Sparsentan in FSGS: pay us a million dollars over 8 years in drug cost. Your EGFR will be 34 instead of 30!!!
Nephrology is becoming the new oncology. Surrogate outcomes and pricey meds galore without real progress. We are winning the war on kidney disease, just as we won the war on cancer.
GFR protection of only 1 ml per minute over 2 years seems underwhelming for a drug that costs $120,000 a year
Leads to more hospitalizations and maybe death for affected patients:
pmc.ncbi.nlm.nih.gov/articles/PMC...
It’s not the longer treatment times, it’s appropriate treatment times that lead to better outcomes. That shared decision making is hard to capture in RCTs as most people will end up around 3.5-4 hours with a very low number of 3 and 5 hours
3 hr dialysis prescribed appropriately is not bad: incremental RCTs.
Retrospective studies: 3 hours marks patients w/ psychosocial/economic challenges who insist on 3 hrs against their nephrologists’ judgment. We all have a patient who will “only do 3 hours” and the surprise question is always a NO
Not sure about the conclusion. It’s not a randomized study so only patients with clinical equipoise would have undergone a biopsy. The results just show nephrologists’ pre-test intuitions are quite good.
What is nephro’s USP?
Smart internists?❌Training fellows w/o residency; most programs hv at least one remedial fellow
Better paid❌
HTN❌Cardio took over for denervation🤑
GN❌rheum taking most
We need our moonshot that revolutionizes kidney disease management AND is reimbursed well. SGLT2i ain’t it
6% would mean 1 out of 20 residents at least. Not even close. I suspect 6% of IM programs have even ONE resident in entire graduating classes where the first (not back-up) choice is nephrology.
Not the best marketing strategy unfortunately. Nephrologists’ professional growth pathways are not as convoluted as pretzel word-finding exercises.
Jeez!! What a masochistic wish. Think about daily patient messages and needless worry:
“My device shows my GFR went down X points. It’s your fault and I don’t want to take this med ever again”.
I already get enough messages about “my ***gist got labs and my kidney function is down X points”.
And my conscience says that a drug costing $600,000 a year should be ashamed of doing a trial with only protenuria as an outcome. They should get a 50% price cut just for cutting corners.
The aspirin result was quite intuitive:
Some anti platelet makes huge difference early on vs placebo. Effect tapers off over time as things move from worsening thrombosis to plaque rupture again. Dual platelet agents in the short term are borderline once asa on board. Nothing smells fishy
Look at the confidence intervals. The observed HR means very little in smaller studies like this. This is why I like a forest plot like presentation. This trial will be like the lower study not the top.
I have 95% confidence that replication studies will show a risk reduction somewhere between 9% and 66%.
Not just a huge vulnerability in medical stuff. This should affect every major corporate application of LLMs. The question is why did the stock market not fall with this study?
CV causes are a major cause of first year post transplant mortality. The US reports that data publicly. Is it a surprise that programs go irrationally overboard in making their numbers look better? Ever seen the absolute panic when a decub ulcer is found 2 days after hospital admission? Same deal.
www.samsclub.com/ip/Member-s-...
www.samsclub.com/ip/Member-s-...
One of my patients brought me the members mark 900 mg fish oil capsules. 3 of them seem to be equivalent from what’s written on them
One of my patients brought me the members mark 900 mg fish oil capsules. 3 of them seem to be equivalent from what’s written on them
What type of fish oil commercially available in the US most closely approximates the PISCES study formulation? Not an expert but I think not every fish oil being sold is equivalent.
#askrenal #nephjc #nephsky
Once you learn about AI in medicine and actually use it, you realize how horribly useless and bad it is.
Then you see how much the economy is betting on it not being so.
Then the horror of it all hits you.
Do you anticipate lowering reward processing like it does in substance use+increased satiety? Or some other mechanism? It was incidentally tried in one of my diabetic HD patients and actually worsened things. IDWG went down a little but weight dropped more. So IDWG/ weight % looked horrible
And why did finerenone get away with it? Kerendia is being prescribed right and left now because they had the RCT data and FDA approval. But it’s very clear to me that old MRAs r just as protective, just lacked the RCT data for non medical circumstances. An unpopular opinion, but I own it.
I agree 100%. May not be a very unpopular opinion.
My initial thoughts about aldosterone synthase inhibitors: why spend $$$$ to achieve what $4 of spironolactone can also achieve? Am I missing something?
#askrenal
