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Joel M. Topf, MD FACP Profile picture
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27 Jun, 7 tweets, 4 min read
There is more AKI after arterial contrast but I wonder if it is the contrast or something else. A thread
In Matrix randomizing patients to femoral or radial caths resulted less CIN/CAN with radial approach. No difference in contrast.
Primary publication: thelancet.com/journals/lance…
Follow-up publication focused on AKI: sciencedirect.com/science/articl…
Here are some visual abstracts for Matrix
The ALERT system reduced contrast volume by 23% in patients getting PCIU. No change in risk of CAN/CIN

sciencedirect.com/science/articl…
The MOZART trial used intravascular ultrasound to successfully reduce contrast volume but it did not reduce CAN/CIN
sciencedirect.com/science/articl…
And in the Mehran CAN/CIN risk calculator Calculation look how unimportant contrast dose is. Having anemia is just risky as getting 300 mL of contrast! sciencedirect.com/science/articl…
Arterial contrast has more AKI and higher doses are riskier than lower doses of contrast but I think all of that are just proxies for higher risk patients.

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More from @kidney_boy

Joel M. Topf, MD FACP Profile picture
16 Mar
So this is the first push back I have seen on the movement to standardize and simplify the language we use in nephrology
As a blogger, I always want more words for everything. I want to luxuriate in as many ways to say kidney as possible. If Eskimos have 50 ways to say snow (and it's over 50), nephrologists should have at least a dozen ways to say kidney.

readable.com/blog/do-inuits…
But what I want is separate from the question of what should we do.

For a long time nephrology projected an aura of mastery. We understood the chemistry of the body better than any other doctor. We jelously hoarded that knowledge behind walls of complexity.
Read 7 tweets
Joel M. Topf, MD FACP Profile picture
31 Jan
How good is Sci-Hub?
Pretty freaking amazing.
I was looking for Mitch Halperin's original article describing urinary anion gap. (Yeah someone had to invent that and of course it was the incredible Halperin)
pubmed.ncbi.nlm.nih.gov/3752165/
So I jump over to Am J Med Sci website to find the document but their archive only goes back to 1995
Read 4 tweets
Joel M. Topf, MD FACP Profile picture
29 Dec 20
Last year for the first time the NSMC required a letter of recommendation. This resulted in a serious disagreement among the faculty as some view letters of rec as standard application steps and require applicants to commit to the process by asking mentors for a letter
Other members of the faculty felt that letters of rec, in addition to having low predictive validity were tools that formalized inherent bias.

See: jamesgmartin.center/2019/07/its-ti… for a review of the lack validity of LoR
The solution last year was a compromise. We required a letter of rec but allowed applicants to opt out via a loop hole where the applicant just describes their reasoning for not submitting a letter of rec.
Read 6 tweets
Joel M. Topf, MD FACP Profile picture
28 Dec 20
So there is about a week left to apply to the Nephrology Social Media Collective Internship. One of the advantages we describe is the ability to become part of the leadership in nephrology. Let me show you what that looks like

nsmc.blog/application-20…
Kidney Medicine is the newest journal from the National Kidney Foundation. Take a look at the masthead and see three of our graduates running social media for them
Go to CJASN and find more of our graduates*

*Actually Joel and Edgar were never NSMC interns
Read 8 tweets
Joel M. Topf, MD FACP Profile picture
9 Dec 20
Let's talk about the evidence behind the use of visual abstracts to communicate SCIENCE!!
This field started with @AndrewMIbrahim, the whizz kid from @UMich. He was a surgical resident exploring ways to communicate scientific manuscripts and came up with the visual abstract

opmed.doximity.com/articles/visua…

H/T @TDAungst
He realized that these would be a great way to communicate information on social media and started creating visual abstracts as part of his gig as creative director at Annals of Surgery (what do you mean your journal doesn't have a creative director?) @Atul_Gawande agreed
Read 13 tweets
Joel M. Topf, MD FACP Profile picture
29 Oct 20
It's time to vote for the nephrology study of the year in the #NephJCkidneys. I think a lot of people are going to vote for DAPA-CKD and there is no doubt that it is an important study, but...
DAPA-CKD is largely just a replication study of CREDENCE, last year's winner. I'd like to make the case for ISCHEMIA-CKD

NephJC summary: nephjc.com/news/ischemiac…
NEJM: nejm.org/doi/full/10.10…
Think of how common this clinical scenario is:

A dialysis patient misses a dialysis session and comes to the hospital with shortness of breath. The ER orders a troponin. The troponin is elevated but is stable over three draws.
Read 7 tweets

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