Welcome to #TenTweetNephJC
✳️ 10 tweets to catch-up on the most recent #NephJC ✳️
This week - when is the ideal time to start dialysis in progressive chronic kidney disease?
Later starts lower the burden on patients & use of healthcare resources, but what’s the trade-off?
✳️ 10 tweets to catch-up on the most recent #NephJC ✳️
This week - when is the ideal time to start dialysis in progressive chronic kidney disease?
Later starts lower the burden on patients & use of healthcare resources, but what’s the trade-off?
What did I miss?
Previous observational studies analysing outcomes by eGFR at point of dialysis initiation suffered from immortal time bias, survivor bias, and lead time bias. This trial used clever new statistical methods to avoid these flaws!
bmj.com/content/375/bm…
Previous observational studies analysing outcomes by eGFR at point of dialysis initiation suffered from immortal time bias, survivor bias, and lead time bias. This trial used clever new statistical methods to avoid these flaws!
bmj.com/content/375/bm…
1 tweet methods
✅ Observational cohort study from 🇸🇪
✅ 10,290 patients with CKD in Swedish registry
✅ Target trial emulation using “cloning, censoring & weighting” method used to avoid biases mentioned above
✅ Observational cohort study from 🇸🇪
✅ 10,290 patients with CKD in Swedish registry
✅ Target trial emulation using “cloning, censoring & weighting” method used to avoid biases mentioned above
1 tweet results
🔹3822 patients started dialysis over 3.1 years follow-up (60:40 HD to PD ratio)
🔹Early starters based on eGFR enjoyed a statistically significant mortality benefit
🛑 BUT, they’d need to start dialysis 4 years earlier to increase survival by 1.6 months
🔹3822 patients started dialysis over 3.1 years follow-up (60:40 HD to PD ratio)
🔹Early starters based on eGFR enjoyed a statistically significant mortality benefit
🛑 BUT, they’d need to start dialysis 4 years earlier to increase survival by 1.6 months
A figure paints 1000 words
Give me something clever to say
“A study made it appear that Oscar winners lived longer than their less successful peers but this was actually just an example of immortal time bias: winners had to live long enough to win, unlike the comparison group of non-winners”
“A study made it appear that Oscar winners lived longer than their less successful peers but this was actually just an example of immortal time bias: winners had to live long enough to win, unlike the comparison group of non-winners”
Chat consensus?
1️⃣ Previous observational studies introduced biases & we should disregard their conclusions
2️⃣ Using new statistical methods to mimic a clinical trial is exciting
3️⃣ If you’re a “wait for symptoms” nephrologist, it’s not time to change your practise
1️⃣ Previous observational studies introduced biases & we should disregard their conclusions
2️⃣ Using new statistical methods to mimic a clinical trial is exciting
3️⃣ If you’re a “wait for symptoms” nephrologist, it’s not time to change your practise
Quote of the fortnight!
Admittedly relates to acute dialysis rather than starting in outpatient CKD, but still one to make nephrologists chuckle. @captainchloride
Admittedly relates to acute dialysis rather than starting in outpatient CKD, but still one to make nephrologists chuckle. @captainchloride
https://twitter.com/captainchloride/status/1491233518806257670?s=21
I want more info
✅ Follow @FuEdouard & @jjcarrero1
✅ Great tweetorial trial summary from author @FuEdouard at this link:
✅ NephJC Summary from @hswapnil & @michaelturk6 here:
nephjc.com/news/dialysis-…
✅ VA from Group of Henle hero @Elena_Cervants 👇
✅ Follow @FuEdouard & @jjcarrero1
✅ Great tweetorial trial summary from author @FuEdouard at this link:
https://twitter.com/fuedouard/status/1465840754820059146?s=21
✅ NephJC Summary from @hswapnil & @michaelturk6 here:
nephjc.com/news/dialysis-…
✅ VA from Group of Henle hero @Elena_Cervants 👇
Final thoughts
✳️ 12 hours/week of haemodialysis = 3.5 months of dialysis over 4 yrs. Trade-off to gain 1.6 month survival doesn’t seem worth it.
➡️ Up next - xenotransplantation using pig kidneys! See you on 22/23 Feb!
onlinelibrary.wiley.com/doi/10.1111/aj…
Tweetorial from @Jamiekwillows
✳️ 12 hours/week of haemodialysis = 3.5 months of dialysis over 4 yrs. Trade-off to gain 1.6 month survival doesn’t seem worth it.
➡️ Up next - xenotransplantation using pig kidneys! See you on 22/23 Feb!
onlinelibrary.wiley.com/doi/10.1111/aj…
Tweetorial from @Jamiekwillows
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