The views expressed here are my own and do not represent the views of my employer or any affiliated institution. Never start, stop, or change the dose of any prescription medication without consulting your physician. Practice kindness and gratitude.

  • July 9 · 14 min

    The 2026 Cholesterol Guidelines: The 2 Numbers Most Panels Leave Off

    Your "normal" cholesterol may be missing two numbers. In March 2026, the American College of Cardiology, the American Heart Association, and ten other organizations rewrote the cholesterol guideline your doctor has used since 2018. In this episode, Dr. Sean Hashmi breaks down what changed and the two numbers you actually want to know. The new guideline does two things. It brings back hard, risk-based LDL targets: the higher your cardiovascular risk, the lower your LDL should go, with a named target for each band. And it gives a formal seat to two numbers most standard panels leave off, ApoB and lipoprotein(a). You have probably heard that cholesterol was never the real problem and statins are a scam. That view is half right and half dangerous. It is wrong on the core science. A landmark analysis from the Cholesterol Treatment Trialists, published in The Lancet in 2010, pooled data from more than 170,000 people and found that for each drop in LDL of about 39 milligrams per deciliter, major cardiovascular events fell by roughly a fifth, and the benefit held even when starting LDL was already low. People born with naturally low LDL get less heart disease. LDL does not just ride along with heart disease, it helps cause it. Where the skeptics are half right is that a normal LDL on a standard panel can still hide real risk. That is a reason to measure better, not to dismiss cholesterol. ApoB counts the particles themselves, not just the cholesterol inside them, and it catches risk that LDL alone can miss. Lipoprotein(a) is an inherited, sticky particle that about 1 in 5 people carry and almost no one has tested. You only need to measure it once in your lifetime. Your one move this week: pull up your most recent labs and see whether ApoB and lipoprotein(a) are even listed. For almost everyone, they are not, and that absence is your single ask at your next visit. The information in this content is for educational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have seen in this content. The views expressed here are my own and do not represent the views of my employer or any affiliated institution. Never start, stop, or change the dose of any prescription medication without consulting your physician. Practice kindness and gratitude.

  • July 5 · 12 min

    Should You Take Blood Pressure Pills At Night? 21,000 Patients Answer

    Should you take blood pressure pills at night or in the morning? For years the advice was to dose at night to protect your heart. Then 21,104 patients put that to the test. In this episode, Dr. Sean Hashmi walks through what the trials actually found and what protects your heart and your kidneys. In the TIME trial, published in The Lancet in 2022, evening dosing was no different from morning dosing over five years. About 3.4% of the evening group and 3.7% of the morning group had a heart attack, stroke, or cardiovascular death, a statistical tie. The lesson: take your pills at the time you will actually remember, because the skipped dose is the enemy, not the wrong hour. You may have read that nighttime dosing cut cardiovascular events almost in half. That came from an earlier Spanish study, the Hygia Chronotherapy Trial, and the effect was so large that the journal later issued a formal expression of concern. When one small study claims a giant effect and a large clean trial finds no difference, you go with the bigger clean trial. The number you live at matters more than the clock. In SPRINT, published in the New England Journal of Medicine in 2015, pushing systolic pressure below 120 instead of below 140 cut major cardiovascular events and all-cause death. But that target came from automated readings that run lower than an office or home cuff, the trial excluded people with diabetes or a prior stroke, and the intensively treated group had more low-pressure episodes, fainting, and short-term kidney function drops. Set your target with your own doctor. For your kidneys, ask for two numbers: your eGFR and your urine albumin-creatinine ratio. The second catches protein leaking into the urine, the earliest sign of damage, and most offices skip it. And take any water pill in the morning so it does not wreck your sleep. Treat the trend, not the timing. The information in this content is for educational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have seen in this content. The views expressed here are my own and do not represent the views of my employer or any affiliated institution. Never start, stop, or change the dose of any prescription medication without consulting your physician. Practice kindness and gratitude.

  • July 5 · 15 min

    The Real Problem With Seed Oils Isn't What You Think

    Are seed oils actually bad for you? Seed oils have been blamed for inflammation, weight gain, diabetes, and heart disease. The uncomfortable part is what happens when you test it: when researchers feed people more of the main fat in seed oils and measure inflammation in their blood, it mostly does not go up. In this episode, Dr. Sean Hashmi walks through what dozens of human trials and a brand-new 2026 study actually found. Seed oils like soybean, canola, sunflower, corn, and grapeseed are mostly one fat, an omega-6 called linoleic acid. The fear has a clean logic: more omega-6 becomes arachidonic acid, which drives inflammation. But the body does not run that chain the way the story claims. The conversion from linoleic acid to arachidonic acid is slow and tightly regulated, so eating more barely moves it. On inflammation, two reviews of controlled trials, 15 trials in 2012 and 30 trials in 2017, found that raising linoleic acid did not raise C-reactive protein or other inflammatory markers. On diabetes, a 2017 analysis in the Lancet Diabetes and Endocrinology pooled nearly 40,000 people and found the highest blood levels of linoleic acid linked to about 35% lower risk. On heart disease, a 2019 analysis in Circulation pooled more than 68,000 people and linked higher levels to lower cardiovascular disease, death, and stroke. The panic is not entirely wrong. A June 2026 randomized trial in Nutrients found that doubling linoleic acid intake for twelve weeks lowered the omega-3 EPA and tilted the balance toward omega-6, though arachidonic acid did not rise and nobody got sick. That is an argument about dose and balance, not proof the oil is poison. The real story is that most linoleic acid in the modern diet rides inside ultra-processed food. The oil was never the lever. The food it is hiding in is. This week, count how many meals come from a package or a drive-thru. The information in this content is for educational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have seen in this content. The views expressed here are my own and do not represent the views of my employer or any affiliated institution. Practice kindness and gratitude.

  • July 1 · 10 min

    Fatty Liver Doesn't Need Bitter Tonics—It Needs This

    Fatty liver: the only thing that truly reverses it. A video with over 100,000 views says a bitter tonic will empty the fat out of your liver. It will not. In this episode, Dr. Sean Hashmi covers what genuinely reverses fatty liver and why the detox drinks sold everywhere do nothing. Fatty liver, now called MASLD, affects about one in three adults. Fat builds up inside liver cells, driven mostly by insulin resistance, too many calories, and fructose from sugary drinks. Most simple fatty liver does not progress, but in a minority it triggers inflammation and scarring, a version called MASH. The 2023 renaming to Metabolic Dysfunction-Associated Steatotic Liver Disease is the tell: if the problem is metabolic, you cannot fix it with a cleanse. There are three levers, in order of importance. Lever one is weight loss. In a 2015 biopsy-proven study by Vilar-Gomez and colleagues in Gastroenterology, people who lost 10% of their body weight saw resolution of fatty liver in about 90%, and 45% had regression of early scarring. No supplement comes close. Lever two is the diet pattern: a plant-predominant Mediterranean plate, with a hard cut to sugary drinks, because fructose is handled almost entirely by the liver and pushes it to make new fat. Dropping soda is the single highest-yield food change for most people. Lever three is new. In March 2024 the FDA approved resmetirom (Rezdiffra), and in August 2025 semaglutide became the first GLP-1 cleared for liver disease. In the ESSENCE trial, fatty liver resolution with no worsening of fibrosis occurred in 62.9% of treated patients versus 34.3% on placebo. Both are for moderate to advanced disease only, and both are third line, after diet and weight loss. Milk thistle, bitter tonics, and liver flush drinks have no biopsy-proven benefit. Start with a real diagnosis, imaging like an ultrasound or a fibrosis scan, not a guess from a symptom video. The information in this content is for educational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have seen in this content. The views expressed here are my own and do not represent the views of my employer or any affiliated institution. Never start, stop, or change the dose of any prescription medication without consulting your physician. Practice kindness and gratitude.

  • June 24 · 12 min

    High Creatinine? Here's What Actually Works.

    Your creatinine is high, and here is what actually lowers it. Your social media feed is full of teas and morning drinks promising to flush it down. Most do nothing, and some can actually harm your kidneys. In this episode, Dr. Sean Hashmi explains what really moves creatinine, what moves your true kidney function, and the three therapies with hard evidence that slow kidney disease. Creatinine is not a toxin your kidneys forgot to take out. It is a waste product from muscle, and the level in your blood depends on how much your kidneys clear and how much your body makes. More muscle makes more creatinine. A big steak dinner can nudge it up for a day. Dehydration concentrates it. That is why two people with the same creatinine can have very different kidney function, and why the 2024 KDIGO guidelines recommend adding cystatin C when precision matters. One reading is a snapshot. The trend over months is what counts. Detox teas, beet drinks, and morning flushes have no high-quality trials showing they improve kidney function. When one nudges the number down, it is usually dilution or eating less meat that week, not healing. And beet or green juices can be high in oxalate or potassium, which can be dangerous in advanced kidney disease. The three therapies with trial-grade evidence: an ACE inhibitor or ARB, especially with protein in the urine; an SGLT2 inhibitor, where the DAPA-CKD trial cut the main kidney outcome by 39%; and for type 2 diabetes with kidney disease, the GLP-1 semaglutide, where the FLOW trial cut its main outcome by 24%. All three work by lowering the pressure inside the kidney's tiny filters. On top of that sits the eating pattern KDIGO supports: more plants, less sodium, fewer phosphate additives. You cannot rebuild nephrons that are already gone, but you can take the pressure off the ones you have left. The information in this content is for educational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have seen in this content. The views expressed here are my own and do not represent the views of my employer or any affiliated institution. Never start, stop, or change the dose of any prescription medication without consulting your physician. Practice kindness and gratitude.

  • June 21 · 10 min

    MUSCLE → BRAIN

    Creatine isn't just for muscle. A video with millions of views says it shrinks your fat cells by 30%. The evidence does not show that, and the real story runs past muscle into your brain and into your kidney lab results. In this episode, Dr. Sean Hashmi sorts the creatine claims with data behind them from the ones invented for clicks. The muscle story is not in dispute. A 2017 meta-analysis by Chilibeck and colleagues found that creatine combined with resistance training added about 1.3 kilograms more lean tissue and produced greater strength gains than training alone in older adults. The effective dose is small: 3 to 5 grams a day of creatine monohydrate, the cheapest and most studied form. The brain is what is driving creatine's breakout moment. A 2023 systematic review in Nutrition Reviews found creatine modestly improves memory, with a pooled effect size of 0.3. But in adults aged 66 to 76, that effect size jumped to about 0.88, a large effect, while in young adults it was essentially zero. A 2024 meta-analysis in Frontiers in Nutrition pointed the same way: the benefit is strongest when the brain is under demand, such as sleep deprivation or heavy cognitive load. Then the part only a kidney doctor talks about. Creatine converts to creatinine, the same waste product used to track kidney function, so supplementing can nudge your serum creatinine up on a standard lab. A 2025 systematic review in BMC Nephrology found that whatever small rise shows up, measured GFR does not change. The kidney is fine. It is like stepping on a scale while holding a bag of groceries. If you need a precise number, a cystatin C test sidesteps the creatine effect entirely. The dose that matters: 3 to 5 grams a day of creatine monohydrate, no loading required, paired with resistance training. The information in this content is for educational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have seen in this content. The views expressed here are my own and do not represent the views of my employer or any affiliated institution. Practice kindness and gratitude.

  • June 17 · 10 min

    The Blood Pressure Number That Protects Your Kidneys

    Are your blood pressure pills hurting your kidneys? Your social media feed keeps saying so. For most people, the truth runs the other way: the right medications are the strongest kidney protection we have. In this episode, Dr. Sean Hashmi explains which blood pressure medications protect your kidneys, why one of them raises creatinine on purpose, and the one combination that genuinely causes harm. The fear usually comes from one lab number doing its job. When you start an ACE inhibitor or an ARB, creatinine often bumps up a little in the first week or two. A 2000 review in Archives of Internal Medicine by Bakris and Weir, pooling 12 studies, found that a rise up to about 30% that stabilizes within two months went hand in hand with better long-term kidney preservation, not damage. A 2013 BMJ network meta-analysis by Wu and colleagues found ACE inhibitors were the only antihypertensive class that significantly cut the risk of creatinine doubling in people with diabetes, with an odds ratio of 0.58. The genuine danger is the triple whammy: an ACE inhibitor or ARB, plus a diuretic, plus an NSAID like ibuprofen. In a 2013 BMJ study by Lapi and colleagues drawing on records from nearly half a million people, that combination carried about a one-third higher risk of acute kidney injury, highest in the first month. The number that matters more than the pill is your blood pressure. The KDIGO 2021 guidelines suggest a systolic under 120 for many adults with kidney disease when tolerated, based heavily on the SPRINT trial, measured properly at home. The one thing to do today: measure your blood pressure at home, arm supported, feet flat, after five minutes of sitting, twice a day for a week, and bring the average to your clinician. A stable creatinine rise under 30% with safe potassium means the drug is protecting you. A rise above 30%, one that keeps climbing, or high potassium is a reason to call your doctor, not to quit on your own. The information in this content is for educational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have seen in this content. The views expressed here are my own and do not represent the views of my employer or any affiliated institution. Never start, stop, or change the dose of any prescription medication without consulting your physician. Practice kindness and gratitude.

  • June 14 · 12 min

    The Belly Fat That Destroys Your Kidneys

    You can be thin, eat clean, hit your steps, and still have the kind of belly fat that destroys your kidneys. A 2023 PLOS One cohort followed 11,050 adults for nearly 6 years. The highest visceral fat group had 7.5 times the risk of chronic kidney disease. The most surprising finding: the effect was strongest in normal-weight people. Hazard ratio 2.32 for new kidney disease in adults with a normal BMI but a high waist circumference. In this episode, Dr. Sean Hashmi walks through why subcutaneous fat and visceral fat are biologically different, the three documented mechanisms by which visceral fat damages kidneys (blood pressure activation through the renin-angiotensin-aldosterone system, insulin resistance leading to glomerular hyperfiltration, and inflammatory cytokine secretion), the two measurements you can do at home tonight, and the four-week plan in the exact order that works. The two home measurements: Waist circumference: above 40 inches in men or 35 inches in women indicates elevated cardiometabolic risk. Lower cutoffs apply to many South and East Asian populations. Waist-to-hip ratio: above 0.90 in men or 0.85 in women is associated with higher kidney and cardiometabolic risk. The one extra lab to ask your doctor for: high-sensitivity C-reactive protein (hsCRP). Elevated hsCRP plus a high waist confirms visceral inflammation. The four-week plan, one lever per week: Week 1: Cut sugar-sweetened beverages. Highest-yield single change. Week 2: Add interval training, 2 sessions per week. Week 3: Set a fixed sleep schedule, 7 to 8 hours, same time every night. Week 4: Add resistance training, 2 sessions per week, major muscle groups. For the free evidence-based kidney guide with the exact labs to ask for and how to interpret them: https://guides.selfprinciple.org/kidney Dr. Sean Hashmi, MD, MS, FASN, is a board-certified nephrologist and obesity medicine specialist. This episode is for educational purposes only and is not medical advice. Always consult your healthcare provider for individual care.

  • June 14 · 8 min

    The 10-Second Test That Predicts How Long You'll Live

    The 10-second balance test that predicts how long you'll live. If you can't stand on one leg for 10 seconds, one 2022 study found your risk of dying over the next several years was about 1.84 times higher, an 84% jump. That number comes from a 2022 study in the British Journal of Sports Medicine by Araujo and colleagues, who followed 1,702 adults ages 51 to 75. Even after adjusting for age, sex, body mass, and major illness, the people who could not hold a 10-second one-legged stance had about 80% higher risk of death over a median seven years. In this episode, Dr. Sean Hashmi walks through four tests you can run at home today and exactly how to train each one. Balance, from that British Journal of Sports Medicine study. Grip strength, from the 140,000-person PURE study in The Lancet, where grip predicted death better than systolic blood pressure. The sit-and-rise test, from a 2014 study in the European Journal of Preventive Cardiology, where each one-point gain on a 10-point scale was tied to 21% better survival. And walking pace, from a 2011 JAMA pooled analysis of more than 34,000 older adults, where every 0.1 meters per second faster meant about 12% lower risk of death. These are risk markers, not diagnoses, and every one of them is modifiable. Muscle and balance respond to training at any age. Run all four this week, pick your weakest, and train it daily. For the free guide with the home tests and the weekly training plan: https://guides.selfprinciple.org/kidney Dr. Sean Hashmi, MD, MS, FASN, is a board-certified nephrologist and obesity medicine specialist. The information in this content is for educational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have seen in this content. The views expressed here are my own and do not represent the views of my employer or any affiliated institution. Practice kindness and gratitude.

  • June 13 · 12 min

    BMI Lies

    You can be thin, eat clean, hit your steps, and still have the kind of belly fat that destroys your kidneys. A 2023 PLOS One cohort followed 11,050 adults for nearly 6 years. The highest visceral fat group had 7.5 times the risk of chronic kidney disease. The most surprising finding: the effect was strongest in normal-weight people. Hazard ratio 2.32 for new kidney disease in adults with a normal BMI but a high waist. In this episode, Dr. Sean Hashmi walks through why subcutaneous fat and visceral fat are biologically different, the three documented mechanisms by which visceral fat damages kidneys (blood pressure activation through the renin-angiotensin-aldosterone system, insulin resistance leading to glomerular hyperfiltration, and inflammatory cytokine secretion), the two measurements you can do at home tonight, and the four-week plan in the exact order that works. The two home measurements: Waist circumference: above 40 inches in men or 35 inches in women indicates elevated cardiometabolic risk. Lower cutoffs apply to many South and East Asian populations. Waist-to-hip ratio: above 0.90 in men or 0.85 in women is associated with higher kidney and cardiometabolic risk. The one extra lab to ask your doctor for: high-sensitivity C-reactive protein (hsCRP). Elevated hsCRP plus a high waist confirms visceral inflammation. The four-week plan, one lever per week: Week 1: Cut sugar-sweetened beverages. Highest-yield single change. Week 2: Add interval training, 2 sessions per week. Week 3: Set a fixed sleep schedule, 7 to 8 hours, same time every night. Week 4: Add resistance training, 2 sessions per week, major muscle groups. For the free evidence-based kidney guide with the exact labs to ask for and how to interpret them: https://guides.selfprinciple.org/kidney Dr. Sean Hashmi, MD, MS, FASN, is a board-certified nephrologist and obesity medicine specialist. This episode is for educational purposes only and is not medical advice. Always consult your healthcare provider for individual care.

  • June 10 · 8 min

    Creatinine vs Cystatin C: Why Your Kidney Lab May Be Lying

    Your creatinine test may be lying to you. The 2021 National Kidney Foundation guidance recommends cystatin C as a second kidney test. Four years later, most labs still default to creatinine alone. By the time creatinine clearly rises on a lab report, you may have already lost a third or more of your kidney function. In this episode, Dr. Sean Hashmi walks through what cystatin C actually measures, the landmark New England Journal of Medicine meta-analysis of more than 90,000 participants showing cystatin C predicts outcomes better than creatinine alone, and the four patient groups the 2021 task force singled out by name. The four groups who need cystatin C: 1. Low muscle mass (older adults with frailty, advanced liver disease, long-term immobility, significant muscle loss) 2. High muscle mass (bodybuilders, strength athletes, anyone with substantial lean tissue) 3. Borderline kidney function (eGFR between 45 and 59 without other markers of kidney damage) 4. High-stakes drug dosing (chemotherapy with kidney-cleared agents, contrast imaging, older adults on multiple medications) The exact sentence to bring to your next appointment: "Given my body type and my risk factors, can we confirm my kidney function with a cystatin C-based eGFR?" References include the 2021 Inker et al. NEJM paper, the 2013 Shlipak et al. NEJM meta-analysis, and the KDIGO 2024 clinical practice guideline. For the free evidence-based kidney guide with the exact labs to ask for and how to interpret them: https://guides.selfprinciple.org/kidney Dr. Sean Hashmi, MD, MS, FASN, is a board-certified nephrologist and obesity medicine specialist. This episode is for educational purposes only and is not medical advice. Always consult your healthcare provider for individual care.

  • June 7 · 13 min

    70 lbs Lost in a Trial: What Retatrutide Means for Your Kidneys

    A new triple-agonist shot, retatrutide, just posted the biggest weight loss we have ever seen from a single injection in a phase 3 obesity trial: 28.3% of body weight at 80 weeks, roughly 70 pounds, and almost double what Ozempic delivered in its pivotal trial. I'm a nephrologist and obesity medicine specialist, and in this episode I break down the TRIUMPH-1 data, how the drug works (GLP-1, GIP, and glucagon all at once), and the dose-by-dose results. Then I get into the part most coverage skips: the dehydration risk that can drive acute kidney injury, the honest answer on whether these drugs protect your kidneys, the realistic timeline to an FDA-approved version, and why you should not buy the compounded "retatrutide" sold online. I close with three specific things to do this week if you are on a GLP-1 or thinking about one. Educational only, not medical advice. Talk to your prescriber before making any medication decisions. JOIN THE NEWSLETTER for weekly evidence-based kidney, metabolic, and longevity research: https://selfprinciple.org/newsletterLearn more about Dr. Sean Hashmi and SELFPrinciple.org, a 501(c)(3) nonprofit: https://selfprinciple.org CONNECTYouTube: https://youtube.com/@SeanHashmiMDInstagram: https://instagram.com/seanhashmimd DISCLAIMERThe information in this content is for educational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have seen in this content. The views expressed here are my own and do not represent the views of my employer or any affiliated institution.

  • June 6 · 13 min

    5 'HEALTHY' FOODS WRONG FOR YOUR KIDNEYS

    If you have kidney disease, the smoothie your cardiologist told you to drink could be the single biggest reason your numbers are getting worse. The same foods you ate for 30 years without a problem can become a problem the day your kidney function drops. Most of the wellness advice on the internet was not written for you. In this episode, Dr. Sean Hashmi walks through 5 foods sold as healthy that actively harm two specific groups of patients: anyone with chronic kidney disease at any stage, and anyone with a history of calcium oxalate kidney stones. For viewers with normal kidney function and no stone history, most of these foods are fine. The risk profile changes once the kidney does. The 5 foods covered: Protein bars and powders with phosphate additives. Anything starting with the word "phos" on the ingredient list (disodium phosphate, phosphoric acid, sodium hexametaphosphate, sodium tripolyphosphate) is inorganic phosphorus, absorbed at 90 percent or higher compared to 20 to 40 percent for plant phosphorus and 40 to 60 percent for animal phosphorus. For CKD patients, that buried additive load drives parathyroid hormone and FGF-23 up, pulls calcium from bones into blood vessels, and accelerates vascular and bone disease. Coconut water. 400 to 600 mg of potassium per cup, roughly the same as a banana, sometimes more. For CKD patients on ACE inhibitors, ARBs, or spironolactone, that load can push blood potassium into a dangerous range. Plain water is the default. Excessive protein shakes. KDIGO 2020 guidelines target 0.55 to 0.6 g of protein per kg of ideal body weight for non-diabetic CKD stage 3+ and beyond. Two scoops of whey can exceed the entire daily ceiling before any food is eaten. Protein needs go up on dialysis, not down. The target gets built with a renal dietitian, not a fitness magazine. Star fruit. Contains a neurotoxin called caramboxin that is normally cleared by the kidneys. When kidney function is reduced, it accumulates and crosses the blood-brain barrier. A 2003 series in Nephrology Dialysis Transplantation followed 32 uremic patients who had ingested star fruit: 30 had intractable hiccups, 22 had vomiting, 21 had disturbed consciousness, 7 had seizures. Patients treated with hemodialysis recovered. Patients on peritoneal dialysis did not survive. The spinach-almond-beet smoothie. Half a cup of cooked spinach has 755 mg of oxalate. One ounce of almonds has 122 mg. The daily oxalate ceiling for stone formers is 50 to 100 mg. A single smoothie can hit 5 to 10 times that ceiling. The fix is not "no greens." Kale, bok choy, collards, and arugula are all low-oxalate. Pumpkin seeds and sunflower seeds substitute for almonds. And pairing any moderate-oxalate food with a calcium source at the same meal binds the oxalate in the gut so it leaves in the stool instead of being absorbed. For plant-based readers, calcium sources include calcium-set tofu (200 to 400 mg per half cup), fortified plant milks (300 to 400 mg per cup), fortified plant yogurts, cooked collards, kale, bok choy, tahini, and white beans. There is no universally good or bad food. There are foods that are right or wrong for your specific kidney function, stone history, and medications. The kidney decides. JOIN THE NEWSLETTER for weekly evidence-based kidney, metabolic, and longevity research: https://selfprinciple.org/newsletter Learn more about Dr. Sean Hashmi and SELFPrinciple.org, a 501(c)(3) nonprofit: https://selfprinciple.org CONNECT YouTube: https://youtube.com/@SeanHashmiMD DISCLAIMER The information in this content is for educational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have. Never disregard professional medical advice or delay seeking it because of something you have seen in this content. The views expressed here are my own and do not represent the views of my employer or any affiliated institution.

  • June 4 · 16 min

    This Kidney Number Predicts How Long You Live

    People who live to 100 share one quiet pattern that nobody talks about. It is not their cholesterol. It is not their gym routine. It shows up as a single number on a routine blood test, and 9 out of 10 people with abnormal kidney function have no idea theirs is wrong. In this episode, Dr. Sean Hashmi walks through the centenarian kidney pattern researchers have actually found across multiple cohorts. The Leiden Longevity Study found that middle-aged offspring of long-lived families had measurably higher eGFR than environmentally matched controls. A 2016 study in Scientific Reports following 60 Chinese centenarian families showed that BUN and creatinine rose with age in the general population but stayed on a plateau in centenarians. The Tokyo Centenarian Cohort followed nearly 2,000 oldest-old participants and showed that even past age 100, kidney function independently predicted survival. Dr. Sean Hashmi explains why kidneys are master chemical regulators rather than simple filters. They handle six different jobs 24 hours a day: blood pressure regulation, sodium and potassium and calcium balance, blood acidity control, red blood cell hormone production, vitamin D activation, and waste clearance. When those control systems drift off target, the heart works harder, bones get fragile, energy drops, and even cognition slows. Someone with chronic kidney disease is far more likely to die of a heart attack or stroke than to ever reach dialysis. The four daily levers (the SELF framework: Sleep, Exercise, Love, Food) come with hard data. Sleeping under 4 hours raises new-onset kidney disease risk by 45 percent. Physical activity in CKD patients reduces mortality by 56 percent (a hazard ratio of 0.44 that most medications cannot match). The Holt-Lunstad meta-analysis of over 300,000 participants found that social isolation raises mortality by 29 percent, exceeding the risk from physical inactivity and obesity. The Singapore Chinese Health Study following 60,000 adults found that replacing one daily serving of red meat with fish, chicken, eggs, or legumes was associated with up to a 62 percent relative reduction in end-stage kidney disease risk. Dr. Sean Hashmi closes with the two labs that cover most of the picture (eGFR and UACR), the difference between age-appropriate and below age-appropriate kidney function, and the exact two-minute conversation to bring to your next appointment. JOIN THE NEWSLETTER for weekly evidence-based kidney, metabolic, and longevity research: https://selfprinciple.org/newsletter Learn more about Dr. Sean Hashmi and SELFPrinciple.org, a 501(c)(3) nonprofit: https://selfprinciple.org CONNECT YouTube: https://youtube.com/@SeanHashmiMD Instagram: https://instagram.com/seanhashmimd DISCLAIMER The information in this content is for educational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have seen in this content. The views expressed here are my own and do not represent the views of my employer or any affiliated institution.

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