Background
Brian Rifkin
Potassium Rollercoaster Heartbreak

This week, we will discuss the use of 3K dialysis bath with sodium zirconium cyclosilicate versus 2K bath and no potassium lowering medications in dialysis patients and the associated risk of arrhythmia.

Potassium Rollercoaster Heartbreak
Background
Jade Teakell
FLOZINATing to the Future- Long Term Effects of ...

This week, we will discuss post-trial follow-up for EMPA-Kidney. What are the longer-term effects of empagliflozin for patients with chronic kidney disease?

FLOZINATing to the Future- Long Term Effects of Empagliflozin in Patients with CKD
Background
Brian Rifkin
The Ondansetron Ballet: Torsades de Pointes

Nausea is a very common and distressing problem. Some medications that treat nausea carry a higher risk for arrhythmias, like Torsades de Pointes, and sudden cardiac death. Is ondansetron safe for use in patients on hemodialysis?

The Ondansetron Ballet: Torsades de Pointes
Background
Cristina Adriana Popa
Re”FINE”ing the role of non steroidal MRAs in ...

This week, we will discuss non-steroidal mineralocorticoid antagonist in the multiverse of cardiovascular-kidney-metabolic. What FINEHEART pooled analysis would add to what we already learned from FIDELIO-DKD trial?

Re”FINE”ing the role of non steroidal MRAs in Cardio Kidney Metabolic syndrome
Background
Cristina Adriana Popa
Playing It Safe: Can Felzartamab Fill the Gap ...

This week is time antibody mediated rejection treatment in kidney transplant. A new molecule targeting CD38, on the horizon, safely tested in a phase 2 trial

Playing It Safe: Can Felzartamab Fill the Gap in AMR Treatment?

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

    Participate in the #NephJC Caucus

    Vote for the next #NephJC article and help make NephJC great again!

    We are going to be talking about anemia on March 22nd with either some classic articles like Beserab and TREAT or the recent systematic review on ESAs and quality of life, but we have a hole in the schedule on March 8th. So help us figure this out by voting in our twitter poll.

    Proton pump inhibitors cause CKD From JAMA Internal Medicine #PPI2CKD

    Maybe statins really are good in dialysis. Long term follow up of the 4D study. #StatinHD 

    Nephrectomies cause heart damage. Early CKD is sowing the seed for future CV catastrophe even at pedestrian GFRs. #GFRgood.

    Sevelamer versus calcium based binders. A systematic review showing a mortality benefit with sevelamer. #BinderWars

    The winner will be discussed March 8th and the others may be put in the cue to be discussed in April and beyond. The loser will drop out of the race and endorse Rubio.

    TWiN (This Week in Nephrology 22 Feb 2016)

    • AVOID-HF - another one bites the dust. The largest trial of ultrafiltration in acute decompensated heart failure was teminated early for poor recruitment. It was also a trial designed to overcome the deficiencies of previous HF studies. Of the 224 patients recruited (<30% of planned) there were not differences in the outcome and no worsening in the renal function. However there was more hypotension and more infections. The article is here ($wall) and the editorial is here. 
    • This BMJ Sytematic Review and meta analysis generated a lot of chatter on twittersphere. It looked into outcomes with use of RAASi versus other anti hypertensive medications in patients with DM. There was no difference in mortality, cardiac or renal outcomes in either group. 
    • In keeping with the Transplant topic of this week's NephJC  here is a collection of Transplant themed tweets
      • This one published in Transplant International explores the economic and clinical consequences of UTI, sepsis and pneumonia in the first year. 
      • Retransplantation with a previously mismatched HLA antigen can be a trigger for a memory immune response. In this registry analysis published in JASN there was no effect of repeated HLA mismatches on all cause or death censored graft loss. However there was increased hazard ratio in patients with class 2 repeated mismatches or if they had previous graft nephrectomy. 
      • Hector Madariaga rocks again with this fantastic storify of a twitter conversation about treatment strategies of Antibody mediated rejection. 
      • C1q+/C3d+ denovo allograft antibodies were shown to have poorer 10 year graft survival in a pediatric transplant population. Check it out here.
    • Another Systematic review and meta analysis showed that correction of anemia using ESA did not improve the health related QoL in patients with CKD. This was published in the Annals. 
    • This cJASN article explores the outcomes of a cohort of patients with primary FSGS treated with steroids/CNIs or conservatively. The response to immunosuppression was better than conservative management, however there were no differences between steroids or CNIs as first line immunosuppression 

     

    Blogs of Note

    • Dr Fred Coe comes up with a superb  blog post on interpretation of the stone work up, equally useful for patients and physicians. Must see. 
    • For the lighter side of Nephrology but no easier!! Check out a collection of crossword puzzles in nephrology on Dr Jhaveri's blog. 
    • And finally a blog post on peer to peer conversation in living transplant donation. Makes interesting reading when the donor also happens to be a nephrologist. 

     

     

    TWiN - The Week In Nephrology (15 Feb 2016)

    • Starting this week comes a provocative study published in AJKD by Kam Kalantar-Zadeh regarding the use of incremental HD/Twice weekly HD in patients with substantial residual kidney function. Read it here. Also read the counter argument in an AJKD editorial.
    • How the evolution of dialysis and related technologies guided the ethics of "how resources should be used and who should have access to them" . Dr Butler and colleagues explore the healthcare delivery system through the history of dialysis in a recent CJASN article.
    • Retweeted and liked this week was a January article published by Dr Kenar Jhaveri in CJASN "Nephrologists as Educators: Clarifying Roles, Seizing Opportunities" . It identifies eight attending roles of the nephrologist which can be converted into educational opportunities.
    • A new drug and a new target for TTP ? This NEJMeditorial discusses the Von Willebrand Factor as the new target and Caplacizumab as the drug. The Phase 2 results of the TITAN trial were published in the same issue.
    • Dr Bargman and Dr Lee discuss the utility or futility of studies exploring the survival of patients by dialysis modality in this CJASN article. The quality of life and not the length of life maybe the deciding factor for the individual patient.
    •  

     

    BLING - BLogs In NephroloGy (15 Feb 2016)

    BLING (BLogs In NephroloGy) 8 Feb 2016

     

     

     

    TWiN (The Week In Nephrology 8 Feb2016)

    • The ASN Innovations in Kidney Education Contest results were revealed this week. Check out their creations here.
      • Water Homeostasis by John Danziger, MD Nephrologist, Harvard Medical School
      • Urine Trouble Board Game by Dorey A. Glenn, MD Fellow, University of North Carolina Kidney Center
      • CRRT Simulator ppt by Kamalanathan K. Sambandam, MD Nephrologist, University of Texas Southwestern Medical School
    • Renewing the discussion on organ trafficking in kidney transplantation are 6 Open Access (Organ Donation and Procurement) articles from Transplantation Direct. You can get them here.
    • Tweeted out this week were the ERA EDTA guidelines on the use of Tolvaptan in ADPKD. Follow this link (Open Access)
    • Ketoanalogues - Should do we still think about them? This latest article from JASN explores a vegetarian diet with ketoanalogue supplementation which showed retardation of CKD progression.
    • From our Pediatric Nephrology friends comes 2 articles of interest
    • One more Belatacept story this week. Published in AJT were results of a new trial which looked into immune manipulation post transplant. They studied the lymphocyte reconstitution after Alemtuzumab induction followed by Belatacept and Rapamycin therapy and showed a reduced rate of acute rejection commonly seen with nondepleting induction with belatacept maintenance.
    • NEJM article on Kidney-Failure Risk Projection for the Living Kidney-Donor Candidate. Get it here.

    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

     

    TWiN (The Week In Nephrology) 1 Feb 2016

    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

    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.

     

    #NephJC is now part of Altmetrics

    Altmetrics is a company that tracks realtime references, reads and mentions of research articles across the web and social media. They give authors and institutions a sense of what research is moving the needle faster and more comprehensively than reference tracking could. The work NephJC does will now be part captured as part of this goal.

    When I read the following on their website, I knew that NephJC and Altmetrics were natural partners:

    “Scientists are increasingly discussing papers online, but on social media sites, rather than on publisher’s sites. There’s huge value in being able to see what your peers - and people in other fields - have said about an article. Up until now, this has been difficult to achieve.”

    Our spotlight just got a little brighter.

    #AmyloidosisJC on staging renal involvement in AL amyloidosis

    You have a patient with 5 grams of proteinuria and normal renal function. The biopsy lights up with congo red like rudolph's nose

    You check the serum free light chains and conclude your patient has AL amyloidosis. The family wants to know will he need dialysis? How long until he does?

    ¯\_(ツ)_/¯

    The patient starts bortezomib and seems to be doing well. How do you know if his kidneys are improving? What do you look at?

    ¯\_(ツ)_/¯

    These are the questions covered intonight's #AmyloidosisJC on:

    A staging system for renal outcome and early markers of renal response to chemotherapy in AL amyloidosis

    The amyloidosis nerds did a nice summary at Amyloid Planet.

     Hope you can join us for a spirited discussion.

    ,

    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