J-David: the wrap up

We had three (!) fabulous #NephJC chats about the use of alfacalcidol in dialysis patients over the the last few days. This was the debut of the Asian NephJC, spearheaded by recent NSMC graduates Aakash and Divya.

The chats were capably hosted by NSMC grads (and now faculty) Aakash and Sinead.

The overall participation over the 2 days was a staggering 173 participants with 1186 tweets. You can see the breakdown at each session below:

The transcripts of the three sessions are available below

Summary of Discussion

Some limitations highlighted in the summary were reiterated again:

  • The sample size (underpowered)

  • Open label, and allowing use of VDRAs and cinacalcet in the control group

Some of the biggest questions revolved around generalizability. The calcium bath (not universally at 3 mEq/L), the low event rate in prevalent hemodialysis patients - though a fact well known about Japan.

Despite these limitations, almost everyone accepted the results, that the use of alfacalcidol, at these low levels of PTH (where mostly no one uses these agents) does not reduce cardiovascular events. Some frustration at PTH level measurement and our need to target them was expressed. This opens the door and reiterates the need for trials of these agents, as well as phosphate binders, at higher levels of PO4 and PTH. And trials to decide what targets of PO4 and PTH are best.

See some of the select tweets that make these points below:

On the meaning of these findings and what should happen next:

The frustration of measuring an treating PTH levels

The final word

Wrapup curated by Swapnil Hiremath