The #nephJC #RIPC stats and @storify

Both the chats were quite stimulating, we saw quite a number of new voices (whom we hope to see again!)

Hector did a great job, again, of storify-ing. Thanks again to Preeti Malani, Ed Livingston and the rest of the JAMA staff for their support. Look forward to the #JAMbag next time!

The winners of the #JAMAcup

At every #NephJC chat I find myself delighted with the bits of Twitter wisdom that get funneled through the hashtag. We are going to try to do a better job of rewarding the best of these. Some of these awards will even have prizes. This week we are delighted to announce winners of a great looking JAMA coffee mug, named the JAMAcup in this pre-chat banter:

The winner of the #JAMAcup for the Tuesday night chat is Azra Bihorac (@AzraBihorac) who wrote this gem: 

We would also like to give honorable mention (but no mug) to Mike Walsh (@lastwalsh) who was the first to alert us to the negative results for RIPC in other large trials:

The Wednesday chat was great and picking a winner was difficult but we selected this dejavu all over again tweet by Graham Abra (@GrahamAbra):

Honorable mention to Michael Hultström (@mhulstrom) for this:


A hearty thanks to JAMA. We love working with them and appreciate their support of post-publication peer review.

#NephJC does #RIPC Tues Aug 11 and Wed Aug 12. And thanks to @jama_current

RIPC = Remote Ischemic PreConditioning

We hope to see many of you in one of these chats. Thanks again to Preeti Malani, and the folks at JAMA for supporting us - both with providing a toll-free access to the article (at this link), and for providing some prizes - cool JAMA swag! 

So for discussion, the topics will be

  • T0: Do you use a risk score to stratify patients pre-op for risk of AKI? The authors in this study used the Cleveland Clinic risk score, but there are others. If you use a risk score, which one do you use?
  • T1: Do you agree with the inclusion exclusion criteria? especially GFR < 30 as an exclusion? How about the particulars of doing the RIPC? 50 mm Hg > systolic or 200 mm Hg, whichever is lower for 5 minutes X 3. Is the sham acceptable? Lack of blinding the investigators an issue?
  • T2: Dive into the results. What do people make of the difference in secondary outcomes (less effect in mild AKI?). The biomarker outcomes are also intriguing, do you agree with the interpretation?
  • T3: What happens now? The authors think of this as a phase-2 study. What outcomes would you like to see in the next study? Intervention is simple and cheap - or is it? 

Cleveland Clinic Foundation score? What's up with that?

This week's NephJC is discussing JAMA's provocative paper on reversible ischemic preconditioning. The methods used The Cleveland Clinic Foundation ARF score to enroll high risk patients:

I had heard of this but was not facile with it. Some quick googling pulled up this Paganini paper about the derivation and validation of the score:

Here is the score they used to predict the risk of dialysis requiring acute renal failure after cardiac surgery:

Look at the score from a creatinine of just 2.1 mg/dl!

Here is the risk from the scores:

Those confidence intervals for scores above 9 are scary wide, but it looks pretty reliable below there.

This Cleveland Clinic Foundation Score was at the center of an interesting Twitter interaction last week. 

Here is the table in question with the strange Cleveland Clinic Score highlighted:

Ross got a quick response from the editors of JAMA. Color me impressed: