Twice monthly (aspirational) recap of the NephJC journal club. NephJC reviews the most important manuscripts which are driving nephrology forward and improving our understanding of the kidney.
Say "Hi" to the #NephMadness PodCrawl
1:16Welcome to the NephMadness PodCrawlThe 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!The Curbsiders gets the skinny on mineralcorticoid receptor antagonistsCore IM will be covering Kidney Transplant in their classic Five Pearl formatThe CardioNerds will be covering the effect of Heart Failure Devices on Kidney HealthFreely Filtered will try to understand thrombotic microangiopathyISN Global Kidney Care goes deep on IgA nephropathyThe 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 OnconephrologyAnd finally, The Nephron Segment looks at Transgender Health and CKD
Freely Filtered 056: MyTEMP
1:21:21The Filtrate:Joel TopfSwapnil HiremathNayan AroraSophia AmbrusoWith Special Guest:Amit Garg @AmitXGarg, Nephrologist at Western University, London, and lead PI of the MYTEMP trial. Editor:Joel TopfShow Notes:MyTEMP in pubmed: Personalised cooler dialysate for patients receiving maintenance haemodialysis (MyTEMP): a pragmatic, cluster-randomised trialMyTEMP Summary on NephJC It’s really cold in OntarioThe NephTrials blog summary on Pragmatic TrialsThe pragmatic TiME trial on longer time on dialysis (ahem, sabotaged by site investigators like Joel who cut dialysate time) Dember et al in JASNPoor 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 NDT47% of centres from a DOPPS study of 273 centers routinely use of lower dialysate temperature, Dasgupta et al in JASNHow 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 CJKHDHow 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 MedPeritoneal dialysis numbers in Ontario are high, Blake et al in PDI, though with ~ 60% CVC rates, Blake et al in Kidney360Dialysate Magnesium #DreamRCT from Swap, NephTrials discussion of DialMagStatistical analysis plan of MyTEMP, Dixon et al in CJKHDTubular SecretionsSwap: Watch Everything, Everywhere All At Once on PrimeNayan: 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 DenverAmit: The wrestling team at Western U from 1990-91Joel: House of the Dragon on HBO Max
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Freely Filtered 055: STOP ACE!
1:18:12The Filtrate:Joel TopfSwapnil HiremathJordy 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 DiseaseSTOP-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 diseaseEfficacy and Safety of Benazepril for Advanced Chronic Renal Insufficiency: NEJMDr. 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 rateStrong opinions, loosely held. “Permissive AKI” with treatment of heart failure. Editorial by Chirag Parish and Steven CocaThe rational for NICE avoiding RASi in black patients: Hypertension and ethnic groupAASK trial showing superiority of RASi in African Americans. JAMAALLHAT post-hoc analysis of outcomes by self-reported race. JAMA | PubMedSophisticated Swedish observational study that Swap loved. Stopping Renin-Angiotensin System Inhibitors in Patients with Advanced CKD and Risk of Adverse Outcomes: A Nationwide StudyTarget Trials in Nephrology Dr Edouard Fu grand rounds at Ottawa Nephrology, YouTubeTarget Trial EmulationA Framework for Causal Inference From Observational Data by Miguel Hernán in JAMATubular SecretionsJordy: Third season of His Dark Materials on HBOSwap: Movies by Wes Anderson on Disney PlusLaurie: 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 | AmazonJoel EO | NYT Review
Freely Filtered 054: EMPA Kidney!
1:31:28The Filtrate:Joel TopfSwapnil HiremathJosh WaitzmanSophia AmbrusoPriya Yenebere With Special Guest:Brendon Neuen, Secretariat of the SGLT2 Trialists Consortium and cool guy on Twitter. Editor: Sophia AmbrusoShow 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 SGLT2iEMPA-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 CautionClick to find the supplement (requires a subscription)Differences in definition in the decreased renal function component of the composite primary outcomes.EMPA-Kidney 40%DAPA-Kidney 50%CREDENCE doubling of serum CrUsability 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)CKD outcomes and the FDA: 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 AgencyThe Peripheral on Amazon PrimeUnsealed the Tylenol Murders PodcastProject Hail Mary by Andrew WeirLizzy McAlpine Singer Song WriterRachel Maddow Presents: UltraTwitter chaos continues. Get your Med-Mastodon handle
Freely Filtered 053: The Kidney Week Draft
1:04:34The Filtrate:Joel TopfSwapnil HiremathNayan AroraSophia AmbrusoEditor: Nayan AroraShow Notes:Joel’s Conflict of Interest StatementThe Draft Board 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 PharmaceuticalsThe CONFIRM Trial Terlipressin plus Albumin for the Treatment of Type 1 Hepatorenal Syndrome in NephJCClinical Practice Session Leveraging Social Media to Create, Learn, Teach, Advocate, and Dispel MisinformationThe 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 upStop ACEiCLARITY Angiotensin receptor blockers for the treatment of covid-19: pragmatic, adaptive, multicentre, phase 3, randomised controlled trialEffects of Pantoprazole on Kidney Outcomes: Post Hoc Analyses From the COMPASS Randomized Controlled Trial by Lonnie Pyne, et alNo Stone: Hydrochlorothiazide for the Prevention of Kidney Stone Recurrence by Daniel Foster, et alMyTEMP: Personalised cooler dialysate for patients receiving maintenance haemodialysis (MyTEMP): a pragmatic, cluster-randomised trialClinical 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 NephrologyAttracting Osteopathic Medical Students Into NephrologyHasan Minhaj’s joke at the expense of DOsTRANSFORM-HF: Torsemide vs. Furosemide in Treating Patients With HFPoint-of-Care Ultrasound in Nephrology specifically VExUS
Freely Filtered 052: Acetazolamide for Acute Decompensated Heart Failure (ADVOR)
1:09:56The Filtrate:Joel TopfJordy CohenNayan AroraSophia AmbrusoSpecial 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)Interpreting the Kansas City Cardiomyopathy Questionnaire in Clinical Trials and Clinical Care: JACC State-of-the-Art ReviewCardiologist Sues Epic Over Copyright InfringementOutcomes 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)
Freely Filtered 051: Pip Tazo and Vanco: Nephrotoxin or Not so toxic
1:09:45The Filtrate:Joel TopfSwapnil HiremathNayan AroraPriya YenebereSpecial Guests:Todd Miano, PharmD, PhD @Miano81 Assistant Professor of Epidemiology, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine.Show Notes:Early Pip/Tazo article showing nephrotoxicity. Covered by NephJCLinazolid 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 CreatinineVancomycin-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 SepsisProposed 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 OpenApplications of propensity score methods in observational comparative effectiveness and safety research: where have we come and where should we go?The effect of glucocorticoids on serum cystatin C in identifying acute kidney injury: a propensity-matched cohort studyProtective effect of piperacillin against nephrotoxicity of cephaloridine and gentamicin in animalsPulmCrit – Myth-busting the conditional nephrotoxicity of piperacillin-tazobactam by Josh FarkasSharp Objects on Good ReadsBandon Dunes The Ocean Course at Kiawah Island Golf ResortBe Real follow me: BeRe.al/kidney_boySNL spoof of BeReal
Freely Filtered 050: CLASSIC Trial
1:29:35The Filtrate:Joel TopfSwapnil HiremathJennie LinSpecial 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 YenebereShow Notes: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 PatientsMed-Peds to NephrologyEarly Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock by Emanuel RiversProMISe: Trial of Early, Goal-Directed Resuscitation for Septic Shock ARISE: Goal-Directed Resuscitation for Patients with Early Septic ShockProCESS: 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 conceptsComparison 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 PatientsLactate conversion MediCalcThe Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)Mottling score is a strong predictor of 14-day mortality in septic patients whatever vasopressor doses and other tissue perfusion parametersCritical Care Reviews Podcast: CLASSIC Trial Results PresentationWhat is the most George Constanza-esque reason you broke up with someone? (reddit)Bonferroni correctionThe Importance of Fluid Management in Acute Lung Injury Secondary to Septic ShockRestrictive versus Liberal Fluid Therapy for Major Abdominal Surgery in the NEJM. RELIEF, NephJC discussionEffect of an Early Resuscitation Protocol on In-hospital Mortality Among Adults With Sepsis and Hypotension: A Randomized Clinical Trial in JAMAFEAST Trial: Mortality after Fluid Bolus in African Children with Severe InfectionRings of Power on Amazon PrimeWhy the Hobbit trilogy suckedIndustry on HBOSandman 2022 on NetflixWhere 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 NephrologyContinuous KRT: A Contemporary Review by J. Pedro Teixeira, Javier A. Neyra and Ashita TolwaniUniversity 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.
Freely Filtered 049: Getting Salty with SODIUM-HF
1:11:32The Filtrate:Joel TopfSwapnil HiremathJosh WaitzmanSophia AmbrusoSpecial 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?)Sadiya Khan @heartDocSadiya Assistant Professor of Medicine (Cardiology) and Preventative Medicine at Northwestern Feinberg School of Medicine. LinkEditor: Sophia AmbrusoDonate to NephJCGet 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-fanIf 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 mgMeta analysis of high versus low sodium diet pulled from Heart due to duplicated and missing data. Retraction Watch.65 mmol of sodium is 1500 mgThe 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 diureticsPREDIMED 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) DietMedical Therapy for Heart Failure With Reduced Ejection Fraction: The CHAMP-HF RegistryInterpreting the Kansas City Cardiomyopathy Questionnaire in Clinical Trials and Clinical Care: JACC State-of-the-Art Review Development and evaluation of the Seattle Angina questionnaire: A new functional status measure for coronary artery diseaseCardiologist Sues Epic Over Copyright Infringement6-minute walking test: a useful tool in the management of heart failure patientsFrank Harrell on Statistical Errors in the Medical LiteratureANCOVA versus change from baseline: more power in randomized studies, more bias in nonrandomized studiesA-HeFT: Combination of Isosorbide Dinitrate and Hydralazine in Blacks with Heart FailureTOPCAT: Spironolactone for Heart Failure with Preserved Ejection FractionSSaSS: Effect of Salt Substitution on Cardiovascular Events and DeathMini 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 CovidFor All Mankind (TV series)
Freely Filtered 048: Putting TESTING to the Test
1:21:15The Filtrate:Joel TopfSwapnil HiremathJosh WaitzmanJordy CohenSpecial Guest:Sean Barbour. Clinical Associate Professor, Division of Nephrology, University of British Columbia Chair, BC Glomerulonephritis Committee and Network, BC RenalEditor:Joel TopfShow 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 JAMASTOP-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 WikipediaPrior 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 nephropathyAnother, earlier, Italian study: Corticosteroids in IgA nephropathy: a randomised controlled trialChinese study: Combination therapy of prednisone and ACE inhibitor versus ACE-inhibitor therapy alone in patients with IgA nephropathy: a randomized controlled trialOriginal 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 5A 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!TreifGeographic Differences in Genetic Susceptibility to IgA Nephropathy: GWAS Replication Study and Geospatial Risk AnalysisThe MEST score provides earlier risk prediction in lgA nephropathyDAPA-IgA: A pre-specified analysis of the DAPA-CKD trial demonstrates the effects of dapagliflozin on major adverse kidney events in patients with IgA nephropathySwap and Josh fight about SGLT2i in IgA NephropathySignificance 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)Omicron in Ontario.Prescribing Nirmatrelvir/Ritonavir for COVID-19 in Advanced CKD by SwapStar Trek: Strange New WorldsOrigins of Renal Physiology: Fellows 2022 Medical Students: Kidney TREKSApplication of the International IgA Nephropathy Prediction Tool one or two years post-biopsy (Kidney International)The Triple Crown in Virginia