The #NephJC chat on IgA nephropathy and the significance of crescents was quite exciting, and we were fortunate to have Dr Jonathan Barratt, one of the authors, join us for the EU chat. Thanks again to JASN for providing full text access!
#NephJC summary for HOPE-3 is Up
Check out the home page - great job by Peter Gallacher putting it together. See you all on April 26th or 27th. We hope to have an author online at the chat too. More soon!
Twitter polls redux
A few months ago, we wrote about the nephro-twitterverse discovering twitter polls. Graham Abra and Thomas Hiemstra were early adopters, though response rates were ~ 20-40 at best then. But there are many more, with much better response rates. Check them out:
During #NephMadness, Krishna Penmatsa made a bunch of #PredictaPolls - check some notable ones:
Graham, again, on IgA nephropathy and pregnancy
Tomas Rohal on tweeps preference of social networks
Matt on the deprescribing PPI question
And the PPI article we discussed at #NephJC was actually decided on the basis of a twitter poll too!
What RRT modality would nephrons choose for themselves (sparked by a tweet from Scherly at #HDu)
Matt again on how nephrons refer to themselves
Joel (was he making fun of my #DreamRCT, #MAGIK?)
#NephJC on desensitization & the winners of the #NEJMCup
This was another great #NephJC. Notable for many firsts:
- Hosting debuts by #NSMC intern, Silvi Shah, and RenalMed founder, Matt Graham-Brown (the latter also wrote the pre-chat summary)
- Lot of fresh faces (hello Pawan, Todd and Sian) and over 700 tweets from more than 60 tweeps
The transcripts and storifys are also already done - and up on the page, due to uber-fast curation from Hector.
Lastly, we have the pleasure of announcing the winners of the coveted #NEJMCup. There were many great tweets, so it took some time to sift through all the nominees. Here are the winning tweets:
Congratulations, Kevin and Sian! Your #NEJMCups should be on the way soon, courtesy of the New England Journal of Medicine.
Announcing the #NEJMCup for the next #NephJC, courtesy @NEJM
We are discussing an NEJM article next week (on that note check out the summary, written by Matt Graham-Brown). The hurdle? Its behind a subscriber-only wall - and this is an issue that has come up as a barrier for many of us not in academia or with a personal subscription to the Journal. However, the nice people at the Journal have kindly agreed to make it easily accessible for #NephJC readers - use the link on our summary page, and you will get the full text.
But there is more good news. Like what we have done in the past with JAMA, the best tweet of the night will get a prize. One for each chat.
The #NEJMCup!
Lastly, thanks to Lisa Rosenbaum for opening to doors to NEJM for us.
Therapeutic Hypothermia: Comments on @PubMed Commons
Back in fall 2015, we discussed one of the few positive trials in nephrology on #NephJC, on the use of therapeutic hypothermia for cooling deceased donors and the impact of subsequent graft function. To our pleasant surprise, a few weeks later, the lead author, Claus Niemann, replied in detail to our Pubmed Commons summary comment (see here).
A weeks ago, we noticed another comment on the same article, which pointed out that the record in clinicaltrials.gov had reported a different primary outcome, which indeed it did (primary outcome was terminal graft function in donor). We noted and tweeted out this comment, and the COMPARE group also replied.
But the story is not done yet. Today there is another comment on PubMedCommons, from Melissa Greenwald of the Health Resources and Services Administration, which funded the trial. From her review of documents, delayed graft function does seem to have been one of the primary outcomes, if not the main one. Read it and decide for yourself!
TWiN: The week in Nephrology (March 1 2016)
This week we bring two resources for both physicians and nurses caring for ESRD patients.
- Starting off with guidelines published in PDI - A syllabus for healthcare professionals for teaching Peritoneal Dialysis to patients and caregivers. Get it here ($wall alert).
- Dr Schell presents a guide for nephrologists on communicating with the elderly on their choices regarding dialysis.
- Pediatric kidneys are at risk of worsening function in the setting of non renal transplant patients. This article sets out recommendations on how one should monitor the kidney functions in children with non-renal transplants and guidelines on when to refer the patient to a pediatric nephrologist.
- We all love to advice about diet and hypertension, and several studies have shown that diet does affect the BP. Coming this week is a systematic review and meta-analysis of studies looking at various kinds of dietary interventions' effect on the BP. The DASH diet still wins with the highest net effect of nearly 7/4 mmHg decrease in BP. This was published in Hypertension.
Blog posts of note
We present two brilliant essays by our newly minted interns of #NSMC (Nephrology Social Media Collective)
- Benjamin Stewart wrote an essay on the the nephron number and the GFR talking about the "Super-Kidney" or the elite kidneys and what nephron endowment means to the GFR. GIve the blogpost a read on Renal Fellow Network and follow him on twitter.
- Our next post was by renal transplant fellow Silvi Shah who describes the implications of pregnancy and kidney transplant in a question answer format. Again Renal Fellow Network features this blogpost.
- Rounding off with my favourite topic - Home Hemodialysis - I came across this excellent essay by a Home Hemodialysis patient in Australia, who describes the econo-socio-political advantages of home hemodialysis and also talks directly to patients (peer-2-peer) about the advantages of HHD. The poem at the end is a touching reminder to all physicians on what a patient really wants for himself. Read it here.
- Nikhil Shah
The #NephJC survey closes soon
Thank you for all of you who have responded and filled out the #NephJC survey - over 300 respondents so far! We wanted to give a heads up to the rest of you - the survey will be closing soon. Wednesday 12 midnight Eastern is the deadline. We would love to hear from any of you who haven't had a chance to voice your opinion. So please go ahead and let us know what you think and how we can improve.
The #NephJC survey
The #NephJC team has designed a survey - to get to know more about you and your opinions. It's a simple, short survey, that will not take more than a few minutes (we promise) to complete. We would really like you to complete all the questions, though the ones where we ask more about you are optional. The overall purpose of doing this survey is two-fold. Firstly, we would like to hear more about what you like, what you don't like and how we can improve what we are doing with #NephJC. The second purpose is to know a little bit about you - all of you, who are following us on twitter or on facebook, who tweet at the chats or who lurk, or who get our weekly mailer.
Needless to say, completing the survey is completely voluntary. None of your information will be divulged. We do have institutional review board approval (from the Ottawa Hospital Health Sciences Research Ethics Board) to conduct this survey.
Lastly, this survey is conducted with Google docs. This makes it simple and easy, but please answer to the best of your ability, truthfully, and complete it only once.
thanks!
The #NephJC team
Oral or IV Iron: Follow up from a previous #nephjc chat
A few months ago, we discussed this trial from Rajiv Agarwal and his team from Indiana, which found increased serious adverse vents with IV iron, in CKD patients. The latest issue of Kidney International now has some interesting correspondence, with two critical letters, and a substantive reply from Rajiv Agarwal.
Rajiv Agarwal
Among the criticism is one from Iain Macdougall and Simon Rogers, questioning the methodology - and why these results are different from the FIND-CKD trial (free PMC link), which did test a different IV iron formulation (iron carboxymaltose in FIND-CKD, iron sucrose in REVOKE), against a lower dose of oral iron. The reply from Dr Agarwal is worth reading in full, but this table highlights the details.
Table from Kidney International Vol 88, pg 1446-7
The Neph-Twitterverse discovers Twitter polls
A few weeks ago, the folks at twitter announced they were rolling out Twitter polls. Previously, tweeps would use manually counting responses or the RT-if-you-agree Fav-if-you-don't approach. This is how the polls were supposed to work:
So what, you might say? A few users (notably @conradhackett from Pew research) played a lot with them, sample poll:
The ease of setting one up, and the option to just click and be done were some of the major selling points. But it wasn't clear if would be just a passing fad or something more. I used one at the #KidneyWk, but there were few responders
Then Matt decided to poll the #nephjc followers after the suPAR chat
And Thomas Hiemstra decided to design his next #DreamRCT on therapy for Membranous nephropathy with a series of tweets:
Second scenario
And it wasn't long before Graham Abra re-ran an older question on the utility of urine eosinophils in allergic interstitial nephritis
another one on the duration of steroids in SLE, in remission
So we guess polls on twitter are here to say. Nephrology tweeps find it awesome (and I can say so with confidence, backed by facts, or shall we say, a poll?)
Swapnil Hiremath
Storify of the Transplant Hypothermia chats
As always, great job by Hector!
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!
#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?
#NephJC does #pericytes: part 2
Part 2 continued to be epic - with first author Rafael Kramann joining in this time. Check out the storify from Hector below -
And the stats were equally impressive - overall picture captured by this tweet from Matt:
#NephJC does #pericytes - part 1
Not #parasites or ... #pedicure?
This was a fantastic chat last night, with great questions from Mal Parmar, Scott Brimble, Dylan Burger and others; clear and articulate answers from Ben Humphreys - and a link heavy tweeting from Matt Sparks. The transcript will read almost like a review article - or commentary.
Stay Tuned for the EU/African chat, occurring in just over 2 hours at 8 pm *BST* - with first author Rafael Kramann joinin in this time.
In the Literature...
We mentioned the #MICE project in the newsletter a few days ago (what newsletter?? Check out and sign up - low volume, once a week, will keep you updated) - authored by Tejas Desai, Edgar Lerma, Ryan Madanick et al. It's published on the Winnower platform and has already accumulated some interesting reviews, including Chi Chu & Francesco. Two in particular stand out for their insightful comments - out-rivalling any peer review you may have seen, by Len Starnes and David Goldfarb, the latter written in his incomparable signature style.
Another fun paper (CoI alert: includes Swapnil and Joel as co-authors) is a 'Ten Steps for Setting up an Online Journal Club' - available here ($walled). This was a fun experience - crowd-sourced, written from start to end in a matter of days, and shepherded quite ably by Teresa Chan to publication.
The power of Twitter
Last week, NPR ran a story on their Shots Blog based on a paper from JAMA Surgery, Quality Improvement Targets for Regional Variation in Surgical End-Stage Renal Disease Care. The story was one sided, and without balance. The truth is that irresponsible nephrologists are not the primary reason patients don't start dialysis with a fistula. Swapnil saw the post and went on a bit of a Twitter rant discussing the limitations of both the post and the article on which it was based. As is typical for our Twitter renal community, a number of other nephrologists chipped in with poignent observations and tweets. It quickly became a great academic discussion on the difficulties with fistulas.
I collected the relevant tweets and published a Storify of the entire event.
A few hours after I published the Storify I received an e-mail from Nadia Whitehead, the author of the NPR post. We did a 15 minute phone interview where I was able to provide some balance to the original article and I urged her to call Swapnil for some more feedback. She did that and posted a follow-up article a few days later.
I think this is a pretty good example of why doctors need to participate in social media in open networks like Twitter rather than behind the locked doors of private physician networks like Doximity and Sermo. We need to be engaged in the same media and networks that the public is immersed in so we can be heard and reman relevant. I think it also shows the value of curating these discussions with a tool like Storify. I played a minimal role in the discussion but she reached out to me, primarily, I imagine, because I was the author of the Storify. The Storify is what triggered the action on her part.
#NephJC 28 - Stats
North American Chat
GMT chat
Quite close - and the stats from Symplur don't capture all the differences. Very different feel, and discussion. Storify to follow.
Swapnil Hiremath, MD
#NephJC has RSS subscribers?
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.