The Daily Med

THE DAILY EDITIONSATURDAY, 7 NOVEMBER 2026

Case of the Day · Clinical Reasoning

Diabetes with CKD and heart failure: prioritize cardiorenal benefit.

A 59-year-old with type 2 diabetes has eGFR 48, urine ACR 420 mg/g and established heart failure despite metformin.

Which class has strong evidence for reducing kidney progression and heart-failure events in eligible patients?

Drug Corner

Pharmacology in practice

SHORT-ACTING BETA2 AGONIST

Salbutamol (inhalation)

Indication: Rapid relief of reversible bronchospasm.
Mechanism: Beta2-receptor agonism relaxes bronchial smooth muscle.
Interactions: Non-selective beta-blockers can oppose bronchodilation; other sympathomimetics can increase adverse effects.
Important adverse effect: Tremor and tachycardia; repeated/high doses can lower potassium.
Dosing: Adults commonly use 100–200 micrograms by inhaler as needed; escalating use requires assessment of disease control.
Sources: SmPC: https://www.medicines.org.uk/emc/product/6339/smpc

Paper of the Day

Research, without the noise

Critical care · Acute kidney injury

Intermittent or Continuous Renal-Replacement Therapy in Acute Kidney Injury

In this multicentre noninferiority trial, 535 critically ill adults with AKI requiring renal replacement were analyzed. Day-90 major adverse kidney events occurred in 78.1% with intermittent versus 71.6% with continuous therapy (adjusted difference 6.28 percentage points, 95% CI −1.22 to 13.79). The trial stopped early after a mortality signal; estimated mortality HR 1.30 (95% CI 1.04–1.63). Early stopping warrants caution.

Authors: S. Gaudry and Others

Published: 14 October 2026 · New England Journal of Medicine

DOI: 10.1056/NEJMoa2608397

Read the original paper →

Journal Watch

What's new in medicine?

Cardiology · Prevention

Atorvastatin, Cardiovascular Events, and Disability-free Survival in Older Adults

In 9,971 community-dwelling adults aged ≥70 without CVD, diabetes or dementia, atorvastatin reduced major cardiovascular events (HR 0.70, 95% CI 0.61–0.82) but not disability-free survival (HR 0.94, 95% CI 0.84–1.05).

Cardiology · AF and stable CAD

Edoxaban antithrombotic therapy in diabetic patients with atrial fibrillation and stable coronary artery disease: the EPIC-CAD trial

In 421 participants with diabetes, edoxaban alone versus edoxaban plus antiplatelet therapy lowered the 12-month net adverse outcome (6.3% vs 13.7%; HR 0.44, 95% CI 0.23–0.83); interaction testing did not show effect modification.

Heart failure · Early-phase therapy

Oral Relaxin Receptor Agonist AZD5462 in Participants With Chronic Heart Failure: Primary Results From the LUMINARA Trial

In LUMINARA, 375 participants across two cohorts were randomized; AZD5462 was well tolerated, with hemodynamic signals, but the primary placebo-adjusted LV end-systolic volume result in cohort A did not reach conventional significance (−5.4 mL/m²; 95% CI −10.9 to 0.1; P=0.054).

Today's Topic

Build your clinical knowledge

Respiratory medicine · Pleural disease

Noninfectious pleural effusion: diagnose the cause

Diagnosis / Testing

For an unexplained unilateral effusion, combine history and imaging with ultrasound-guided diagnostic aspiration. Send fluid for biochemical classification and tests directed by suspected infection or malignancy.

Treatment / Care Decisions

Use Light’s criteria to identify an exudate. Cytology is an initial test when malignancy is suspected; if fluid studies and imaging are nondiagnostic, consider image-guided biopsy or thoracoscopy. Treat the underlying cause and relieve symptoms.

Risk Assessment / Prognosis / Epidemiology

Heart failure, malignancy, pulmonary embolism, autoimmune disease and medications are among causes. Negative cytology or CT does not exclude malignancy; follow persistent unexplained effusions.

Pathophysiology / Basic Science

Effusions reflect altered hydrostatic/oncotic forces, lymphatic drainage or pleural inflammation. Exudates typically reflect local disease; transudates more often systemic imbalance.

Further reading: British Thoracic Society Guideline for Pleural Disease (2023).