Episódios
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The Filtrate:
Jennie Lin
Joel Topf
Josh Waitzman
Swapnil Hiremath
With Special Guests
Pedro Teixeira
Jay Koyner
Editor
Sophia Ambruso
Show Notes
The article: A Randomized Trial of Intravenous Amino Acids for Kidney Protection
NephJC Summary
KDIGO Clinical Practice Guideline for Acute Kidney Injury (PDF)
Steve Coca study Evaluation of Short-Term Changes in Serum Creatinine Level as a Meaningful End Point in Randomized Clinical Trials (PubMed)
Using Nephrocheck to prevent AKI: Prevention of cardiac surgery-associated AKI by implementing the KDIGO guidelines in high risk patients identified by biomarkers: the PrevAKI randomized controlled trial (PubMed)
Brenner’s Review of protein intake and renal hemodynamics: Dietary Protein Intake and the Progressive Nature of Kidney Disease: — The Role of Hemodynamically Mediated Glomerular Injury in the Pathogenesis of Progressive Glomerular Sclerosis in Aging, Renal Ablation, and Intrinsic Renal Disease (NEJM)
Husain-Syed a look at preoperative renal functional reserve and risk of AKI: Preoperative Renal Functional Reserve Predicts Risk of Acute Kidney Injury After Cardiac Operation (PubMed)
Dana Fuhrman review of renal functional reserve: The Role of Renal Functional Reserve in Predicting Acute Kidney Injury (PubMed)
Use of SGLT2i prevented AKI in the placebo controlled trials. Clinical Adverse Events Associated with Sodium-Glucose Cotransporter 2 Inhibitors: A Meta-Analysis Involving 10 Randomized Clinical Trials and 71 553 Individuals (PubMed)
Assessment of P values for demographic data in randomized controlled trials (PubMed)
Tubular Secretions
Swapnil The Lord of the Rings: Rings of Power Season 2 on Amazon Prime (Wikipedia)
Josh Fortnite (Website)
Pedro CRRT Academy at University of Alabama Birmingham (Website)
Jay Koyner Slow Horses on AppleTV (Wikipedia)
Jennie Linn #KidneyWk Run Club Friday 10/25 at 6:15 am PST Meet in front of Sally’s Fish House ~2 miles. Easy pace (10-12 min/mile) (Strava)
Joel Topf Your Honor on Netflix (Wikipedia)
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The draft order:
Sophia Ambruso
Nayan Arora
Swapnil Hiremath
AC Gomez
Joel Topf
Editor
Nayan Arora
Show Notes
Previous drafts:
2021 KDIGO Hypertension —Joel, Sophia, Swap, Nayan, Josh
2021 ASN Kidney Week Draft—Joel, Sophia, Swap, Nayan, Jennie
2022 The ISPD Peritonitis Guideline— Joel, Sophia, Swap, Nayan
2022 ASN Kidney Week Draft—Joel, Sophia, Swap, Nayan
2023 ASN Kidney Week Draft—Joel, Sophia, Swap, Nayan, AC, Josh
2024 KDIGO CKD Clinical Practice Guideline —Joel, Sophia, Swap, Nayan, Josh, AC
The guideline
The NephJC discussion Part 1 | Part 2
First Round
Sophia’s Pick 3.7.1 We recommend treating patients with type 2 diabetes (T2D), CKD, and an eGFR ≥20 ml/min per 1.73 m2 with an SGLT2i (1A).
Not Nayan’s Pick 3.7.3: We suggest treating adults with eGFR 20 to 45 ml/min per 1.73 m2 with urine ACR <200 mg/g (<20 mg/mmol) with an SGLT2i (2B).Nayan’s Pick 2.2.1: In people with CKD G3–G5, we recommend using an externally validated risk equation to estimate the absolute risk of kidney failure (1A).
A birdie told me there will not be a Tangri KFRE vs the World debate at Kidney Week
The action points based on absolute risk results:Practice Point 2.2.1: A 5-year kidney failure risk of 3%–5% can be used to determine need for nephrology referral in addition to criteria based on eGFR or urine ACR, and other clinical considerations.
Practice Point 2.2.2: A 2-year kidney failure risk of >10% can be used to determine the timing of multidisciplinary care in addition to eGFR-based criteria and other clinical considerations.
Practice Point 2.2.3: A 2-year kidney failure risk threshold of >40% can be used to determine the modality education, timing of preparation for kidney replacement therapy (KRT) including vascular access planning or referral for transplantation, in addition to eGFR-based criteria and other clinical considerations.
Swap’s Pick 3.15.1.1: In adults aged ‡50 years with eGFR <60 ml/min per 1.73 m2 but not treated with chronic dialysis or kidney transplantation (GFR categories G3a–G5), we recommend treatment with a statin or statin/ezetimibe combination (1A).
AC’s Pick 3.7.2: We recommend treating adults with CKD with an SGLT2i for the following (1A):
eGFR ≥20 ml/min per 1.73 m2 with urine ACR ≥200 mg/g (≥20 mg/mmol), or
heart failure, irrespective of level of albuminuria. (1A)
Joel’s Pick 3.10.1: In people with CKD, consider use of pharmacological treatment with or without dietary intervention to prevent development of acidosis with potential clinical implications (e.g., serum bicarbonate <18 mmol/l in adults).
Practice Point 3.10.2: Monitor treatment for metabolic acidosis to ensure it does not result in serum bicarbonate concentrations exceeding the upper limit of normal and does not adversely affect BP control, serum potassium, or fluid status.
Freely Filtered 061: Bicarb in Transplant with Nav TangriSecond Round
Joel’s Pick 3.3.1.1: We suggest maintaining a protein intake of 0.8 g/kg body weight/d in adults with CKD G3–G5 (2C).
Practice points related to protein intake:3.3.1.1: Avoid high protein intake (>1.3 g/kg body weight/d) in adults with CKD at risk of progression.
3.3.1.2: In adults with CKD who are willing and able, and who are at risk of kidney failure, consider prescribing, under close supervision, a very low–protein diet (0.3–0.4 g/kg body weight/d) supplemented with essential amino acids or ketoacid analogs (up to 0.6 g/kg body weight/d).
3.3.1.3: Do not prescribe low- or very low–protein diets in metabolically unstable people with CKD.
AC’s Pick 3.9.1: In adults with T2D and CKD who have not achieved individualized glycemic targets despite use of metformin and SGLT2 inhibitor treatment, or who are unable to use those medications, we recommend a long-acting GLP-1 RA (1B).
Swapnil’s Pick Practice Point 5.4.1: Initiate dialysis based on a composite assessment of a person’s symptoms, signs, QoL, preferences, level of GFR, and laboratory abnormalities.
IDEAL Trial: A Randomized, Controlled Trial of Early versus Late Initiation of Dialysis NEJM
Timing of dialysis initiation to reduce mortality and cardiovascular events in advanced chronic kidney disease: nationwide cohort study NephJC
Nayan’s Pick Practice Point 1.1.4.2: Use tests to establish a cause based on resources available (Table 6b).
Sophia’s Pick Practice Point 1.1.1.2: Following incidental detection of elevated urinary albumin-to-creatinine ratio (ACR), hematuria, or low estimated GFR (eGFR), repeat tests to confirm presence of CKD.
Joel’s cystatin C Tweet
The cystatin C guideline recommendation 1.1.2.1: In adults at risk for CKD, we recommend using creatinine-based estimated glomerular filtration rate (eGFRcr). If cystatin C is available, the GFR category should be estimated from the combination of creatinine and cystatin C (creatinine and cystatin C– based estimated glomerular filtration rate [eGFRcr-cys]) (1B).
Nayan’s additional thoughts. He is not a fan of Practice Points 3.6.4 and 3.6.5
Practice Point 3.6.4 Continue ACEi or ARB therapy unless serum creatinine rises by more than 30% within 4 weeks following initiation of treatment or an increase in dose.
and
Practice Point 3.6.5: Consider reducing the dose or discontinuing ACEi or ARB in the setting of either symptomatic hypotension or uncontrolled hyperkalemia despite medical treatment, or to reduce uremic symptoms while treating kidney failure (estimated glomerular filtration rate [eGFR] <15 ml/min per 1.73 m2).
Tubular Secretion
Swap The Murderbot Diaries by Martha Wells
Nayan Searching for Hobey Baker Narrated by David Duchovny
AC Rosie Revere, Engineer
Sophia Bassnectar
How to fix the Apple Music automatically playing when you connect to bluetooth.
Joel The Veil with Elizabeth Moss
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Estão a faltar episódios?
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The Filtrate:
Joel Topf
Josh Waitzman
With Special Guest:
Brad Rovin (@BradRovin) Chief of nephrology at The Ohio State University Wexner Medical Center, one of the authors of the Nefigard trial.
Koyal Jain (@koyaljainMD) Program director of the GN Fellowship at University of North Carolina
Roger Rodby (@NephRodby) Associate program director of the Rush University Nephrology Fellowship
Editor
Sophia Ambruso
Show Notes
The manuscript (The Lancet | PubMed | NephJC)
The Results of Part A (Kidney Int | PubMed)
Edmund (Ed) Louis memorium by Steve Korbet in KI
Steve Korbet Do not miss this tweet
TESTING Freely Filtered #48 with Sean Barbour
Iptapocan at the World Congress of Nephrology: WCN24-1506 Efficacy And Safety Of Iptacopan In Patients With IgA Nephropathy: Interim Results From The Phase 3 APPLAUSE-IgAN Study
FDA and mandatory post-marketing studies. What happens when the study is negative (or not completed) (UNDARK)
Who should treat lupus nephritis: rheumatologists or nephrologists? (Nature Reviews Nephrology)
Protein and albumin-to-creatinine ratios in random urines accurately predict 24 h protein and albumin loss in patients with kidney disease (PubMed)
MEST Scores in NephJC
Risk scores in IgAN in NephJC
Repeat renal biopsy improves the Oxford classification-based prediction of immunoglobulin A nephropathy outcome (NDT)
Tarpeyo pills 4 mg. Four pills once a day. (WellRx has a picture of the pills)
IgA nephropathy in African Americans: uncommon but possible (PubMed Central)
Aberrantly Glycosylated IgA1 in IgA Nephropathy: What We Know and What We Don’t Know (PubMed Central)
Effectiveness of Mycophenolate Mofetil Among Patients With Progressive IgA Nephropathy (JAMA Network Open)
Tubular Secretions
Joel: Constellation on Apple TV (Wikipedia). Not good. Dune audio books are excellent. (Audible)
Josh: Podcasts about donating a kidney
One Is Enough Podcast (National Kidney Registry)
Donor Diaries (National Kidney Donation Organization)
Roger Iceland (Wikipedia)
Koyal India (Wikipedia)
Brad Fishing in Dubai
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The Filtrate:
Joel Topf
Swapnil Hiremath
Josh Waitzman
Nayan Arora
Sophia Ambruso
With Special Guest:
Brendon Neuen Super smart guy and clinical trialist
Vlado Perkovic Lead author of FLOW and friend of NephJC
Editor
Joel Topf
Show Notes
The manuscript (NEJM): Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes
The acronym FLOW from the title: evaluate renal Function with semagLutide Once Weekly (Twitter)
Joel wrote a blog post prior to the FLOW publication to try to set the table: Peeking Inside Schrödinger’s Box
Brendon’s Neuen’s tweet about total versus chronic slope (X | Twitter)
Modification of Association of Cystatin C With Kidney and Cardiovascular Outcomes by Obesity (Science Direct)
Semaglutide and Diabetic Retinopathy Risk in Patients with Type 2 Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials (PubMed)
The Efficacy and Safety of the Combination Therapy With GLP-1 Receptor Agonists and SGLT-2 Inhibitors in Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis (Frontiers in Pharmacology)
Statistical considerations for testing multiple endpoints in group sequential or adaptive clinical trials (PubMed)
Proteinuria Thresholds Are Irrational: A Call for Proteinuria Indexing (Nephron Clinical Practice)
Frank Harrel on why the NNT sucks (data methods)
Regulation of Na+/H+ exchanger NHE3 by glucagon-like peptide 1 receptor agonist exendin-4 in renal proximal tubule cells (PubMed)
Switching Between Glucagon-Like Peptide-1 Receptor Agonists: Rationale and Practical Guidance (PubMed)
Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial (PubMed)
Doctors are like the pyromaniac fireman (PBFluids)
Suggest topics for NephMadness (Twitter)
Design of the COmbinatioN effect of FInerenone anD EmpaglifloziN in participants with chronic kidney disease and type 2 diabetes using a UACR Endpoint study (CONFIDENCE) (PubMed)
Albuminuria-Lowering Effect of Dapagliflozin, Eplerenone, and Their Combination in Patients with Chronic Kidney Disease: A Randomized Crossover Clinical Trial (PubMed)
Spitzer’s involvement in revolutionizing nephrology is part of this lecture I did at the University of Nebraska Diabetes Symposium. (Dropbox: Start on slide 29)
Spitzer Resigns, Citing Personal Failings (New York Times)
Tubular Secretions
Swap: Dumb Money on NetFlix (Wikipedia)
Josh: Hiking Zion National Park (National Park Service)
Sophia: Lost in Space 2018 TV series on NetFlix (Wikipedia)
Nayan: Pelican Hill resort (Website)
Joel: Bodkin
NephJC Summer Book Club: Covenant of Water by Abraham Verghese (Amazon)
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The Filtrate:
Joel Topf
Swapnil Hiremath
AC Gomez
Nayan Arora
With Special Guest:
Anuja Java, complement god and pre-eclampsia research (Twitter)
Shannon M. Clark, MD, FACOG, an honest to god, true, maternal-fetal medicine specialist. (Website | Instagram)
Editor
Nayan Arora
Show Notes
CHIP Study from 2015 (NEJM | NephMadness 2015)
CHAP study from 2022 (NEJM | NephJC)
NephMadness 2024 coverage of the diagnosis of preeclampsia
sFlt background: Pathogenesis of Preeclampsia and Therapeutic Approaches Targeting the Placenta (PubMed)
PlGF background: Perspectives on the Use of Placental Growth Factor (PlGF) in the Prediction and Diagnosis of Pre-Eclampsia: Recent Insights and Future Steps (PubMed)
The PRAECIS trial (NephJC | NEJM Evidence)
You may just want to listen to Anna Burgner discuss preeclampsia with Kenar Jhaveri and Koyal Jain (GN in Ten) for the NephMadness PodCrawl
Bene Gesserit (Wikipedia)
Pathogenesis of preeclampsia: the genetic component (PubMed)
Tubular Secretions
Swap Slow Horses on Apple TV (Wikipedia)
AC Hidden Figures (Amazon)
Nayan Baseball, little league
Anuja Young Sheldon (Wikipedia)
Joel Dune audiobook (Amazon)
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The Filtrate:
Joel Topf
Swapnil Hiremath
Priya Yenebere
Nayan Arora
With Special Guest:
Brendon Neuen Super smart guy and clinical trialist
Michelle Rheault Lead author of DUPLEX and friend of the pod
Show Notes
Sparsentan versus Irbesartan in Focal Segmental Glomerulosclerosis
NephJC Summary | PubMed | NEJM
KDIGO FSGS Guidelines 2021 (PDF)
Characterization of the Clinical Evidence Supporting Repository Corticotropin Injection for FDA-Approved Indications, A Scoping Review (JAMA Internal Medicine)
DUET: A Phase 2 Study Evaluating the Efficacy and Safety of Sparsentan in Patients with FSGS (PubMed)
Vlado Perkovic, mentor and sponsor extradenoire (UNSW Sydney)
Shimer Its a floor wax and a desert topping (TikTok)
SONAR: Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease: a double-blind, randomised, placebo-controlled trial. (NephJC)
Travere Therapeutics Announces FDA Accelerated Approval of FILSPARIᵀᴹ (sparsentan), the First and Only Non-immunosuppressive Therapy for the Reduction of Proteinuria in IgA Nephropathy (Travere press release)
GFR Slope: Chronic vs Total slope: A meta-analysis of GFR slope as a surrogate endpoint for kidney failure (Nature Medicine)
There are dozens of us! Dozens! (Know your Meme)
Brendon’s Neuen’s tweet about total versus chronic slope (X | Twitter)
Julie R. Ingelfinger, deputy editor for the New England Journal of Medicine (Wikipedia)
You know nothing, John Snow (YouTube shorts)
Tubular Secretions
Swapnil Foundation season two on Apple TV Wheel of Time season two Amazon Prime
Brendon Andor
Priya Poverty, by America Mattew Desmond
Nayan The Armor of Light: A Novel by Ken Follett
Michelle Lessons in Chemistry: A Novel by Bonnie Garmus
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The Filtrate:
Joel Topf
Swapnil Hiremath
Jordy Cohen
AC Gomez
With Special Guest:
Tim Anderson @TimAndersonMD
Editor:
Priya Yenebere
Show Notes
Clinical Outcomes of Intensive Inpatient Blood Pressure Management in Hospitalized Older Adults
NephJC Summary | PubMed | JAMA Internal Medicine
The Jordy AC collab: An Interactive Ambulatory Nephrology Curriculum for Internal Medicine Interns: Design, Implementation, and Participant Feedback (PubMed)
Clinical Outcomes After Intensifying Antihypertensive Medication Regimens Among Older Adults at Hospital Discharge (PubMed)
Trends in Blood Pressure Treatment Intensification in Older Adults With Hypertension in the United States, 2008 to 2018 (PubMed)
Overlap Weighting: A Propensity Score Method That Mimics Attributes of a Randomized Clinical Trial (JAMA Guide to Statistics and Methods)
Tubular secretions
Swap The Dispatcher by John Scalzi (Wikipedia)
AC A Heart that Works by Rob Delaney (NYT Review)
Tim Demon Copperhead by Barbara Kingsolver (Amazon)
Jordy The Anthropocene Reviewed: Essays on a Human-Centered Planet (Amazon)
Joel The Dolomites for hiking n Northern Italy
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Animal House Region
NephMadness description by Tiffany Truong
Editorial by Kelly Hyndman @DrKeeksPhD They May Look Cute, But Are All Animals Sweet?
The Filtrate:
Joel Topf
Swapnil Hiremath
Sophia Ambruso
Josh Waitzman
With Special Guest:
Kelly Hyndman
Editor:
Sophia Ambruso
Show Notes
Animal House 2018 with Mark Zeidel, MD (AJKDblog)
Animal House 2021 with Kelly Hyndman (AJKDBlog)
Animal House 2022 with Kelly Hyndman (AJKDBlog)
Mount Desert Island Summer Junket (Website)
First person account go a Gila Monster bite (YouTube)
Looks like Gila Hank, the gun toting mascot of Eastern Arizona College has been replaced by a non-gun toting Gila monster cowboy. Old logo (Reddit) | New logo (Gila Valley Central Newspaper)
Discovery, characterization, and clinical development of the glucagon-like peptides (Drucker JCI 2017)
The rationale, design and baseline data of FLOW, a kidney outcomes trial with once-weekly semaglutide in people with type 2 diabetes and chronic kidney disease (Rossing NDT 2023)
Semaglutide 1.0 mg demonstrates 24% reduction in the risk of kidney disease-related events in people with type 2 diabetes and chronic kidney disease in the FLOW trial (Novo Nordisk)
King Gizzard & The Lizard Wizard - Gila Monster (YouTube)
Eastern Arizona Campus Store
Tubular Secretions
Swap: Three Body Problem (Wikipedia)
Josh: Animal Crossing (Nintendo)
Sophie: Pyelonephritis in inflammatory bowel disease. Is this a thing?
Joel: Maggie Moore(s) (Wikipedia)
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How Medicine Works, and When It Doesn’t
Amazon
The Filtrate:
Joel Topf
Josh Waitzman
Jennie Lin
With Special Guest:
Jade Teakell
Perry Wilson
Editor:
Joel Topf
Show Notes
Understanding Medical Research: Your Facebook Friend is Wrong. Coursera
Illusory truth effect (Wikipedia)
Number needed to treat (Wikipedia)
NNT at MedPage Today:
NNT on NephJC
Deaths of Despair:
Suicide (CDC 2001-2021)
Drug Overdose (CDC 2001-2021)
Steve Jobs delayed therapy for his treatable pancreatic cancer (ABC News)
Residents are unionizing at Mass General Brigham. Here's what you need to know (WBUR)
Pi and bouncing bricks (YouTube)
Doctors in New Zealand—the only non-U.S. country that allows DTC advertising—call for bans (FiercePharma)
The Surgisphere Scandal: What Went Wrong? (The Scientist)
VITAL SIGNS: FERTILITY; A Study Links Prayer and Pregnancy (The New York Times)
Researcher Pulls His Name From Paper on Prayer and Fertility (The New York Times)
Tubular Secretions
Josh: Glomerular Nephritis by Thomas Addis (Review in JAMA from 1948)
Jennie: The Chicago Marathon
Jade: The People’s Hospital (Amazon)
Perry: Anathem by Neal Stephenson (Amazon)
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The Filtrate:
Joel Topf
Nayan Aurora
Sophia Ambruso
With Special Guest:
Michael Collins
Editor:
Nayan Aurora
Show Notes:
Twitter is now X (NYT)
Michael Collins (the astronaut, not the real one)
PlasmaLyte by Baxter
NephJC BEST Fluids summary
Early Goal Directed Therapy for Sepsis NEJM manuscript which changed practice patterns and welcomed in an era of massive fluid resuscitation.
PLUS Trial NEJM
SPLIT Trial JAMA
BaSICS NephJC Summary
SALTED and SMART NephJC Summary
Adaptive minimization wikipedia
BEST Fluids statistical plan
BEST Fluids in CLinicalTrials.gov
Delayed Graft Function review in American Journal of Transplant
Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis in NEJM Evidence
A pragmatic, open-label, randomized controlled trial of Plasma-Lyte-148 versus standard intravenous fluids in children receiving kidney transplants (PLUTO) in Kidney International
Tubular Secretion
Nayan finally getting around to Succession on HBO
Sophia autoimmune protocol diet
Hawthorne Effect
Michael Stephen Fry reading Harry Potter
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The Filtrate:
Joel Topf
Swapnil Hiremath
Sophia Ambruso
AC Gomez
Josh Waitzman
Jennie Lin
Nayan Arora
The Curbsiders
Matt F. Watto (@DoctorWatto)
Paul Nelson Williams, America’s primary care physician (@PaulNWilliamz)
With Special Guest:
JD Foster (@KidneyVet)
Sayed Tabatabai (@TheRealDoctorT) Nephrologist in Austin and the author of These Vital Signs
Michelle Rheault (@rheault_m) Chief of Pediatric Nephrology at the University of Minnesota and lead author of the DUPLEX Trial
Editor:
Joel Topf
Show Notes:
Lily toxicity in the cat (PubMed)
Surgeons perform kidney transplants in cats amid rising demand for advanced pet care (ABC News)
Treatment of ibuprofen toxicity with serial charcoal hemoperfusion and hemodialysis in a dog (PubMed)
Nephrology in Veterinary Medicine (Kidney 360)
Star Wars Society of San Antonio (FaceBook)
These Vital Signs (Amazon)
Dr Tabatabai read a short story called The Handholder, here is the original tweet thread for that story (ThreadReader)
The pearl not the patient (PubMed)
Late Braking and High Impact Clinical Trial press release
MENTOR, Rituximab or Cyclosporine in the Treatment of Membranous Nephropathy, was in 2019 not 2017 (NEJM)
KALM-1, A Phase 3 Trial of Difelikefalin in Hemodialysis Patients with Pruritus, was in 2019 not 2017 (NEJM)
Sophie’s number one pick: Efficacy and safety of sparsentan versus irbesartan in patients with IgA nephropathy (PROTECT): 2-year results from a randomised, active-controlled, phase 3 trial (Lancet)
Patients in the sparsentan group had a slower rate of eGFR decline than those in the irbesartan group. eGFR chronic 2-year slope (weeks 6–110) was −2·7 mL/min per 1·73 m2 per year versus −3·8 mL/min per 1·73 m2 per year (difference 1·1 mL/min per 1·73 m2per year, 95% CI 0·1 to 2·1; p=0·037); total 2-year slope (day 1–week 110) was −2·9 mL/min per 1·73 m2 per year versus −3·9 mL/min per 1·73 m2 per year (difference 1·0 mL/min per 1·73 m2 per year, 95% CI −0·03 to 1·94; p=0·058).
Clinical Trial Considerations in Developing Treatments for Early Stages of Common, Chronic Kidney Diseases: A Scientific Workshop Cosponsored by the National Kidney Foundation and the US Food and Drug Administration (AJKD)
AC Gomez’s Pick: MDR-101-MLK Update: Operational Immune Tolerance Achieved in Living Related HLA-Matched Kidney Transplant Recipients (ASN-Online.org)
Josh’s Pick: A Phase 2 Trial of Sibeprenlimab in Patients with IgA Nephropathy (NEJM)
Nayan’s Pick: The EnAKT LKD Cluster Randomized Clinical Trial (JAMA Internal Medicine)
The Freely Filtered simultaneous release (NephJC)
Freely Filtered is now a verb.
Swap’s Pick: Strategies for the Management of Atrial Fibrillation in PatiEnts Receiving Dialysis (SAFE-D) (ASN-Online.org)
Joel’s Pick: AYAME Study: Randomized, Double-Blind, Placebo-Controlled Phase 3 Study of Bardoxolone Methyl in Diabetic Kidney Disease (DKD) Patients (ASN-Online.org)
Reata is a no-show to the 2012 ASN Kidney Week (PBFluids)
Michelle’s Pick: Sparsentan versus Irbesartan in Focal Segmental Glomerulosclerosis. The DUPLEX Study (NEJM)
DUET: A Phase 2 Study Evaluating the Efficacy and Safety of Sparsentan in Patients with FSGS (PubMed)
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The Filtrate:
Joel Topf
Swapnil Hiremath
Sophia Ambruso
AC Gomez
With Special Guest:
Amit Garg (@AmitXGarg) Nephrologist at Western University, London, and lead PI of the EnAKT LKD trial.
Susan Q. McKenzie (LinkedIn) Co-Founder & Chair, Transplant Ambassador Program. President of the Kidney Patient and Donor Alliance of Canada.
Editor:
Joel Topf
Show Notes:
Late Braking and High Impact Clinical Trial press release
JAMA Internal Medicine
MyTEMP trial Personalised cooler dialysate for patients receiving maintenance haemodialysis (MyTEMP): a pragmatic, cluster-randomised trial (PubMed | NephJC | Freely Filtered)
Transplant is cheaper! An economic assessment of contemporary kidney transplant practice (PDF)
Transplant is better! Survival for waitlisted kidney failure patients receiving transplantation versus remaining on waiting list: systematic review and meta-analysis (PubMed)
Transplant disparities Association of Race and Ethnicity With Live Donor Kidney Transplantation in the United States From 1995 to 2014 (PubMed)
MUC1 Kidney Disease Autosomal Dominant Tubulointerstitial Kidney Disease: An Emerging Cause of Genetic CKD (Kidney International Reports)
This study has all the adjectives: “We conducted a pragmatic, two-arm, parallel-group, open-label, registry-based, superiority, cluster- randomized clinical trial.”
Explore Transplant by Amy Waterman, PhD
Transplant Ambassador Program
Kidney Failure Risk Equation A Predictive Model for Progression of Chronic Kidney Disease to Kidney Failure (JAMA | Calculator)
The complete protocol A Quality Improvement Intervention to Enhance Access to Kidney Transplantation and Living Kidney Donation (EnAKT LKD) in Patients With Chronic Kidney Disease: Clinical Research Protocol of a Cluster-Randomized Clinical Trial (PDF)
Pre-published statistical plan Enhance Access to Kidney Transplantation and Living Kidney Donation (EnAKT LKD): Statistical Analysis Plan of a Registry-Based, Cluster-Randomized Clinical Trial (PubMed)
Hawthorne effect (Wikipedia)
The Advancing American Kidney Health Initiative “Aim for 80% of new American ESRD patients in 2025 receiving either home dialysis or a transplant” (NKF)
Tubular Secretions
Swapnil The Time Travelers Wife by Audrey Niffenegger (Wikipedia) and HBO movie of the same name (Wikipedia).
Sophia The Wheel of Time streaming on Amazon (Wikipedia) based on the series of books of the same name by Robert Jordan and Brandon Sanderson.
Susan The Woman Who Loved Giraffes movie (Website)
Amit Canadians cannot get Visas to visit India (Reuters)
AC Eagles are good at Football (Fox Sports) and Alport Connect Meeting in San Diego (Alport Syndrome Foundation Website)
Joel Live podcast recording at Kidney Week (NephJC)
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The Filtrate:
Joel Topf
Jennie Lin
Josh Waitzman
With Special Guest:
AC Gomez MedPeds nephrology fellow at Mass General/Brigham and Boston Children’s | Twitter
Gentian Hall Assistant Professor of Medicine Duke Department of Medicine
Editor:
Sophia Ambruso
Show Notes:
APOL1 review by the OG Scientists APOL1 Nephropathy: From Genetics to Clinical Applications
MYH9 and APOL1 connection: The population genetics of chronic kidney disease: insights from the MYH9–APOL1 locus
Martin Pollack Lab
Vertex Lab
Worldwide Frequencies of APOL1 Renal Risk Variants (NEJM)
Kidney Disease-Associated APOL1 Variants Have Dose-Dependent, Dominant Toxic Gain-of-Function
End-Stage Renal Disease in African Americans With Lupus Nephritis Is Associated With APOL1
Apolipoprotein L1 Risk Variants Associate with Systemic Lupus Erythematosus-Associated Collapsing Glomerulopathy
HEK293 Cells Wikipedia
Tubular Secretions
Josh: From Serial and the New York Times: The Retrievals
Jennie: Marathon induced hyponatremia (NEJM)
Donate to the NKF of Illinoise in honor of Jennie’s really long run
Donate to New England Donor Services in honor of Josh’s much shorter ruinGentian: Vivien Thomas wikipedia. HBO Movie: Something the Lord Made
AC: Talking to the FDA about SGLT2i Tweet
Joel: NephJC 2023 Fund drive
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Bicarbonate did not slow the loss of GFR in this well done Swiss, single-blind study of transplant patients.
The Filtrate:
Joel Topf
Nayan Arora
Swapnil Hiremath
Pirya Yenebere
With Special Guest:
Nav Tangri nephrologist and epidemiology at the University of Manitoba
Editor:
Nayan Arora
Show Notes:
Arsenal FC
The London study that kicked it all off!
de Brito-Ashurst, I., Varagunam, M., Raftery, M. J., & Yaqoob, M. M. (2009). Bicarbonate supplementation slows progression of CKD and improves nutritional status. Journal of the American Society of Nephrology: JASN, 20(9), 2075–2084.
The multi center (but unblinded) UBI Study with mortality benefit!
Di Iorio, B. R., Bellasi, A., Raphael, K. L., Santoro, D., Aucella, F., Garofano, L., Ceccarelli, M., Di Lullo, L., Capolongo, G., Di Iorio, M., Guastaferro, P., Capasso, G., & UBI Study Group. (2019). Treatment of metabolic acidosis with sodium bicarbonate delays progression of chronic kidney disease: the UBI Study. Journal of Nephrology, 32(6), 989–1001.
The BiCARB Study: Double blinded and negative
BiCARB study group. (2020). Clinical and cost-effectiveness of oral sodium bicarbonate therapy for older patients with chronic kidney disease and low-grade acidosis (BiCARB): a pragmatic randomised, double-blind, placebo-controlled trial. BMC Medicine, 18(1), 91.
The initial Veverimer Study
Wesson, D. E., Mathur, V., Tangri, N., Stasiv, Y., Parsell, D., Li, E., Klaerner, G., & Bushinsky, D. A. (2019). Long-term safety and efficacy of veverimer in patients with metabolic acidosis in chronic kidney disease: a multicentre, randomised, blinded, placebo-controlled, 40-week extension. In The Lancet (Vol. 394, Issue 10196, pp. 396–406). doi.org/10.1016/s0140-6736(19)31388-1
The Valor CKD trial is still unpublished. But here is the press release.
VALOR-CKD design manuscript
The study of the night: Sodium bicarbonate for kidney transplant recipients with metabolic acidosis in Switzerland: a multicentre, randomized, single-blind, placebo-controlled, phase 3 trial
NephJC | PubMed | Lancet
Alkali with normal bicarb? Sure, take a look at: Goraya, N., Simoni, J., Jo, C., & Wesson, D. E. (2012). Dietary acid reduction with fruits and vegetables or bicarbonate attenuates kidney injury in patients with a moderately reduced glomerular filtration rate due to hypertensive nephropathy. Kidney International, 81(1), 86–93.
Metforminator!
The BASE Trial: Raphael, K. L., Isakova, T., Ix, J. H., Raj, D. S., Wolf, M., Fried, L. F., Gassman, J. J., Kendrick, C., Larive, B., Flessner, M. F., Mendley, S. R., Hostetter, T. H., Block, G. A., Li, P., Middleton, J. P., Sprague, S. M., Wesson, D. E., & Cheung, A. K. (2020). A Randomized Trial Comparing the Safety, Adherence, and Pharmacodynamics Profiles of Two Doses of Sodium Bicarbonate in CKD: the BASE Pilot Trial. Journal of the American Society of Nephrology: JASN, 31(1), 161–174.
Tubular Secretions
Swap The Three-Body Problem (novel) | Netflix
Nayan Women’s World Cup
Tangri English Premier Soccer and Inflation
Priya Silo on Apple TV
Joel Live Podcast recording at ASN Kidney
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The Filtrate:
Joel Topf
Nayan Arora
Sophia Ambruso
With Special Guest:
Boback Ziaeian @boback Assistant Professor of Medicine David Geffen School of Medicine at UCLA. His Google Schoolar page is better than yours.
And returning for her fourth time (why do we keep inviting her back?)
Sadiya Khan @heartDocSadiya Assistant Professor of Medicine (Cardiology) and Preventative Medicine at Northwestern Feinberg School of Medicine. LinkEditor:
Priya Yenebere
Show Notes:
Diuretic Therapy review by. Craig Brater NEJM
The manuscript in JAMA | NephJC
Metoprolol vs Carvedilol: Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial (Lancet)
EMPULSE: The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure: a multinational randomized trial (Nature Medicine)
Effect of Aliskiren on Postdischarge Mortality and Heart Failure Readmissions Among Patients Hospitalized for Heart Failure The ASTRONAUT Randomized Trial
Effects of Oral Tolvaptan in Patients Hospitalized for Worsening Heart Failure The EVEREST Outcome Trial
Sophia ended up placing fifth in NephMadness 2023. (Link)
Joel finished 697th
After winning in the opening round, Northwestern lost to UCLA, in the second round of the March Madness tournament, 68-63.
Torsemide to furosemide equivalents
CardioMems positive trial: Sustained efficacy of pulmonary artery pressure to guide adjustment of chronic heart failure therapy: complete follow-up results from the CHAMPION randomised trial (The Lancet)
CardioMems negative trial: Haemodynamic-guided management of heart failure (GUIDE-HF): a randomised controlled trial (The Lancet)
Estimation of the Absolute Risk of Cardiovascular Disease and Other Events: Issues With the Use of Multiple Fine-Gray Subdistribution Hazard Models (Circulation)
Torasemide in chronic heart failure: results of the TORIC study (PubMed)
Tubular Secretions
Nayan: Louise Penny A World of Curiosities: A Novel (Amazon)
Sadiya: Ted Lasso season three
Sophia:The Last of Us on HBO and SNL skit Mario Cart as Prestige Drama
Boback: Duolingo for Japanese
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The Filtrate:
Joel Topf
Swapnil Hiremath
Josh Waitzman
Nayan Arora
Sophia Ambruso
With Special Guest:
Megan Prochaska Assistant professor of medicine at University of Chicago
John Asplin Medical Director Consultant LithoLink (Twitter)
Editor:
Joel Topf
Show Notes:
The LithoLink website
Stone Camp tweet
Prevention of Repeated Episodes of Kidney Stones in Adults: A Clinical Practice Guideline From the American College of Physicians (link)
NOSTONE in the NEJM and NephJC
Fred Coe Google Scholar | YouTube | Blog
Hypercalcuria. Curhan et al. 24-h uric acid excretion and the risk of kidney stones PubMed
EQUIL2 software to evaluate urinary super saturation
Anna Zisman Racial Differences in Risk Factors for Kidney Stone Formation (CJASN)
Potassium Citrate on GoodRx
Moonstone Nutrition
Potassium and citrate by Fred Coe (blog)
Thiazide Diuretics and Fracture Risk: A Systematic Review and Meta‐Analysis of Randomized Clinical Trials (PubMed)
Chlorthalidone promotes mineral retention in patients with idiopathic hypercalciuria by Coe et al (PubMed)
NHANES 24-hour urine Na (Abstract)
Kidney Stone risk is reduced with empagliflozin (PubMed)
Prospective trial to determine the effect of SGLT2i on urinary supersaturation (BMJ Open)
GLP agonists and kidney stone risk
Tubular Secretions
Swap: Star Wars: Thrawn Series by Timothy Zahn (Penguin Random House)
Josh: Little League
Megan: Renal related podcasts
Sophia Renal Stone Camp and ABCKidney.com
Nayan: Ted Lasso Robert Galbraithand The Comoran Strike Novels (home page)
John: Fred Coe’s Blog
Joel: Spiderman across the Spider-Verse (Wikipedia)
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The Filtrate:
Joel Topf
Swapnil Hiremath
Josh Waitzman
Jordy Cohen
With Special Guest:
Areef ishani lead author and Chief of Medicine VA Minneapolis
Editor:
Nayan Arora
Show Notes:
MRFIT switches diuretics and finds better outcomes.
Swapnil shows how many studies he is familiar with by spewing out a string of them.
Chlorthalidone wins: ALLHAT, MRFIT, SPRINT, HYVET, CLICK (not mentioned by Swap but by Jordy later)
HCTZ loses: HOPE3, ACCOMPLISH
Diuretic half-lifes NEJM review
Edarbyclor: Azilsartan and Chlorthalidone $240/month as per GoodRx
Nice mention of late study originator Frank Lederle. Please see his article in Annals about his diagnosis of pancreatic cancer. Moving.
Network analysis of HCTZ vs chlorthalidone
Antihypertensive efficacy of hydrochlorothiazide vs chlorthalidone combined with azilsartan medoxomil by George Bakris
Synopsis of the 2020 U.S. Department of Veterans Affairs/U.S. Department of Defense Clinical Practice Guideline: The Diagnosis and Management of Hypertension in the Primary Care Setting (Annals of Internal Medicine)
Testing for Primary Aldosteronism and Mineralocorticoid Receptor Antagonist Use Among U.S. Veterans: A Retrospective Cohort Study by Jordy Cohen
Study showing better risk reward ratio of low dose than high dose thiazide diuretics. Treatment of hypertension in the elderly: I. Blood pressure and clinical changes. Results of a Department of Veterans Affairs Cooperative Study.
Tubular Secretions
Swapnil Louise Penny author of book upon which the Amazon Prime series, Three Pines is based on.
Jordy Last of Us series on HBO
Josh Channel Your Enthusiasm A Very Special Episode: Meet the Glaucomfleckens
Areef The Body: A Guide for Occupants
Joel NephMadness (this did not age well)
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The Filtrate:
Joel Topf
Swapnil Hiremath
Josh Waitzman
Sophia Ambruso
With Special Guest:
Anna Vinakova Associate Professor of Medicine at Virginia Commonwealth University. NephMadness Executive.
Vanuja Java is a transplant nephrologist at Washington University in St. Louis, MO. Her research involves functional characterization of genetic variants in complement-mediated diseases. She co-chairs the ClinGen complement gene curation expert panel.
Editor:
Sophia Ambruso
Show Notes:
#NephMadness 2023: Thrombotic Microangiopathy Region
TMA Review article in the NEJM from 2014: Syndromes of Thrombotic Microangiopathy
Dr. Anuja Java Co-chairs Working Group in an International Committee for Revising aHUS Nomenclature
Nephrology Secrets 4th Edition at Amazon
University of Iowa Genetic testing for aHUS
Early Eculizumab Withdrawal in Patients With Atypical Hemolytic Uremic Syndrome in Native Kidneys Is Safe and Cost-Effective: Results of the CUREiHUS Study. KI reports. This is the Netherlands study. They used home urine dipsticks to monitor for relapses.
Clinical promise of next-generation complement therapeutics Nature reviews. Drug Discovery
NephMadness Podcrawl
Tubular Secretions
Swap: Neuromancer and the works of William Gibson (@GreatDismal)
Sophia: The Magicians on Netflix
Anna: Recommends nephrology. Says it is awesome.
Anuja: Dope Sick on Hulu and Women in Nephrology mentor program
Josh: Mobituaries with Mo Rocca. Specifically “Death of a Banana”
Joel: Ivory by TapBot
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Welcome to the NephMadness PodCrawl
The idea behind a podcrawl is for a variety of podcasts to coordinate on timing and topic to push a theme and get each other’s listeners to explore all of the podcasts. One of the first goals behind NephMadness was to build a community and in the early years of Twitter, NephMadness was central to the formation of #NephTwitter and defining the ethos that makes our online community kind, intelligent, vibrant, and interesting. The NephMadness Podcrawl hopes to inspire and grow the nephrology podcast community in the same way. For 2023, our second year, the PodCrawl has assembled the Avengers of Medical Pods!
Go to NephMadness.com/podcrawl for more information and links to all of the podcasts!
The Curbsiders gets the skinny on mineralcorticoid receptor antagonistsCore IM will be covering Kidney Transplant in their classic Five Pearl format
The CardioNerds will be covering the effect of Heart Failure Devices on Kidney Health
Freely Filtered will try to understand thrombotic microangiopathy
ISN Global Kidney Care goes deep on IgA nephropathy
The Cribsiders look at transitions, first the Peditrics to Adult nephrology transition and then from living to death with palliative nephrology
Fellow on Call will be covering Onconephrology
And finally, The Nephron Segment looks at Transgender Health and CKD
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The Filtrate:
Joel Topf
Swapnil Hiremath
Nayan Arora
Sophia Ambruso
With Special Guest:
Amit Garg @AmitXGarg, Nephrologist at Western University, London, and lead PI of the MYTEMP trial.
Editor:
Joel Topf
Show Notes:
MyTEMP in pubmed: Personalised cooler dialysate for patients receiving maintenance haemodialysis (MyTEMP): a pragmatic, cluster-randomised trial
MyTEMP Summary on NephJC
It’s really cold in Ontario
The NephTrials blog summary on Pragmatic Trials
The pragmatic TiME trial on longer time on dialysis (ahem, sabotaged by site investigators like Joel who cut dialysate time) Dember et al in JASN
Poor quality of trial data preceding MyTEMP, a systematic review from Mustafa et al in JASN
The 2007 European Best Practice Guideline (EBPG) from 2007, recommending “Cool dialysate temperature dialysis (35–36°C) or isothermic treatments by blood temperature controlled feedback should be prescribed in patients with frequent episodes of IDH (Evidence level I).” in NDT
47% of centres from a DOPPS study of 273 centers routinely use of lower dialysate temperature, Dasgupta et al in JASN
How do you convert from C to F? Almanac.com (35.5 C is 96.9 F; 37 C is 98.6 F)
More on the rationale and design of MyTEMP: Al-Jaishi et al in CJKHD
How big is 4.3 million (the number of hemodialysis treatments in MyTEMP)? Very big indeed.
NephJC discussion of another cluster RCT and granular data only on a subset SSASS
Participants in dialysis clinical trials are not representative of the real world dialysis cohorts, Smyth et al in JAMA Int Med
Peritoneal dialysis numbers in Ontario are high, Blake et al in PDI, though with ~ 60% CVC rates, Blake et al in Kidney360
Dialysate Magnesium #DreamRCT from Swap, NephTrials discussion of DialMag
Statistical analysis plan of MyTEMP, Dixon et al in CJKHD
Tubular Secretions
Swap: Watch Everything, Everywhere All At Once on Prime
Nayan: Read The Midnight Ride from Ben Mezrich (brother of Josh Mezrich from the NephJC Summer Book Club 2021)
Sophia: Making nephrology education fun at the UC Denver
Amit: The wrestling team at Western U from 1990-91
Joel: House of the Dragon on HBO Max
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