Freely Filtered, a NephJC Podcast (NephJC Team)
Explore every episode of Freely Filtered, a NephJC Podcast
| Pub. Date | Title | Duration | |
|---|---|---|---|
| 25 Mar 2019 | NephJC Drive Time 001: An army of NSAIDs | ||
This is the audio commentary of the NephJC Chats on March 19 and 20, 2019. The article (open access) is available here. The NephJC summary can be read here, with links to the visual abstract. Links from the show: In the background section, we mentioned the data from the Physicians Health Study (two reports) and the Nurses Health Study. There was also discussion about this high quality study from Switzerland in patients with rheumatoid arthritis. The NephMadness pain region scouting report, from Sam Gelfand The PRECISION trial published in NEJM, and the NephJC summary by Scherly Leon High risk of GI bleeding in CKD patients A study from Taiwan reporting high risk of stroke with NSAIDs even in anuric patients Host: Joel Topf Co-hosts: Samira Farouk, Swapnil Hiremath, Jennie Lin and Matt Sparks | |||
| 23 Apr 2019 | Freely Filtered 002 ASCEND | 00:45:34 | |
This week we discussed the ASCEND trial published in Annals of Internal Medicine, on the comparative effectiveness of cognitive behavioural therapy and Sertraline in patients on dialysis with depression. The article is available here. The NephJC summary can be read here, with links to the visual abstract. Links from the show: In the background section, we mentioned the data from a recent JASN study on cardiovascular safety of different antidepressants. The contrast with the CAST trial came up as well. PDF links to the BDI, QIDS-SR and QIDS-C scores. KIDNEYCon 2020 will be in April. Follow @KIDNEYCon to stay updated, as well for the links to the recorded sessions from #KIDNEYCon 2019. Host: Joel Topf Discussants: Swapnil Hiremath, Jennie Lin and Matt Sparks. We missed Samira Farouk who was travelling. | |||
| 30 Apr 2019 | Freely Filtered 003 CREDENCE | 01:06:25 | |
This week we discussed the CREDENCE trial published in the NEJM, on the effect of Canaglifozin on diabetic nephropathy. There was lots to discuss so it may be a long podcast. The article is available here. The NephJC summary can be read here, with links to the visual abstract, and the wrapup.
Swapnil’s first post at AJKDblog on SGLT2i in 2014! SGLT-2 Inhibitors: Can They Prevent Diabetic Nephropathy? Lonnie Pyne’s brilliant tweetorial on proteinuria as a proposed end-point in CKD trials. Combined RAAS blockade (don’t do it) Combining ACEI and direct renin inhibitors We repeatedly compare CREDENCE to IDNT by Ed Lewis and RENAAL by Barry Brenner You will need to be familiar with EMPA-REG and CANVAS (links to summaries on NephJC) Why run-in periods are bad for clinical trials: Run-in Periods in Randomized Trials Implications for the Application of Results in Clinical Practice Hispanics in the study: https://twitter.com/VladoPerkovic/status/1121078118029103105 Lot of discussion on mechanisms: • The original description of phlorizin by Josef von Mering in 1800 • Podocyte effects in JCI • Effect on Hyperfiltration by SGlT2i in humans • Emerging role of proximal tubule in CKD via GWAS studies • SGLT2i effect on Na/H exchangers in heart and kidney • SGLT2i interact with heart NHE1 (mouse model) • SGLT2i as the ‘betablockers’ of the kidney? Jordan Weinstein on the clinical scientists’ mechanism of SHGLT2i: https://twitter.com/drjjw/status/1121577808164159491 Why subgroups should be interpreted very carefully Host: Joel Topf Discussants: Samira Farouk, Swapnil Hiremath, Jennie Lin and Matt Sparks. | |||
| 02 Jun 2019 | Freely Filtered 004 Hypernatremia | 00:52:36 | |
Joel Topf Jennie Lin Matt Sparks Samira Farouk The strange story of Jennifer Strange. https://insiderexclusive.com/radios-deadly-stunts-the-jennifer-strange-story/ Water Poker https://www.thelocal.se/20120706/41878 Nintendo Game Consoles https://en.wikipedia.org/wiki/Nintendo_video_game_consoles 2019 Narins winner, Mitchel Rosner on MDMA induced hyponatremia https://www.ncbi.nlm.nih.gov/pubmed/18684895 And Rosner again on exercise induced hyponatremia. https://cjasn.asnjournals.org/content/2/1/151 The Arieff article on the dangers of severe hyponatremia: Hyponatremia, Convulsions, Respiratory Arrest, and Permanent Brain Damage after Elective Surgery in Healthy Women https://www.nejm.org/doi/full/10.1056/NEJM198606123142401 The Richard Sterns article on the dangers of rapid correction of hyponatremia: Osmotic Demyelination Syndrome Following Correction of Hyponatremia https://www.nejm.org/doi/10.1056/NEJM198606123142402 The editorial by the man himself, Robert Narins: Therapy of Hyponatremia https://www.nejm.org/doi/full/10.1056/NEJM198606123142409 The infant study showing seizures associated with rapid correction of hypernatremia. https://www.ncbi.nlm.nih.gov/pubmed/35558?dopt=Abstract Follow up study with oral rehydration. https://www.ncbi.nlm.nih.gov/pubmed/3958850?dopt=Abstract The Linder study of adults admitted to the ICU https://www.ncbi.nlm.nih.gov/pubmed/18037096 French study on patients presenting to the ER with hypernatremia. https://bmcnephrol.biomedcentral.com/articles/10.1186/1471-2369-15-37 Study on US veterans showing poorer outcomes with slow correction of hypernatremia. https://www.ncbi.nlm.nih.gov/pubmed/21358313 Cerebral edema during the treatment of DKA. https://emj.bmj.com/content/21/2/141 The MIMIC 3 Database. MIMIC is an openly available dataset developed by the MIT Lab for Computational Physiology, comprising deidentified health data associated with ~40,000 critical care patients. It includes demographics, vital signs, laboratory tests, medications, and more. Chalrson Comorbidity Index https://www.mdcalc.com/charlson-comorbidity-index-cci#creator-insights The paper: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. https://www.ncbi.nlm.nih.gov/pubmed/3558716 JCI article on organic brain osmnoles in response to hypernatremia https://www.ncbi.nlm.nih.gov/pubmed/2332498?dopt=Abstract John Booth on the value of MIMIC 3 https://twitter.com/ThePeanutKidney/status/1128742219471642624 Sri Lekha on checking labs in hypernatremia https://twitter.com/LTummalapalli/status/1128479041634226176 Steve Coca on chunky water administration https://twitter.com/scoca1/status/1128744643422769152 Steve Coca musing the Cersei’s sodium level https://twitter.com/scoca1/status/1128698514026975232 Steve Coca swearing in High Valarlian: https://twitter.com/scoca1/status/1128629713826721792 Steve Coca proving the non-existence of hypernatremia therapy being associated with brain damage through the inability of trial lawyers to find and sue doctors for this issue: https://twitter.com/scoca1/status/1128652586612080642 The original paper on the Kardashian Index https://genomebiology.biomedcentral.com/articles/10.1186/s13059-014-0424-0 Kardashian Index Calculator http://theinformationalturn.net/kardashian-index/ Facebook CEO Mark Zuckerberg says the ‘future is private’ https://www.theverge.com/2019/4/30/18524188/facebook-f8-keynote-mark-zuckerberg-privacy-future-2019 Khenar Jhaveri et al on ‘WhatsApp’ening in nephrology training https://academic.oup.com/ckj/advance-article/doi/10.1093/ckj/sfz045/5482109 Mike Morrison’s video on how to rebuild the scientific poster https://www.youtube.com/watch?v=1RwJbhkCA58 Mike’s Twitter: https://twitter.com/mikemorrison?lang=en with lot’s of examples of his design in the wild. Make your own QR code: https://www.qr-code-generator.com GoodRx: https://www.goodrx.com Ten Worst Drugs for your Kidney: https://www.goodrx.com/blog/10-worst-medications-for-your-kidneys/ Drugs that can falsely elevate your creatinine levels: https://www.goodrx.com/blog/drugs-cause-false-high-creatinine-levels-blood-test/ Dr Orrange, not wishing to engage on Twitter in a meaningful way: https://twitter.com/Orrangemd/status/1129165083194511361 | |||
| 10 Jun 2019 | Freely Filtered 005 IgA Nephropathy | 01:01:13 | |
Joel Topf Jennie Lin Matt Sparks Swapnil Hiremath Show Notes: IgA Nephropathy Score Levi Strauss: https://www.biography.com/fashion-designer/levi-strauss Levey MDRD study: https://www.ncbi.nlm.nih.gov/pubmed/10075613 ADPKD Total Kidney Volume: https://www.nejm.org/doi/10.1056/NEJMoa054341 Halt PKD: https://www.nejm.org/doi/full/10.1056/nejmoa1402685 Tempo 3:4 Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1205511 Description description of IgA nephropathy by Berger and Hiunglais: https://www.ncbi.nlm.nih.gov/pubmed/4180586 The reprint in JASN in 2000 with commentary as part of the Milestones in Nephrology series: https://jasn.asnjournals.org/content/jnephrol/11/10/1957.full.pdf JASN supplies an English translation from the original French. Nice reference from JASN backing up Matt’s assertion that preeclampsia and not IgA nephropathy is the most common glomerular disease in the world: https://jasn.asnjournals.org/content/18/8/2281 Description of the Singapore Army screening recruits from the Oxford Textbook of Clinical Nephrology: https://books.google.com/books?id=fVItBQAAQBAJ&lpg=PA485&ots=JRoOnUnleT&dq=singapore%20kidney%20biopsy%20army&pg=PA485#v=onepage&q&f=false Description of the Japanese glomerulonephritis screening program: https://cjasn.asnjournals.org/content/2/6/1360 Swapnil’s studies on autopsy studies: Finland: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC501386/ Japan: https://www.ncbi.nlm.nih.gov/pubmed/12753320/
TESTING Trial on NephJC: http://www.nephjc.com/news/2017/8/28/testing
Discovery of new risk loci for IgA nephropathy implicates genes involved in immunity against intestinal pathogens https://www.nature.com/articles/ng.3118 Genome-wide polygenic risk predictors for kidney disease https://www.nature.com/articles/s41581-018-0067-6
Animal models of IgA nephropathy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4337240/ Matt’s Book Originals: https://www.amazon.com/gp/product/014312885X/ref=dbs_a_def_rwt_bibl_vppi_i1 Eric Neilson, Dean of Northwestern University https://www.feinberg.northwestern.edu/faculty-profiles/az/profile.html?xid=23239 Brussels sprout Insta-famous dog and future dean of the medical school: https://www.instagram.com/brussels.sprout/?hl=en Josh Farkas Rantorial about Contrast Nephropathy: https://twitter.com/PulmCrit/status/1134922050794139648 Swapnil’s Tweetorial about Contrast Nephropathy: https://twitter.com/hswapnil/status/1133906398096609280 Tukaram’s pic of NEJM’s progression from Contrast Induced Nephropathy to Contrast Associated Nephropathy: https://twitter.com/tukaramj/status/1135214980985266178 Zero sodium dialysate for heart failure? https://twitter.com/i/moments/1134811009217155072 | |||
| 24 Jul 2019 | Freely Filtered 006 SONAR | 00:56:42 | |
Cast: Joel Topf Jennie Lin Samira Farouk Swapnil Hiremath Show Notes: NephJC coverage of SONAR: http://www.nephjc.com/news/sonar SONAR in PubMed: https://www.ncbi.nlm.nih.gov/pubmed/30995972 Avosentan for overt diabetic nephropathy, the ASCEND trial: https://www.ncbi.nlm.nih.gov/pubmed/20167702 RADAR coverage at NephJC, May 2014: http://www.nephjc.com/atrasentan RADAR in PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24722445/ Google Hangout on RADAR: https://www.youtube.com/watch?v=pkkQbb-isog&feature=youtu.be Vlado Perkovic: https://twitter.com/VladoPerkovic SONAR: https://en.wikipedia.org/wiki/Sonar Nephmadness adaptive trial: https://ajkdblog.org/2016/03/10/nephmadness-2016-statistics-in-nephrology-region/#adaptive KIDNEYcon adaptive trial tweet thread: https://twitter.com/hswapnil/status/1117194018331471873?s=21 Excellent NEJM review on adaptive trials: https://www.nejm.org/doi/10.1056/NEJMra1510061 Potential role of Adaptive trials in AKI: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4869991/ BNP levels in CKD: https://cjasn.asnjournals.org/content/3/6/1644 Generalizability from Wikipedia: https://en.wikipedia.org/wiki/Generalizability_theory Anemia (and other adverse effects) of Endothelin antagonists: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5210319/ Data safety monitoring boards: https://www.nidcr.nih.gov/research/human-subjects-research/interventional-studies/data-and-safety-monitoring-board-guidelines AbbVie Allergen Merger: https://www.barrons.com/articles/abbvie-allergan-merger-pharma-deals-takeda-celgene-bristol-myers-squibb-51563890831 Tangri Kidney Failure Risk Equation: https://qxmd.com/calculate/calculator_308/kidney-failure-risk-equation-4-variable Fragility index paper: https://www.ncbi.nlm.nih.gov/m/pubmed/24508144/ LITFL write up: https://litfl.com/fragility-index/ Calculator: https://clincalc.com/Stats/FragilityIndex.aspx CANVAS Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1811744 Rates of Hyperkalemia after Publication of the Randomized Aldactone Evaluation Study by David Juurlink et al.: https://www.nejm.org/doi/full/10.1056/NEJMoa040135 Vinay Prasad: https://en.wikipedia.org/wiki/Vinay_Prasad Classic mouse studies looking at endothelin: https://www.jci.org/articles/view/119297/pdf Nice reviews: Review of vascular effects: | |||
| 18 Aug 2019 | Freely Filtered 007 MENTOR | 01:01:18 | |
Cast: Joel Topf Jennie Lin Swapnil Hiremath Matt Sparks Show Notes: NephJC Coverage of MENTOR: http://www.nephjc.com/news/mentor MENTOR: https://www.nejm.org/doi/full/10.1056/NEJMoa1814427 KDIGO Membranous recommendations: https://kdigo.org/wp-content/uploads/2017/02/KDIGO-2012-GN-Guideline-English.pdf 2017 Kidney Week Abstract: https://www.asn-online.org/education/kidneyweek/2017/program-abstract.aspx?controlId=2831149 PEXIVAS: http://www.nephjc.com/news/pexivasearly Heymann Nephritis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3042693/ Susan Quaggin: https://www.feinberg.northwestern.edu/faculty-profiles/az/profile.html?xid=26269 Manasi Bapat on non-inferiority trials: http://www.nephjc.com/news/2019/7/8/understanding-the-vortex-of-non-inferiority-trials Prognosis and risk factors for idiopathic membranous nephropathy with nephrotic syndrome in Japan: https://www.sciencedirect.com/science/article/pii/S0085253815498503 Nice review of Membranous by Alfaadhel and Cattrran that purports to say than CNI are the standard therapy for idiopathic membranous. (It doesn’t) https://www.ncbi.nlm.nih.gov/pubmed/27536673?dopt=Abstract Pablo Garcia saves the day: https://twitter.com/PabloGarciaMD/status/1148767319323099136?s=20 Larry beck’s land mark study demonstrating antiPLA2r as the antigen in idiopathic membranous. https://www.nejm.org/doi/full/10.1056/NEJMoa0810457 GEMRITUX Study: https://www.ncbi.nlm.nih.gov/pubmed/27352623 Jennie Lin’s How to Be a Nephrology Fellow, Choose Your Own Adventure: https://twitter.com/jenniejlin/status/1156329711057981442?s=20 CJASN How to Review a Paper Podcast: https://www.asn-online.org/media/podcast/CJASN/2019_07_23_How_to_Write_a_Cons.mp3 | |||
| 14 Oct 2019 | Freely Filtered 008 Deep Mind | 00:55:49 | |
Cast: Joel Topf Samira Farouk Jennie Lin Swapnil Hiremath and special guest, Perry Wilson A clinically applicable approach to continuous prediction of future acute kidney injury. https://www.ncbi.nlm.nih.gov/pubmed/?term=A+clinically+applicable+approach+to+continuous+prediction+of+future+acute+kidney+injury# Deep Mind National Health services scandal https://www.telegraph.co.uk/technology/2017/07/03/googles-deepmind-nhs-misused-patient-data-trial-watchdog-says/ KDIGO AKI guidelines (PDF) https://kdigo.org/wp-content/uploads/2016/10/KDIGO-2012-AKI-Guideline-English.pdf Frank Harrell on the value of continuous variables http://biostat.mc.vanderbilt.edu/wiki/Main/CatContinuous https://twitter.com/f2harrell/status/1176908371464794113?s=20 Wilson’s AKI Alert trial published in The Lancet, Automated, electronic alerts for acute kidney injury: a single-blind, parallel-group, randomised controlled trial. http://www.nephjc.com/aki-alert The NINJA trial http://www.nephjc.com/news/2016/8/3/ninja-using-technology-to-prevent-acute-kidney-injury?rq=ninja The end of EPICparodyEMR: https://twitter.com/EPICEMRparody/status/1178788488881299457?s=20 EPICparodyEMR on Explore the Space: https://www.explorethespaceshow.com/podcasting/epicparodyemr-on-electronic-medical-records/ Tweet where Nassim Nicholas Taleb calls Swap an imbecile: https://twitter.com/nntaleb/status/1178252052453089281?s=20 Blood Pressure Medicines for Five Years to Prevent Death, Heart Attacks, and Strokes. https://www.thennt.com/nnt/anti-hypertensives-to-prevent-death-heart-attacks-and-strokes/ NNT is SPRINT: In participants assigned to intensive BP lowering, major adverse cardiovascular events were reduced by 25% (5.2% v. 6.8%; hazard ratio [HR] 0.75, 95% confidence interval [CI] 0.64–0.89; number needed to treat [NNT] of 62 over 3 yr) and all-cause mortality was reduced by 27% (3.3% v. 4.5%; HR 0.73, 95% CI 0.60–0.90; NNT of 90 over 3 yr). NNT is highly misleading when assessing chronic disease prevention. https://www.ncbi.nlm.nih.gov/pubmed/25027390 Washington University School of Medicine establishes Division of Physician-Scientists https://medicine.wustl.edu/news/school-of-medicine-establishes-division-of-physician-scientists/ Physician scientists in the NEJM https://www.nejm.org/doi/full/10.1056/NEJMp1904482 NYT article on Physician Scientists: https://www.nytimes.com/2019/09/23/opinion/doctor-scientist-medical-research.html brussels.sprout on Instagram https://www.instagram.com/brussels.sprout/?hl=en Superintelligence by Nick Bostrom https://www.amazon.com/Superintelligence-Dangers-Strategies-Nick-Bostrom/dp/1501227742 Amazon bulk powdered cheese: https://www.amazon.com/s?k=powdered+cheese&ref=nb_sb_noss | |||
| 27 Dec 2019 | Freely Filtered 009 AMBER | 00:58:38 | |
Cast: Joel Topf Jennie Lin Swapnil Hiremath Matt Sparks Samira Farouk Show Notes: Pathway 2 Trial https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00257-3/fulltext NephJC discussion of Pathway2 The DIAMOND Trial. Much more ambitious than I described in the podcast. https://clinicaltrials.gov/ct2/show/NCT03888066 SPRINT https://www.nejm.org/doi/full/10.1056/NEJMoa1511939 Omron 907 BP cuff only $678 from Amazon: https://www.amazon.com/Omron-HEM-907XL-IntelliSense-Professional/dp/B000FENZPS Evaluation of the Potential for Drug Interactions With Patiromer in Healthy Volunteers: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5555446/ The TOPCAT Trial story: A Clinical Trial Torpedoed By Fraud and Incompetence CJSAN article looking at 24-hour urine for calcium and phos with patiromer https://cjasn.asnjournals.org/content/14/1/103 Swap’s best tweeters of #Kidney Wk aldorodrigo https://twitter.com/aldorodrigo Alex Meraz https://twitter.com/nephroguy Joshua Waitzman https://twitter.com/Jwaitz KIDNEYcon | |||
| 31 Jan 2020 | Freely Filtered 010 Difelakefalin | 00:54:03 | |
Cast: Joel Topf Jennie Lin Swapnil Hiremath Matt Sparks Show Notes: The NephJC discussion can be found here. The study was published in the NEJM. NephJC summary of the AJKD systematic review of uremic pruritus Atul Gawande on itching. Comprehensive review on toxicodendron dermatitis: poison ivy, oak, and sumac. Tom Oates 12 days of Poems on Twitter | |||
| 10 Mar 2020 | Freely Filtered 011 Gadolinium Meta-analysis | 00:59:30 | |
Just the dudes gathered to talk about the JAMA Internal Medicine Meta Analysis on Gadolinium in CKD stage 4 and 5. Cast: Joel Topf Swapnil Hiremath Matt Sparks Show Notes: Swap has a disclosure! He was an author on the Canadian Association of Radiology guidelines on use of Gad in CKD. Grobner’s original paper reporting the association between gadolinium and NSF. Matt’s article on alternatives to gadolinium in MRI: Using Ferumoxytol as an MRI contrast agent. Saurabh Jha’s editorial (@RogueRad) for NephMadness when Gadolinium in CKD 4 was a team in 2018. PEXIVAS was an abstract in 2018 and was not published until 2020. A Cultural History of Rock-Paper-Scissors Michelle’s recent case of NSF in a child (in case you thought this disease was gone) Matt’s tubular secretion: Biorender.com John Mandrola Expert or not an expert? JACC Case Reports on the Kardashian Index Robert Cardiff’s editorial on the Kardashian Index in JACC Case Reports. Bryan Vartabedian blog post on Robert Cardiff’s editorial And NephMadness is coming! Friday March 13, 2020! | |||
| 21 Mar 2020 | Freely Filtered 012 PEXIVAS | 01:17:07 | |
Plasma Exchange and Glucocorticoids in Severe ANCA-Associated Vasculitis Cast: Joel Topf Swapnil Hiremath Samira Farouk Jennie Lin Jordy Cohen Show Notes: 55th ERS-EDTA Congress, late breaking and high impact trials. June 2018 The CJASN Review recommended by Jennie C5a antagonist, Avacopan in ANCA-Associated Vasculitis The fragility index as described in JAMA Surgery Michael Walsh looks at the Fragility Index in 399 trials in medical literature The EVOLVE trial of Cinacalcet. Age-adjusted HR results in statistically significant results for primary outcome, but was not defined as the primary endpoint. Patients were one year older in the cinacalcet group; older age known to increase mortality in dialysis patients. Wiki Journal Club. Ron Falk and his irresponsible editorial. NephMadness is now in full swing at the AJKDblog! | |||
| 25 Mar 2020 | Freely Filtered 013 COVID-19 and the Kidney | 01:02:43 | |
NephJC’s COVID-19 and the Kidney Patient Cast: Joel Topf Swapnil Hiremath Samira Farouk Jennie Lin Matt Sparks Show Notes: The NephJC Page on ACE2 and COVID-19 Nature Letter showing AER2’s central role in lung injury (in mice). This was SARS from 2005. Losartan RCT in COVID-19; University of Minnesota: Outpatient NCT04311177 Inpatient NCT04312009 France's health ministry says NSAIDs may be bad in COVID-19 coverage by CNN WHO Tweets its position on NSAIDs. Early case report on COVID-19 and (heart) transplant Matt’s question to Twitter about cytokine storm ASN Webinar on dialysis and COVID-19 NephJC page on dialysis and COVID-19 Dimitrios G. Oreopoulos, one of the giants of peritoneal dialysis Christos Argyropoulos the Nostradamus of COVID-19 | |||
| 09 Apr 2020 | Freely Filtered 014 COVID-19 Podcast No. 2 | 00:56:25 | |
Loeb’s Laws of Medicine or Loeb’s Rules of Therapeutics Robert Frederick Loeb (March 14, 1895-October 21, 1973) was a famous American Physician who provided some very simple common sense approach to treating patients know as: 1. If what you are doing is doing good, keep doing it. 2. If what you are doing is not doing good, stop doing it. 3. If you do not know what to do, do nothing. 4. Never make the treatment worse than the disease. The last ‘law’ in present times is often replaced with: “If at all possible, keep your patient out of the operating room.” Or “Above all, never let a surgeon get your patient.” This is a decent reference for this: https://www.ncbi.nlm.nih.gov/books/NBK13258/ Dr. Glaucomflecken gives some tips for attending trying to go back to the ICU: https://twitter.com/DGlaucomflecken/status/1238954558140772354?s=20 Francis Deng and going back to become an internist: https://twitter.com/francisdeng/status/1245475268158009349?s=20 JCI article on using convalescent serum for treating disease: https://www.jci.org/articles/view/138003 Human trial of convalescent serum from JAMA: https://jamanetwork.com/journals/jama/fullarticle/2763983 It works! (in uncontrolled, observational trials) Monkeys develop protective antibodies: https://www.biorxiv.org/content/10.1101/2020.03.13.990226v1 Time course for antibodies and viral clearance in SARS-CoV2 from Nature: https://www.nature.com/articles/s41586-020-2196-x Peripheral blood monocyte proeonomics: https://www.biorxiv.org/content/10.1101/2020.03.31.019216v1.full.pdf Cytokine storm in the New York Times. Check mate Rheumatologists: https://www.nytimes.com/2020/04/01/health/coronavirus-cytokine-storm-immune-system.html Dr. Anthony Chang and Thrombi on COVID biopsies: https://twitter.com/ChangUCanSpare/status/1240686922332160001?s=20 ASN April 2 Webinar on dialysis and COVID-19 with Anitha Vijayan (among others): https://www.asn-online.org/ntds/resources/Webcast_2020_04_02_COVID-19.mp4 UK data on length of ventilatory support (ICNARC): https://t.co/WB1ZnODRFF?amp=1 Swap forgot Michele Mokrzycki’s name. Her name is Michele. Samira’s elementary school shampoo: https://www.influenster.com/reviews/pert-plus-classic-clean-2-in-1-shampoo-conditioner Prolonged Intermittent Renal Replacement Therapy (PIRRT): https://www.ncbi.nlm.nih.gov/pubmed/27113696 MDCalc COVID-Resource Center: https://www.mdcalc.com/covid-19 Acute PD for COVID-19 is discussed in this article from CJASN: https://cjasn.asnjournals.org/content/early/2020/04/03/CJN.03750320 PD for AKI, the experience from Brazil https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3525422/ The lead author, Daniela Ponce is really the world authority on PD and AKI: https://www.ncbi.nlm.nih.gov/pubmed/?term=Ponce%20D%5BAuthor%5D&cauthor=true&cauthor_uid=22641732 NEJM ACE2 review article that Matt didn’t read or peer review: https://www.nejm.org/doi/full/10.1056/NEJMsr2005760 NephJC COVID site: http://www.nephjc.com/covid19 | |||
| 14 Apr 2020 | Freely Filtered 016 MinTac trial and COVID-19 Podcast No. 3 | 01:05:07 | |
Cast: Joel Topf Swapnil Hiremath Samira Farouk Jennie Lin Matt Sparks And special guest Joshua Waitz Martin Pollak: http://www.nasonline.org/member-directory/members/20033579.html Josh Waitz @jwaitz 100 Days of COVID-19: https://www.voanews.com/episode/100-days-covid-19-4236811 MinTac: http://www.nephjc.com/news/mintac My magical experience with minimal change disease. This is not the actual tweet, but a dramatization: http://pbfluids.com/2020/04/the-magic-of-treating-minimal-change-disease/ Non-inferiority, NephJC: http://www.nephjc.com/news/2019/7/8/understanding-the-vortex-of-non-inferiority-trials Non-inferiority, through the looking glass: https://pubmed.ncbi.nlm.nih.gov/21539749/ Kevin Fowler on Tacrolimus side effects: https://twitter.com/gratefull080504/status/1247697780736512000?s=20 Mt Sinai is converting some transplant patients from tacrolimus to belatecept: https://www.nejm.org/doi/full/10.1056/nejmoa1506027 CAPSULOLOGY: Open the “Images” tab https://www.webmd.com/drugs/2/drug-10097-6108/tacrolimus-oral/tacrolimus-oral/details Tacrolimus for your cat and dog dry eye needs: https://vcahospitals.com/know-your-pet/tacrolimus-ophthalmic-in-dogs WHO, NSAIDs, and double negatives: https://twitter.com/kidney_boy/status/1240452941187821570?s=20 CJASN stands for the Clinical Journal of the American Society of Nephrology. The C does not stand for Canada. Sorry Swap. Conversion calculator from old world (SI) units, mg/mole Cr, to freedom units (gram protein / gram creatinine): http://www.scymed.com/en/smnxps/psdjf223.htm Michelle Rheault about starting the clock to relapse tweet: https://twitter.com/rheault_m/status/1247703322200596483?s=20 Marvin Gonzalez calls for larger studies: https://twitter.com/MarvinGonzlez16/status/1247701186972733442?s=20 Acute PD for COVID-19 is discussed in this article from CJASN: https://cjasn.asnjournals.org/content/early/2020/04/03/CJN.03750320 PD for AKI, the experience from Brazil https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3525422/ The lead author, Daniela Ponce is really the world authority on PD and AKI: https://www.ncbi.nlm.nih.gov/pubmed/?term=Ponce%20D%5BAuthor%5D&cauthor=true&cauthor_uid=22641732 Nursing home outbreaks in Durham: https://www.newsobserver.com/news/coronavirus/article241975401.html Prison outbreak: https://www.npr.org/2020/04/06/827922287/inmates-staff-on-edge-as-covid-19-spreads-through-federal-prisons Ottawa COVID-19: https://ottawacitizen.com/news/local-news/covid-19-long-term-care-outbreaks-continue-devastating-spread-across-ontario/ West Coast herd immunity: https://www.ksbw.com/article/new-study-investigates-californias-possible-herd-immunity-to-covid-19/32073873# The History of HIV associated Nephropathy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3494840/ Racial breakdown of NYC coronavirus deaths reveals ‘disparities,’ de Blasio says https://nypost.com/2020/04/08/de-blasio-releases-racial-breakdown-data-of-coronavirus-deaths/ Michelle Rheault is tired: https://twitter.com/rheault_m/status/1248371721356402689?s=20 KidneyCon Lite! Saturday April 18 from 9-11. Kidney Pathology workshop. Lunch Doodles with Mo Willems: https://youtu.be/7KBkUyE6MOw Dr Glaucomflecken and Telehealth: https://twitter.com/DGlaucomflecken/status/1247709538322657282?s=20 NephSim for kindergartner’s https://nephsim.com NephSim live: https://twitter.com/Neph_SIM/status/1247637727048327170?s=20 | |||
| 26 Apr 2020 | Freely Filtered 017: COVID Autopsy, Acute PD, and Making CRRT Dialysate | 01:07:05 | |
The Filtrate: Joel Topf Swapnil Hiremath Samira Farouk Jennie Lin Matt Sparks And special guests: Agnes Fozo: John L. Shapiro Chair of Pathology at Vanderbilt University and on Twitter: https://twitter.com/AgnesFogo Hua Su: Professor of Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China Osama El Shamy: Home Therapy Fellow at Mount Sinai and on Twitter: https://twitter.com/osamaelshamy88 Chirag Parikh: Director of Nephrology Johns Hopkins and on Twitter: https://twitter.com/KidneydrChirag Show Notes: Mark Denison, Corona virus expert. https://www.vumc.org/viiii/person/mark-r-denison-md and on Twitter: https://twitter.com/DenisonLab Discussion on Twitter that the 3electron microgrpahs may show clathrin coated pits rather than Conorna virus. https://twitter.com/vighnesh_w/status/1250880961463513088?s=20 Chris Larsen’s case of collapsing glomerulopathy in a patient with COVID-19 https://www.kireports.org/article/S2468-0249(20)31172-4/abstract Osler's rule: States that a neurological defect has to be related to a specific lesion, in contrast to Hickam's dictum, which states that the neurological defect can be due to several lesions. Altered Lipid Metabolism in Recovered SARS Patients Twelve Years after Infection. https://www.ncbi.nlm.nih.gov/pubmed/28831119 We don’t record (or roll) on the sabath https://www.youtube.com/watch?v=GPo9OBrIOi4 Using a dialysis machine to make CRRT dialysate, the Tweet: https://twitter.com/KidneydrChirag/status/1249867795602583554 Derek Fine, Parikh’s partner in crime: https://www.hopkinsmedicine.org/profiles/results/directory/profile/0007605/derek-fine and on Twitter: https://twitter.com/DerekFineMD Tablo Machine makes its own dialysate. It does not look like a cooler. https://www.outsetmedical.com/tablo/ Is Canada a communist country? https://www.quora.com/Is-Canada-a-communist-country Lokelma is not a sponsor of Freely Filtered Complications and Catheter Survival With Prolonged Embedding of Peritoneal Dialysis Catheters https://pubmed.ncbi.nlm.nih.gov/18281722/ Ontario Nursing Homes,”It felt like a war zone” https://www.pri.org/stories/2020-04-24/it-felt-war-zone-coronavirus-tears-through-canada-nursing-homes | |||
| 14 May 2020 | Freely Filtered 018: ISCHEMIA-CKD, Courage, and Céline Dion | 01:13:16 | |
The Filtrate: Joel Topf Swapnil Hiremath Samira Farouk Jennie Lin Matt Sparks And special guests: David J. Cohen: Professor of Medicine at the University of Missouri-Kansas City and Director of Cardiovascular Research at Saint Luke’s Mid America Heart Institute. In addition, he is Medical Director of the Medical Economics and Technology Assessment Group at Mid America Heart Institute. He was previously Associate Director of Interventional Cardiology at Beth Israel Deaconess Medical Center where he was also Associate Professor of Medicine at Harvard Medical School and Director of Economics and Quality of Life Research at the Harvard Clinical Research Institute. He is on Twitter at @djc795 Keith Bellovich: Chief Medical Officer Ascension St John. He is also on the board of directors of the renal physician association where he currently the treasurer/secretary. Show Notes: Ischemia CKD trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1915925 The most famous figure in nephrology: https://jasn.asnjournals.org/content/10/7/1606 (This figure was originally published in AJKD, but is now behind a paywall, hence the JASN link https://www.ajkd.org/article/S0272-6386(98)00339-4/pdf) Should Statins Be Banned from Dialysis? https://jasn.asnjournals.org/content/28/6/1675 Ischemia trial (not CKD) https://www.nejm.org/doi/full/10.1056/NEJMoa1915922 Courage trial from 2007: https://www.nejm.org/doi/full/10.1056/NEJMoa070829 Drug eluting stents approved in 2003: https://en.wikipedia.org/wiki/Drug-eluting_stent Céline Dion, Courage: https://www.youtube.com/watch?v=WN-ZHOHmvcw Dr. Farouk hanging with her close personal friend Ms. Dion: https://twitter.com/ssfarouk/status/1246448332039471107 https://twitter.com/ssfarouk/status/1235935956152311808 A lot of the enrollment of CKD-Ischemia was from Asia, 25% Methods: 19:40 Avoiding the Oculostenotic Reflex: https://www.acc.org/membership/sections-and-councils/fellows-in-training-section/section-updates/2016/02/12/16/29/avoiding-the-oculostenotic-reflex Beta blockers in dialysis patients: https://www.ncbi.nlm.nih.gov/pubmed/10201019 Mehran Score: https://www.mdcalc.com/mehran-score-post-pci-contrast-nephropathy Ultra-low contrast coronary angiography and zero-contrast percutaneous coronary intervention for prevention of contrast-induced nephropathy: step-by-step approach and review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6727230/ Capsulology 32:30 Antiplatelet treatment of STEMI with P2Y12 inhibitors https://en.wikipedia.org/wiki/P2Y12#Antiplatelet_treatment_of_STEMI Impact of concomitant use of proton pump inhibitors and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4826890/ Jennie is an intermediate metabolizer so she will be sluggish to activate P2Y12 inhibitor pro-drugs (which is just about all of them) https://www.mdmag.com/conference-coverage/acc-2018/realtime-genetic-data-impacts-physician-prescribing-behavior-following-stent-procedures St John's Wort Supplements Endanger the Success of Organ Transplantation: https://jamanetwork.com/journals/jamasurgery/fullarticle/212243 Results 37:10 Frank Harrell https://twitter.com/f2harrell His blog: https://www.fharrell.com Discussion 46:56 Samira does not work at NYU. The Argument for Abolishing Cardiac Screening of Asymptomatic Kidney Transplant Candidates https://pubmed.ncbi.nlm.nih.gov/31492488/ Coronary-Artery Revascularization before Elective Major Vascular Surgery. The CARP study https://www.nejm.org/doi/full/10.1056/NEJMoa041905 A Single Ventilator for Multiple Simulated Patients to Meet Disaster Surge https://onlinelibrary.wiley.com/doi/pdf/10.1197/j.aem.2006.05.009 Joel’s enthusiasm for Remdesivir: The COVID Diaries 3: Ladies and Gentleman, I think this tweet is going to get me in trouble… http://pbfluids.com/2020/05/the-covid-diaries-3-the-tweet-heard-round-the-world/ Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31022-9/fulltext NIH Clinical Trial Shows Remdesivir Accelerates Recovery from Advanced COVID-19 https://www.niaid.nih.gov/news-events/nih-clinical-trial-shows-remdesivir-accelerates-recovery-advanced-covid-19 | |||
| 24 May 2020 | Freely Filtered 019: CRIC on NSAIDs v Opioids | 01:08:45 | |
The Filtrate: Joel Topf Swapnil Hiremath Matt Sparks And special guests: Joshua Waitzman, third year nephrology fellow at Beth Israel Harold “Harv” Feldman. Editor in Chief at AJKD and national study chair of CRIC and principal investigator of the Scientific and Data Coordinating Center of the CRIC Study. https://www.dbei.med.upenn.edu/bio/harold-i-feldman-md-msce Show Notes: CRIC: Chronic Renal Insufficiency Cohort http://www.cristudy.org/ NSAID Studies at NephJC: Precision: http://www.nephjc.com/news/2017/1/20/hwgrko70d3z88djtjcmzvwpzlirm6c?rq=precision Army of NSAIDs: http://www.nephjc.com/news/nsaids and the podcast (from before the name Freely Filtered, http://www.nephjc.com/freelyfiltered/2019/3/24/nephjc-drive-time-001-an-army-of-nsaids) And this week’s study: CRIC: http://www.nephjc.com/news/nsaids-vs-opioids Methods at 16:55 Matt had to get a mouse study 🐁 in, so here it is: Renal Abnormalities And An Altered Inflammatory Response In Mice Lacking Cyclooxygenase Ii https://www.nature.com/articles/378406a0 The Beth Israel Flex, “The first time I read the paper…” Results at 32:46 Discussion 48:13 Josh King on opioids being nephrotoxic: https://twitter.com/nephrotox/status/1260400636253921281?s=20 This Week in Covid The fight over round spikey things. German autopsy study showing SARS-CoV2 in the kidney: https://www.nejm.org/doi/full/10.1056/NEJMc2011400 Kidney International walking back some previous declarations of what they are seeing on EM: https://twitter.com/Kidney_Int/status/1263641195416150018?s=20 MedRxIV on AKI with COVID-19 at Mount Sinai Medical Center: https://www.medrxiv.org/content/10.1101/2020.05.04.20090944v1 Juan Carlos discussing etiologies of AKI in COVID-19 outbreak in New Orleans. https://kidney360.asnjournals.org/content/early/2020/05/13/KID.0002652020 Triple combination of interferon beta-1b, lopinavir–ritonavir, and ribavirin in the treatment of patients admitted to hospital with COVID-19: an open-label, randomised, phase 2 trial https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31042-4/fulltext Friend of the Podcast, Kenar Jhaveri and his data on COVID19 and AKI in Kidney International. https://www.kidney-international.org/article/S0085-2538(20)30532-9/fulltext | |||
| 15 Jun 2020 | Freely Filtered 020: SGLT2i are diuretics, but not like any other diuretics | 01:06:43 | |
The Filtrate: Joel Topf Swapnil Hiremath Samira Farouk Matt Sparks And special guests: Sadiya Kahn a heart failure specialist at Northwestern University. @HeartDocSadiya and Paul Welling a professor of medicine and nephrology at Johns Hopkins. @PAWellingMD Show Notes: The Study: https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.120.045691 Coverage at NephJC: http://www.nephjc.com/news/sglt2mechanism Diuretics for heart failure NEJM Review article: https://www.nejm.org/doi/full/10.1056/nejmra1703100 Don’t say renal: https://www.kidney-international.org/article/S0085-2538(20)30233-7/fulltext?mobileUi=0 Sanjiv “We pronounce HFpEF huff-puff” Shah, MD https://www.feinberg.northwestern.edu/faculty-profiles/az/profile.html?xid=16814 and https://asecho.org/wp-content/uploads/2016/02/Shah-HFpEF.pdf Huff Puff is like fetch. It is not going to happen. https://www.youtube.com/watch?v=Pubd-spHN-0 Did he have buttons? https://ajkdblog.org/2019/06/17/muscle-relaxant-use-in-dialysis/ Rate My Room: https://twitter.com/ratemyskyperoom?lang=en Review on Renal Glucosuria from CJASN: https://cjasn.asnjournals.org/content/5/1/133 and another from the National Organizations of Rare Disorders: https://rarediseases.org/rare-diseases/renal-glycosuria/ Mechanism of Impaired Natriuretic Response to Furosemide during Prolonged Therapy: https://pubmed.ncbi.nlm.nih.gov/2811065/ Two studies that showed drops in BNP with SGLT2i DAPA HF: https://www.nejm.org/doi/full/10.1056/NEJMoa1911303 DEFINE HF showing nice reduction BNP with dapagliflozen: https://pubmed.ncbi.nlm.nih.gov/31524498/?dopt=Abstract Copeptin, what is it? https://pubmed.ncbi.nlm.nih.gov/18291667/?dopt=Abstract SIADH treatment with empagliflozen: https://jasn.asnjournals.org/content/31/3/615.abstract and it is JASN not CJASN. My bad. EVEREST. Tolvaptan for heart failure: https://jamanetwork.com/journals/jama/fullarticle/206251 Remdesivir placebo controlled RCT: https://www.nejm.org/doi/full/10.1056/NEJMoa2007764 Joel’s Remdesivir study: https://www.nejm.org/doi/full/10.1056/NEJMoa2007016 Remdesivir for 5 or 10 Days in Patients with Severe Covid-19: https://www.nejm.org/doi/full/10.1056/NEJMoa2015301 Swap showing a lot of skepticism to the Lancet HCQ data even before the retraction (which happened after this recording) https://www.the-scientist.com/news-opinion/lancet-retracts-surgispheres-study-on-hydroxychloroquine-67613 Baclofen is dangerous https://www.kidney-international.org/article/S0085-2538(20)30552-4/abstract | |||
| 14 Jul 2020 | Freely Filtered 021: Aldosteronism is everywhere | 00:48:15 | |
The Filtrate: Joel Topf Swapnil Hiremath Samira Farouk Matt Sparks Jordy Cohen And special guests: Brian Byrd, a cardiologist investigating aldosteronism at the University of Michigan and Susan Steigerwalt, a nephrologist and hypertension specialist who unfortunately due to technical problems largely was cut out of this episode 😢. The Study: The Unrecognized Prevalence of Primary Aldosteronism Coverage at NephJC: http://www.nephjc.com/news/aldosterone “What gets measured, gets managed.” Peter Drucker, or not How much sodium comes from the food processing? 71%. Fourteen percent comes from the food itself, with 5% coming from food prep at home and another 5% from the salt shaker at the table. https://www.ahajournals.org/doi/epub/10.1161/CIRCULATIONAHA.116.024446 Surgical versus medical therapy for primary hyperaldosteronism: https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.117.10596 . And the editorial by David Calhoun: https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.118.10759 I could find no empiric data to support Swap’s supposition that the French and Italian people are more courageous than people in Canada. Citation needed. ENAC inhibitors as treatment for primary hyperaldosteronism: https://onlinelibrary.wiley.com/doi/full/10.1111/jch.13566 Pathway 3 Trial: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(15)00377-0/fulltext Rennin in cow stomachs: http://www.vivo.colostate.edu/hbooks/pathphys/digestion/stomach/rennin.html Sodium content of muffins: https://www.fatsecret.com/calories-nutrition/food/muffins/sodium The MICE Package in R: MICE: Multivariate Imputation via Chained Equations) https://www.analyticsvidhya.com/blog/2016/03/tutorial-powerful-packages-imputing-missing-values/ Gender-Affirming Hormone Therapy, Vascular Health and Cardiovascular Disease in Transgender Adults https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.119.13080 False-positive aldosterone renin ratios in patients on combined estrogen progesterone treatment (only with direct renin concentration, the plasma renin activity is not fooled) https://academic.oup.com/jcem/article/102/7/2329/3093639 John Funder video commentary on the study: https://www.acpjournals.org/doi/abs/10.7326/M20-1758 ACD blood pressure guidelines (note the absence of B): https://pubmed.ncbi.nlm.nih.gov/17083059/ Pathway 2 study: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00257-3/fulltext ALLHAT trial: https://pubmed.ncbi.nlm.nih.gov/12479763/international.org/article/S0085-2538(20)30552-4/abstract | |||
| 28 Jul 2020 | Freely Filtered 022: Uric Acid faces the Music. | 01:15:58 | |
The Filtrate: Joel Topf Swapnil Hiremath Samira Farouk And special guests: Katalin Susztak, Professor of Medicine Perlman School of Medicine, University of Pennsylvania. @KSusztak Show Notes: CKD-FIX: Effects of Allopurinol on the Progression of Chronic Kidney Disease PERL: Serum Urate Lowering with Allopurinol and Kidney Function in Type 1 Diabetes Coverage at NephJC: Effects of Allopurinol on the Progression of Chronic Kidney Disease Richard Johnson’s theory in pay-walled Nature Reviews Nephrology: Hypothesis: fructose-induced hyperuricemia as a causal mechanism for the epidemic of the metabolic syndrome Richard Johnson’s theory in open access Nehrology Dialysis and Transplantation: Uric acid and chronic kidney disease: which is chasing which? PERL: Preventing early renal loss Iohexol, good for measuring GFR as well as causing contrast associated nephropathy? Uric acid versus urate: The Crystallization of Monosodium Urate WHO list of essential medications Fixing the numbers, specifically phosphorous Cost of allopurinol: $7/month but it is only $9 for 3 months Febuxostat Therapy for Patients With Stage 3 CKD and Asymptomatic Hyperuricemia: A Randomized Trial Tipping point analysis - multiple imputation for stress test under missing not at random (MNAR) or a YouTube video if that’s your speed (sorry, I couldn’t find a TikTok on imputation stress tests). Mendelian randomization study of urate and CKD by Ron Do and team Fake systematic review by Johnson’s group showing Urate lowering prevented CKD Hyperuricemia As a trigger of Immune Response in Hypertension and Chronic Kidney Disease by Claudio Ponticelli published the week after these two RCTs were published. NEJM Editorial: Urate-Lowering Therapy and Chronic Kidney Disease Progression by Daniel Feig ‘WhatsApp®’ening in nephrology training Arkana LIVE Pathology Sessions NephJC Summer Book Club. Read Rana Awdish’s In Shock | |||
| 20 Aug 2020 | Freely Filtered 023: Race and Estimated GFR | 01:15:59 | |
The Filtrate: Matt Sparks Joel Topf Swapnil Hiremath Samira Farouk Jennie Lin And three special guests: Carina Seah a second year MD PhD student Mt Sinai who led the initiative to remove race from the eGFR formulas Poyan Mehr, founder of GlomCon and author of this post on the use of race in eGFR estimating formulas. Deidra Crews Professor of Medicine and researcher in health disparities. Show Notes: Petition for Removal of “Race Correction” in eGFR at Mount Sinai https://docs.google.com/document/d/1vJCwVndyzemWCx8RXZLvLm6JLuFN7NdgEFVCFaDnSOk/edit Dr Murphy, Dean For Clinical Integration And Population Health. Professor And System Chair. https://icahn.mssm.edu/profiles/barbara-murphy The Bowman Society at the University of Chicago. I can not find a recording of the webinar https://pritzker.uchicago.edu/resources/bowman-society Social Determinants of Racial Disparities in CKD https://jasn.asnjournals.org/content/27/9/2576 Socioeconomic Disparities in Chronic Kidney Disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4291541/ Shortcomings of the current GFR estimating equations https://pubs.glomcon.org/archives/1491 Alan S Go’s work on eGFR, hospitalization and death: https://www.nejm.org/doi/full/10.1056/nejmoa041031 Tangri Kidney Failure Risk Calculation https://kidneyfailurerisk.com De-adjusting for body surface area: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2756662/ 2018 Nature Reviews Nephrology Porrini Estimated GFR: time for a critical appraisal https://www.nature.com/articles/s41581-018-0080-9 Estimating Glomerular Filtration Rate from Serum Creatinine and Cystatin C https://www.nejm.org/doi/full/10.1056/nejmoa1114248 Transdermal Measurement of Glomerular Filtration Rate in Mice https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6235579/ Worldwide Frequencies of Apolipoprotein L1 Renal Risk Variants https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6482949/ Health Affairs Blog about when and how to measure race in research: https://www.healthaffairs.org/do/10.1377/hblog20200630.939347/full/ ASN Kidney Stars https://www.asn-online.org/grants/travel/details.aspx?app=MSR | |||
| 01 Sep 2020 | Freely Filtered 024: STARRT me up! | 01:11:13 | |
The Filtrate: Matt Sparks Joel Topf Swapnil Hiremath COI: he was a sub-investigator on STARRT Jennie Lin And two special guests: Dr. Jay Koyner of the University of Chicago and #NephBBQ fame. Anitha Vijayan, professor of medicine at Wash U in St Louis Show Notes: The STARRT-AKI trial acronym is: Standard versus Accelerated Initiation of Renal-Replacement Therapy in Acute Kidney Injury Matt suggests STAKRT-AKI Standard versus Accelerated Initiation of Kikdney-Replacement Therapy in Acute Kidney Injury Coverage at NephJC: Time to Stop Starting RRT Early in AKI House of God by Samuel Shem. Contemporary Review in the New Yorker. Amazon Ronco’s legendary dose of CRRT study. Lancet 2000. AJKD Meta analysis on initiation of dialysis in AKI by VF Seabra. Timing of Initiation of Dialysis in Critically Ill Patients with Acute Kidney Injury Initiation of dialysis by BUN in the Picard trial by Dr. Kathleen Liu. AKIKI and ELAIN trials as covered by NephJC Issues surrounding informed consent in the ICU Dr Palevsky’s ATN Study, AKA Intensity of Renal Support in Critically Ill Patients with Acute Kidney Injury Debate at Kidney Week: Intensivist vs Nephrologist for Renal Replacement Therapy (RRT) in the ICU Internal and External Validation of a Machine Learning Risk Score for Acute Kidney Injury That sweet sweet NephJC pot of gold Furosemide Stress Test and Biomarkers for the Prediction of AKI Severity Thai study that used FST to randomize patients for early versus late start KRT: Early versus standard initiation of renal replacement therapy in furosemide stress test non-responsive acute kidney injury patients (the FST trial) AKIKI 2 at clinical trials.gov Swapnil’s Tubular secretion, the Twitter timeline of Oded Rechavi Matt’s Tubular Secretion: #kidneydietchallenge Anitha comes from the land of coconuts. Lots of potassium in coconut water. The Skeleton Key Group on The Renal Fellow Network | |||
| 21 Sep 2020 | Freely Filtered 025: Making sense of albuminuria, proteinuria, and the dipstick | 00:59:15 | |
The Filtrate: Matt Sparks Joel Topf Swapnil Hiremath Jennie Lin Jordy Cohen And two special guests: Morgan Grams, study author. Talar Kharadjian, nephrology fellow UC San Diego Show Notes: History of albuminuria from Matt’s opening monolog: https://academic.oup.com/ndt/article/18/7/1281/1809803 Microalbuminuria As A Predictor Of Clinical Nephropathy In Insulin-Dependent Diabetes Mellitus in the Lancet 1982. Microalbuminuria Predicts Clinical Proteinuria and Early Mortality in Maturity-Onset Diabetes in the NEJM 1984 Episode of Freely Filtered with Dr. Feldman, the big guy at the top of the CRIC trial: NSAIDs vs Opioids. The Aldo study where they didn’t do a meta-analysis but they should have: Aldosteronism is everywhere. Estimating Urine Albumin-to-Creatinine Ratio from Protein-to-Creatinine Ratio: Development of Equations using Same-Day Measurements. Canadian data. CJASN The kidney failure risk equation has a dotcom: https://kidneyfailurerisk.com KDIGO Controversies Conference on Early Identification & Intervention in CKD Choose Your Own Adventure: Cave of Time. Witte et al. in 2009 JASN on first morning urine vs 24 hour collection: First Morning Voids Are More Reliable Than Spot Urine Samples to Assess Microalbuminuria Sensitivity and specificity for Joel to study Your Manuscript On Peer Review Nephrology Business Leaders University (NBLU) Cloth Masks May Prevent Transmission of COVID-19: An Evidence-Based, Risk-Based Approach with lead author Catherine Clase Elimination or Prolongation of ACE Inhibitors and ARB in Coronavirus Disease 2019 (REPLACECOVID) Fast Grant. Apparently they are not just for Brian Byrd NephJC ACE2 Stuff as Jordy calls it: http://www.nephjc.com/news/covidace2 The BRACE-CORONA trial a 700 person RCT of ACEi and ARB in Covid-19. No effect. Tweet stream by Swapnil. MC Hammer is a science nerd: https://cen.acs.org/education/science-communication/Hammer-time-Science-Twitter-drummers/98/i31 Hammerman origin story for the MC Hammer cartoon. Bowman Society Lecture - Race & Renal Function Calculations Basic Research Forum for Emerging Kidney Scientists: A Partnership Between APS and ASN | |||
| 06 Nov 2020 | Freely Filtered 026: Interventional Nephrology meet NephJC, NephJC meet Interventional Nephrology | 01:05:58 | |
The Filtrate: Swapnil Hiremath Samira Farouk Matt Sparks Joel Topf And two special guests: Vandana Dua Niyyar, Professor of Medicine at Emory University and the president elect of American Society of Diagnostic and Interventional Nephrology. Wears lead. Sophia Ambruso, assistant professor and nephrologist at the University of Colorado. Show Notes: Drug-Coated Balloons for Dysfunctional Dialysis Arteriovenous Fistulas The Haskal study, Stent Graft versus Balloon Angioplasty for Failing Dialysis-Access Grafts in the NEJM from 2010 Accuracy of physical examination in the detection of arteriovenous fistula stenosis The Big Three was a trio of Major League Baseball starting pitchers for the Atlanta Braves from 1993-2002 which consisted of Greg Maddux, Tom Glavine, and John Smoltz. The Big Three combined to win seven National League Cy Young Awards in the 1990s and helped lead the Atlanta Braves to a 1995 World Series win. Each member of the Big Three has had their jersey retired by the Atlanta Braves and has been inducted into the Baseball Hall of Fame. (From Wikipedia) The Trerotola study, Drug Coated Balloon Angioplasty in Failing AV Fistulae Scathing anti-interventional nephrologist editorial by Trerotola Rebuttal though data by Beathard, Effectiveness and safety of dialysis vascular access procedures performed by interventional nephrologists And then a walk back and update by Tretola…What is the current and future status of interventional nephrology? Paclitaxel mechanism of action video with awesome music The role of fungus in the paclitaxel story Twitter comment on the half life of balloon delivered paclitaxel The meta analysis of peripheral revasculaization having a mortality signal with paclitaxel: Risk of Death Following Application of Paclitaxel-Coated Balloons and Stents in the Femoropopliteal Artery of the Leg: A Systematic Review and Meta-Analysis of Randomized Controlled Trials FDA warning about paclitaxel balloons: Treatment of Peripheral Arterial Disease with Paclitaxel-Coated Balloons and Paclitaxel-Eluting Stents Potentially Associated with Increased Mortality The NephJC primer on non-inferiority trials: Understanding the vortex of non-inferiority trials ASN Distinguished Clinical Service Award 2020 goes to Vandana Dua Niyyar! (and Derek Fine, who is also a great guy) ASN Kidney Week Sessions: Samira: Embracing Technology: Nephrology 2.0 Swapnil: Hard-to-Control Hypertension: What to Do Next? Vandana: A Look Inside: Noninvasive Imaging of Kidney Diseases | |||
| 29 Nov 2020 | Freely Filtered 027: Long and deep on the KDIGO Diabetes Guidelines | 01:33:16 | |
The Filtrate: Swapnil Hiremath Samira Farouk Matt Sparks Joel Topf Jennie Lin And two special guests: Katherine Tuttle Clinical Professor Division of Nephrology, Medical & Scientific Director, Providence Medical Research Center/Sacred Heart Center, Professor of Basic Medical Sciences, WWAMI Program Washington State Universityendocrinologist and nephrologist at the University of Washington Ian de Boer Professor in the Division of Nephrology, Adjunct Professor, Epidemiology and Associate Director, Kidney Research Institute Show Notes: Accord study showing harm from tight glycemic control Advance Trial the other trial showing harm from tight glycemic control 2007 KDOQI diabetes guidelines 2012 KDOQI diabetes guidelines Rob Nelson, diabetes legend Classic pathology of diabetic nephropathy Should all patients with diabetes have a kidney biopsy? Flow trial: A Research Study to See How Semaglutide Works Compared to Placebo in People With Type 2 Diabetes and Chronic Kidney Disease The Grading of Recommendations Assessment, Development and Evaluation (short GRADE) working group. Don’t you love it when the first word in an acronym is the acronym itself. Continuous glucose monitoring and icodextrin. Keto diets have 1.2 to 1.7 g protein/kg Jordy Cohen and Bariatric surgery in CKD at Kidney Week Metformin knocking out of the park in UKPDS Kidneys at the Zoo: What Can We Learn from Comparative Renal Physiology? at Kidney Week | |||
| 25 Dec 2020 | Freely Filtered 028: Finerenone for diabetic kidney disease | 01:02:27 | |
The Filtrate: Swapnil Hiremath Samira Farouk Matt Sparks Joel Topf Jennie Lin And two special guests: Katherine Tuttle Clinical Professor Division of Nephrology, Medical & Scientific Director, Providence Medical Research Center/Sacred Heart Center, Professor of Basic Medical Sciences, WWAMI Program Washington State Universityendocrinologist and nephrologist at the University of Washington Ian de Boer Professor in the Division of Nephrology, Adjunct Professor, Epidemiology and Associate Director, Kidney Research Institute Show Notes: Accord study showing harm from tight glycemic control Advance Trial the other trial showing harm from tight glycemic control 2007 KDOQI diabetes guidelines 2012 KDOQI diabetes guidelines Rob Nelson, diabetes legend Classic pathology of diabetic nephropathy Should all patients with diabetes have a kidney biopsy? Flow trial: A Research Study to See How Semaglutide Works Compared to Placebo in People With Type 2 Diabetes and Chronic Kidney Disease The Grading of Recommendations Assessment, Development and Evaluation (short GRADE) working group. Don’t you love it when the first word in an acronym is the acronym itself. Continuous glucose monitoring and icodextrin. Keto diets have 1.2 to 1.7 g protein/kg Jordy Cohen and Bariatric surgery in CKD at Kidney Week Metformin knocking out of the park in UKPDS Kidneys at the Zoo: What Can We Learn from Comparative Renal Physiology? at Kidney Week | |||
| 15 Feb 2021 | Freely Filtered 029: Belimumab for lupus nephritis | 01:09:12 | |
The Filtrate: Matt Sparks Jennie Lin Samira Farouk Joel Topf Swapnil Hiremath And two special guests: Dawn J. Caster, Assistant Professor at University of Louisville Alfred Kim, Assistant Professor of Medicine at Washington University (Twitter) Show Notes: NephJC coverage of the trial: The Bliss trial In the NEJM: https://www.nejm.org/doi/full/10.1056/NEJMoa2001180 Turtles all the way down: https://en.wikipedia.org/wiki/Turtles_all_the_way_down Nature previews Nephrology on BAFF: https://www.nature.com/articles/nri844 Phase III trial results with blisibimod, a selective inhibitor of B-cell activating factor, in subjects with systemic lupus erythematosus (SLE): results from a randomised, double-blind, placebo-controlled trial: https://pubmed.ncbi.nlm.nih.gov/29563108/ BRIGHT-SC: Blisibimod Response in IgA Nephropathy Following At-Home Treatment by Subcutaneous Administration: https://clinicaltrials.gov/ct2/show/NCT02062684 Guideline for naming monoclonal drugs: https://www.antibodysociety.org/wordpress/wp-content/uploads/2017/07/INN-2017-Reference-20.pdf A long-term study of hydroxychloroquine withdrawal on exacerbations in systemic lupus erythematosus. The Canadian Hydroxychloroquine Study Group: https://pubmed.ncbi.nlm.nih.gov/9541091/ Long-term follow-up of the MAINTAIN Nephritis Trial, comparing azathioprine and mycophenolate mofetil as maintenance therapy of lupus nephritis https://pubmed.ncbi.nlm.nih.gov/25757867/ A Day In The Life Of Dr. Anthony Fauci: https://www.huffpost.com/entry/anthony-fauci-fighting-covid-19_n_5fc7fed7c5b61bea2b14e3ee MC Arbatin MD FPCP FPSN @mcamd: the glomerulus tree: https://twitter.com/mcamd/status/1337744822543605760 finished product: https://twitter.com/mcamd/status/1338429211963322371 | |||
| 15 Mar 2021 | Freely Filtered 030: DAPA-CKD | 00:59:01 | |
| 28 Mar 2021 | Freely Filtered 031: Roxadustat | 01:07:12 | |
| 10 Apr 2021 | Freely Filtered 032: Animal House | 00:56:38 | |
| 20 Apr 2021 | Freely Filtered 033: The Roxadustat Statistics shenanigans | 01:07:12 | |
| 06 May 2021 | Freely Filtered 034: Terlipressin for Hepatorenal Syndrome | 01:11:33 | |
| 25 May 2021 | Freely Filtered 035: ASN Fellow Survey, COVID-19 Edition | 00:55:12 | |
| 13 Jun 2021 | Freely Filtered 036: AKIKI-2, How soon is now? | 01:24:30 | |
The Filtrate: Joel Topf Swapnil Hiremath Nayan Arora Sophie Ambruso And special guests: Jay L Koyner, Professor of Medicine, University of Chicago Sarah Faubel, Professor of Medicine, University of Colorado Editor Nayan Arora Show Notes: It was Kidney 360, not Kidney Medicine. Here is the study I was thinking of: https://kidney360.asnjournals.org/content/2/1/33 SNL Five-Timers Club: https://www.youtube.com/watch?v=6bWGoWFMwKE The Fluid and Electrolyte Companion. Download The Whole Enchilada About the Authors from Topf and Faubel’s first book, The Microbiology Companion. Ted Post: The Sarah Faubel of The Clinical Physiology of Acid Base and Electrolyte Disorders. Meta analysis of early dialysis in AKI by Victor Seabra: https://pubmed.ncbi.nlm.nih.gov/18562058/ Meta analysis of early dialysis in AKI by Morgan Grimes: https://www.ajkd.org/article/S0272-6386(15)00530-2/abstract H-index: https://en.wikipedia.org/wiki/H-index Mortality in ARDS: ACURASYS study. The hazard ratio for death at 90 days in the cisatracurium group, as compared with the placebo group, was 0.68 https://www.nejm.org/doi/full/10.1056/nejmoa1005372 Has Mortality from Acute Respiratory Distress Syndrome Decreased over Time? A Systematic Review It is commonly stated and assumed that mortality from acute respiratory distress syndrome (ARDS) is decreasing. We found that mortality from ARDS has not decreased substantially since the publication of a consensus definition in 1994. Based on our findings, a baseline mortality risk from ARDS of 40 to 45% for observational studies and 35 to 40% for randomized control trials should be expected. These results highlight the need for future effective therapeutic interventions for this highly lethal syndrome. https://www.atsjournals.org/doi/full/10.1164/rccm.200805-722oc From Up To Date: Numerous studies suggest that survival has improved over time [2,9,10,11]. As an example, an observational study of 2451 patients who had enrolled in ARDSNet randomized trials found a fall in mortality from 35 to 26 percent between 1996 and 2005 [10]. To the extent that mortality may be decreasing with time, several issues should be considered: ● It is not known if mortality has decreased among patients who received their care outside of a specialized center or a clinical trial. ● The improved mortality may be attributable to patients who have ARDS related to risk factors other than sepsis, such as trauma [9]. ● To the extent that mortality has decreased, the reasons are uncertain. Likely causes include better supportive care and improved ventilatory strategies, such as low tidal volume ventilation [10,12,13] Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock by Emanuel Rivers https://www.nejm.org/doi/full/10.1056/nejmoa010307 Early Goal Directed Therapy from NephMadness 2015 https://ajkdblog.org/2015/03/01/nephmadness-2015-critical-care-nephrology-region/#Early Counter point by NSMC graduate Kamran Boka https://ajkdblog.org/2015/03/18/nephmadness-2015-process-arise-promise-and-the-promise-of-early-goal-directed-therapy/ Furosemide stress test https://jasn.asnjournals.org/content/26/8/2023 EM Crit looks at the furosemide stress test: https://emcrit.org/pulmcrit/furosemide-stress-test/ ASN Kidney Week Biomarker debate between Faubel and Koyner. https://www.asn-online.org/education/kidneyweek/2020/program-session-details.aspx?sessId=371699&sessPar=371678 NAD therapy Samir Parikh Don Seldin Young Investigator Award winner 2019. Sarah Faubel’s Dream RCT https://ukidney.com/nephrology-resources/dream-rct-initiative/dream-rct-entries/item/nephrologist-driven-rrt-usual-late-or-early-start-for-acute-kidney-injury Perry Wilson’s DreamRCT https://www.medpagetoday.com/Nephrology/DreamRCT/53876 Steve Coca on “Permissive AKI” with treatment of heart failure https://www.kidney-international.org/article/S0085-2538(19)30708-2/pdf Edward Clark on HIRRT: Mechanisms for hemodynamic instability related to renal replacement therapy: a narrative review https://pubmed.ncbi.nlm.nih.gov/31407042/ Cytokine adsorption in patients with severe COVID-19 pneumonia requiring extracorporeal membrane oxygenation (CYCOV): a single centre, open-label, randomised, controlled trial https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00177-6/fulltext The Handbook of Critical Care Nephrology Amazon | Target (actually not available 😩) Sophia and Sarah Tweetorial on her Lung metabolomics in AKI study: https://twitter.com/sophia_kidney/status/1390394006366994432 AKIKI NephJC coverage | NEJM manuscript | |||
| 25 Jul 2021 | Freely Filtered 037: The first Guideline Draft: KDIGO Hypertension Guidelines | 01:30:49 | |
The Filtrate: Joel Topf Swapnil Hiremath Nayan Arora Sophie Ambruso Joshua Weisman Editor Joel Topf Show Notes: Soccer star Christian Eriksen 'was gone' after on-field cardiac arrest, doctor says (NBC News) 120-sided Die. This was covered in Wired Magazine. Respect. https://www.wired.com/2016/05/mathematical-challenge-of-designing-the-worlds-most-complex-120-sided-dice/ Nephrologists that played D&D: https://twitter.com/kidney_boy/status/1398660927680036865?s=20 Doctors that played D&D (i.e. control group): https://twitter.com/kidney_boy/status/1398661170328899586?s=20 Average sodium intake among Americans is 3,400 mg (147 mEq of Na per day). Sodium and the Dietary Guideline Factsheet (PDF) DASH Sodium Diet Trial https://www.nejm.org/doi/10.1056/NEJM200101043440101 The PURE Trial as discussed by NephJC and as seen in the NEJM Formulas to Estimate Dietary Sodium Intake From Spot Urine Alter Sodium-Mortality Relationship https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.119.13117 The Taiwan Nursing Home study: https://pubmed.ncbi.nlm.nih.gov/16762939/ Peruvian Cluster RCT of sodium reduction in Nature (oooh!) https://www.nature.com/articles/s41591-020-0754-2 DASH Diet in CKD https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4957723/ A comparison of treating metabolic acidosis in CKD stage 4 hypertensive kidney disease with fruits and vegetables or sodium bicarbonate https://pubmed.ncbi.nlm.nih.gov/23393104/ ACCORD https://www.nejm.org/doi/full/10.1056/nejmoa1001286 Kidney Damage Biomarkers and Incident CKD During Blood Pressure Reduction: A Case-Control Study within SPRINT https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6953744/ Association of Urinary Biomarkers of Inflammation, Injury, and Fibrosis with Renal Function Decline: The ACCORD Trial https://pubmed.ncbi.nlm.nih.gov/27189318/ Lake Wobegon https://en.wikipedia.org/wiki/Lake_Wobegon SPRINT https://www.nejm.org/doi/full/10.1056/nejmoa1511939 Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia https://jamanetwork.com/journals/jama/fullarticle/2723256 Characterizing Frailty Status in the Systolic Blood Pressure Intervention Trial https://pubmed.ncbi.nlm.nih.gov/26755682/ Syncope, Hypotension, and Falls in the Treatment of Hypertension: Results from the SPRINT Randomized Clinical Trial https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8045467/ The USPSTF recommends screening for hypertension in adults 18 years or older with office blood pressure measurement (OBPM). The USPSTF recommends obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/hypertension-in-adults-screening Concordance Between Blood Pressure in the Systolic Blood Pressure Intervention Trial and in Routine Clinical Practice https://pubmed.ncbi.nlm.nih.gov/33044494/ | |||
| 23 Oct 2021 | Freely Filtered 038: AURORA1, a new treatment for Lupus Nephritis | 01:27:11 | |
The Filtrate: Joel Topf Swapnil Hiremath Nayan Arora Jennie Lin Joshua Waitzman Special Guests Alfred Kim assistant Professor at Washington University, director of the lupus clinic. Receives support from Arena Pharmaceuticals, manufacturer of volcloosporin, or at least he did before this episode aired. Dawn Castor assistant professor at The University of Louisville School of Medicine. She is on the speaker bureau for Arena Pharmaceuticals, manufacturer of volcloosporin. She was a site principle investigator (PI) as well as an author of the trial. Editor Nayan Arora Show Notes: NIH Cyclophosphamide trial, long term follow-up: Combination therapy with pulse cyclophosphamide plus pulse methylprednisolone improves long-term renal outcome without adding toxicity in patients with lupus nephritis. Other important publications on this trial include: Therapy of lupus nephritis. Controlled trial of prednisone and cytotoxic drugs NEJM 1986 Controlled trial of pulse methylprednisolone versus two regimens of pulse cyclophosphamide in severe lupus nephritis Lancet 1992 Voclosporin is approved by FDA in January 2021 Previous Lupus Nephritis podcast with Dawn and Alfred: Freely Filtered 029: Belimumab for lupus nephritis Rituximab în Lupus. The LUNAR Trial (Spoiler, it didn’t work): Efficacy and safety of rituximab in patients with active proliferative lupus nephritis: the Lupus Nephritis Assessment with Rituximab study Conclusion The interpretation of renal biopsy in lupus nephritis is poorly reproducible, causing serious doubts about its validity and its clinical application. As it can lead to serious diagnosis, treatment and prognosis errors, it is necessary to intensify research in this field. The ALMS trials of mycohenolate mofetil (MMF) trials in lupus nephritis Induction: Mycophenolate Mofetil versus Cyclophosphamide for Induction Treatment of Lupus Nephritis (JASN 2009) Maintenance: Mycophenolate versus Azathioprine as Maintenance Therapy for Lupus Nephritis (NEJM 2011) Jacob deGrom on the mound. Baseball Reference. DeGrom is a two time Cy Young award winner, a 4-time All-Star and former Rookie of the Year winner. AURORA2: Aurinia Renal Assessments 2: Aurinia Renal Response in Lupus With Voclosporin (ClinicalTrials.gov) KDIGO 2021 Glomerulonephritis Guidelines Daily aspirin vs placebo for suspected acute myocardial infarction is highly protective except for patients born under Libra or Gemini. Current misconception 3: that subgroup-specific trial mortality results often provide a good basis for individualising patient care Multitarget therapy for induction treatment of lupus nephritis: a randomized trial. Patient Benefits Justify Price of New Lupus Nephritis Drugs “The estimated annual price of belimumab is approximately $43,000 per patient; the estimated annual price for voclosporin is approximately $92,000 per patient.” Dr. Glaucomflecken on Twitter Cardiology vs Nephrology Round 1 Nephrology vs Cardiology Round 2 In the Heights (Wikipedia) The Mitchells vs. the Machines (Wikipedia) | |||
| 21 Nov 2021 | Freely Filtered 039: The First Annual ASN #KidneyWk Draft | 01:10:18 | |
The Filtrate: Joel Topf Swapnil Hiremath Nayan Arora Jennie Lin Sophie Ambruso Editor Joel Topf Show Notes: Sign Up for NephSim Nephrons. Deadline 11/30. https://nephsim.com/nephsim-nephrons/ The Draft Board except for Swapnil’s picks because…Calvin Ball: https://docs.google.com/document/d/1Unk_27uqTpMGXrOyrxbI-2csKg2W_qnbbN7IE3wZY_Y/edit?usp=sharing Calvinball per the Calvin and Hobbes Wiki: Calvinball is a game invented by Calvin and Hobbes. Calvinball has no rules; the players make up their own rules as they go along, so that no Calvinball game is like another. https://www.polygon.com/comics/2020/5/13/21254476/calvin-and-hobbes-comic-strips-books-quarantine Swap’s Twitter Moment after he Tweeted all 28 Late Breaking and High Impact Clinical Trial Posters:https://twitter.com/i/events/1456347526936809480 Selena Gomez’s Kidney Transplant: https://www.youtube.com/watch?v=cMgfp0hu5lw and Kidney Transplant drama due to…Justin Bieber! https://www.koimoi.com/hollywood-news/selena-gomez-cut-ties-with-her-kidney-donor-francia-raisa-in-2018-the-reason-was-allegedly-related-to-justin-bieber/ | |||
| 25 Dec 2021 | Freely Filtered 040: Double CLICK for BP control in CKD stage 4 | 01:13:51 | |
The Filtrate: Joel Topf Swapnil Hiremath Jennie Lin (who was only there because her plans got boxed by covid) Jordy Cohen Josh Waitzman Special Guest: Rajiv Agarwal (@AgarwalRajivMD) Editor: Joel Topf Show Notes: NephJC discussion of CLICK: http://www.nephjc.com/news/click4chlorthalidone CLICK Visual abstract: http://www.nephjc.com/news/2021/12/7/the-click-visual-abstract Hawthorne effect: https://en.wikipedia.org/wiki/Hawthorne_effect A nice discussion run in periods in clinical trials: http://www.nephjc.com/news/run-in-period The ABCD trial Agarwal used to describe the need for a beta blocker to enroll in the trial, but it looks like a review article https://pubmed.ncbi.nlm.nih.gov/12574784/ Canadian trial showing that atenolol did as well as evidence based beta blockers: https://pubmed.ncbi.nlm.nih.gov/31495887/ Associated editorial by Agarwal: https://pubmed.ncbi.nlm.nih.gov/31578572/ Meta-analysis of dose-response relationships for hydrochlorothiazide, chlorthalidone, and bendroflumethiazide on blood pressure, serum potassium, and urate by Mark A Peterzan https://pubmed.ncbi.nlm.nih.gov/22547443/ HCTZ vs Chlorthalidone compete to the death: VA CSP Study No. 597: Diuretic Comparison Project https://www.research.va.gov/programs/csp/597/default.cfm Effectiveness versus Efficacy Trials: https://www.ncbi.nlm.nih.gov/books/NBK44024/ Foundation on Apple TV+: https://www.indiewire.com/2021/09/foundation-review-apple-tv-plus-sci-fi-adaptation-1234666972/ The Expanse on Amazon Prime: https://en.wikipedia.org/wiki/The_Expanse_(TV_series) The Beatles: Get Back on Disney+: https://en.wikipedia.org/wiki/The_Beatles:_Get_Back School of chocolate on Netflix: https://www.themarysue.com/school-of-chocolate/ And Just Like That... on Disney+: https://en.wikipedia.org/wiki/And_Just_Like_That... Past-president of AHA forced to make a statement about the Sex and the City episode: https://twitter.com/NMCardioVasc/status/1471627453885997068 https://twitter.com/NMCardioVasc/status/1471817955344371717 Chris Noth is a bad guy and how Peloton dealt with this. https://variety.com/2021/digital/news/peloton-deletes-chris-noth-ad-sexual-assault-allegations-1235135264/ Apply for the NSMC Social Media Internship: https://www.nsmc.blog | |||
| 21 Feb 2022 | Freely Filtered 041: Top Nephrology Stories of 2021 | 00:50:26 | |
The Filtrate: Joel Topf Swapnil Hiremath Matt Sparks Editor: Joel Topf Show Notes: The 2010 RFN Top Nephrology Stories The 2021 NephJC Top Nephrology Stories Number 10: AKIKI Number 9: Effect of Salt Substitution on Cardiovascular Events and Death The Salt Substitute and Stroke Study (SSaSS) in the NEJM The Salt Substitute and Stroke Study (SSaSS) in NephJC FDA Issues Final Guidance Regarding Use of an Alternate Name for Potassium Chloride in Food Labeling Number 8: AURORA, voclosporin for Lupus Nephritis Efficacy and safety of voclosporin versus placebo for lupus nephritis (AURORA 1) in the Lancet Number 7: FIGARO trial of finerenone for CV outcomes Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes in the NEJM Rates of Hyperkalemia after Publication of the Randomized Aldactone Evaluation Study by David Juurlink Joel’s intermission FDA Rejections Number 6: Pig Kidney Transplant. As covered in the New York Times Clinical Pig Kidney Xenotransplantation: How Close Are We? from JASN Number 5: KDIGO Blood Pressure Guidelines And on Freely Filtered Matt’s article on ACCORD he wrote for RFN as a fellow Number 4: Chlorthalidone for Hypertension in Advanced Chronic Kidney Disease (CLICK) Number 3: Dapagliflozin helps IgA nephropathy FDA OKs First Proteinuria Drug for IgA Nephropathy: delayed released budesonide Number 2: New eGFR formulas, now race free. New Creatinine- and Cystatin C–Based Equations to Estimate GFR without Race in the NEJM Number 16: Fixing ADPKD in mice Renal plasticity revealed through reversal of polycystic kidney disease in mice in Nature Genetics Press release from Yale Number 1: KDIGO GN Guidelines Last Month in Nephrology skeptical of all the Rituximab Tubular Secretions | |||
| 27 Feb 2022 | Freely Filtered 042: Nephrin Antibodies Cause Minimal Change Disease. Wait...What? | 01:17:58 | |
The Filtrate: Joel Topf Jennie Lin Joshua Waitzman Nayan Arora Sophia Ambruso Special Guest: Astrid Weins (@AstridWeins) renal pathologist at the Brigham and Woman’s Hospital and Harvard Medical School Editor: Nayan Aurora Show Notes: Summary of minimal change disease according to the orthodoxy: Light microscopy of renal biopsy specimens from patients with MCD shows minimal to no change; however, electron microscopy reveals the effacement of podocyte foot processes. To add to the conundrum, immunofluorescent staining of biopsy specimens is negative, and no immune complexes are evident. Minimal change disease and idiopathic FSGS: manifestations of the same disease New Views of the Glomerulus: Advanced Microscopy for Advanced Diagnosis Imaging of the Porous Ultrastructure of the Glomerular Epithelial Filtration Slit Measles in the Nephrotic Syndrome NEPTUNE: NEPhrotic syndrome sTUdy NEtwork Congenital nephrotic syndrome and recurrence of proteinuria after renal transplantation Most of these patients have a homozygous truncating mutation (Fin-major mutation) in the nephrin gene (NPHS1), leading to total absence of the major podocyte protein, nephrin. After RTx, these patients develop anti-nephrin antibodies resulting in nephrotic range proteinuria. Nephrotic syndrome relapse in a boy with COVID-19 Dr. Laurence Beck and the discovery of Phospholipase A2 Receptor as Target Antigen in Idiopathic Membranous Nephropathy as published in the NEJM. Cheer Season 2 now on Netflix Cloud Cuckoo Land: A Novel by Anthony Doerr | |||
| 19 Mar 2022 | Freely Filtered 043: NephMadness and Animal House | 01:00:40 | |
The Filtrate: Joel Topf Joshua Waitzman Nayan Arora Sophia Ambruso Jordy Cohen Special Guest: Kelly Hyndman Editor: Joel Topf PodCrawl Monday, March 14: The Curbsiders An Internal Medicine Podcast…for the Internist. This episode will focus on the Cardiorenal region with Game Maker, Joel Topf @Kidney_Boy, and Selection Committee Member, Sadiya Khan @HeartDocSadiya. Tuesday, March 15: The Drs. Washington The Drs. Washington are three sister physicians who discuss their story and the stories of minority physicians, tips for students interested in careers in medicine, and health-related topics. In this episode, Katie Rizzolo @katierizzolo and Dinushika Mohottige @DMohottige discuss social and physical determinants of health as well as governmental and institutional initiatives that affect health inequities in nephrology.Listen on Apple or Spotify Wednesday, March 16: The Cribsiders On this pediatric podcast, go deep into the Neonatal AKI bracket with the writer, Michelle Starr @mcstarr1. Thursday, March 17: Up My Nursing Game Up My Nursing Game is an educational nursing podcast that uses expert interviews to address common nursing questions and pitfalls. It offers free CE credits through VCU Health. This episode featuring Bourne Auguste @bourneauguste and Daniel Weiner @DanTheKidneyMan will focus on blood pressure and Dialysis. Friday, March 18: Best Science (BS) Medicine The Best Science Medicine podcast is all about helping primary care clinicians incorporate the best available evidence into their practice in order to help facilitate shared decision-making. In this episode, Game Makers Samira Farouk @ssfarouk and Matthew Sparks @Nephro_Sparks discuss the tricky issue of albuminuria – who to monitor, what to monitor, and who to treat. They spend a lot of time dribbling and end up deciding that nothing is a slam dunk, so stay until the end for a real buzzer beater. Saturday, March 19: Freely Filtered The Filtrate break down the Animal House region with Selection Committee Member Kelly Hyndman @DrKeeksPhD. Show Notes: Kelly Hyndman is an Assistant Professor of Medicine in the Section of Cardio-Renal Physiology and Medicine, Division of Nephrology, at the University of Alabama at Birmingham. She has trained both in comparative physiology and kidney physiology labs and is currently a principal investigator of a basic science lab with research interests in novel mechanisms of fluid-electrolyte balance. From Fish to Philosopher by Homer Smith. Review from 1954 in JAMA. Marine Iguana Visual Abstract by Sophie Animal House 2022 blog post by Tiffany Truong Giraffes sleep 4.6 hours a day. Behavioural sleep in the giraffe (Giraffa camelopardalis) in a zoological garden ManBearPig from South Park Emus, not mammels Climate Change Threats on Black Bears in California As Winter Warms, Bears Can’t Sleep. And They’re Getting Into Trouble. Fat Bear Week has a champion: All hail 480 Otis Stillsuit in Dune Freely Filtered 042: Nephrin Antibodies Cause Minimal Change Disease. Wait...What? A molecular mechanism explaining albuminuria in kidney disease American Heart Association Hypertension Podcast with Swapnil Hiremath and Carolyn Thomas The Trojan horse Affair podcast | |||
| 11 Apr 2022 | Freely Filtered 044: Pigs on the Wing: Xenotransplantation | 01:03:12 | |
The Filtrate: Joel Topf Joshua Waitzman Nayan Arora Jordy Cohen Special Guest: Josh Mezrich Editor: Nayan Arora Show Notes: When Death Becomes Life: Notes from a Transplant Surgeon. Amazon Am J Transplant 2022 Jan 20. doi: 10.1111/ajt.16930. PMID: 35049121 First transplant of a pig into a human. NYU transplant. Keith Reemtsma’s experience with chimpanzees transplantation: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1408776/?page=1 Infection of human cells by an endogenous retrovirus of pigs United Therapeutics page on xenokidney. Article by Starzl on the early days of kidney transplant, including David Humes experiment grafting kidneys to the arms and grafts of patients. The Early Days of Transplantation Patient in Groundbreaking Heart Transplant Dies Heterotopic heart transplantation: where do we stand? Denton Cooley and the first artificial heart transplant Blacksburg company raised genetically modified pig for first heart transplant into human Christiaan Barnard and the first human-to-human heart transplant Making The Impossible Possible: A Conversation With Martine Rothblatt. The founder of United Therapeutics and SiriusXM Paige Porrett, M.D., Ph.D. first author Jayme Locke, M.D., MPH senior author Louise Penny author page Joshua Malina, not the new cantor at Temple Israel. | |||
| 09 May 2022 | Freely Filtered 045: Salt Substitution and Stroke Study (SSaSS) | 01:09:24 | |
The Filtrate: Joel Topf Joshua Waitzman Nayan Arora Jennie Lin Sophia Ambruso Special Guest: Paul A Welling Editor: Sophia Ambruso Show Notes: Paul Welling’s tweetorial on the potassium switch The 2016 Canadian Hypertension guidelines were the first to suggest adding potassium: Hypertension Canada's 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension Swapnil’s Potassium Trial: Diet or additional supplement to increase potassium intake: protocol for an adaptive clinical trial When Food Firms Cut The Salt, What Do They Put In Instead? From NPR. Effect of lower sodium🧂 intake on health: systematic review and meta-analyses FDA Issues Final Guidance Regarding Use of an Alternate Name for Potassium Chloride in Food Labeling David Ellison and Paul Welling’s reviewing the NEJM: Insights into Salt Handling and Blood Pressure NephTrials on Cluster Randomized Trials: http://www.nephjc.com/news/clusterct Nu-Salt (KCl) 3 oz for $4.97 at Amazon (no afiliate link because we don’t have our act together) Salt for Life looks like it is 75% KCl 25% NaCl and it is 11.99 for 10.5 oz at Amazon (see above disclaimer) Bridgerton, only 8 episodes for Season 2 Inhibition of nonalcoholic fatty liver disease in mice by selective inhibition of mTORC1: The Paper | The Tweet Work in Josh’s lab. Get in touch: jswaitzm@bidmc.harvard.edu Open Educational Resources (OER) | |||
| 14 May 2022 | Freely Filtered 046: The ISPD Peritonitis Guideline Draft | 01:22:20 | |
The Filtrate: Joel Topf Nayan Arora Sophia Ambruso Swapnil Hiremath Special Guest: Jeff Perl, Great Twitter handle, PD_Perls Editor: Joel Topf Show Notes: ISPD 2022 Peritonitis Guidelines Dimitrios Oreopoulos obituary in JASN. Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis The draft board: Google Doc The PROMPT Study showing delayed peritonitis treatment increases the risk of treatment failure: The Relationship Between Presentation and the Time of Initial Administration of Antibiotics With Outcomes of Peritonitis in Peritoneal Dialysis Patients: The PROMPT Study Embedded PD catheters: Complications and catheter survival with prolonged embedding of peritoneal dialysis catheters Nikhil Shah asking questions about fungal prophylaxis Icodextrin antibiotic compatibility: Stability and compatibility of antibiotics in peritoneal dialysis solutions or in Tweet Form. Nikhil Shah on having antibiotics at home Tweet thread about the things we do for little reason regarding getting people listed for transplant. Regarding the trend in duration of antibiotics: Duration of Antibiotic Therapy: Shorter Is Better ‘Spelling the Dream’ Review: Netflix’s Inspiring Spelling Bee Doc Is an Unexpected Rallying Cry Home Dialysis University was May 1, 2 The Grand Canyon, second largest hole in the ground. | |||
| 29 Jun 2022 | Freely Filtered 047: CHAP, time to treat hypertension in pregnancy | 01:19:22 | |
The Filtrate: Joel Topf Nayan Arora Sophia Ambruso Swapnil Hiremath Josh Waitzman Special Guest: Natalie Bello Director of Hypertension Research at Cedars Sinai Editor: Nayan Arora Show Notes: CHIPS study: Less-Tight versus Tight Control of Hypertension in Pregnancy Prevention, Diagnosis, and Management of Hypertensive Disorders of Pregnancy: a Comparison of International Guidelines (Pubmed) SFLT in preeclampsia from where else but NephMadness and here. Aspirin Use to Prevent Preeclampsia and Related Morbidity and MortalityUS Preventive Services Task Force Recommendation Statement (JAMA) The NNT for aspirin in pregnancy is like a relationship on Facebook, it’s complicated. Astrologic signs as predictor of aspirin effectiveness in Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group (Pubmed) ACOG revises the guidelines on hypertension: Clinical Guidance for the Integration of the Findings of the Chronic Hypertension and Pregnancy (CHAP) Study Meta-analysis showing treating blood pressure in pregnancy didn’t help. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. | |||
| 01 Aug 2022 | Freely Filtered 048: Putting TESTING to the Test | 01:21:15 | |
The Filtrate: Joel Topf Swapnil Hiremath Josh Waitzman Jordy Cohen Special Guest: Sean Barbour. Clinical Associate Professor, Division of Nephrology, University of British Columbia Chair, BC Glomerulonephritis Committee and Network, BC Renal Editor: Joel Topf Show Notes: NephJC Summary of TESTING: Re-TESTING Steroids for IgA Nephropathy (have you ever noticed how good the titles for the NephJC summaries are?) TESTING in JAMA STOP-IgA NephJC Summary: Don't just do something, stand there. Another great title, this one from from a long time ago. The British Columbia GN network really owes its existence to TESTING: An overview of the British Columbia Glomerulonephritis network and registry: integrating knowledge generation and translation within a single framework (PubMed) Dunning–Kruger effect Wikipedia Prior Art for steroids in IgA nephropathy: Italian study: Randomized controlled clinical trial of corticosteroids plus ACE-inhibitors with long-term follow-up in proteinuric IgA nephropathy Another, earlier, Italian study: Corticosteroids in IgA nephropathy: a randomised controlled trial Original TESTING publication from 2017, also in JAMA. Oh, and we covered that in NephJC too, IgA Nephropathy: Testing Steroids Again. NephJC also talked about Sean Barbour’s risk score for IgA Nephropathy: Summary | Freely Filtered Podcast episode 5 A Controlled Trial of Fish Oil in IgA Nephropathy in the NEJM! Stevens-Johnson Syndrome. “When to see a doctor Stevens-Johnson syndrome requires immediate medical attention. Seek emergency medical care if you experience signs and symptoms of this condition.” Change in Albuminuria and GFR as End Points for Clinical Trials in Early Stages of CKD: A Scientific Workshop Sponsored by the National Kidney Foundation in Collaboration With the US Food and Drug Administration and European Medicines Agency (PubMed) Adaptive Trials in NephMadness 2016 with Selection Committee Member, Perry Wilson! The MEST score provides earlier risk prediction in lgA nephropathy Swap and Josh fight about SGLT2i in IgA Nephropathy Significance of serum galactose deficient IgA1 as a potential biomarker for IgA nephropathy: A case control study (PubMed) FDA approves first drug to decrease urine protein in IgA nephropathy, a rare kidney disease. FDA has granted accelerated approval for budesonide delayed release capsules to reduce proteinuria in adults with primary IgA nephropathy at risk of rapid disease progression. It has not been established whether budesonide delayed release capsules slow kidney function decline in patients with IgA nephropathy. Targeted-release budesonide versus placebo in patients with IgA nephropathy (NEFIGAN): a double-blind, randomised, placebo-controlled phase 2b trial (Lancet) Prescribing Nirmatrelvir/Ritonavir for COVID-19 in Advanced CKD by Swap Origins of Renal Physiology: Fellows 2022 Medical Students: Kidney TREKS Application of the International IgA Nephropathy Prediction Tool one or two years post-biopsy (Kidney International) The Triple Crown in Virginia | |||
| 13 Sep 2022 | Freely Filtered 049: Getting Salty with SODIUM-HF | 01:11:32 | |
The Filtrate: Joel Topf Swapnil Hiremath Josh Waitzman Sophia Ambruso Special Guests: Boback Ziaeian @boback Assistant Professor of Medicine David Geffen School of Medicine at UCLA. His Google Schoolar page is better than yours. And returning for her third time (why sdo we keep inviting her back?) Editor: Sophia Ambruso Donate to NephJC Get your Freely Filtered Mug by becoming a Freely Filtered Fan, all proceeds go to NephJC. All donations are tax deductible in the U.S. http://www.nephjc.com/new-products/freely-filtered-fan If you want to support NephJC to a different tune than $200, take a look at the NephJC September Pledge Drive page. Show Notes: 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure says: Restricting dietary sodium is a common nonpharmacological treatment for patients with HF symptomatic with congestion, but specific recommendations have been based on low-quality evidence. Concerns about the quality of data regarding clinical benefits or harm of sodium restriction in patients with HF include the lack of current pharmacological therapy, small samples without sufficient racial and ethnic diversity, questions about the correct threshold for clinical benefit, uncertainty about which subgroups benefit most from sodium restriction, and serious questions about the validity of several RCTs in this area. However, there are promising pilot trials of sodium restriction in patients with HF. The AHA currently recommends a reduction of sodium intake to <2300 mg/d for general cardiovascular health promotion; however, there are no trials to support this level of restriction in patients with HF. Sodium restriction can result in poor dietary quality with inadequate macronutrient and micronutrient intake. Nutritional inadequacies have been associated with clinical instability, but routine supplementation of oral iron, thiamine, zinc, vitamin D, or multivitamins has not proven beneficial. The DASH diet is rich in antioxidants and potassium, can achieve sodium restriction without compromising nutritional adequacy when accompanied by dietary counseling, and may be associated with reduced hospitalizations for HF. This is 2a Class of Recommendation (moderate strength) with a C-LoD level of evidence (Limited data). Study acronym: the Study Of Dietary Intervention Under 100 Milimoles in Heart Failure. 100 mmol of sodium is 2300 mg Meta analysis of high versus low sodium diet pulled from Heart due to duplicated and missing data. Retraction Watch. 65 mmol of sodium is 1500 mg The trial design papers: Design and Region-Specific Adaptation of the Dietary Intervention Used in the SODIUM-HF Trial: A Multicentre Study and Rationale and design of the Study of Dietary Intervention Under 100 MMOL in Heart Failure (SODIUM-HF) 3-day food diaries underestimate sodium intake vs 24 hour urine - and this is worse for patients on loop diuretics: Evaluation of 2 methods for sodium intake assessment in cardiac patients with and without heart failure: the confounding effect of loop diuretics PREDIMED trial of Mediterranean diet: retracted, republished, still trusted? DASH Diet trial where they gave food to the participants Effects on Blood Pressure of Reduced Dietary Sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet Medical Therapy for Heart Failure With Reduced Ejection Fraction: The CHAMP-HF Registry Cardiologist Sues Epic Over Copyright Infringement 6-minute walking test: a useful tool in the management of heart failure patients Frank Harrell on Statistical Errors in the Medical Literature A-HeFT: Combination of Isosorbide Dinitrate and Hydralazine in Blacks with Heart Failure TOPCAT: Spironolactone for Heart Failure with Preserved Ejection Fraction SSaSS: Effect of Salt Substitution on Cardiovascular Events and Death Mini Cooper SE Electric hardtop 2 door Taylor Swift can't stop emitting CO2 with her private plane. The Captain (miniseries) Nope. The Mystery of Why Some People Don’t Get Covid For All Mankind (TV series) | |||
| 08 Oct 2022 | Freely Filtered 050: CLASSIC Trial | 01:29:35 | |
The Filtrate: Joel Topf Swapnil Hiremath Jennie Lin Special Guests: Priya Yenebere @PriRenalAKI Transplant nephrologist at Indiana University School of Medicine. She is a current NSMC Intern. J Pedro Teixeira @NephCrit_NM ICU Nephrologist at the University of New Mexico. Editor: Priya Yenebere
Critical Care Nephrology Critical Care Nephrology: Core Curriculum 2020 by Benjamin R Griffin, Kathleen D Liu, and J Pedro Teixeira. Critical Care Rheumatology Dual-Trained Rheumatologists Take Multidisciplinary Approach to Their Patients Med-Peds to Nephrology Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock by Emanuel Rivers ProMISe: Trial of Early, Goal-Directed Resuscitation for Septic Shock ARISE: Goal-Directed Resuscitation for Patients with Early Septic Shock ProCESS: A Randomized Trial of Protocol-Based Care for Early Septic ShockThe Filtrate: Rinaldo Bellomo and micro circulatory disorders as cause of AKI in sepsis. Septic acute kidney injury: new concepts Comparison of Two Fluid-Management Strategies in Acute Lung Injury (FACTT) The negative trial we accept as a positive trial because of the secondary outcomes. The prime minister of Finland was caught on the dance floor. This is a bad thing? (NY Times) Deferred Consent: A New Approach for Resuscitation Research on Comatose Patients Lactate conversion MediCalc The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) Critical Care Reviews Podcast: CLASSIC Trial Results Presentation What is the most George Constanza-esque reason you broke up with someone? (reddit) The Importance of Fluid Management in Acute Lung Injury Secondary to Septic Shock Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery in the NEJM. RELIEF, NephJC discussion Effect of an Early Resuscitation Protocol on In-hospital Mortality Among Adults With Sepsis and Hypotension: A Randomized Clinical Trial in JAMA FEAST Trial: Mortality after Fluid Bolus in African Children with Severe Infection Industry on HBO Sandman 2022 on Netflix Where did Liverpool FC go wrong with the 2021/2022 Premier League? (Quora) CRRT Academy at University of Alabama with 2020 Robert G. Narins Award Recipient: Ashita Tolwani, MD, MS (YouTube) Life as a Nephrologist podcast on CritCare Nephrology Continuous KRT: A Contemporary Review by J. Pedro Teixeira, Javier A. Neyra and Ashita Tolwani University of New Mexico Nephrology Program. Apply to their fellowship. The Pledge Drive is over, but you can always support NephJC. NephJC is a 501(3)c registered non-profit and all donations are tax deductible in the US. | |||
| 17 Oct 2022 | Freely Filtered 051: Pip Tazo and Vanco: Nephrotoxin or Not so toxic | 01:09:45 | |
The Filtrate: Joel Topf Swapnil Hiremath Nayan Arora Priya Yenebere Special Guests: Todd Miano, PharmD, PhD @Miano81 Assistant Professor of Epidemiology, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine.
Early Pip/Tazo article showing nephrotoxicity. Covered by NephJC Linazolid vs Vanco RCT showing excess AKI with Vanco. Yes Vance is a lot less toxic than it was in the Mississippi mud days but your attending telling you it is no longer nephrotoxic is wrong. Linezolid in methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a randomized, controlled study and Vancomycin and the Risk of AKI: A Systematic Review and Meta-Analysis. Vancomycin-Associated Acute Kidney Injury with a Steep Rise in Serum Creatinine Vancomycin-Associated Cast Nephropathy: Reality or Fantasy? Molecular Epidemiology of SepsiS in the ICU (MESSI) prospective cohort. Learn about it her: A multibiomarker-based outcome risk stratification model for adult septic shock* Cystatin C in acute kidney injury Changing Definitions of Sepsis Proposed new definitions of AKI incorporating biomarkers: Recommendations on Acute Kidney Injury Biomarkers From the Acute Disease Quality Initiative Consensus Conference. A Consensus Statement in JAMA Network Open Protective effect of piperacillin against nephrotoxicity of cephaloridine and gentamicin in animals PulmCrit – Myth-busting the conditional nephrotoxicity of piperacillin-tazobactam by Josh Farkas Sharp Objects on Good Reads The Ocean Course at Kiawah Island Golf Resort Be Real follow me: BeRe.al/kidney_boy SNL spoof of BeReal | |||
| 26 Nov 2022 | Freely Filtered 052: Acetazolamide for Acute Decompensated Heart Failure (ADVOR) | 01:09:56 | |
The Filtrate: Joel Topf Jordy Cohen Nayan Arora Sophia Ambruso Special Guests: Boback Ziaeian @boback Assistant Professor of Medicine David Geffen School of Medicine at UCLA returns for his second episode (SODIUM-HF). His Google Schoolar page is better than yours. David Ellison @dhekidney is professor of medicine at Oregon Health Science University and head of the Oregon Clinical & Translational Institute. Show Notes: Ultrafiltration in Decompensated Heart Failure with Cardiorenal Syndrome (The CARESS Trial) Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure (The UNLOAD trial) Diuretic Strategies in Patients with Acute Decompensated Heart Failure (The DOSE Trial) Diuretic Strategies for Loop Diuretic Resistance in Acute Heart Failure (The 3T Trial) Sequential nephron blockade with a thiazide diuretic has a 1 B-NR (non-radomized) grade in the AHA/ACC Heart Failure Guidelines (7.2) Three important acute decompensated heart failure with SGLT2i: 1. Sotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure (SOLOIST-WHF Trial) 2. The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure: a multinational randomized trial (The EMPULSE Trial) 3. Effects of Early Empagliflozin Initiation on Diuresis and Kidney Function in Patients With Acute Decompensated Heart Failure (EMPAG-HF) Cardiologist Sues Epic Over Copyright Infringement Outcomes associated with a strategy of adjuvant metolazone or high-dose loop diuretics in acute decompensated heart failure: a propensity analysis. Acetazolamide to increase natriuresis in congestive heart failure at high risk for diuretic resistance (PubMed) Efficacy and Safety of Spironolactone in Acute Heart Failure (ATHENA Trial) Joel with a video on acetazolamide for altitude sickness. The Butchering Art: Joseph Lister's Quest to Transform the Grisly World of Victorian Medicine(Amazon) | |||
| 11 Dec 2022 | Freely Filtered 053: The Kidney Week Draft | 01:04:34 | |
The Filtrate: Joel Topf Swapnil Hiremath Nayan Arora Sophia Ambruso Editor: Nayan Arora Show Notes: Joel’s Conflict of Interest Statement EMPA-Kidney is “off the board” Lunch Symposium on Current and Future Approaches to the Diagnostic Assessment and Management of AKI in Patients with Cirrhosis provided by an educational grant from Mallinckrodt Pharmaceuticals The CONFIRM Trial Terlipressin plus Albumin for the Treatment of Type 1 Hepatorenal Syndrome in NephJC Clinical Practice Session Leveraging Social Media to Create, Learn, Teach, Advocate, and Dispel Misinformation The BEST-Fluids Trial: A Randomized Controlled Trial of Balanced Crystalloid Solution vs. Saline to Prevent Delayed Graft Function in Deceased Donor Kidney Transplantation - Michael G. Collins, Magid Fahim, Elaine Pascoe, Carmel Hawley, David W. Johnson, Philip A. Clayton, Steven J. Chadban (ClinicalTrials.gov) The Late Breaking and High Impact Trials Session line up Stop ACEi Effects of Pantoprazole on Kidney Outcomes: Post Hoc Analyses From the COMPASS Randomized Controlled Trial by Lonnie Pyne, et al No Stone: Hydrochlorothiazide for the Prevention of Kidney Stone Recurrence by Daniel Foster, et al Clinical Practice Session Best of NephJC “We'd Now Like To Open The Floor To Shorter speeches disguised as questions.” ASN Task Force on the Future of Nephrology Attracting Osteopathic Medical Students Into Nephrology Hasan Minhaj’s joke at the expense of DOs TRANSFORM-HF: Torsemide vs. Furosemide in Treating Patients With HF Point-of-Care Ultrasound in Nephrology specifically VExUS | |||
| 25 Dec 2022 | Freely Filtered 054: EMPA Kidney! | 01:31:28 | |
The Filtrate: Joel Topf Swapnil Hiremath Josh Waitzman Sophia Ambruso Priya Yenebere With Special Guest: Brendon Neuen, Secretariat of the SGLT2 Trialists Consortium and cool guy on Twitter. Editor: Sophia Ambruso Show Notes: Joel’s Conflict of Interest Statement. Sophia is also conflicted with Astra Zeneca and Brendon with everybody in the SGLT2i space. Joel starts off with a history of SGLT2i EMPA-REG Outcomes. First! CANVAS. OMG this signal is reproducible! CREDENCE (🎧). It works in a dedicated population at high risk of kidney disease. And in a study designed for renal end-points. DAPA-CKD (🎧). It’s not just for diabetics! EMPA-Kidney. It works at really low GFR. And without albuminuria. And again in non-diabetics. SGLT Inhibitors for Type 1 Diabetes: Proceed With Extreme Caution Click to find the supplement (requires a subscription) EMPA-Kidney 40% DAPA-Kidney 50% CREDENCE doubling of serum Cr Usability Testing of a Sick-Day Protocol in CKD (Pubmed) New Guidelines for Statistical Reporting in the Journal (link, commentary on said guidelines by Frank Harrell) The Peripheral on Amazon Prime Unsealed the Tylenol Murders Podcast Project Hail Mary by Andrew Weir Lizzy McAlpine Singer Song Writer Rachel Maddow Presents: Ultra Twitter chaos continues. Get your Med-Mastodon handle | |||
| 29 Jan 2023 | Freely Filtered 055: STOP ACE! | 01:18:12 | |
The Filtrate: Joel Topf Swapnil Hiremath Jordy Cohen With Special Guest: Laurie Tomlinson. @Roxytonin Nephrologist at University Hospitals Sussex and research hero of Jordy. Editor: Priya Yenebere Show Notes: STOP-ACE in pubmed: Renin-Angiotensin System Inhibition in Advanced Chronic Kidney Disease STOP-ACE Summary in NephJC Prior data showing preservation of renal function by stopping ACEi: The impact of stopping inhibitors of the renin-angiotensin system in patients with advanced chronic kidney disease Efficacy and Safety of Benazepril for Advanced Chronic Renal Insufficiency: NEJM Dr. Tomlinson’s article on creatinine changes in RASi from 2017: Serum creatinine elevation after renin-angiotensin system blockade and long term cardiorenal risks: cohort study NephJC | PubMed Accuracy of eGFR at low GFR: A new equation to estimate glomerular filtration rate Strong opinions, loosely held. “Permissive AKI” with treatment of heart failure. Editorial by Chirag Parish and Steven Coca The rational for NICE avoiding RASi in black patients: Hypertension and ethnic group AASK trial showing superiority of RASi in African Americans. JAMA ALLHAT post-hoc analysis of outcomes by self-reported race. JAMA | PubMed Sophisticated Swedish observational study that Swap loved. Stopping Renin-Angiotensin System Inhibitors in Patients with Advanced CKD and Risk of Adverse Outcomes: A Nationwide Study Target Trials in Nephrology Dr Edouard Fu grand rounds at Ottawa Nephrology, YouTube Target Trial EmulationA Framework for Causal Inference From Observational Data by Miguel Hernán in JAMA Tubular Secretions Jordy: Third season of His Dark Materials on HBO Swap: Movies by Wes Anderson on Disney Plus Laurie: The Book, “Nearly All the Men in Lagos are Mad” Jordy: How Medicine Works and When It Doesn't: Learning Who to Trust to Get and Stay Healthy | Amazon Joel EO | NYT Review | |||
| 07 Feb 2023 | Freely Filtered 056: MyTEMP | 01:21:21 | |
The Filtrate: Joel Topf Swapnil Hiremath Nayan Arora Sophia Ambruso With Special Guest: Amit Garg @AmitXGarg, Nephrologist at Western University, London, and lead PI of the MYTEMP trial. Editor: Joel Topf Show Notes: MyTEMP in pubmed: Personalised cooler dialysate for patients receiving maintenance haemodialysis (MyTEMP): a pragmatic, cluster-randomised trial MyTEMP Summary on NephJC It’s really cold in Ontario The NephTrials blog summary on Pragmatic Trials The pragmatic TiME trial on longer time on dialysis (ahem, sabotaged by site investigators like Joel who cut dialysate time) Dember et al in JASN Poor quality of trial data preceding MyTEMP, a systematic review from Mustafa et al in JASN The 2007 European Best Practice Guideline (EBPG) from 2007, recommending “Cool dialysate temperature dialysis (35–36°C) or isothermic treatments by blood temperature controlled feedback should be prescribed in patients with frequent episodes of IDH (Evidence level I).” in NDT 47% of centres from a DOPPS study of 273 centers routinely use of lower dialysate temperature, Dasgupta et al in JASN How do you convert from C to F? Almanac.com (35.5 C is 96.9 F; 37 C is 98.6 F) More on the rationale and design of MyTEMP: Al-Jaishi et al in CJKHD How big is 4.3 million (the number of hemodialysis treatments in MyTEMP)? Very big indeed. NephJC discussion of another cluster RCT and granular data only on a subset SSASS Participants in dialysis clinical trials are not representative of the real world dialysis cohorts, Smyth et al in JAMA Int Med Peritoneal dialysis numbers in Ontario are high, Blake et al in PDI, though with ~ 60% CVC rates, Blake et al in Kidney360 Dialysate Magnesium #DreamRCT from Swap, NephTrials discussion of DialMag Statistical analysis plan of MyTEMP, Dixon et al in CJKHD Tubular Secretions Swap: Watch Everything, Everywhere All At Once on Prime Nayan: Read The Midnight Ride from Ben Mezrich (brother of Josh Mezrich from the NephJC Summer Book Club 2021) Sophia: Making nephrology education fun at the UC Denver Amit: The wrestling team at Western U from 1990-91 Joel: House of the Dragon on HBO Max | |||
| 01 Mar 2023 | Say "Hi" to the #NephMadness PodCrawl | 00:01:16 | |
Welcome to the NephMadness PodCrawl The idea behind a podcrawl is for a variety of podcasts to coordinate on timing and topic to push a theme and get each other’s listeners to explore all of the podcasts. One of the first goals behind NephMadness was to build a community and in the early years of Twitter, NephMadness was central to the formation of #NephTwitter and defining the ethos that makes our online community kind, intelligent, vibrant, and interesting. The NephMadness Podcrawl hopes to inspire and grow the nephrology podcast community in the same way. For 2023, our second year, the PodCrawl has assembled the Avengers of Medical Pods! Go to NephMadness.com/podcrawl for more information and links to all of the podcasts! Core IM will be covering Kidney Transplant in their classic Five Pearl format The CardioNerds will be covering the effect of Heart Failure Devices on Kidney Health Freely Filtered will try to understand thrombotic microangiopathy ISN Global Kidney Care goes deep on IgA nephropathy The Cribsiders look at transitions, first the Peditrics to Adult nephrology transition and then from living to death with palliative nephrology Fellow on Call will be covering Onconephrology And finally, The Nephron Segment looks at Transgender Health and CKD | |||
| 11 Mar 2023 | Freely Filtered 057: NephMadness 2023 TMA | 01:21:41 | |
The Filtrate: Joel Topf Swapnil Hiremath Josh Waitzman Sophia Ambruso With Special Guest: Anna Vinakova Associate Professor of Medicine at Virginia Commonwealth University. NephMadness Executive. Vanuja Java is a transplant nephrologist at Washington University in St. Louis, MO. Her research involves functional characterization of genetic variants in complement-mediated diseases. She co-chairs the ClinGen complement gene curation expert panel. Editor: Sophia Ambruso Show Notes: #NephMadness 2023: Thrombotic Microangiopathy Region TMA Review article in the NEJM from 2014: Syndromes of Thrombotic Microangiopathy Dr. Anuja Java Co-chairs Working Group in an International Committee for Revising aHUS Nomenclature Nephrology Secrets 4th Edition at Amazon University of Iowa Genetic testing for aHUS Early Eculizumab Withdrawal in Patients With Atypical Hemolytic Uremic Syndrome in Native Kidneys Is Safe and Cost-Effective: Results of the CUREiHUS Study. KI reports. This is the Netherlands study. They used home urine dipsticks to monitor for relapses. Clinical promise of next-generation complement therapeutics Nature reviews. Drug Discovery Tubular Secretions Swap: Neuromancer and the works of William Gibson (@GreatDismal) Sophia: The Magicians on Netflix Anna: Recommends nephrology. Says it is awesome. Anuja: Dope Sick on Hulu and Women in Nephrology mentor program Josh: Mobituaries with Mo Rocca. Specifically “Death of a Banana” Joel: Ivory by TapBot | |||
| 25 Jun 2023 | Freely Filtered 060: HCTZ v Kidney Stones, The NOSTONE trial | 01:42:42 | |
The Filtrate: Joel Topf Swapnil Hiremath Josh Waitzman Nayan Arora Sophia Ambruso With Special Guest: Megan Prochaska Assistant professor of medicine at University of Chicago John Asplin Medical Director Consultant LithoLink (Twitter) Editor: Joel Topf Show Notes: The LithoLink website Stone Camp tweet Prevention of Repeated Episodes of Kidney Stones in Adults: A Clinical Practice Guideline From the American College of Physicians (link) NOSTONE in the NEJM and NephJC Fred Coe Google Scholar | YouTube | Blog Hypercalcuria. Curhan et al. 24-h uric acid excretion and the risk of kidney stones PubMed EQUIL2 software to evaluate urinary super saturation Anna Zisman Racial Differences in Risk Factors for Kidney Stone Formation (CJASN) Potassium Citrate on GoodRx Potassium and citrate by Fred Coe (blog) Thiazide Diuretics and Fracture Risk: A Systematic Review and Meta‐Analysis of Randomized Clinical Trials (PubMed) Chlorthalidone promotes mineral retention in patients with idiopathic hypercalciuria by Coe et al (PubMed) NHANES 24-hour urine Na (Abstract) Kidney Stone risk is reduced with empagliflozin (PubMed) Prospective trial to determine the effect of SGLT2i on urinary supersaturation (BMJ Open) GLP agonists and kidney stone risk
Tubular Secretions Swap: Star Wars: Thrawn Series by Timothy Zahn (Penguin Random House) Josh: Little League Megan: Renal related podcasts Sophia Renal Stone Camp and ABCKidney.com Nayan: Ted Lasso Robert Galbraithand The Comoran Strike Novels (home page) John: Fred Coe’s Blog Joel: Spiderman across the Spider-Verse (Wikipedia) | |||
| 03 Jul 2023 | Freely Filtered 059: Furosemide v Torsemide | 01:02:29 | |
The Filtrate: Joel Topf Nayan Arora Sophia Ambruso With Special Guest: Boback Ziaeian @boback Assistant Professor of Medicine David Geffen School of Medicine at UCLA. His Google Schoolar page is better than yours. And returning for her fourth time (why do we keep inviting her back?) Editor: Priya Yenebere Show Notes: Diuretic Therapy review by. Craig Brater NEJM The manuscript in JAMA | NephJC Metoprolol vs Carvedilol: Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial (Lancet) EMPULSE: The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure: a multinational randomized trial (Nature Medicine) Effect of Aliskiren on Postdischarge Mortality and Heart Failure Readmissions Among Patients Hospitalized for Heart Failure The ASTRONAUT Randomized Trial Effects of Oral Tolvaptan in Patients Hospitalized for Worsening Heart Failure The EVEREST Outcome Trial Sophia ended up placing fifth in NephMadness 2023. (Link) Joel finished 697th After winning in the opening round, Northwestern lost to UCLA, in the second round of the March Madness tournament, 68-63. Torsemide to furosemide equivalents CardioMems positive trial: Sustained efficacy of pulmonary artery pressure to guide adjustment of chronic heart failure therapy: complete follow-up results from the CHAMPION randomised trial (The Lancet) CardioMems negative trial: Haemodynamic-guided management of heart failure (GUIDE-HF): a randomised controlled trial (The Lancet) Estimation of the Absolute Risk of Cardiovascular Disease and Other Events: Issues With the Use of Multiple Fine-Gray Subdistribution Hazard Models (Circulation) Torasemide in chronic heart failure: results of the TORIC study (PubMed) Tubular Secretions Nayan: Louise Penny A World of Curiosities: A Novel (Amazon) Sadiya: Ted Lasso season three Sophia:The Last of Us on HBO and SNL skit Mario Cart as Prestige Drama Boback: Duolingo for Japanese | |||
| 25 Sep 2023 | Freely Filtered 062: Inaxaplin for APOL1 Kidney Disease | 01:31:17 | |
The Filtrate: Joel Topf Jennie Lin Josh Waitzman With Special Guest: AC Gomez MedPeds nephrology fellow at Mass General/Brigham and Boston Children’s | Twitter Gentian Hall Assistant Professor of Medicine Duke Department of Medicine Editor: Sophia Ambruso Show Notes: APOL1 review by the OG Scientists APOL1 Nephropathy: From Genetics to Clinical Applications MYH9 and APOL1 connection: The population genetics of chronic kidney disease: insights from the MYH9–APOL1 locus Worldwide Frequencies of APOL1 Renal Risk Variants (NEJM) Kidney Disease-Associated APOL1 Variants Have Dose-Dependent, Dominant Toxic Gain-of-Function End-Stage Renal Disease in African Americans With Lupus Nephritis Is Associated With APOL1 HEK293 Cells Wikipedia Tubular Secretions Josh: From Serial and the New York Times: The Retrievals Jennie: Marathon induced hyponatremia (NEJM) Gentian: Vivien Thomas wikipedia. HBO Movie: Something the Lord Made AC: Talking to the FDA about SGLT2i Tweet Joel: NephJC 2023 Fund drive | |||
| 24 Sep 2023 | Freely Filtered 061: Bicarb in Transplant | 01:18:11 | |
Bicarbonate did not slow the loss of GFR in this well done Swiss, single-blind study of transplant patients. The Filtrate: Joel Topf Nayan Arora Swapnil Hiremath Pirya Yenebere With Special Guest: Nav Tangri nephrologist and epidemiology at the University of Manitoba Editor: Nayan Arora Show Notes: The London study that kicked it all off! de Brito-Ashurst, I., Varagunam, M., Raftery, M. J., & Yaqoob, M. M. (2009). Bicarbonate supplementation slows progression of CKD and improves nutritional status. Journal of the American Society of Nephrology: JASN, 20(9), 2075–2084. The multi center (but unblinded) UBI Study with mortality benefit! Di Iorio, B. R., Bellasi, A., Raphael, K. L., Santoro, D., Aucella, F., Garofano, L., Ceccarelli, M., Di Lullo, L., Capolongo, G., Di Iorio, M., Guastaferro, P., Capasso, G., & UBI Study Group. (2019). Treatment of metabolic acidosis with sodium bicarbonate delays progression of chronic kidney disease: the UBI Study. Journal of Nephrology, 32(6), 989–1001. The BiCARB Study: Double blinded and negative BiCARB study group. (2020). Clinical and cost-effectiveness of oral sodium bicarbonate therapy for older patients with chronic kidney disease and low-grade acidosis (BiCARB): a pragmatic randomised, double-blind, placebo-controlled trial. BMC Medicine, 18(1), 91. The initial Veverimer Study Wesson, D. E., Mathur, V., Tangri, N., Stasiv, Y., Parsell, D., Li, E., Klaerner, G., & Bushinsky, D. A. (2019). Long-term safety and efficacy of veverimer in patients with metabolic acidosis in chronic kidney disease: a multicentre, randomised, blinded, placebo-controlled, 40-week extension. In The Lancet (Vol. 394, Issue 10196, pp. 396–406). doi.org/10.1016/s0140-6736(19)31388-1 The Valor CKD trial is still unpublished. But here is the press release. VALOR-CKD design manuscript The study of the night: Sodium bicarbonate for kidney transplant recipients with metabolic acidosis in Switzerland: a multicentre, randomized, single-blind, placebo-controlled, phase 3 trial Alkali with normal bicarb? Sure, take a look at: Goraya, N., Simoni, J., Jo, C., & Wesson, D. E. (2012). Dietary acid reduction with fruits and vegetables or bicarbonate attenuates kidney injury in patients with a moderately reduced glomerular filtration rate due to hypertensive nephropathy. Kidney International, 81(1), 86–93. Metforminator! The BASE Trial: Raphael, K. L., Isakova, T., Ix, J. H., Raj, D. S., Wolf, M., Fried, L. F., Gassman, J. J., Kendrick, C., Larive, B., Flessner, M. F., Mendley, S. R., Hostetter, T. H., Block, G. A., Li, P., Middleton, J. P., Sprague, S. M., Wesson, D. E., & Cheung, A. K. (2020). A Randomized Trial Comparing the Safety, Adherence, and Pharmacodynamics Profiles of Two Doses of Sodium Bicarbonate in CKD: the BASE Pilot Trial. Journal of the American Society of Nephrology: JASN, 31(1), 161–174. Tubular Secretions Swap The Three-Body Problem (novel) | Netflix Nayan Women’s World Cup Tangri English Premier Soccer and Inflation Priya Silo on Apple TV | |||
| 03 Nov 2023 | Freely Filtered 063: Late Breaking and High Impact Clinical Trial Simultaneous Release! | 02:05:22 | |
The Filtrate: Joel Topf Swapnil Hiremath Sophia Ambruso AC Gomez With Special Guest: Amit Garg (@AmitXGarg) Nephrologist at Western University, London, and lead PI of the EnAKT LKD trial. Susan Q. McKenzie (LinkedIn) Co-Founder & Chair, Transplant Ambassador Program. President of the Kidney Patient and Donor Alliance of Canada. Editor: Joel Topf Show Notes: Late Braking and High Impact Clinical Trial press release MyTEMP trial Personalised cooler dialysate for patients receiving maintenance haemodialysis (MyTEMP): a pragmatic, cluster-randomised trial (PubMed | NephJC | Freely Filtered) Transplant is cheaper! An economic assessment of contemporary kidney transplant practice (PDF) Transplant is better! Survival for waitlisted kidney failure patients receiving transplantation versus remaining on waiting list: systematic review and meta-analysis (PubMed) Transplant disparities Association of Race and Ethnicity With Live Donor Kidney Transplantation in the United States From 1995 to 2014 (PubMed) MUC1 Kidney Disease Autosomal Dominant Tubulointerstitial Kidney Disease: An Emerging Cause of Genetic CKD (Kidney International Reports) This study has all the adjectives: “We conducted a pragmatic, two-arm, parallel-group, open-label, registry-based, superiority, cluster- randomized clinical trial.” Explore Transplant by Amy Waterman, PhD Kidney Failure Risk Equation A Predictive Model for Progression of Chronic Kidney Disease to Kidney Failure (JAMA | Calculator) The complete protocol A Quality Improvement Intervention to Enhance Access to Kidney Transplantation and Living Kidney Donation (EnAKT LKD) in Patients With Chronic Kidney Disease: Clinical Research Protocol of a Cluster-Randomized Clinical Trial (PDF) Pre-published statistical plan Enhance Access to Kidney Transplantation and Living Kidney Donation (EnAKT LKD): Statistical Analysis Plan of a Registry-Based, Cluster-Randomized Clinical Trial (PubMed) Hawthorne effect (Wikipedia) The Advancing American Kidney Health Initiative “Aim for 80% of new American ESRD patients in 2025 receiving either home dialysis or a transplant” (NKF) Tubular Secretions Swapnil The Time Travelers Wife by Audrey Niffenegger (Wikipedia) and HBO movie of the same name (Wikipedia). Sophia The Wheel of Time streaming on Amazon (Wikipedia) based on the series of books of the same name by Robert Jordan and Brandon Sanderson. Susan The Woman Who Loved Giraffes movie (Website) Amit Canadians cannot get Visas to visit India (Reuters) AC Eagles are good at Football (Fox Sports) and Alport Connect Meeting in San Diego (Alport Syndrome Foundation Website) Joel Live podcast recording at Kidney Week (NephJC) | |||
| 12 Nov 2023 | Freely Filtered 064: Freely Filtered with The Curbsiders Live at Kidney Week! | 01:32:08 | |
The Filtrate: Joel Topf Swapnil Hiremath Sophia Ambruso AC Gomez Josh Waitzman Jennie Lin Nayan Arora The Curbsiders Matt F. Watto (@DoctorWatto) Paul Nelson Williams, America’s primary care physician (@PaulNWilliamz) With Special Guest: JD Foster (@KidneyVet) Sayed Tabatabai (@TheRealDoctorT) Nephrologist in Austin and the author of These Vital Signs Michelle Rheault (@rheault_m) Chief of Pediatric Nephrology at the University of Minnesota and lead author of the DUPLEX Trial Editor: Joel Topf Show Notes: Lily toxicity in the cat (PubMed) Surgeons perform kidney transplants in cats amid rising demand for advanced pet care (ABC News) Treatment of ibuprofen toxicity with serial charcoal hemoperfusion and hemodialysis in a dog (PubMed) Nephrology in Veterinary Medicine (Kidney 360) Star Wars Society of San Antonio (FaceBook) These Vital Signs (Amazon) Dr Tabatabai read a short story called The Handholder, here is the original tweet thread for that story (ThreadReader) The pearl not the patient (PubMed) Late Braking and High Impact Clinical Trial press release MENTOR, Rituximab or Cyclosporine in the Treatment of Membranous Nephropathy, was in 2019 not 2017 (NEJM) KALM-1, A Phase 3 Trial of Difelikefalin in Hemodialysis Patients with Pruritus, was in 2019 not 2017 (NEJM) Sophie’s number one pick: Efficacy and safety of sparsentan versus irbesartan in patients with IgA nephropathy (PROTECT): 2-year results from a randomised, active-controlled, phase 3 trial (Lancet) Patients in the sparsentan group had a slower rate of eGFR decline than those in the irbesartan group. eGFR chronic 2-year slope (weeks 6–110) was −2·7 mL/min per 1·73 m2 per year versus −3·8 mL/min per 1·73 m2 per year (difference 1·1 mL/min per 1·73 m2per year, 95% CI 0·1 to 2·1; p=0·037); total 2-year slope (day 1–week 110) was −2·9 mL/min per 1·73 m2 per year versus −3·9 mL/min per 1·73 m2 per year (difference 1·0 mL/min per 1·73 m2 per year, 95% CI −0·03 to 1·94; p=0·058). Clinical Trial Considerations in Developing Treatments for Early Stages of Common, Chronic Kidney Diseases: A Scientific Workshop Cosponsored by the National Kidney Foundation and the US Food and Drug Administration (AJKD) AC Gomez’s Pick: MDR-101-MLK Update: Operational Immune Tolerance Achieved in Living Related HLA-Matched Kidney Transplant Recipients (ASN-Online.org) Josh’s Pick: A Phase 2 Trial of Sibeprenlimab in Patients with IgA Nephropathy (NEJM) Nayan’s Pick: The EnAKT LKD Cluster Randomized Clinical Trial (JAMA Internal Medicine) The Freely Filtered simultaneous release (NephJC) Freely Filtered is now a verb. Swap’s Pick: Strategies for the Management of Atrial Fibrillation in PatiEnts Receiving Dialysis (SAFE-D) (ASN-Online.org) Joel’s Pick: AYAME Study: Randomized, Double-Blind, Placebo-Controlled Phase 3 Study of Bardoxolone Methyl in Diabetic Kidney Disease (DKD) Patients (ASN-Online.org) Reata is a no-show to the 2012 ASN Kidney Week (PBFluids) Michelle’s Pick: Sparsentan versus Irbesartan in Focal Segmental Glomerulosclerosis. The DUPLEX Study (NEJM) DUET: A Phase 2 Study Evaluating the Efficacy and Safety of Sparsentan in Patients with FSGS (PubMed) | |||
| 10 Feb 2024 | Freely Filtered 065: BEST Fluids | 01:10:36 | |
The Filtrate: Joel Topf Nayan Aurora Sophia Ambruso With Special Guest: Michael Collins Editor: Nayan Aurora Show Notes: Twitter is now X (NYT) Michael Collins (the astronaut, not the real one) PlasmaLyte by Baxter NephJC BEST Fluids summary Early Goal Directed Therapy for Sepsis NEJM manuscript which changed practice patterns and welcomed in an era of massive fluid resuscitation. PLUS Trial NEJM SPLIT Trial JAMA BaSICS NephJC Summary SALTED and SMART NephJC Summary Adaptive minimization wikipedia BEST Fluids in CLinicalTrials.gov Delayed Graft Function review in American Journal of Transplant Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis in NEJM Evidence A pragmatic, open-label, randomized controlled trial of Plasma-Lyte-148 versus standard intravenous fluids in children receiving kidney transplants (PLUTO) in Kidney International Tubular Secretion Nayan finally getting around to Succession on HBO Sophia autoimmune protocol diet Michael Stephen Fry reading Harry Potter | |||
| 28 Feb 2024 | Freely Filtered 66: NephJC Summer Book Club | 01:15:09 | |
How Medicine Works, and When It Doesn’t The Filtrate: With Special Guest: Editor: Joel Topf Show Notes Understanding Medical Research: Your Facebook Friend is Wrong. Coursera Illusory truth effect (Wikipedia) Number needed to treat (Wikipedia) NNT at MedPage Today: NNT on NephJC Deaths of Despair: Suicide (CDC 2001-2021) Drug Overdose (CDC 2001-2021) Steve Jobs delayed therapy for his treatable pancreatic cancer (ABC News) Residents are unionizing at Mass General Brigham. Here's what you need to know (WBUR) Pi and bouncing bricks (YouTube) Doctors in New Zealand—the only non-U.S. country that allows DTC advertising—call for bans (FiercePharma) The Surgisphere Scandal: What Went Wrong? (The Scientist) VITAL SIGNS: FERTILITY; A Study Links Prayer and Pregnancy (The New York Times) Researcher Pulls His Name From Paper on Prayer and Fertility (The New York Times) Tubular Secretions Josh: Glomerular Nephritis by Thomas Addis (Review in JAMA from 1948) Jennie: The Chicago Marathon Jade: The People’s Hospital (Amazon) Perry: Anathem by Neal Stephenson (Amazon) | |||
| 07 Mar 2024 | Freely Filtered 67: NephMadness and Animal House | 00:47:44 | |
Animal House Region NephMadness description by Tiffany Truong Editorial by Kelly Hyndman @DrKeeksPhD They May Look Cute, But Are All Animals Sweet? The Filtrate: Joel Topf Swapnil Hiremath Sophia Ambruso Josh Waitzman With Special Guest: Kelly Hyndman Editor: Sophia Ambruso Show Notes Animal House 2018 with Mark Zeidel, MD (AJKDblog) Animal House 2021 with Kelly Hyndman (AJKDBlog) Animal House 2022 with Kelly Hyndman (AJKDBlog) Mount Desert Island Summer Junket (Website) First person account go a Gila Monster bite (YouTube) Looks like Gila Hank, the gun toting mascot of Eastern Arizona College has been replaced by a non-gun toting Gila monster cowboy. Old logo (Reddit) | New logo (Gila Valley Central Newspaper) Discovery, characterization, and clinical development of the glucagon-like peptides (Drucker JCI 2017) The rationale, design and baseline data of FLOW, a kidney outcomes trial with once-weekly semaglutide in people with type 2 diabetes and chronic kidney disease (Rossing NDT 2023) Semaglutide 1.0 mg demonstrates 24% reduction in the risk of kidney disease-related events in people with type 2 diabetes and chronic kidney disease in the FLOW trial (Novo Nordisk) King Gizzard & The Lizard Wizard - Gila Monster (YouTube) Tubular Secretions Swap: Three Body Problem (Wikipedia) Josh: Animal Crossing (Nintendo) Sophie: Pyelonephritis in inflammatory bowel disease. Is this a thing? Joel: Maggie Moore(s) (Wikipedia) | |||
| 16 Mar 2024 | Freely Filtered 68: Inpatient hypertension | 01:28:08 | |
The Filtrate: Joel Topf Swapnil Hiremath Jordy Cohen AC Gomez With Special Guest: Tim Anderson @TimAndersonMD Editor: Priya Yenebere Show Notes Clinical Outcomes of Intensive Inpatient Blood Pressure Management in Hospitalized Older Adults NephJC Summary | PubMed | JAMA Internal Medicine The Jordy AC collab: An Interactive Ambulatory Nephrology Curriculum for Internal Medicine Interns: Design, Implementation, and Participant Feedback (PubMed) Clinical Outcomes After Intensifying Antihypertensive Medication Regimens Among Older Adults at Hospital Discharge (PubMed) Trends in Blood Pressure Treatment Intensification in Older Adults With Hypertension in the United States, 2008 to 2018 (PubMed) Overlap Weighting: A Propensity Score Method That Mimics Attributes of a Randomized Clinical Trial (JAMA Guide to Statistics and Methods) Tubular secretions Swap The Dispatcher by John Scalzi (Wikipedia) AC A Heart that Works by Rob Delaney (NYT Review) Tim Demon Copperhead by Barbara Kingsolver (Amazon) Jordy The Anthropocene Reviewed: Essays on a Human-Centered Planet (Amazon) Joel The Dolomites for hiking n Northern Italy | |||
| 22 Apr 2024 | Episode 69:DUPLEX Sparsentan, it’s no Acthar Gel | 01:41:55 | |
The Filtrate: Joel Topf Swapnil Hiremath Priya Yenebere Nayan Arora With Special Guest: Brendon Neuen Super smart guy and clinical trialist Michelle Rheault Lead author of DUPLEX and friend of the pod Show Notes Sparsentan versus Irbesartan in Focal Segmental Glomerulosclerosis NephJC Summary | PubMed | NEJM KDIGO FSGS Guidelines 2021 (PDF) Characterization of the Clinical Evidence Supporting Repository Corticotropin Injection for FDA-Approved Indications, A Scoping Review (JAMA Internal Medicine) DUET: A Phase 2 Study Evaluating the Efficacy and Safety of Sparsentan in Patients with FSGS (PubMed) Vlado Perkovic, mentor and sponsor extradenoire (UNSW Sydney) Shimer Its a floor wax and a desert topping (TikTok) SONAR: Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease: a double-blind, randomised, placebo-controlled trial. (NephJC) Travere Therapeutics Announces FDA Accelerated Approval of FILSPARIᵀᴹ (sparsentan), the First and Only Non-immunosuppressive Therapy for the Reduction of Proteinuria in IgA Nephropathy (Travere press release) GFR Slope: Chronic vs Total slope: A meta-analysis of GFR slope as a surrogate endpoint for kidney failure (Nature Medicine) There are dozens of us! Dozens! (Know your Meme) Brendon’s Neuen’s tweet about total versus chronic slope (X | Twitter) Julie R. Ingelfinger, deputy editor for the New England Journal of Medicine (Wikipedia) You know nothing, John Snow (YouTube shorts) Tubular Secretions Swapnil Foundation season two on Apple TV Wheel of Time season two Amazon Prime Brendon Andor Priya Poverty, by America Mattew Desmond Nayan The Armor of Light: A Novel by Ken Follett Michelle Lessons in Chemistry: A Novel by Bonnie Garmus | |||
| 26 May 2024 | Episode 70: Predicting Preeclampsia, the PRAECIS trial | 01:16:20 | |
The Filtrate: Joel Topf Swapnil Hiremath AC Gomez Nayan Arora With Special Guest: Anuja Java, complement god and pre-eclampsia research (Twitter) Shannon M. Clark, MD, FACOG, an honest to god, true, maternal-fetal medicine specialist. (Website | Instagram) Editor Nayan Arora Show Notes CHIP Study from 2015 (NEJM | NephMadness 2015) CHAP study from 2022 (NEJM | NephJC) NephMadness 2024 coverage of the diagnosis of preeclampsia sFlt background: Pathogenesis of Preeclampsia and Therapeutic Approaches Targeting the Placenta (PubMed) PlGF background: Perspectives on the Use of Placental Growth Factor (PlGF) in the Prediction and Diagnosis of Pre-Eclampsia: Recent Insights and Future Steps (PubMed) The PRAECIS trial (NephJC | NEJM Evidence) You may just want to listen to Anna Burgner discuss preeclampsia with Kenar Jhaveri and Koyal Jain (GN in Ten) for the NephMadness PodCrawl Bene Gesserit (Wikipedia) Pathogenesis of preeclampsia: the genetic component (PubMed) Tubular Secretions Swap Slow Horses on Apple TV (Wikipedia) AC Hidden Figures (Amazon) Nayan Baseball, little league Anuja Young Sheldon (Wikipedia) Joel Dune audiobook (Amazon) | |||
| 01 Jun 2024 | Episode 71: The Spice must FLOW! | 01:23:59 | |
The Filtrate: Joel Topf Swapnil Hiremath Josh Waitzman Nayan Arora Sophia Ambruso With Special Guest: Brendon Neuen Super smart guy and clinical trialist Vlado Perkovic Lead author of FLOW and friend of NephJC Editor Joel Topf Show Notes The manuscript (NEJM): Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes The acronym FLOW from the title: evaluate renal Function with semagLutide Once Weekly (Twitter) Joel wrote a blog post prior to the FLOW publication to try to set the table: Peeking Inside Schrödinger’s Box Brendon’s Neuen’s tweet about total versus chronic slope (X | Twitter) Modification of Association of Cystatin C With Kidney and Cardiovascular Outcomes by Obesity (Science Direct) Semaglutide and Diabetic Retinopathy Risk in Patients with Type 2 Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials (PubMed) The Efficacy and Safety of the Combination Therapy With GLP-1 Receptor Agonists and SGLT-2 Inhibitors in Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis (Frontiers in Pharmacology) Statistical considerations for testing multiple endpoints in group sequential or adaptive clinical trials (PubMed) Proteinuria Thresholds Are Irrational: A Call for Proteinuria Indexing (Nephron Clinical Practice) Frank Harrel on why the NNT sucks (data methods) Regulation of Na+/H+ exchanger NHE3 by glucagon-like peptide 1 receptor agonist exendin-4 in renal proximal tubule cells (PubMed) Switching Between Glucagon-Like Peptide-1 Receptor Agonists: Rationale and Practical Guidance (PubMed) Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial (PubMed) Doctors are like the pyromaniac fireman (PBFluids) Suggest topics for NephMadness (Twitter) Design of the COmbinatioN effect of FInerenone anD EmpaglifloziN in participants with chronic kidney disease and type 2 diabetes using a UACR Endpoint study (CONFIDENCE) (PubMed) Albuminuria-Lowering Effect of Dapagliflozin, Eplerenone, and Their Combination in Patients with Chronic Kidney Disease: A Randomized Crossover Clinical Trial (PubMed) Spitzer’s involvement in revolutionizing nephrology is part of this lecture I did at the University of Nebraska Diabetes Symposium. (Dropbox: Start on slide 29) Spitzer Resigns, Citing Personal Failings (New York Times) Tubular Secretions Swap: Dumb Money on NetFlix (Wikipedia) Josh: Hiking Zion National Park (National Park Service) Sophia: Lost in Space 2018 TV series on NetFlix (Wikipedia) Nayan: Pelican Hill resort (Website) Joel: Bodkin NephJC Summer Book Club: Covenant of Water by Abraham Verghese (Amazon) | |||
| 15 Jun 2024 | Episode 72: Nefecon for IgAN, The NefIgArd part B trial | 01:32:16 | |
The Filtrate: Joel Topf Josh Waitzman With Special Guest: Brad Rovin (@BradRovin) Chief of nephrology at The Ohio State University Wexner Medical Center, one of the authors of the Nefigard trial. Koyal Jain (@koyaljainMD) Program director of the GN Fellowship at University of North Carolina Roger Rodby (@NephRodby) Associate program director of the Rush University Nephrology Fellowship Editor Sophia Ambruso Show Notes The manuscript (The Lancet | PubMed | NephJC) The Results of Part A (Kidney Int | PubMed) Edmund (Ed) Louis memorium by Steve Korbet in KI Steve Korbet Do not miss this tweet TESTING Freely Filtered #48 with Sean Barbour Iptapocan at the World Congress of Nephrology: WCN24-1506 Efficacy And Safety Of Iptacopan In Patients With IgA Nephropathy: Interim Results From The Phase 3 APPLAUSE-IgAN Study FDA and mandatory post-marketing studies. What happens when the study is negative (or not completed) (UNDARK) Who should treat lupus nephritis: rheumatologists or nephrologists? (Nature Reviews Nephrology) Protein and albumin-to-creatinine ratios in random urines accurately predict 24 h protein and albumin loss in patients with kidney disease (PubMed) MEST Scores in NephJC Risk scores in IgAN in NephJC Repeat renal biopsy improves the Oxford classification-based prediction of immunoglobulin A nephropathy outcome (NDT) Tarpeyo pills 4 mg. Four pills once a day. (WellRx has a picture of the pills) IgA nephropathy in African Americans: uncommon but possible (PubMed Central) Aberrantly Glycosylated IgA1 in IgA Nephropathy: What We Know and What We Don’t Know (PubMed Central) Effectiveness of Mycophenolate Mofetil Among Patients With Progressive IgA Nephropathy (JAMA Network Open) Tubular Secretions Joel: Constellation on Apple TV (Wikipedia). Not good. Dune audio books are excellent. (Audible) Josh: Podcasts about donating a kidney One Is Enough Podcast (National Kidney Registry) Donor Diaries (National Kidney Donation Organization) Roger Iceland (Wikipedia) Koyal India (Wikipedia) Brad Fishing in Dubai | |||
| 01 Aug 2024 | Episode 73: The KDIGO CKD 2024 Guideline Draft | 01:32:16 | |
The draft order: Sophia Ambruso Nayan Arora Swapnil Hiremath AC Gomez Joel Topf Editor Nayan Arora Show Notes Previous drafts: 2021 KDIGO Hypertension —Joel, Sophia, Swap, Nayan, Josh 2021 ASN Kidney Week Draft—Joel, Sophia, Swap, Nayan, Jennie 2022 The ISPD Peritonitis Guideline— Joel, Sophia, Swap, Nayan 2022 ASN Kidney Week Draft—Joel, Sophia, Swap, Nayan 2023 ASN Kidney Week Draft—Joel, Sophia, Swap, Nayan, AC, Josh 2024 KDIGO CKD Clinical Practice Guideline —Joel, Sophia, Swap, Nayan, Josh, AC The NephJC discussion Part 1 | Part 2 First Round Sophia’s Pick 3.7.1 We recommend treating patients with type 2 diabetes (T2D), CKD, and an eGFR ≥20 ml/min per 1.73 m2 with an SGLT2i (1A).
Nayan’s Pick 2.2.1: In people with CKD G3–G5, we recommend using an externally validated risk equation to estimate the absolute risk of kidney failure (1A).
Practice Point 2.2.1: A 5-year kidney failure risk of 3%–5% can be used to determine need for nephrology referral in addition to criteria based on eGFR or urine ACR, and other clinical considerations. Practice Point 2.2.2: A 2-year kidney failure risk of >10% can be used to determine the timing of multidisciplinary care in addition to eGFR-based criteria and other clinical considerations. Practice Point 2.2.3: A 2-year kidney failure risk threshold of >40% can be used to determine the modality education, timing of preparation for kidney replacement therapy (KRT) including vascular access planning or referral for transplantation, in addition to eGFR-based criteria and other clinical considerations. Swap’s Pick 3.15.1.1: In adults aged ‡50 years with eGFR <60 ml/min per 1.73 m2 but not treated with chronic dialysis or kidney transplantation (GFR categories G3a–G5), we recommend treatment with a statin or statin/ezetimibe combination (1A). AC’s Pick 3.7.2: We recommend treating adults with CKD with an SGLT2i for the following (1A): eGFR ≥20 ml/min per 1.73 m2 with urine ACR ≥200 mg/g (≥20 mg/mmol), or heart failure, irrespective of level of albuminuria. (1A) Joel’s Pick 3.10.1: In people with CKD, consider use of pharmacological treatment with or without dietary intervention to prevent development of acidosis with potential clinical implications (e.g., serum bicarbonate <18 mmol/l in adults). Practice Point 3.10.2: Monitor treatment for metabolic acidosis to ensure it does not result in serum bicarbonate concentrations exceeding the upper limit of normal and does not adversely affect BP control, serum potassium, or fluid status. Second Round Joel’s Pick 3.3.1.1: We suggest maintaining a protein intake of 0.8 g/kg body weight/d in adults with CKD G3–G5 (2C). 3.3.1.1: Avoid high protein intake (>1.3 g/kg body weight/d) in adults with CKD at risk of progression. 3.3.1.2: In adults with CKD who are willing and able, and who are at risk of kidney failure, consider prescribing, under close supervision, a very low–protein diet (0.3–0.4 g/kg body weight/d) supplemented with essential amino acids or ketoacid analogs (up to 0.6 g/kg body weight/d). 3.3.1.3: Do not prescribe low- or very low–protein diets in metabolically unstable people with CKD. AC’s Pick 3.9.1: In adults with T2D and CKD who have not achieved individualized glycemic targets despite use of metformin and SGLT2 inhibitor treatment, or who are unable to use those medications, we recommend a long-acting GLP-1 RA (1B). Swapnil’s Pick Practice Point 5.4.1: Initiate dialysis based on a composite assessment of a person’s symptoms, signs, QoL, preferences, level of GFR, and laboratory abnormalities. IDEAL Trial: A Randomized, Controlled Trial of Early versus Late Initiation of Dialysis NEJM Timing of dialysis initiation to reduce mortality and cardiovascular events in advanced chronic kidney disease: nationwide cohort study NephJC Nayan’s Pick Practice Point 1.1.4.2: Use tests to establish a cause based on resources available (Table 6b). Sophia’s Pick Practice Point 1.1.1.2: Following incidental detection of elevated urinary albumin-to-creatinine ratio (ACR), hematuria, or low estimated GFR (eGFR), repeat tests to confirm presence of CKD. Joel’s cystatin C Tweet The cystatin C guideline recommendation 1.1.2.1: In adults at risk for CKD, we recommend using creatinine-based estimated glomerular filtration rate (eGFRcr). If cystatin C is available, the GFR category should be estimated from the combination of creatinine and cystatin C (creatinine and cystatin C– based estimated glomerular filtration rate [eGFRcr-cys]) (1B). Nayan’s additional thoughts. He is not a fan of Practice Points 3.6.4 and 3.6.5 Practice Point 3.6.4 Continue ACEi or ARB therapy unless serum creatinine rises by more than 30% within 4 weeks following initiation of treatment or an increase in dose. and Practice Point 3.6.5: Consider reducing the dose or discontinuing ACEi or ARB in the setting of either symptomatic hypotension or uncontrolled hyperkalemia despite medical treatment, or to reduce uremic symptoms while treating kidney failure (estimated glomerular filtration rate [eGFR] <15 ml/min per 1.73 m2). Tubular Secretion Swap The Murderbot Diaries by Martha Wells Nayan Searching for Hobey Baker Narrated by David Duchovny Sophia Bassnectar How to fix the Apple Music automatically playing when you connect to bluetooth. Joel The Veil with Elizabeth Moss | |||
| 18 Oct 2024 | Episode 74: Amino Acids for AKI | 01:32:54 | |
The Filtrate: Jennie Lin Joel Topf Josh Waitzman Swapnil Hiremath With Special Guests Pedro Teixeira Jay Koyner Editor Sophia Ambruso Show Notes The article: A Randomized Trial of Intravenous Amino Acids for Kidney Protection KDIGO Clinical Practice Guideline for Acute Kidney Injury (PDF) Steve Coca study Evaluation of Short-Term Changes in Serum Creatinine Level as a Meaningful End Point in Randomized Clinical Trials (PubMed) Using Nephrocheck to prevent AKI: Prevention of cardiac surgery-associated AKI by implementing the KDIGO guidelines in high risk patients identified by biomarkers: the PrevAKI randomized controlled trial (PubMed) Brenner’s Review of protein intake and renal hemodynamics: Dietary Protein Intake and the Progressive Nature of Kidney Disease: — The Role of Hemodynamically Mediated Glomerular Injury in the Pathogenesis of Progressive Glomerular Sclerosis in Aging, Renal Ablation, and Intrinsic Renal Disease (NEJM) Husain-Syed a look at preoperative renal functional reserve and risk of AKI: Preoperative Renal Functional Reserve Predicts Risk of Acute Kidney Injury After Cardiac Operation (PubMed) Dana Fuhrman review of renal functional reserve: The Role of Renal Functional Reserve in Predicting Acute Kidney Injury (PubMed) Use of SGLT2i prevented AKI in the placebo controlled trials. Clinical Adverse Events Associated with Sodium-Glucose Cotransporter 2 Inhibitors: A Meta-Analysis Involving 10 Randomized Clinical Trials and 71 553 Individuals (PubMed) Assessment of P values for demographic data in randomized controlled trials (PubMed) Tubular Secretions Swapnil The Lord of the Rings: Rings of Power Season 2 on Amazon Prime (Wikipedia) Josh Fortnite (Website) Pedro CRRT Academy at University of Alabama Birmingham (Website) Jay Koyner Slow Horses on AppleTV (Wikipedia) Jennie Linn #KidneyWk Run Club Friday 10/25 at 6:15 am PST Meet in front of Sally’s Fish House ~2 miles. Easy pace (10-12 min/mile) (Strava) Joel Topf Your Honor on Netflix (Wikipedia) | |||
| 04 Nov 2024 | FF 75 NephJC Night at Kidney Week | 02:17:47 | |
We had a great NephJC get together. We recorded the whole event and packaged it into a podcast. Musical entertainment Too Sweet by Hozier Fairy Tale of New York by written Jem Finer and Shane MacGowan. Hear it performed by the Pogues. Interview of Tom Mueller Tom Mueller author of How to Make a Killing Interview of Tom Mueller Tom Mueller author of How to Make a Killing NephMadness logo reveal NephJC Kidneys NephJC Manuscript of the Year: Flow accepted by Meg Jardine Manjula Kurella Tamura, winner of the 2015 NephMadness, oh and author of NEJM manuscripts and subject of a NYT article. NephJC Visual Abstract of the Year: Corina Teodusiu, creator of the Flozinator logo NephJC Social Justice Award: ISN petition to the WHO on Kidney Health Most Engaged Scientist Award: Michelle Rheault Rookie of the Year: Milagros Flores MVP: Christina Popa NephJC Founders Award: Joshua Waitzman Nathan Hellman Social Media Project of the Year: Edgar Lerma and the ASN Visual Abstract Team More Music with Tim Saginaw, Michigan as performed by Johny Cash Betty, written by Taylor Swift The Kidney Connection Freely Filtered Kidney Week Draft Previous drafts List of all the simultaneous publications from Kidney Week 2024 Sophia: SMART Trial (Link goes to the new KidneyCompass podcast that interview lead author Hiddo Heerspink Jordy’s editorial in the European Heart Journal. Link Josh: APPLAUSE Alternative Complement Pathway Inhibition with Iptacopan in IgA Nephropathy in the NEJM APPLAUSE results announcement at The World Congress of Neophrology in Buenos Aries Iptapocan is a factor B inhibition Jordy: POISE-3 with simultaneous publication in KI Mentions she wanted to pick KAT-AKI because she worked with Perry Wilson. Per Nayan, Amit Garg is the Beyonce of Nephrology Accord Trial (NEJM) Joel: HSK21541 for Pruritus Correction link to source (graph) Nayan: FINEARTS-HF with simultaneous publication in JACC BARACH-D: Low-dose spironolactone and cardiovascular outcomes in moderate stage chronic kidney disease: a randomized controlled trial (Nature Medicine) Swapnil comes out as a SpiroStan TOPCAT funny business PATHWAY-2 Trial (NephJC coverage) Swap: K Bath and cardiac arrhythmia with simultaneous publication in Kidney International CAST: A study that rocked the cardiology world and became the poster child for evidence-based medicine (Link) Tubular Secretions Swap: Late breaking and high impact sessions Nayan: Intro to… Joel: Student poster on blood pressure technique Jordy: The Penguin. A couple of mentee posters Sophie: Tracks her sessions on paper. Josh: Quiz and Questionaire session with JC Velez, Bea Concepcione, Anna Burgner, Roger Rodby. | |||
| 16 Nov 2024 | Episode 70b Do Over: Predicting Preeclampsia, the PRAECIS trial | 00:34:50 | |
The Filtrate: Joel Topf Swapnil Hiremath With Special Guest: Michelle Hladunewich, Nephrologist at the University of Toronto Mir Melamed, Maternal-Fetal Medicine at the University of Toronto Editor Simon Topf Show Notes Priscilla Smith’s letter: Dear Joel and the Freely Filtered team, I am a long-time fan of your podcast and was looking forward to hearing your recently aired discussion of the Praecis study of sflt1:PlGF use in preeclampsia. Preeclampsia and renal disease in pregnancy are areas that many nephrologists report a lack of knowledge or confidence in discussing and managing. I am a nephrologist who has been co-leading a renal pregnancy clinic in London while writing a PhD on progression of renal disease in pregnancy. I have had the immense privilege of working with experts and key opinion leaders in preeclampsia research both in the UK and internationally. As you know, preeclampsia is a serious and significant condition contributing to global maternal mortality and is also associated with future CKD and CVD risk so is both relevant and important within our professional group. Sadly, I found myself disappointed by the episode and felt it was a missed opportunity. I appreciate that you had difficulties obtaining appropriate experts to join the discussion, but perhaps it would have been better to delay production. While you all valiantly proceeded to discuss this important study, the topic is complex and there appeared to be a lack of understanding of the surrounding literature and pathogenesis of preeclampsia. Sadly, the maternal medicine expert’s comments at the end of the podcast added little as she seemed determine to negate any benefit from the results despite declaring she had no experience or expertise in the use of these biomarkers. There are many people who understand the clinical aspects of preeclampsia as well as having direct experience of the use and utility of these biomarkers who would have been able to contribute much to your conversation. I look forward to future discussions of renal disease in pregnancy on your podcast and would be happy to suggest some expert panellists if you ever find yourself stuck. Kind regards, Priscilla Excess placental soluble fms-like tyrosine kinase 1 (sFlt1) may contribute to endothelial dysfunction, hypertension, and proteinuria in preeclampsia (JCI 2003) sFlt background: Pathogenesis of Preeclampsia and Therapeutic Approaches Targeting the Placenta (PubMed) PlGF background: Perspectives on the Use of Placental Growth Factor (PlGF) in the Prediction and Diagnosis of Pre-Eclampsia: Recent Insights and Future Steps (PubMed) The PRAECIS trial (NephJC | NEJM Evidence) | |||
| 15 Dec 2024 | FF 76 FINE ARTS | 01:30:38 | |
The Filtrate Joel Topf Swapnil Hiremath AC Gomez Jordy Cohen Nayan Arora Special Guest Brendon Nuen Editing by Simon Topf and Nayan Arora Show Notes FINEARTS-HF in NEJM FINEARTS Kidney outcomes in JACC FINE-HEART pooled analysis of cardiovascular, kidney and mortality outcomes in Nature Medicine discussion in NephJC BARACH-D: Low-dose spironolactone and cardiovascular outcomes in moderate stage chronic kidney disease: a randomized controlled trial (Nature Medicine) Live Freely Filtered at KidneyWk Swapnil comes out as a SpiroStan post to NephJC TOPCAT TOPCAT primary publication TOPCAT North American results TOPCAT funny business explained AHA/ACC/HFSA Heart Failure Guidelines (PDF) SGLT2i are 2a MRA are a 2b ARBs are a 2b ARNI are a 2b Kansas city cardiomyopathy questionnaire in patients with CKD without a diagnosis of heart failure: https://pubmed.ncbi.nlm.nih.gov/21187260/
Why Has it Been Challenging to Modify Kidney Disease Progression in Patients With Heart Failure? (JACC) Tubular Secretions Swap: Disclaimer on Apple TV AC: Duo Lingo Plushy (Amazon) Nayan: The Puzzle Box Jordy: Project Hail Mary Brendon has a podcast, The Kidney Compass with Shikha Wadhwani. And he recommends singer-songwriter, Maggie Rogers (YouTube) Joel: The Singularity Is Nearer: When We Merge with AI by Ray Kurzweil Closing music, Tim Yau with The Kidney Connection | |||
| 26 Feb 2025 | FF 77 Top Nephrology Stories | 01:12:25 | |
The Filtrate Joel Topf Swapnil Hiremath AC Gomez Sopia Ambruso Nayan Arora Special Guests Michelle Rheault, Director, Division of Pediatric Nephrology, Professor of Medicine Tiffany Caza, Nephropathologist, Scientist and self-described Freely Filtered fan girl Editing by Simon Topf and Sophia Ambruso Show Notes 10. Healthcare Cyberattacks 9. ApoE in C3 glomerulonephropathy 8. Workforce woes in Adult and Pediatric Nephrology 7. Hyponatremia correction meta-analysis 6. Microvascular inflammation increases risk of graft loss - in all of its forms 5. Xenotransplantation 4. KDIGO CKD Guidelines 3. Hypertension control trials (ESPRIT, BPROAD) 2. The Renaissance of IgAN: IgAN treatment trials 1. FLOW: GLP-1 RAs in CKD | |||
| 13 Mar 2025 | FF 78 NephMadness, the dialysis region | 01:08:59 | |
The Filtrate Joel Topf Jordy Cohen Nayan Arora Special Guest Katie Kwon @katiekwonmd.bsky.social Mariana Murea @MarianaMurea Editing by Simon Topf and Joel Topf Show Notes NephMadness at AJKDblog.org | |||
| 22 Apr 2025 | FF 79 REGENCY, Efficacy and Safety of Obinutuzumab in Active Lupus Nephritis | 01:42:51 | |
The Filtered Fragments (OG Filtrate) Joel Topf Jennie Lin Swapnil Hiremath Special Guest Brad Rovin GN God and second author from The Ohio State Koyal Jain GN Specialist from UNC Alfred Kim Rheumatologist from Washington University Editing by Simon Topf and Nayan Arora The Kidney Connection written and performed by by Tim Yau Show Notes Joel’s monologue One of the most surprising facts of nephrology is that despite conventional wisdom that lupus nephritis is an antibody mediated disease, that over a decade ago, the LUNAR investigtors were unable to find a significant benefit when rituximab was added to conventional therapy. And this was after the equally negative phase 2 trial of rituximab, EXPLORER. In fact, despite this finding rituximab has been able to burough its way into treatment of many nephrologists and rheumatologists as well as the KDIGO guidelines where it is suggested for patients with persistent disease activity or inadequate response to initial standard-of-care therapy. This long conflict is now coming to an end. Obinutuzumab, a newer, better monoclonal antibody targeting the same CD20 that we grew to love with rituximab, but it has a number of advantages. One. It is humanized antibody rather than a chimeric mouse-human antibody Two. It’s cytotoxicity is not complement dependent an particular advantage if you want to deploy it ina disease where hypocomplementemia is a disease characteristic Three, and most importantly, it causes stronger and deeper b-cell depletion than rituximab. Better B-cell depletion in the blood and tissue. And this brings us to tonight’s topic, we had already seen the phase two results of obinutuzumab which, unlike EXPLORER, were positive, we will look at the phase three regency trial. This makes the third novel lupus nephritis drug in the last 4 years. We continue to remake glomerular nephritis. LUNAR: Efficacy and safety of rituximab in patients with active proliferative lupus nephritis: the Lupus Nephritis Assessment with Rituximab study Pubmed EXPLORER: Efficacy and safety of rituximab in moderately-to-severely active systemic lupus erythematosus: the randomized, double-blind, phase II/III systemic lupus erythematosus evaluation of rituximab trial Pubmed REGENCY: Efficacy and Safety of Obinutuzumab in Active Lupus Nephritis NEJM | NephJC NOBILITY: B-cell depletion with obinutuzumab for the treatment of proliferative lupus nephritis: a randomised, double-blind, placebo-controlled trial Annals of Rheumatic Disease Comparison of intravenous and subcutaneous exposure supporting dose selection of subcutaneous belimumab systemic lupus erythematosus Phase 3 program PubMed Central Class 5 lupus nephritis is slow to respond Long-term Use of Voclosporin in Patients with Class V Lupus Nephritis: Results from the AURORA 2 Continuation Study ACR Meeting abstract Tubular Secretions Swap: Young Adult novel I Must Betray You by Ruta Sepetys (Amazon) Koyal: Taekwondo (Wikipedia) Jennie: these unprecedented times Trump NYT: Administration Freezes $1 Billion for Cornell and $790 Million for Northwestern, Officials Say Al: Acquired Podcast Brad: The Feather Thief by Kirk Wallace Johnson (Amazon) Joel: Paradise on Hulu (Wikipedia) | |||
| 13 May 2025 | FF 80 KDIGO ADPKD Guidelines | 01:18:01 | |
The Filtrate Joel Topf AC Gomez Sophia Ambruso Nayan Arora Special Guest Charles Edelstein, MD, PhD Professor, Medicine-Renal Med Diseases/Hypertension Extra-Special Guest Michelle Rheault, MD Professor of Pediatrics, University of Minnesota Editing by Simon and Joel Topf The Kidney Connection written and performed by by Tim Yau Show Notes KDIGO ADPKD Guidelines: Guideline PDF NephJC coverage Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease (CRISP) Hy’s Law (Wikipedia) has three components: ALT or AST by 3-fold or greater above the upper limit of normal And total serum bilirubin of greater than 2× the upper limit of normal, without findings of cholestasis (defined as serum alkaline phosphatase activity less than 2× the upper limit of normal) And no other reason can be found to explain the combination of increased aminotransferase and serum total bilirubin, such as viral hepatitis, alcohol abuse, ischemia, preexisting liver disease, or another drug capable of causing the observed injury Meeting this definition yields a very high risk of fulminant kidney failure (76% in one series) Clinical Pattern of Tolvaptan-Associated Liver Injury in Subjects with Autosomal Dominant Polycystic Kidney Disease: Analysis of Clinical Trials Database (PubMed) Two of 957 patients on tolvaptan met Hy’s law criteria. None had fulminant kidney failure. Effects of Hydrochlorothiazide and Metformin on Aquaresis and Nephroprotection by a Vasopressin V2 Receptor Antagonist in ADPKD: A Randomized Crossover Trial (PubMed) Patients had a baseline urine volume on tolvaptan of 6.9 L/24 h. Urine volume decreased to 5.1 L/24 h with hydrochlorothiazide and to 5.4 L/24 h on metformin. TEMPO 3:4 Tolvaptan in Patients with Autosomal Dominant Polycystic Kidney Disease (NEJM) Reprise Trial Tolvaptan in Later-Stage Autosomal Dominant Polycystic Kidney Disease ( NEJM | NephJC ) Unified ultrasonographic diagnostic criteria for polycystic kidney disease by Edelstein in JASN (PubMed) Tolvaptan and Kidney Function Decline in Older Individuals With Autosomal Dominant Polycystic Kidney Disease: A Pooled Analysis of Randomized Clinical Trials and Observational Studies (PubMed) Charles’ draft choice Recommendation 4.1.1.1: We recommend initiating tolvaptan treatment in adults with ADPKD with an estimated glomerular filtration rate (eGFR) ‡25 ml/min per 1.73 m2 who are at risk for rapidly progressive disease (1B). Sophia’s draft choice Recommendation 1.4.2.1: We recommend employing the Mayo Imaging Classi cation (MIC) to predict future decline in kidney function and the timing of kidney failure (1B). Progression to kidney failure in ADPKD: the PROPKD score underestimates the risk assessed by the Mayo imaging classification (Frontiers of Science) AC’s draft choice Recommendation 9.2.1: We recommend targeting BP to ≤ 50th percentile for age, sex, and height or ≤ 110/70 mm Hg in adolescents in the setting of ADPKD and high BP (1D). HALT-PKD Blood Pressure in Early Autosomal Dominant Polycystic Kidney Disease (NEJM) Nayan’s draft choice Recommendation 6.1.2: We recommend screening for ICA in people with ADPKD and a personal history of SAH or a positive family history of ICA, SAH, or unexplained sudden death in those eligible for treatment and who have a reasonable life expectancy (1D). Screening for Intracranial Aneurysms in Patients with Autosomal Dominant Polycystic Kidney Disease (CJASN) Surgical Clipping Versus Endovascular Coiling in the Management of Intracranial Aneurysms (PubMed) Clipping is associated with a higher rate of occlusion of the aneurysm and lower rates of residual and recurrent aneurysms, whereas coiling is associated with lower morbidity and mortality and a better postoperative course. Joel’s editorial pick Recommendation 6.1.1: We recommend informing adults with ADPKD about the increased risk for intracranial aneurysms (ICAs) and subarachnoid hemorrhage (1C). Joel’s first draft pick The bring out your dead pick: Recommendation 4.3.1: We recommend not using mammalian target of rapamycin (mTOR) inhibitors to slow kidney disease progression in people with ADPKD (1C). Recommendation 4.4.1: We suggest not using statins specfiically to slow kidney disease progression in people with ADPKD (2D). Recommendation 4.5.1: We recommend not using metformin specifically to slow the rate of disease progression in people with ADPKD who do not have diabetes (1B). Recommendation 4.6.1: We suggest that somatostatin analogues should not be prescribed for the sole purpose of decreasing eGFR decline in people with ADPKD (2B). Perfect match: mTOR inhibitors and tuberous sclerosis complex (Orphanet Journal of Rare Diseases) Navitor Pharmaceuticals Announces Janssen Has Acquired Anakuria Therapeutics, Inc. (BioSpace) This is press release about acquiring the mTor1 inhibitor. Joel’s second draft pick Recommendation 4.2.1.1: We suggest adapting water intake, spread throughout the day, to achieve at least 2–3 liters of water intake per day in people with ADPKD and an eGFR ≥ 30 ml/min per 1.73 m2 without contraindications to excreting a solute load (2D). Nayan’s bonus draft Practice Point 4.7.1: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) should not be used to slow eGFR decline in people with ADPKD. Open-Label, Randomized, Controlled, Crossover Trial on the Effect of Dapagliflozin in Patients With ADPKD Receiving Tolvaptan (KIReports) SMART Trial of GLP-1ra in non-diabetics: Semaglutide in patients with overweight or obesity and chronic kidney disease without diabetes: a randomized double-blind placebo-controlled clinical trial (PubMed) Tubular Secretions Nayan: Landman on Paramount Plus (IMDB) Sophia: Pass Nayan: steps in with The Pitt on HBO (Wikipedia) Charles: The White Lotus, Yellowstone 1923, Poirot (IMDB) AC: The Pitt Michael Crichton’s Estate Sends The Pitt to the Courtroom (Vulture) Joel: I Must Betray you by Ruta Sepetys (Amazon) | |||
