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21 Sep, 18 tweets, 21 min read
๐Ÿ/ ๐Ÿ๐Ÿ–๐Ÿ“Š ๐–๐ก๐ข๐œ๐ก ๐จ๐Ÿ ๐ญ๐ก๐ž ๐Ÿ๐จ๐ฅ๐ฅ๐จ๐ฐ๐ข๐ง๐  ๐ข๐ฌ ๐ญ๐ก๐ž ๐ฅ๐ž๐š๐๐ข๐ง๐  ๐œ๐š๐ฎ๐ฌ๐ž ๐จ๐Ÿ ๐๐ž๐š๐ญ๐ก ๐ข๐ง ๐‚๐Š๐ƒ ๐ฉ๐š๐ญ๐ข๐ž๐ง๐ญ๐ฌ?
@AbduGaip @ISNeducation @Gawad_Nephro @sibgokcay @gag_aggarwal
#ISNTweetorial #tweetorial #Meded #Nephtwitter
@AbduGaip @Gawad_Nephro @sibgokcay @gag_aggarwal ๐Ÿ/๐Ÿ๐Ÿ– ๐‚๐•๐ƒ ๐ซ๐ข๐ฌ๐ค ๐ข๐ง ๐‚๐Š๐ƒ:
๐Ÿ“ŒPts with stages G3-G4 CKD have 2-3Xโฌ†๏ธmortality compared w/ pts w/out CKD, ๐Ÿ‘‰๐Ÿฝ sciencedirect.com/science/articlโ€ฆ

๐Ÿ“ŒCKD pts exhibitโฌ†๏ธrisk for CV events: 50% of pts with CKD stage 4 to 5 have CVD ๐Ÿ‘‰๐Ÿฝ kidney-international.org/action/showPdfโ€ฆ
#ISNTweetorial #Nephtwitter
๐Ÿ‘/๐Ÿ๐Ÿ– ๐Ÿ“Š ๐–๐ก๐ข๐œ๐ก ๐จ๐Ÿ ๐ญ๐ก๐ž ๐Ÿ๐จ๐ฅ๐ฅ๐จ๐ฐ๐ข๐ง๐  ๐ข๐ฌ ๐œ๐จ๐ง๐ฌ๐ข๐๐ž๐ซ๐ž๐ ๐š๐ฌ ๐ซ๐ข๐ฌ๐ค ๐Ÿ๐š๐œ๐ญ๐จ๐ซ ๐Ÿ๐จ๐ซ ๐‚๐•๐ƒ ๐ข๐ง ๐‚๐Š๐ƒ ๐ฉ๐š๐ญ๐ข๐ž๐ง๐ญ๐ฌ?
#ISNTweetorial #tweetorial #Meded #Nephtwitter
๐Ÿ’/๐Ÿ๐Ÿ– ๐‚๐•๐ƒ ๐ข๐ง ๐‚๐Š๐ƒ ๐ข๐ฌ ๐๐ซ๐ข๐ฏ๐ž๐ง ๐›๐ฒ ๐๐ข๐Ÿ๐Ÿ๐ž๐ซ๐ž๐ง๐ญ ๐ซ๐ข๐ฌ๐ค ๐Ÿ๐š๐œ๐ญ๐จ๐ซ๐ฌ:
๐Ÿ“ŒTraditional risks (HTN, DM, smoking, dyslipidemia)
๐Ÿ“ŒNontraditional risks (vascular calcifications, inflammation...etc)
๐Ÿ‘‰๐Ÿฝahajournals.org/doi/10.1161/CIโ€ฆ
#ISNTweetorial #Meded #Nephtwitter
๐Ÿ“/๐Ÿ๐Ÿ– ๐Ÿ“Š๐–๐ก๐š๐ญ ๐ข๐ฌ '๐ฆ๐จ๐ฌ๐ญ ๐œ๐ก๐š๐ซ๐š๐œ๐ญ๐ž๐ซ๐ข๐ฌ๐ญ๐ข๐œ ๐œ๐ฅ๐ข๐ง๐ข๐œ๐š๐ฅ ๐ฉ๐ซ๐ž๐ฌ๐ž๐ง๐ญ๐š๐ญ๐ข๐จ๐ง ๐จ๐Ÿ ๐š๐œ๐ฎ๐ญ๐ž ๐Œ๐ˆ ๐ข๐ง ๐‚๐Š๐ƒ?
@Gawad_Nephro @elliotktannor @sibgokcay @ISNkidneycare @gag_aggarwal @NamrataYParikh
#ISNTweetorial #Meded #Nephtwitter
@Gawad_Nephro @elliotktannor @sibgokcay @ISNkidneycare @gag_aggarwal @NamrataYParikh ๐Ÿ”/๐Ÿ๐Ÿ– ๐“๐ก๐ž ๐œ๐ฅ๐ข๐ง๐ข๐œ๐š๐ฅ ๐ฉ๐ซ๐ž๐ฌ๐ž๐ง๐ญ๐š๐ญ๐ข๐จ๐ง ๐จ๐Ÿ ๐Œ๐ˆ ๐ข๐ง ๐‚๐Š๐ƒ ๐ฉ๐จ๐ฉ๐ฎ๐ฅ๐š๐ญ๐ข๐จ๐ง ๐ข๐ฌ ๐จ๐Ÿ๐ญ๐ž๐ง ๐š๐ญ๐ฒ๐ฉ๐ข๐œ๐š๐ฅ.
Only 40% of patients with stages G3 to G5 with MI have typical symptoms ๐Ÿ‘‰๐Ÿฝ ajkd.org/article/S0272-โ€ฆ
#ISNTweetorial #Meded #Nephtwitter
๐Ÿ•/๐Ÿ๐Ÿ–๐Ÿ“Š๐“๐ซ๐ฎ๐ž ๐จ๐ซ ๐Ÿ๐š๐ฅ๐ฌ๐ž: ๐…๐ซ๐š๐ฆ๐ข๐ง๐ ๐ก๐š๐ฆ ๐ž๐ช๐ฎ๐š๐ญ๐ข๐จ๐ง ๐ก๐š๐ฏ๐ž ๐ ๐จ๐จ๐ ๐๐ข๐ฌ๐œ๐ซ๐ข๐ฆ๐ข๐ง๐š๐ญ๐ข๐จ๐ง ๐ข๐ง ๐‚๐Š๐ƒ ๐ข๐ง ๐œ๐จ๐ฆ๐ฉ๐š๐ซ๐ข๐ฌ๐จ๐ง ๐ญ๐จ ๐ ๐ž๐ง๐ž๐ซ๐š๐ฅ ๐ฉ๐จ๐ฉ๐ฎ๐ฅ๐š๐ญ๐ข๐จ๐ง.
@Gawad_Nephro @sibgokcay @aiakl2001
#ISNTweetorial #Meded #Nephtwitter
๐Ÿ–/๐Ÿ๐Ÿ– ๐‚๐•๐ƒ ๐ซ๐ข๐ฌ๐ค ๐ข๐ง ๐‚๐Š๐ƒ:
๐Ÿ“ŒFramingham equation prediction systematically fall below 'actual risk
๐Ÿ‘‰๐Ÿฝsciencedirect.com/science/articlโ€ฆ
๐Ÿ“ŒBiomarkers may improve performance of risk prediction models in early CKD
๐Ÿ‘‰๐Ÿฝlinkinghub.elsevier.com/retrieve/pii/Sโ€ฆ
#ISNTweetorial #Meded #Nephtwitter
๐Ÿ—/๐Ÿ๐Ÿ– ๐Ÿ“Š๐“๐ซ๐ฎ๐ž ๐จ๐ซ ๐Ÿ๐š๐ฅ๐ฌ๐ž: ๐‘๐ž๐ ๐ฎ๐ฅ๐š๐ซ ๐ฌ๐œ๐ซ๐ž๐ž๐ง๐ข๐ง๐  ๐Ÿ๐จ๐ซ ๐œ๐จ๐ซ๐จ๐ง๐š๐ซ๐ฒ ๐š๐ซ๐ญ๐ž๐ซ๐ฒ ๐๐ข๐ฌ๐ž๐š๐ฌ๐ž ๐ข๐ง ๐š๐ฌ๐ฒ๐ฆ๐ฉ๐ญ๐จ๐ฆ๐š๐ญ๐ข๐œ ๐ฉ๐š๐ญ๐ข๐ž๐ง๐ญ๐ฌ ๐ฐ๐ข๐ญ๐ก ๐‚๐Š๐ƒ ๐ข๐ฌ ๐ซ๐ž๐œ๐จ๐ฆ๐ฆ๐ž๐ง๐๐ž๐
#ISNTweetorial #Meded #Nephtwitter
@Gawad_Nephro @BasuNephro
๐Ÿ๐ŸŽ/๐Ÿ๐Ÿ– ๐’๐œ๐ซ๐ž๐ž๐ง๐ข๐ง๐  ๐Ÿ๐จ๐ซ ๐œ๐จ๐ซ๐จ๐ง๐š๐ซ๐ฒ ๐š๐ซ๐ญ๐ž๐ซ๐ฒ ๐๐ข๐ฌ๐ž๐š๐ฌ๐ž ๐ข๐ง ๐‚๐Š๐ƒ
๐Ÿ“ŒCAD screening in asymptomatic CKD is not recommended. No evidence supporting efficacy of coronary revascularizatn inโฌ‡๏ธdeath or MI in these pts ๐Ÿ‘‰๐Ÿฝ jamanetwork.com/journals/jama/โ€ฆ
#ISNTweetorial
๐Ÿ๐Ÿ/๐Ÿ๐Ÿ– ๐’๐œ๐ซ๐ž๐ž๐ง๐ข๐ง๐  ๐Ÿ๐จ๐ซ ๐‚๐€๐ƒ ๐ข๐ง ๐‚๐Š๐ƒ (๐œ๐จ๐ง๐ญ.)
๐Ÿ“ŒExercise test is limited byโฌ‡๏ธfunctional capacity๐Ÿ‘‰๐Ÿฝpubmed.ncbi.nlm.nih.gov/18510627/
๐Ÿ“ŒCoronary art. Ca score or CTA has advantage over functional imaging๐Ÿ‘‰๐Ÿฝsciencedirect.com/science/articlโ€ฆ
#ISNTweetorial
๐Ÿ๐Ÿ/๐Ÿ๐Ÿ– ๐’๐œ๐ซ๐ž๐ž๐ง๐ข๐ง๐  ๐Ÿ๐จ๐ซ ๐œ๐จ๐ซ๐จ๐ง๐š๐ซ๐ฒ ๐š๐ซ๐ญ๐ž๐ซ๐ฒ ๐๐ข๐ฌ๐ž๐š๐ฌ๐ž ๐ข๐ง ๐‚๐Š๐ƒ (๐œ๐จ๐ง๐ญ.)
Dialysis pts haveโฌ†๏ธ risk for coronary artery stenosis w/โฌ†๏ธCAC scores, but 'risk is โฌ‡๏ธthan in pts without CKD with similar CAC scores.๐Ÿ‘‰๐Ÿฝ ncbi.nlm.nih.gov/pmc/articles/Pโ€ฆ
#ISNTweetorial
๐Ÿ๐Ÿ‘/๐Ÿ๐Ÿ–๐Ÿ“Š๐“๐ซ๐ฎ๐ž ๐จ๐ซ ๐Ÿ๐š๐ฅ๐ฌ๐ž: ๐‚๐š๐ซ๐๐ข๐š๐œ ๐ญ๐ซ๐จ๐ฉ๐จ๐ง๐ข๐ง๐ฌ ๐š๐ซ๐ž ๐Ÿ๐ซ๐ž๐ช๐ฎ๐ž๐ง๐ญ๐ฅ๐ฒ ๐ง๐จ๐ซ๐ฆ๐š๐ฅ ๐ข๐ง ๐š๐๐ฏ๐š๐ง๐œ๐ž๐ ๐‚๐Š๐ƒ
#ISNTweetorial #tweetorial #Meded #Nephtwitter
๐Ÿ4/๐Ÿ๐Ÿ– ๐Œ๐š๐ซ๐ค๐ž๐ซ๐ฌ ๐จ๐Ÿ ๐Œ๐ฒ๐จ๐œ๐š๐ซ๐๐ข๐š๐ฅ ๐ˆ๐ง๐ฃ๐ฎ๐ซ๐ฒ ๐ข๐ง ๐‚๐Š๐ƒ
๐Ÿ“ŒDynamic changes in troponinโฌ†๏ธspecificity for Dx MI in ESKD๐Ÿ‘‰๐Ÿฝ sciencedirect.com/science/articlโ€ฆ
๐Ÿ“ŒTroponins are frequently โฌ†๏ธ in advanced CKD ๐Ÿ‘‰๐Ÿฝ academic.oup.com/clinchem/articโ€ฆ
#ISNTweetorial #tweetorial #Nephtwitter
๐Ÿ๐Ÿ“/๐Ÿ๐Ÿ– ๐Œ๐š๐ซ๐ค๐ž๐ซ๐ฌ ๐จ๐Ÿ ๐ฆ๐ฒ๐จ๐œ๐š๐ซ๐ข๐๐š๐ฅ ๐ข๐ง๐ฃ๐ฎ๐ซ๐ฒ ๐ข๐ง ๐‚๐Š๐ƒ (๐œ๐จ๐ง๐ญ.) Although sensitivity of high-sensitivity troponin I in Dx of MI is not modified by kidney function, its specificityโฌ‡๏ธwith GFR decline ๐Ÿ‘‰๐Ÿฝ jasn.asnjournals.org/content/29/2/6โ€ฆ
#ISNTweetorial
๐Ÿ๐Ÿ”/๐Ÿ๐Ÿ–๐Ÿ“Š๐“๐จ๐ซ๐…: ๐€๐๐ฏ๐š๐ง๐œ๐ž๐ ๐‚๐Š๐ƒ ๐ฐ/ ๐ฌ๐ญ๐š๐›๐ฅ๐ž ๐œ๐จ๐ซ๐จ๐ง๐š๐ซ๐ฒ ๐๐ข๐ฌ๐ž๐š๐ฌ๐ž & ๐ฆ๐จ๐๐ž๐ซ๐š๐ญ๐ž/๐ฌ๐ž๐ฏ๐ž๐ซ๐ž ๐ข๐ฌ๐œ๐ก๐ž๐ฆ๐ข๐š, ๐ข๐ง๐ข๐ญ๐ข๐š๐ฅ ๐ข๐ง๐ฏ๐š๐ฌ๐ข๐ฏ๐ž ๐ฌ๐ญ๐ซ๐š๐ญ๐ž๐ ๐ฒ ๐ข๐ฌ ๐ž๐Ÿ๐Ÿ๐ข๐œ๐ข๐ž๐ง๐ญ ๐ญ๐ก๐š๐ง ๐œ๐จ๐ง๐ฌ๐ž๐ซ๐ฏ๐š๐ญ๐ข๐ฏ๐ž ๐จ๐ง๐ž
#ISNTweetorial
๐Ÿ๐Ÿ•/๐Ÿ๐Ÿ– ๐Œ๐š๐ง๐š๐ ๐ž๐ฆ๐ž๐ง๐ญ ๐จ๐Ÿ ๐‚๐€๐ƒ ๐ข๐ง ๐‚๐Š๐ƒ
Among advanced CKD pts w/ stable coronary disease, and moderate/severe ischemia, initial invasive strategy, as compared w/ conservative strategy, didn't โฌ‡๏ธ'risk of death or nonfatal MI๐Ÿ‘‰๐Ÿฝ
nejm.org/doi/full/10.10โ€ฆ
#ISNTweetorial
๐Ÿ8/๐Ÿ8 CKD pts are not enrolled sufficiently in CVD trials. More recruitment is needed for strong evidence.
๐‰๐จ๐ข๐ง ๐ง๐ž๐ฑ๐ญ ๐๐ฎ๐š๐ง๐œ๐ž๐ฌ ๐ข๐ง ๐๐ž๐ฉ๐ก ๐ฐ๐ž๐›๐ข๐ง๐š๐ซ "Coronary Artery Revascularization Strategy in 'Advanced Stage of CKD"

#ISNTweetorial

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More from @ISNeducation

ISN Education Profile picture
8 Jun
1/13 Use of Direct Oral Anticoagulants (DOACs) in Kidney Disease
โ˜‘๏ธโฌ‡๏ธ Better bleeding risk profile
โ˜‘๏ธNo need for monitoring!
โ˜‘๏ธFaster action
โ˜‘๏ธ less drug & dietary interactions
โ˜‘๏ธ?โฌ‡๏ธ risk of Vascular calcifications
๐Ÿ‘‰@Kidney_Int
kidney-international.org/article/S0085-โ€ฆ
๐Ÿงตby @gag_aggarwal
2/ Originally referred to as new/novel/non-VKA oral anticoagulants (NOACs)
the preferred international consensus nomenclature for OACs that directly inhibit 1 molecular target is ->DOAC
Also they are not new anymore๐Ÿ™ˆbeen around since early 2000s
ahajournals.org/doi/full/10.11โ€ฆ
3/ Do you use DOACs in patients with GFR<15ml/min/1.73m2 for stroke prevention in AF or VTE?
@ISNkidneycare @arvindcanchi @sibgokcay @FerArceAmare @hswapnil @divyaa24 @AnandhUrmila @Gawad_Nephro @gag_aggarwal @nefrorantes @edgarvlermamd
Read 13 tweets
ISN Education Profile picture
26 Mar
Check out this excellent review in @KIReports of a very important topic relevant to all clinicians involved in the care of CKD pts.
โ–ถ๏ธPts with CKD are at โฌ†๏ธsed risk of CAD with โฌ‡๏ธing eGFR
โ–ถ๏ธMany CKD pts have atypical presentations of CAD; presenting more often with MI directly and more NSTEMI
โ–ถ๏ธRisk stratification calculators like the Framingham criteria are inadequate and underestimate the risk in CKD pts
โ–ถ๏ธAddition of eGFR/albuminuria/biomarkers can improve sensitivity but remains suboptimal
โ–ถ๏ธDialysis is an independent risk factor; โฌ†๏ธSudden Cardiac Deathโฌ†๏ธCHF
Read 12 tweets
ISN Education Profile picture
24 Mar
Important study published in @KIReports. The 1st report from the developing world ๐Ÿ‡ฎ๐Ÿ‡ณ looking at the outcome of dialysis in #COVID19 positive patients. Image
โ–ถ๏ธMajority of patients were male and older and had been on dialysis for some time.
โ–ถ๏ธAnd presented with symptoms necessitating a #COVID19 test.
โ–ถ๏ธA good 30% were referred because their home unit didn't have facilities to dialyse Covid+ve patients. ImageImage
โ–ถ๏ธ The prevalence of #Covid19 was 20% higher in dialysis pts than the general population for the same time period
โ–ถ๏ธ Close to a quarter of Covid+ve dialysis pts died
โ–ถ๏ธ The usual suspect co-morbidities predicted worse outcomes; diabetes,HTN, Older age, longer dialysis vintage Image
Read 5 tweets
ISN Education Profile picture
23 Mar
How many of your dialysis patients have well controlled blood pressure?๐Ÿ“‹
Admit it! Hypertension in dialysis patients is a universal problem!โ˜น๏ธ
The next edition of Nuances in Nephrology will address this and more!
Register now! ๐Ÿ”—register.gotowebinar.com/register/21253โ€ฆ
But to give you a head start, hereโ€™s a #ISNtweetorial
#meded #tweetorials
โ—Data suggests that approximately 50-60% of hemodialysis (HD) patients are hypertensive

โ€ผ๏ธIn a study of 2535 adult HD pts, 86% were found to be hypertensive๐Ÿคฏ

pubmed.ncbi.nlm.nih.gov/12967694/

Even among peritoneal dialysis patients, >80% have hypertension ๐Ÿ˜ณ
pubmed.ncbi.nlm.nih.gov/10383021/
Read 16 tweets
ISN Education Profile picture
20 Mar 20
#COVID19 for the Nephrologist- Real life experience from Italy @caioqualunque Webinar now available on the ISN Academy
@caioqualunque Thank you for sharing your experience with the ISN community. On the panel ISN President @vjha126 Moderator @arvindcanchi. ISN education highlights by @gag_aggarwal
@caioqualunque STORY OF THE EPIDEMIC-Feb14 38yr old Italian starts with symptoms after being asymptomatic for weeks->Feb 20 only 3cases->fast forward to 2 weeks later the country is in lockdown #COVID #COVID2019italia #COVID2019india #COVID2019 #nCoV2019 #Covid_19
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