This week, we will discuss intermittent hemodialysis versus continuous hemodialysis for AKI in the ICU (ICRAKI study)
Day 3 : yet another IgA trial, and we are back with some flozin news: in ADPKD, their effect on hemoglobin, and on BP (with finerenone)
Day 2 was less exciting: we cover 1 IgA trial (Ravulizumab) along with another calcimimetic, and a pentoxifylline meta-analysis.
Day of Kidney Week 2026. The NephJC crew discusses 6 studies, including some blockbustr IgA news.
This week, we will discuss whether decreased donor transplantation improves mortality in all patients. In this target trial emulation standard donor, extended donor, donation after brain death and donation after cardiac death outcomes are compared across age groups with different co-morbid conditions.
A few months ago, we mentioned how to subscribe our feed with RSS.
At that time, we had one subscriber (Swapnil) - and to our great surprise, it seems to be that RSS is back. Just see below:
Unless there are spam RSS subscriptions somehow....
In some other news, we would like to thank Marjorie Lazoff for mentioning us in the LITFL blog - go check out their literature review here.
Swapnil Hiremath, M.D.
Tonight's and Wednesday's #NephJC is going to focus on the ACP guidelines. But it is important to recognize that a different group looked at the same data and came up with very different conclusions of what CPG should look like.
The systemic review that is the primary source...
...was the same in both clinical practice guidelines.
The American Urological Association Guideline (PDF) consists of 27 guidelines covering:
The AUA did consider 18 additional studies that were not part of the AHRQ analysis. The recommendations are graded and the authors interpreted the grades thusly:
The authors are transparent about one of the primary gaps in the use of diagnostic information about the nature of a stone in the therapy for that stone.
One caveat, all the RCTs diet studies were done in stone forming men.
The 27 guidelines themselves are pretty straight forward and read like a description of what takes place in a well run stone clinic. The authors are again transparent, labeling many of the guidelines as Clinical Principle and Expert Opinion. In terms of the final score it looks like this:
Well over half the guidelines are opinion or clinical principle (which is just an opinion in a new hat).
Here is the breakdown by section:
Not surprisingly, only pharmacologic therapy has received significant RCT attention.
The AUA and ACP guidelines are based on the same evidence but ultimately look very different. The ACP guidelines look at this evidence desert and provide guidelines so sparse they end up functionally useless. The AUA, on the other hand, hitches the evidence to common sense, scientific innuendo, and long-held medical habit to provide fairly comprehensive guidelines that primary care doctors and part-time stone-physicians can use to actually take care of patients. The AUA guidelines paired with the AHRQ evidence analysis are documents I would have every fellow add to their iPad library. The ACP guidelines? Not so much.
In the end the ACP guidelines read like political statement protesting the sorry state of stone evidence, while the AUA guidelines provide a practical manual guiding stone care while still being transparent about the poor state of evidence.
Joel Topf, MD
We are working on a survey of NephJC and I am trying to wrap my mind around what are the most important questions to ask. I really want to know how well NephJC compares as an educational experience to "In Real Life" journal clubs Thinking about that lead to this discussion on Twitter:
Some of the best NephJC discussions come after the hour long chat and can be off topic.
With a healthy bump in participants post #ERAEDTA15, just compare the participants. 'Nuff said.
The American chat
The GMT chat
As promised, the GMT chat storify is here, complete with the after party discussion on diuretics. Another superb curation by Hector!
Hector Madariaga - Nephrology Fellow from Syracuse and #NSMC intern - has now joined the #NephJC team. And you can see that why with the excellent job he has done with the storify of last week's chat. Watch this space for more contributions.
In case you were all wondering where the EU/African leg of the PD/CHF #NephJC chat disappeared, it will be held - albeit with a week's delay - on Wednesday June 3rd. It is all for a good reason. It has been quite busy for the Europeans this week - as you must have seen with all the furious tweeting from Charlie Tomson, Daniel McGuinness, David Arroyo, and many more including our very own Paul Phelan (who also wrote some excellent AJKD blog posts).
But, better late than never - and we hope many of you join us this week for the PD/CHF #nephjc chat.
Add this to the two articles by Alex Djuricich to flesh out your live-tweeting medical library.
You may have seen the evidence pyramid before, with animal studies and case reports at the bottom, and systematic reviews on the top.
Well, an interesting paper was published a few days ago, in the Journal of Medical Internet Research. Go ahead, click on that link and check it out.
It is a systematic review of all twitter-based journal clubs (and they seem to have captured all that were existing at that time). They have then examined the impact of these journals clubs using many different metrics. Interestingly, the one that immediately stands out is in table 2:
Table 2 from Roberts et al, http://www.jmir.org/2015/4/e103/
There's only one journal club with over a million impressions. Take a bow, all of you who have ever participated in a #NephJC chat!
The paper does make for interesting reading, apart from what we mention above. Some of the analyses agrees with our thoughts after the first dozen #nephJC chats.
If it wasn't from the pages of the New York Times I wouldn't believe it.
Please join us on #NephJC, Tuesday at 9PM EDT and Wednesday at 8PM GMT for a discussion of proper medical director behavior.
It was pretty well attended...
So was the GMT chat next day...
So our NSMC intern, Nikhil Shah not only did a super job of writing the sumary up for the BK virus #NephJC 22, he also has done a great job of curating the first chat into a storify.
The American chat (mostly by virtue of its longevity) still has more participants and tweets, but the GMT (EU/African) chat makes up by being fun and entertaining. Tom Oates, Paul Phelan, Francesco and their merry band of tweeters make for delightful reading. Jungle Juice, scud missiles and more. See some highlights below
@NephJC I never do EKG before starting quinolone, but always ask the patient: how long is your QTc? ;) #nephjc
— Fra Ian (@caioqualunque) March 4, 2015@ThePeanutKidney @NephJC Ideally when we use the untested jungle juice (cido,leflun,IVIg) we should do it as part of a study #nephjc
— Paul Phelan (@paulphel) March 4, 2015@swissnephro like the term PyVan 😄 pic.twitter.com/uA3wegSi1E
— John Booth (@ThePeanutKidney) March 4, 2015@NephJC nephrology's equivalent of a Scud missile - probably effective but lots of collateral damage #nephJC
— John Booth (@ThePeanutKidney) March 4, 2015
You might remember Perry Wilson, the young dapper nephrologist from Yale who presented his trial on AKI alerts at NephJC live a few months ago. He was tweeting as @nephrolalia - and has now renamed and rebranded himself as @methodsmanmd, which is quite apt given his recent blog posts and succinct and snappy videos up at MedPage Today.
More notably, the data he presented at #NephJC live has been published today - with some great additional analyses, in the Lancet. We sure know how to pick winners - so the next time we come calling, pick up the phone!
Dr. Faubel nailed the best comment about NephroCheck by reminding us while we pick apart the particulars of NephroCheck that we have some other dragons to slay:
@hswapnil @Nephro_Sparks @dr_nikhilshah btw, nephrocheck and urine eos cost about the same. urine eos useless. this much better. #nephjc
— sarah faubel (@doc_faubel) February 18, 2015
And then Edgar slides in with the appropriate #NephPearl (How does he do that so fast?)
@NephJC @doc_faubel Why I DO NOT order URINE EOSINOPHILS anymore #Nephpearls #NephJC http://t.co/NH9PdFK7fc pic.twitter.com/cbneNsoZPl
— Edgar V. Lerma (@edgarvlermamd) February 18, 2015
Last night we were off to a rollicking start with a great #NephJC chat - in great part due to the participation of Azra, Jay and Sarah! Joel took no time - burning the candle at both ends to do some storifys.
Here is the entire unedited archive with all the tweets from both chats:
The GMT chat today was also very intense - Storify will follow shortly!
In case you haven't signed up for our mailing list (really - why not? go there and do it now!) - We are going deep on the FDA approved NephroCheck™, a new test for the early diagnosis of AKI. This is not industry sponsored BS, just honest, crowd-sourced, EBM.
For this #NephJC we have three topics we want to discuss:
Topic Zero: How are you currently diagnosing AKI?
Topic 1: Evaluate their strategy for developing a novel test for AKI.
Three studies in 2 papers:
Discovery: the scientists tested 340 biomarkers and came up with a pair that performed best. N=522.
Sapphire: validated the biomarker from Discovery in a unique cohort. N=744.
Topaz: A separate study just to validate the results of Sapphire. N=420.
Is this a compelling story line? Is this a fair way to discover and validate a test? Do you agree with the conclusions?
Topic 2: Evaluating a test.
Topic 3: So what?
