This week, we will discuss the prognostic role of microvascular inflammation in kidney transplantation. Can the capillaries whisper their damage in lesions before antibodies speak? Maybe this study compels us to treat the injury we see, not just the disease we can name…
This week, we will discuss another target trial emulation study. The FDA says to stop metformin at a GFR of 30. Are they right?
This week, we will discuss the first iteration of KDIGO’s 2025 guidelines on ADPKD. These guidelines are a result of a decade of global collaboration between physicians, researchers, advocates, and patients. The guidelines incorporate ADPKD-specific care as well as many general CKD management practice points.
This week, we will celebrate in advance World Kidney Day by discussing the results of OBInutuzumab in active lupus nephritis. The LUNAR trial (rituximab versus placebo) was “almost” positive, but not quite there. Would Obi overpower its cousin ritux? ✨
March is Kidney awareness month and in honor of that, Pallimed, the Hospice and Palliative Care Blog is talking about intersection of nephrology and palliative care. They asked NephJC co-creator, Joel Topf to host their chat. This happens on Wednesday. Topf wrote the introduction:
Have you ever read a journal article and as soon as you finished the abstract you had this forbidding feeling that if the authors actually proved what they claimed to have discovered your medical life will never be the same?
This happened when I read, Functional Status of Elderly Adults before and after Initiation of Dialysis by Tamura et al. in 2009.
The study simply looked at mortality and functional status of nursing home residents who initiated dialysis. The cohort consisted of 3,704 Americans. The average age of this predominantly white (64%) female (60%) cohort was 74 years. The outcomes were horrifying:
While this study did not track patients who deferred dialysis it is hard to imagine they could do much worse. The view of dialysis as a way to improve functional status by clearing uremia leading to improved nutrition and other downstream benefits was revealed to be a false hope. Instead we have a treatment that appears to be too rough for frail, at-risk patients and left them significantly worse than they were before dialysis.
The discussion section of the article had a sentence that should be embroidered to every nephrologists white coat:
“...kidney failure may be a reflection of terminal multiorgan dysfunction rather than a primary cause of functional decline, and thus the initiation of dialysis may not rescue patients from an inevitable decline.”
As nephrologists we need to elevate conservative, non-dialytic, therapy to be a clear option for patients, one that should be discussed along with peritoneal dialysis and transplant. Conservative care should not merely be a last resort when all other options have been exhausted.
I hope you will join us as we discuss the intersection of nephrology and palliative care this Wednesday at #hpm chat.
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!
Symplur don't lie
NephJC number 20 had the second most tweets and the third most participants. Thanks everyone for participating.
Discussing biomarkers.
Tonight's journal club requires knowledge of the KDIGO acute kidney injury stages. These are nearly direct translations from the previous AKI staging systems.
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?
Tom Oates and his merry gang of GMT chatters shattered previous records for the Euro/Afro chat. Great work guys!
Not quite up to the pace of the western hemisphere, but gaining fast.
#NephJC analytics for tonights donor risk discussion: • 33 participants • 374 tweets http://t.co/9VMYNoacvN
— Nephrology Jrnl Club (@NephJC) February 4, 2015
In a related note, NephJC.com reached 4,000 page views in a month for the first time in January.
From the International Journal of Occupational and Environmental Health comes this article looking at Changes in kidney function among Nicaraguan sugarcane workers. The article is behind a paywall but according to the NPR article it exonerates the fertilizers and pesticides and adds to the data on chronic and recurrent dehydration as the culprit:
“But this new study casts doubt on that theory. It found that field workers whose primary jobs were spraying for weeds and pests (and who thus had the most contact with agricultural chemicals) had the least decline in kidney function over the course of the harvest.
The researchers also found that dehydration among workers with the most physically demanding job — cutting cane — could contribute to the illness.”
I found this bit interesting:
“Cutters who drank more of a generic energy drink while on the job had less of a drop in kidney function than co-workers who drank less of the beverage.”
If the energy drink is protective that seems to counter the fructose/uric acid hypothesis that Dr. Johnson was proposing in his article. This continues to be one of the most interesting stories in nephrology.
We had a great NephJC last night. We had a new contributor who was excellent, Eric Weinhandl of Minnesota.
those models for ESRD risk are like spinning plates. 31 events and HRs bounce around with every adjustment #nephjc
— Eric Weinhandl (@EWeinhandl) February 4, 2015
Dr. Weinhandl works with the new PEER Kidney Care Initiative. It looks like a cool project. Here is some press from Nephrology News and Issues.
The latest NephJC newsletter was just pushed out. For the second week there is a section that calls out what is new or noteworthy in the nephrology social media sphere.
This week's letter calls out Nikhil Shah's new nephrology blog, Nephrology Tweetbook and Fred Coe's kidney stone blog. We started identifying highlights last week. In the inaugural edition we identified the work being done by Tejas Desai and one of the latest nephrologist on Twitter, Dr. Ratna Samanta.
If you see or hear of anything that should be promoted on Noteworthy in Nephrology, drop us a tweet.
RSS feed users
If you like subscribing to RSS feeds to get updates - we now make it easy to subscribe to our blog feed.
Click on this link and it will allow you to subscribe easily using your choice of reader.
If You Don't Know What RSS Stands for and Would Like to Know
RSS (Rich Site Summary - or really simple syndication as it is known more popularly) refers to a family of web formats that is used to publish information for frequently updated web sites, like blog posts, newspaper headlines and journals. Subscribing to a website RSS removes the need for the user to manually check the website for new content. In addition, by entering these 'feeds' into an aggregator or feed reader (Feedly is our current favourite - since Google decided to nix Google Reader), you will have all that content 'pushed' to you, notifying you of new posts. That's our secret to knowing the latest article published in Lancet. Look for this icon to find RSS feeds for your favourite website:
There are many advantages to using RSS feeds - you can get all the content you consume into one 'reader' i.e. news, medical journals, blogs etc. And, in addition, you can skim the headline, or the abstract - and decided if you want to click the link to read the full article in the original website. Enjoy!
The rheumatology crew that killed it during the Rituximab for ANCA vasculitis NephJC are striking out on there own with an ambitious plan for their own twitter journal club. They are kicking it off this coming Thursday with a GMT and EST at the exact same time as our NephJCs, 8GMT and 9EST. They are then doing a consolidation wrap up discussion the following day.
The first topic is one near and dear to all of our hearts, lupus nephritis. RCT of tacrolimus versus MMF for induction.
It would be great if some of our community could support the rheumatologists as they launch their journal club.
How long before we stop trumping data on sodium and blood pressure and start paying attention to the accumulating data on sodium and mortality. Latest data comes complements of the Health ABC Study in JAMA Internal Medicine:
“In our study, we observed no association between FFQ- determined dietary sodium intake and 10-year mortality or in- cident CVD and HF among older adults participating in the Health ABC Study. Compared with baseline sodium intake of 1500 to 2300 mg/d, no signal of benefit was observed with less than 1500 mg/d of sodium intake. ”
See this NephJC from August for on the subject of dietary sodium intake, blood pressure and mortality.
We had 30 people tweeting and 421 tweets. We were delighted to have study author, Areef Ishani join us:
@kidney_boy Thanks. This was a very good session. I was skeptical at first but I really liked this. Great job!! #nephjc
— Areef ishani (@Areefishani) January 21, 2015
@nephjc @kidney_boy I'll be here. I'll get our fellows on also! #nephjc
— Areef ishani (@Areefishani) January 21, 2015
Also making his first appearance at NephJC was John Asplin with some excellent input
PTX being used as salvage therapy in medical failures. Don't be surprised it has limited benefit as currently utilized #nephjc
— John Asplin (@ravineja) January 21, 2015
Transcript and analytics
In late December, we announced the first Nephrology Social Media Internship. We had a great response with 16 applications. Honestly, I was hoping to get at least four applications. It was difficult sorting through all the capable applicants but we managed and are delighted to announce the initial crew:
Announcing the NSMC Internship inaugural class: http://t.co/9FV8yQZn4M Welcome aboard: @HekmagsMD @SLeonMD @dr_nikhilshah @cdchu
— Nephrology Jrnl Club (@NephJC) January 17, 2015
See more at the NSMC Internship Home Page and keep up with what the interns are doing at the Intern's Blog.
#NephJC on the front page of PubMed! Excuse me while do a little happy dance! H/T @MDaware pic.twitter.com/5npN67OKy8
— Joel Topf (@kidney_boy) January 11, 2015
Check it out quick while it's still there.
