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Dec 20 • 7 tweets • 5 min read
#1
A few hours to go for the #NephJC chat on the MYTEMP trial ⏳

❓Have you ever paused to wonder how we came up with the ‘standard’ dialysate temperature of 37°C (98.6°F)???🤔

❓How does core body temperature (CBT) differ in dialysis patients from the general population?🤔
#2
👉Historical reasons for std dialysate 🌡️seem unclear

👉37°C considered avg body 🌡️in adults ⏩ arbitrarily selected as ‘neutral’ dialysate 🌡️

👉Assumed to prevent body 🌡️ changes during HD

#NephJC

pubmed.ncbi.nlm.nih.gov/15211448/
#3
❓How did we come up with 37°C as the normal body 🌡️?

👉From Dr. Carl Wunderlich
▶️Father of clinical thermometry
▶️Analyzed >1million axillary 🌡️from 25K adults (pre-digital era!🤯)
▶️Noted 🌡️differences with race, sex, circadian rhythm
#NephJC
pubmed.ncbi.nlm.nih.gov/8011836/
#4
❓But is a dialysate 🌡️ 37°C physiologic in HD patients?🤔

✨🌡️varies according to:
▶️Time of the day ▶️📈4-9PM ▶️📉2-8AM➡️Consider dialysis shift
▶️🚺>🚹

#NephJC

ncbi.nlm.nih.gov/pmc/articles/P…
#5
▶️🌟 Studies have shown avg body 🌡️ <37°C in long-term HD patients🌟

#NephJC

pubmed.ncbi.nlm.nih.gov/15211448/
#6

▶️🌡️also varies with site of measurement
▶️Options for measurement sites and their pros & cons 👇

✨How was 🌡️ measured in the MYTEMP study?

#NephJC

pubmed.ncbi.nlm.nih.gov/15211448/
#7
🌟Read the comprehensive summary of the MYTEMP study by my amazing POD4 colleague @dana_m_larsen to learn more about dialysate 🌡️

🌟And join the #NephJC chat on Tuesday 9PM EST/ Wednesday 9PM IST (330PM GMT)

👋A short drop by from @sandyrvsdav

nephjc.com/news/mytemp

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More from @NephJC

Nephrology Jrnl Club Profile picture
Apr 8
✳️ #TenTweetNephJC ✳️

👉 where we catch you up on the week's #NephJC chat in 10 tweets 

The topic at hand was Plasma Exchange and Vasculitis: the infamous debate of to PLEX or not to PLEX in AAV

Check out this thread to see if you change your mind on this comPLEX topic 👇 Image
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✅ updated systematic review & meta-analysis

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Mar 25
✳️ Welcome to #TenTweetNephJC, where we catch you up on the week's #NephJC chat in 10 tweets ✳️

The topic at hand was diuretic resistance, specifically compensatory post-diuretic sodium reabsorption (CPDSR). Let’s walk you through how it all flowed 💧
What did I miss?

We teach medical students that diuretic resistance occurs in large part due to CPDSR. While this has been validated in healthy individuals, does this hold true in patients w/ acute decomp heart failure (ADHF)?
Enter the study in question
pubmed.ncbi.nlm.nih.gov/34529781/
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✅Single center, prospective, observational study, with a randomized sub-cohort
✅Evaluating mechanisms of diuretic resistance in patients with ADHF on IV loops 💉
✅Supervised urine collection pre and post diuresis
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Nephrology Jrnl Club Profile picture
Mar 13
This weeks #TenTweetNephJC makes us sad - does taking regular acetaminophen (paracetamol) cause hypertension?

Find out below in this rapid review of the Scottish trial, as we catch up on the #NephJC take on things 👇 Image
What did I miss?

Observational trials suggest that acetaminophen increases BP, but (unlike NSAIDs) the widespread impression remains of a safe first-line therapy for chronic pain. The largest previous RCT had n=33.

Then PATH-BP dropped last month….

pubmed.ncbi.nlm.nih.gov/35130054/
1 Tweet Methods

✔️ Single-centre, double-blind, placebo-controlled, crossover study

✔️ 4g/day acetaminophen (the standard UK dose) 🆚 placebo

✔️ 2 weeks active or placebo ➡️ 2 weeks washout ➡️ 2 weeks on opposite treatment

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Nephrology Jrnl Club Profile picture
Feb 28
✳️ #TenTweetNephJC ✳️

Did you see in the news that they’ve transplanted a pig kidney into a human and it (sort of) worked?

That was the #NephJC chat last week - for a rapid summary check out the thread👇 Image
What did I miss?

We need more kidneys to transplant, hence the University of Alabama is running xenotransplant research.

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pubmed.ncbi.nlm.nih.gov/35049121/
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✅Family of a 57 y.o. man with brain death gave consent

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✅Negative crossmatch

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Nephrology Jrnl Club Profile picture
Feb 16
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?

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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…
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✅ Observational cohort study from 🇸🇪

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Nephrology Jrnl Club Profile picture
Jan 29
Return of #TenTweetNephJC

✳️Rapid #NephJC catch-up✳️

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What did I miss?

We actually covered two studies this week in collaboration with @ipnajc but we can’t do both in #TenTweetNephJC! We’ll focus on the PREDNOS-2 trial.

jamanetwork.com/journals/jamap…
1 tweet methods

✅ 122 centres in UK

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✅ Did they get proteinuria +++ or worse over next fortnight?
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