{ "schemaVersion": "deck-intelligence.v1", "id": "019dd923-622c-750b-8b97-5cb48bf2a635", "slug": "b8afd3741673", "title": "Chinook Therapeutics Inc (KDNY)", "subtitle": "Carson C. Block · 2023-05", "author": "Carson C. Block", "date": "2023-05-16 00:00:00", "pageCount": 36, "kind": "research-note", "orientation": "portrait", "aspectRatio": 0.77272725, "targetCompany": "Chinook Therapeutics Inc", "targetTicker": "KDNY", "document": { "id": "019dd923-622c-750b-8b97-5cb48bf2a635", "slug": "b8afd3741673", "title": "Chinook Therapeutics Inc (KDNY)", "rawTitle": "MW KDNY 20230516", "authorId": "51_Muddy_Waters", "authorName": "Carson C. Block", "authorDisplay": "Carson C. 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Word-processor style with extensive footnotes (>150 citations to clinical literature and FDA/clinicaltrials.gov data). Combines clinical-trial forensics (re-reading SONAR, RADAR, AFFINITY data to find concealed mortality, anemia, heart failure, and graph-distortion evidence) with a regulatory-blocking argument (sparsentan's orphan-drug exclusivity). Villain posture is directed primarily at the underlying drug development and AbbVie's conduct; Chinook is implicated via its reporting and conference presentations. No stake disclosed beyond the standard MW short-interest disclaimer. No explicit price target. Most visuals are reproduced third-party clinical charts, not original visx-grade artwork — hence low visual_craft_interest.", "kpisCited": [ { "detail": "0.06 — fails statistical significance; numerical difference only 14 patients (atrasentan 5.1% vs placebo 6.1%)", "metric": "End-stage renal disease p-value (SONAR)" }, { "detail": "58 deaths on atrasentan vs 52 on placebo", "metric": "All-cause mortality among SONAR responders" }, { "detail": "18.5% atrasentan vs 10.3% placebo (p<0.0001)", "metric": "Anemia incidence (SONAR)" }, { "detail": "36.6% atrasentan vs 32.3% placebo (p=0.022)", "metric": "Hypervolemia / fluid retention (SONAR)" }, { "detail": "136 atrasentan vs 93 placebo", "metric": "Cardiac failure events (FDA SONAR data, Muddy Waters recount)" }, { "detail": "All differences between atrasentan and placebo disappear within 30 days of cessation (RADAR) and ~6 weeks (SONAR) — consistent with hemodynamic, not structural, effect", "metric": "UACR durability post-treatment" }, { "detail": "3.5% atrasentan vs 2.6% placebo", "metric": "Hospital admission for heart failure (SONAR)" }, { "detail": "February 17, 2030 — 7 years of exclusivity for IgAN proteinuria reduction", "metric": "Sparsentan (Filspari) orphan exclusivity end date" }, { "detail": "Only 20 patients, no placebo arm, only 11 reached 24-week point at ERA 2022 presentation", "metric": "AFFINITY trial size" }, { "detail": "Only 2,648 of 3,666 randomized patients completed the study before AbbVie abruptly halted the trial", "metric": "SONAR double-blind completion" } ], "closingAsk": "Recognize that atrasentan will not receive FDA approval — due to its own lack of efficacy and safety, and sparsentan's blocking orphan-drug exclusivity — and price KDNY accordingly.", "extraction": { "at": "2026-04-22 19:57:01+00", "model": "unknown-legacy", "runId": null, "seconds": 144.40692, "promptVersion": null }, "scqaReward": "If atrasentan fails approval or is blocked by sparsentan's exclusivity, Chinook's single-asset pipeline collapses, making KDNY equity substantially overvalued at current levels and vindicating Muddy Waters' short position.", "thesisTypes": [ "fraud_exposure", "other" ], "top3Reasons": [ "SONAR trial shows atrasentan fails to slow ESRD (p=0.06); biomarker gains vanish within weeks of cessation", "Atrasentan raises mortality, heart failure (136 vs 93) and anemia (18.5% vs 10.3%) versus placebo", "Travere's sparsentan holds exclusive FDA orphan drug approval for IgAN through February 2030" ], "scqaSituation": "Chinook Therapeutics is a clinical-stage biotech whose valuation rests almost entirely on atrasentan, an endothelin-receptor antagonist in-licensed from AbbVie, now in the Phase 3 ALIGN trial for IgA nephropathy.", "thesisSummary": "Muddy Waters is short Chinook Therapeutics (NASDAQ:KDNY) on the thesis that its lead candidate atrasentan will not win FDA approval. SONAR Phase 3 data, originally run by AbbVie, shows atrasentan produces no statistically-significant effect on end-stage renal disease (p=0.06), while UACR, systolic blood pressure and other surrogate biomarkers snap back to placebo within weeks of drug cessation — consistent with a hemodynamic, not structural, renal effect. Patients on atrasentan died at numerically higher rates than placebo and suffered elevated heart failure (136 vs 93 events) and anemia (18.5% vs 10.3%). Both AbbVie and Chinook appear to have manipulated graphs, composite endpoints, and stroke numbers to obscure these results. Critically, rival Travere Therapeutics' sparsentan already holds exclusive FDA orphan-drug approval for IgA nephropathy through February 2030, leaving atrasentan without a viable path to market.", "primaryDemands": [ "Reject atrasentan's path to FDA approval: drug is inefficacious for CKD", "Acknowledge elevated mortality, heart failure, and anemia risks obscured by AbbVie/Chinook", "Recognize sparsentan's exclusive orphan-drug approval blocks atrasentan from IgAN market through 2030" ], "scqaResolution": "Investors should recognize that the FDA is unlikely to approve atrasentan, and that Travere's sparsentan — already holding exclusive orphan-drug approval for IgAN through 2030 — structurally blocks Chinook's only commercial path even if efficacy and safety were acceptable.", "thesisOneLiner": "Muddy Waters is short Chinook (KDNY): lead drug atrasentan is inefficacious, harmful, and blocked by sparsentan's IgAN orphan-drug exclusivity — FDA approval is highly unlikely.", "precedentsCited": [ "Avosentan (discontinued for heart failure risk)", "Sparsentan PROTECT/DUET studies (Travere)", "AbbVie SONAR trial closure (2018)" ], "scqaComplication": "AbbVie's earlier SONAR Phase 3 trial showed atrasentan is inefficacious for CKD — no statistically-significant ESRD benefit — and carries elevated mortality, heart failure, and anemia risks; both companies appear to have manipulated graphs and composite endpoints to conceal these findings.", "narrativeInterest": 4, "notableSlidePages": [ 2, 5, 8, 20, 21, 30 ], "peerCompaniesCited": [ "AbbVie", "Travere Therapeutics (TVTX)" ], "valuationFrameworks": [ "not_shown" ], "visualCraftInterest": 2 }, "pitchdeck": { "metadata": null, "profile": null }, "slides": [ { "page": 1, "type": "setup", "function": "other", "imagePath": "https://imgproxy.kitesheet.com/JfZVmXZJxxCvjPgoeuK7TdMm0Mii9nXtMNxPPt4z7dk/rs:fit:1200:1200:0/q:82/f:webp/czM6Ly9raXRlc2hlZXQvY29ycHVzL3NsaWRlcy9iOGFmZDM3NDE2NzMvcDAwMS5qcGc", "rawType": "disclaimer", "block": null, "metadata": { "slideType": "disclaimer", "slideTypeCanon": { "name": "Disclaimer", "slug": "disclaimer", "status": "active", "canonId": "019de52d-0801-727b-b98a-5ed095aeee78", "version": 1, "description": null }, "function": "other", "functionCanon": { "name": "Other (fallback)", "slug": "other", "status": "active", "canonId": "019de52d-15e1-75bc-99dc-07732380e2ce", "version": 1, "description": null }, "density": "sparse", "densityScore": 10, "componentCount": 3, "textChars": 337, "nDataPoints": 0, "notes": null, "elementsJson": [ "paragraph" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:47:25.461+00", "seconds": 1.51, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b97-5cb48bf2a635/1", "deck": "/decks/019dd923-622c-750b-8b97-5cb48bf2a635", "deckAnchor": "/decks/019dd923-622c-750b-8b97-5cb48bf2a635#slide-1", "deckJson": "/decks/019dd923-622c-750b-8b97-5cb48bf2a635.json" }, "components": [ { "bbox": { "h": 0.05, "w": 0.9, "x": 0.05, "y": 0.16 }, "kind": "disclaimer", "text": "These Terms of Use govern current reports published by Muddy Waters Research and supersede any prior Terms of Use for older reports of Muddy Waters Research, which you may download from the Muddy Waters Research's website.", "attrs": null, "canon": { "kind": { "name": "Disclaimer", "slug": "disclaimer", "status": "active", "canonId": "91173477-d91f-4024-bbaf-d4f93e3f82dc", "version": 1, "description": "Legal/cautionary text that occupies most of the body of its slide." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:47:25.461+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9eaf88de-d088-4cf4-a909-deb1b6e9190c", "parentComponentId": null }, { "bbox": { "h": 0.7, "w": 0.9, "x": 0.05, "y": 0.22 }, "kind": "paragraph", "text": "The reports on this website have been prepared by Muddy Waters Capital LLC... 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In the largest available study, atrasentan had no statistically-significant effect on advancement to end-stage renal disease.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:47:29.778+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "aac9c947-6ee2-4e7b-aece-8910a754ee43", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.78, "x": 0.11, "y": 0.65 }, "kind": "source-note", "text": "1-13 Footnotes detailing sources for the claims made in the text.", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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BNP was normal for all patients entering treatment, but quickly became elevated in atrasentan patients.17 Atrasentan is also associated with a statistically-significantly elevated rate of anemia.18 Anemia is a serious risk factor for disease progression in IgAN, an important patient population for Chinook.19,20,21 Reported mortality on atrasentan was numerically higher than reported mortality on placebo in the double-blind period of the SONAR trial.22 This mortality increase in the atrasentan group is also present in the enrichment period.23 Avosentan, a drug with a similar mechanism to atrasentan, had a clinical trial abruptly stopped because of an increased risk of heart failure.24 Studies done on atrasentan and similar drugs show that they raise heart failure risk.25 A sum of cardiac events from the FDA reported adverse effects gives 136 heart failure events on atrasentan and 93 on placebo.26 A very small study using an arguably superior biomarker, inulin, to measure GFR, found that atrasentan seemingly made GFR worse.27 As discussed infra, sparsentan, which has exclusive orphan drug approval for reducing proteinuria in IgAN, is likely safer, showing a less alarming effect on heart failure and anemia.28", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:47:28.252+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "687587c0-c2ff-4770-8e88-6b55e4cddd18", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.78, "x": 0.11, "y": 0.45 }, "kind": "paragraph", "text": "Both AbbVie and Chinook appear to have manipulated facts and figures to conceal dangers associated with atrasentan. AbbVie appears to have manipulated graphs to modify the apparent effect of atrasentan by visually distorting enrichment and post-treatment periods, thereby modifying the slope of the drug effect.29 AbbVie used composite endpoints in its data that conflated positive and negative outcomes from atrasentan, which runs contrary to best clinical practice.30 The SONAR authors then label these endpoints in a misleading way and include questionable endpoints in composites, including non-fatal stroke figures that entirely reverse the meaning of critical endpoints.31 Chinook appears to have misled investors about the number of patients in which atrasentan was trialed, likely to give a false impression of drug safety.32 Chinook has also misrepresented atrasentan's safety profile by claiming no SAEs associated with", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:47:28.252+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "eb815e78-f509-4556-9021-b1634dc91b29", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.78, "x": 0.11, "y": 0.72 }, "kind": "source-note", "text": "14-32: Citations and references to clinical trial documents and external studies.", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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The study data shows that there was no statistically significant improvement in advancement to", "attrs": null, "canon": { "kind": { "name": "Disclaimer", "slug": "disclaimer", "status": "active", "canonId": "91173477-d91f-4024-bbaf-d4f93e3f82dc", "version": 1, "description": "Legal/cautionary text that occupies most of the body of its slide." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:47:36.091+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5a63f683-7720-481a-87f3-fb3745274ae3", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.8, "x": 0.1, "y": 0.35 }, "kind": "paragraph", "text": "SONAR made use of an enrichment-based study design, in which patients were stratified into \"responder\" and \"non-responder\" drug populations following a six-week \"enrichment\" period on atrasentan.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:47:36.091+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1afce0fe-bd4c-400b-970d-7ee1319b93e5", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.8, "x": 0.1, "y": 0.78 }, "kind": "paragraph", "text": "Only 3,666 patients—the responder population and about 1,000 non-responders—entered the double-blind treatment period, and only 2,648 patients completed the study. As we note supra, the trial was then abruptly halted.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:47:36.091+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1eea88c2-48f4-4181-8452-b223ebaa1f57", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.8, "x": 0.1, "y": 0.55 }, "kind": "paragraph", "text": "Patients were required to enter treatment with an angiotensin receptor blocker or an angiotensin-converting enzyme inhibitor and a diuretic, both of which measures were intended to make heart failure less likely and renal repair more likely.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:47:36.091+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "2c9f53ac-2fa4-4a48-91f5-68f5c818a4a4", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.8, "x": 0.1, "y": 0.43 }, "kind": "paragraph", "text": "Patients were excluded from consideration if they had a previous hospital admission for heart failure, a history of pulmonary hypertension, any known non-diabetic kidney disease, a history of severe peripheral or facial oedema, or other-than-normal levels of brain natriuretic peptide (among other criteria).", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:47:36.091+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "62d2b95f-43e5-4757-8a35-03fdf562f93e", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.8, "x": 0.1, "y": 0.63 }, "kind": "paragraph", "text": "Then, all eligible patients were given a six-week round of atrasentan, after which they were stratified into responder and non-responder populations. Responders were those patients who showed a 30% reduction in urine albumin-to-creatinine ratio, who did not have substantial fluid retention, and did not show an increase in serum creatinine during the enrichment period—again, all measures intended to ensure that the population that continued in the trial would be as likely as possible to benefit from the treatment, and as unlikely as possible to suffer cardiovascular complications.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:47:36.091+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "79f1dc2c-de5c-4ed0-9568-7e55bda5e744", "parentComponentId": null }, { "bbox": { "h": 0.1, "w": 0.8, "x": 0.1, "y": 0.25 }, "kind": "paragraph", "text": "Despite being designed to reduce the odds of serious adverse effects, the SONAR trial was abruptly halted. We see it as telling that despite the design, the data indicates increased risk of serious cardiovascular events from atrasentan.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:47:36.091+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a32384d0-786f-4dc1-a990-331cb3876c2a", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "Atrasentan in patients with diabetes and chronic kidney disease — Vincenzo Sepe, Carmelo Libetta (Lancet January 25, 2020).", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:33:13+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-25b7-709e-b8cf-a0ddb8d79bad", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.8, "x": 0.1, "y": 0.93 }, "kind": "source-note", "text": "Footnotes 33-43", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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This is not the result we should expect if atrasentan is slowing renal decline.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:47:28.536+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "fe36f71a-02dd-4dbc-91c1-051086a107d7", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "SONAR was designed on the basis of the observation that risk of progressive kidney disease is correlated to albuminuria... There are caveats to the usefulness of this design. Most importantly, the biologic response is most likely to predict a clinical treatment response if the biologic response lies on the causal pathway. 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If albuminuria is, in this case, to be taken as an indicator of renal health, we should expect the albuminuria to (1) decline slowly after drug initiation, as the kidney improves, and (2) remain lower than at baseline after drug cessation. 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These results are far more consistent with a frank hemodynamic effect of atrasentan: endothelin blockers increase kidney outflow more than they increase kidney inflow, without necessarily improving kidney filtration. The result is an elevated risk of heart failure, due likely to anemia, fluid retention, and resulting cardiac stress, with no real efficacy for kidney repair.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:47:28.56+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d6a9627c-10c5-4bae-a652-ae70100db439", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.78, "x": 0.11, "y": 0.23 }, "kind": "paragraph", "text": "At the end of the 30-day follow-up period without study medication, the median UACRs were 737±912 mg/g, 1051±1206 mg/g, and 727±821 mg/g for the placebo, 0.75 mg/d, and 1.25 mg/d groups, respectively. The geometric mean changes from baseline to recovery were -5.3%, +4.3%, and -7.8% for the placebo, 0.75 mg/d, and 1.25 mg/d groups, respectively, thus showing that UACR values returned to baseline values.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:47:28.56+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e0f60d3f-ede1-4d75-883f-6c8dc286ffb2", "parentComponentId": null }, { "bbox": { "h": 0.09, "w": 0.78, "x": 0.11, "y": 0.44 }, "kind": "paragraph", "text": "The UACR data from SONAR manifests the same effect. It is important to note that in SONAR, the median treatment period was 2.2 years, so atrasentan had considerably more time to exert its rehabilitative influence on patients’ kidneys than it did in RADAR’s 84-week treatment period. Nevertheless, all UACR differences between groups disappear within six weeks of treatment cessation, again suggesting an effect on the biomarker (serum creatinine) that is not accompanied by any real slowing of kidney decline.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:47:28.56+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f729fb4c-9481-4175-821e-5b57a6fcab77", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.6, "x": 0.11, "y": 0.88 }, "kind": "source-note", "text": "50 https://journals.lww.com/jasn/Fulltext/2014/05000/The_Endothelin_Antagonist_Atrasentan_Lowers.27.aspx\n51 https://repo.dma.dp.ua/6035/1/SONAR.pdf, see Appendix.", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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So Chinook's claims—that (1) atrasentan has been studied in >5,100 patients and (2) that it showed an acceptable safety profile—are both distortions.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:47:31.942+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e41303d7-ec39-4ba8-91fa-ec1a0dfa0301", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "[n]o SAEs related to the study drug [atrasentan] to date. — Chinook Therapeutics", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:33:15+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-25b7-709e-b8d1-f71805c95a71", "parentComponentId": null }, { "bbox": { "h": 0.125, "w": 0.764, "x": 0.118, "y": 0.807 }, "kind": "source-note", "text": "146 See Appendix. 147 Atrasentan for the Treatment of IgA Nephropathy - Interim Results - AFFINITY Study, May 2022, p.8... 148 https://clinicaltrials.gov/ct2/show/NCT04573478... 149 http://repo.dma.dp.ua/6035/1/SONAR.pdf", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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