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.
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?
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?
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?
Eric Topol begins this book by setting the stage of why patients will become more empowered. Topol argues that patients are not going to settle for the amount of power physicians are comfortable yielding, but rather that forces larger than medicine will fundamentally alter the traditional patient-doctor relationship.
The introduction by Matt Graham-Brown is excellent but I think the post by Josh Farkas will be a major influence on the discussion. Don't miss it.
This has been a hot topic that has been gaining momentum. See the discussion in NephMadness 2015 and ALiEM. We should have an official summary up in a day or two. Please join us for the discussion next week.
Neesh Pannu (@nipannu) and others published a new risk prediction score for #AKI requiring renal replacement therapy post cardiac surgery using variables available pre-op like - congestive heart failure, Canadian Cardiovascular Society angina class III or higher, diabetes mellitus , baseline estimated glomerular filtration rate , increasing hemoglobin concentration, proteinuria , coronary artery bypass graft (CABG) plus valve surgery (v. CABG only), other cardiac procedure (v. CABG only) and emergent status for surgery booking. This new tool published in CMAJ improves the prediction over the previously available Cleveland Clinic Score.
An excellent review on the pathophysiology and treatment of Lupus Nephritis from Kidney International was just published. And published in NDT is a comparison of all the Lupus Nephritis treatment guidelines. A nice 1-2 for #Lupus Nephritis this week.
In a recent study published in CJASN, a group of investigators studied the outcomes of use of various induction therapies and the use of steroids in deceased donor kidney transplants. The data suggested that rATG may have better outcomes in patients on a steroid avoidance protocol.
A review from Nature Reviews Nephrology - Phil Halloran authors an informative review on the molecules of kidney transplant disease states from transplant biopsies. #mustread
A fascinating review on the role of infectious diseases and its impact on kidney diseases was published by Vivek Jha (@vjha126) and N.Prasad in AJKD. Though this articles relates to the Asia Pacific region, Veeraish Chauhan(@DrVC_kidney) makes a compelling argument for all nephrologists (incl Western Hemisphere) to pay heed, in his AJKDBlog post.
- Nikhil Shah (@dr_nikhilshah)
In the last few months we have been scheduling our chats out further and further, however this breaks down when a high impact trial is published. This led to the concept of the emergency NephJC chat. We did it first for AKIKI and ELAIN:
And then most recently for this week's chat on EMPA-REG
#NephJC emergency meeting on empagliflozin for diabetic kidney disease. Next week June 28 and 29. pic.twitter.com/uSc4k5oxne
— Nephrology Jrnl Club (@NephJC) June 24, 2016
Some people have asked about the buildings in the cityscape. They are:
Sears Tower in Chicago for Edgar
Leaning Tower of Pisa for Francesco
The Gherkin in London for Tom and Matt
The Statue of Liberty in New York for Kenar and Scherly
The CN Tower of Toronto for Swapnil (closest I could get to Ottawa)
The Renaissance Center in Detroit for Joel
The AT&T building in Nashville for Anna
The Trans America Pyramid in San Francisco for Graham
That's not the whole team but it is a start.
This chat was really special. We had a lot of new participants - experts from the toxicology world, and many individuals sharing their experience. Many scintillating conversations (with some prominent disagreements!). Should we dialyse someone with asymptomatic high Lithium levels (yes), is rebound of lithium levels after we stop dialysis a bad thing (maybe not) and should we really dialyse in acetaminophen toxicity (ahem...see the storify and make up your mind on that one!).
If you haven't yet, check out all the summaries on UKidney. The full texts of the EXTRIP guidelines are easily available on their website too.
Lastly, remember - we have an emergency session of #NephJC *next week* on June 28 and 29. #NephJC staff is working overtime to cover the EMPAREG-Renal outcomes.
Mycophenolic acid inhibits the rate limiting enzyme in de novo purine synthesis. Its action is not limited to T and B cells. It has some effects on non-immune cells like mesangial cells and podocytes. This review paper in Pediatric Nephrology sheds light on the molecular mechanisms of the anti proteinuric effect of MMF.
The conundrum of selecting the most appropriate vascular access for elderly patients who choose hemodialysis is explored in this review by Tushar Vachharajani (@tvachh), Kevan Polinghorne (@kevanp2) and others in Nature Reviews.
SGLT2 inhibitors are getting increasing footage in the press with the recently published trials. The FDA has strengthened its kidney injury warning for this group of drugs and as Dr Alice Cheng(@AliceYYCheng), endocrinologist from Toronto reminds us that SGLT2 inhibitors are part of the SADMANS - Sick day medication mnemonic.
Multiple Myeloma - 2016 update on diagnosis, risk stratification and management was recently published in the American Journal of Hematology by Dr Vincent Rajkumar(@VincentRK) from Mayo.
ICYMI - An 2010 Seminars in Dialysis paper from Dr Jula Inrig on antihypertensive agents for the hemodialysis patients was doing the rounds on twitter this week. Good bookmark!
The new classification of donation after circulatory death (DCD) donors (Modified Maastricht Classification) was published recently in Transplant International.
- Nikhil Shah (@dr_nikhilshah)
And now Hector Madariaga(@HecmagsMD) brings you the best of #ATC2016Boston in a 5 part storify collection.
The #EXTRIP blog posts by the NephJC team are live at Ukidney and a summary of the chat about the intoxications.
It has been an exciting year for trials in Nephrology. The latest one is EMPAREG, which reported its renal outcomes in the NEJM recently. We will be discussing this trial on June 28th and June 29th.
Rates of parathyroidectomy similar and stable over last decade at 5.4/1000 patient. Rates of all cause mortality in these patients were better than the last decade, however there was significantly increased mortality in patients with cardiovascular morbidity and peripheral vascular disease. Study published in CJASN.
Peritoneal Dialysis International published the ISPD Peritonitis Recommendations 2016 Update.
The old adage of hypertension leading to progressive CKD has been blown out of the water by a study from Norway published recently in Kidney International. They studied a representative population of nearly 1600 hypertensive individuals aged 50 - 62 years with no DM, CKD or cardiovascular disease. These patients were followed for a median of 5+ years and the GFR decline was <1 ml/min/year with neither the baseline systolic or diastolic BP being significantly associated with it.
Though published some time ago, this excellent paper from NDT reviews all the major landmark trials in management of diabetic renal disease. Worth a re-look if not bookmarked earlier.
Take a look at a comprehensive review from Dr Agati et al on Obesity related glomerulopathy in Nature Reviews.
Nanotechnology in medicine and its specific role in kidney diseases. Check this interesting review in Kidney International.
Journal of American Heart Association has selected 5 #mustread papers related to Hypertension including the one related to "Life's Simple 7" paper relating to healthy lifestyle predicting development of CKD - The targetsbeing- nonsmoker or quit >1 year ago; body mass index <25 kg/m2; ≥150 minutes/week of physical activity; healthy dietary pattern (high in fruits and vegetables, fish, and fiber‐rich whole grains; low in sodium and sugar‐sweetened beverages); total cholesterol <200 mg/dL; blood pressure <120/80 mm Hg; and fasting blood glucose <100 mg/dL .
The Endocrine Society has published clinical practice guideline for detection, diagnosis and treatment of primary aldosteronism.
Lactic acidosis - A review ofcurrent and future directions towards management of Lactic acidosis. Published in AJKD.
American Society of Transplantation has a webpage dedicated to patient information packets for all transplants including a recent one on Pediatric Kidney transplant. Excellent resource for all patients.
The role of Tregs in kidney disease especially in kidney transplantation is discussed in this review from Kidney International.
The focus of the June issue of Transplantation is Living Donors! Excellent selection of papers from around the world.
Another negative RCT. A study from the Netherlands, published this month in NDT. investigated the role of extended course of maintenance azathioprine (4 years) vs standard course (1 year) in patients with positive cANCA at remission. There was no difference in the relapse rate in both the arms and hence extended azathioprine maintenance is of limited benefit.
Patient engagement and patient centered investigations are becoming centerstage especially in CKD, ESRD and Transplantation. This recent publication in CJASN looks at patient centered outcomes in glomerulonephritis. Very timely.
The sympathetic nervous system, HTN and renal denervation 101! A comprehensive review on the pathophysiology of SNS in HTN and the various trials investigating the role of RDN. Published in JASH
Another study from the the Netherlands published in April in CJASN. This is a single center observational study comparing outcomes in patients >70 years of age choosing conservative management or RRT. They concluded that patients >70 year old with > 3 comorbid conditions (incl Cardiovascular comorbidity) or patient age > 80 did not have a survival advantage in choosing RRT over conservative care.
An excellent review on pulmonary ultrasound to detect and characterize extra vascular lung water in the European Heart Journal recently. This technique may have potential role in assessing the fluid status of our dialysis patients.
The artificial wearable kidney has been in news for some time now. The first FDA approved trial was recently published in JCI Insight. This demonstrated that WAK is a possibility, however the trial was stopped early due to technical reason related to the device. This serves as a proof of concept for this method of dialysis pending further improvements in the device.
The Lancet published a Series of 3 review papers related to ESRD recently. The first is a review of the heart and the vascular system in dialysis. The second is controversies and problems of volume control and hypertension in dialysis patients and the third is a paper integrating DOPPS and USRDS data on factors affecting outcomes in ESRD patients worldwide. #mustread
#HemoPause - a checklist from the St Mike's Hospital in Toronto is being designed to prevent medical errors in dialysis patients who are inherently complex and may have multiple comorbidities and polypharmacy. The feasibility study of this checklist was published recently in Clincial Kidney Journal.
The AKI timing chats were very ....fast-paced? Lot of great input from the authors, Stephane Gaudry (who made it to both chats) and John Kellum. We had over 80 participants in all
And for those who missed it, check out the great curations via our exemplary storifier, Hector:
