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Nephrology Journal Club Profile picture
@NephJC
Apr 5, 2023 • 11 tweets • 9 min read • Read on X
Scrolly
Welcome to #TenTweetNephJC for a short recap! Nephrologists warned of renalism neglecting cardiac ischemia in kidney pts. ISCHEMIA-CKD dashed hopes. Waiting for a deceased donor kidney transplant in the US is a grueling journey for +100K pts with advanced chronic kidney disease Image
2/10
What did I miss?
🌤️Retrospective study: asymptomatic kidney transplant candidates tested for coronary heart disease (CHD) vs non-tested pubmed.ncbi.nlm.nih.gov/36595271/
Aim: to determine the effect of CHD testing on the risk of death or acute MI within 30 days after transplant
3/10
1 tweet methods

⏪ Retrospective cohort study, USRDS, 2000-2014

✅ 79334 Adults, 1st time kidney transplant

✅ CHD testing 12 months before transplant

🛠️ Instrumental analysis variable - less biased by confounding than standard methods @Husamjz ImageImage
4/10
1 tweet results
❤️‍ Primary outcome reached in 5.3% (4604) patients - are this numbers correct?
💔Death in 2063 patients while acute MI in 2329 patients Image
5/10
A figure paints 1000 words
From: ahajournals.org/doi/full/10.11…
H/T @ssfarouk Image
6/10
Give me something clever to say

We are quoting a cardiologist, but not every cardiologist, the son of a nephrologist @jelevenson

Image
7/10
Chat consensus?

1️⃣ Revascularization (by extension testing) isn't benign. Denying transplants is definitely doing people harm

2️⃣ Isn't dialysis a form of stress testing?

3️⃣ CV events decline after transplant. We should think of transplant as revascularization by proxy
8/10
Quote of the fortnight!
Is @hswapnil the most quoted in #TenTweetNephJC? 🧠
Image
9/10
I want more info
✅Follow @gchertow, @BaiocchiMike & @StanfordNeph
✅ About journey to the waitlist in @Nephmasness blog
ajkdblog.org/2023/03/01/nep…
✅#NephJC summary: @DrCool_Beans @meyyappannephro
nephjc.com/news/pre-trans…

✅2 VAs by @renspasilan @Nihal_Hamary @MedPEEdsKidneys ImageImage
10/10
Final thoughts
✳️ Waitlist journey can be daunting as it is, our patients don’t need more impediments when aren't really necessary
➡️Up next, Rolling Stone's new hit Hydrochlorothiazide couldn't give any satisfaction in preventing kidney stones
pubmed.ncbi.nlm.nih.gov/36856614/ Image
I admit sometimes I'm stumbling more than I'm learning. But thanks to truly fantastic support and guidance of #NephJC people, I am here today, 1 year after hosting my 1st #NephJC, happy to continue my journey along with #NephJC & @NSMCInternship Cristina Popa, @NephroSeeker Image

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More from @NephJC

Nephrology Journal Club Profile picture
Jun 7, 2023
Welcome to #TenTweetNephJC
✳️10 tweets #NephJC catch-up ✳️

In the last NephJC, we discussed interim results📊from the PROTECT trial on efficacy & safety of Sparsentan in IgAN.

New light✨on the horizon for IgAN yet?

Check out this flying summary in case you've missed the chat! Image
2/10
What did I miss?

3 decades of fateful trials of ERAs in PAH, HTN, DKD, FSGS & IgAN (AFFINITY,ALIGN) set the stage for

🛡️PROTECT🛡️
Sparsentan🎲Irbesartan
thelancet.com/journals/lance…

✔️Phase3⃣RCT
✔️Active-controlled
✔️Double-blind🚫

✔️18 countries🗺️
✔️134 sites🏥

The cohort⬇️ Image
3/10
1 tweet methods

n=406
270 weeks (114+156 weeks open label with SGLT2i!)

➡️Carefully selected population for nil significant cardio/cerebro-vascular or hepatic disease
➡️On MLD/50% MLD of RAASi
➡️1:1 randomisation
➡️Stratification as per eGFR & proteinuria
➡️MMRM statistics Image
Read 11 tweets
Nephrology Journal Club Profile picture
Dec 20, 2022
#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/
Read 7 tweets
Nephrology Journal Club Profile picture
Dec 9, 2022
Would a new drug option for resistant hypertension get you excited? How about a superior trial design?

Time to learn about PRECISION - our twitter journal club had 720 tweets, but you can catch the highlights quickly with the regular #TenTweetNephJC thread👇 Image
2/10
What did I miss?

We know we miss targeting many pathways that contribute to resistant hypertension, a condition with high cardiovascular morbidity.

Enter aprocitentan, a dual endothelin receptor antagonist, for it’s crack at a Phase 3 trial.

pubmed.ncbi.nlm.nih.gov/36356632/
3/10
1 tweet methods

✅ Multi-center, blinded, randomised, parallel-group

✅ Elaborate run-in (figure) to give all amlod + HCTZ + valsartan, and then exclude pseudoresistant hypertension

✅ Does adding aprocitentan to regime improve unattended automated office BP 🆚 placebo? Image
Read 10 tweets
Nephrology Journal Club Profile picture
Apr 8, 2022
✳️ #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
What did I miss?

PLEX, with its plausible biological rationale, has been in the center of debate for management of AAV since the 1980s, with several RCTs in favor of PLEX or against it

🔸️An updated meta-analysis which included the PEXIVAS results was discussed
1 tweet methods

✅ updated systematic review & meta-analysis

✅ RCTs of patients with AAV or pauci-immune RPGN receiving PLEX and ≥12mo. follow-up

✅ Outcome measures were at least one of: mortality, ESKD, serious infection, relapse, AE or health-related QoL
Read 10 tweets
Nephrology Journal Club Profile picture
Mar 25, 2022
✳️ 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/
1 tweet methods

✅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
✅Primary outcome = level of CPDSR
Read 10 tweets
Nephrology Journal Club Profile picture
Mar 13, 2022
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

✔️ Primary outcome = change in 24 hour ambulatory BP
Read 10 tweets

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