TWiN (The Week in Nephrology) 19 Sep 2016

An article published sometime back in NEJM was being tweeted again this week. It was about the predictive value of sFLT-1:PlGF ratio in suspected preeclampsia. In this study the negative predictive value of ratio of sFLT-1:PlGF <38 was 99.3%  ([CI], 97.9 to 99.9), with 80.0% sensitivity and 78.3% specificity.

Management of sepsis remains controversial as ever. One more review was published in BMJ recently. This is a #mustread as it is a very comprehensive and detailed review with an excellent interactive infographic about the evidence behind most management strategies.

Disasters natural or otherwise can strike anytime and dialysis patients are some of the more vulnerable populations who need to deal with this. The National Kidney Foundation recently tweeted a link to their "Emergency Meal Planning" which has a detailed 3 day meal plan for dialysis patients unable to attend dialysis due to any emergency. Our dialysis patients must have this at home. Get it here.

An excellent review on Living Kidney Donation for the non specialist was published in the BMJ. Good information and nice graphics in this will make it easy to communicate with nonspecialists/Family physicians and for them to talk to their patients. Potential living donors may frequently approach their family physician before approaching nephrology. Good resource.

P<0.05 and P= NS can trials be distilled down to this value and is this all that takes for a trial to be "positive" or "negative" respectively. In a pair of very informative reviews in NEJM (Positive & Negative ), the authors guide us through the thought process necessary to appraise a positive/negative trial and help apply the evidence to individual practice. (The trials discussed are cardiovascular trials but the thought process is universal).

Beware the Relapsing AKI - In an interesting study John Kellum and others have identified 5 distinct phenotypes of AKI - Early reversal that was sustained through discharge, No reversal, Late reversal after day 7, Early reversal with one or more relapses but with ultimate recovery and Relapsing without recovery. Relapses were common (37.3%) and these patients had higher mortality (5x) at one year compared to those with sustained reversal of AKI.

And lastly the KDIGO CKD MBD guideline update public review is now available online. View it here - last date for suggestions is 23 Sep 2016.

- Nikhil Shah (@dr_nikhilshah)