lonnie's splash

Happening tomorrow!

@lonniepyne.bsky.social from McMaster will present on eGFR changes as outcomes of interest

#NephGR #NephSky

The 2.0 version of the Ontario Renal Network #KidneyWise toolkit is live now

www.ontariorenalnetwork.ca/en/kidney-ca...

From @sbrimble.bsky.social and team
- referral forms
- referral criteria
- guidance on CKD mgt for PCPs

#NephSky #MedSky

How can you say twitter is dead? Where else will I learn from some random dude with a blue checkmark what the 10 most important things are to be successful before 5am while hitting the jackpot in crypto?

I landed more or less in the same place reading the paper. Good thing we are not debating it!

Many can’t tolerate all 4 so think some rational sequencing makes sense. For most people I’m going to see, SGLT2i makes the most sense as the first add-on. 6-month goal makes sense to me.

Agreed - my graph has been iterative, starting with dapa and only a couple of days ago coming across the losartan paper. We are updating the Kidneywise toolkit for primary care and some do not feel we should suggest any drug over another.

For fun I created this. Retrieved data from DAPA-CKD on change in eGFR over time in 2 arms. Then looked at other drugs, adjusting for differences in placebo progression rates between trials. Then started at median eGFR for DAPA-CKD. Time to eGFR of 8. Pseudo-science perhaps but interesting

Anecdotally every patient I see on these drugs gets AKI/pseudo-AKI. I’m sure it’s not ascertainment bias…😏

Also industry scientists with tremendous resources behind them. I’m really not sure what the answer is to your question. Most research has no tangible impact but agree the skills and knowledge acquired are often transferable. Questionable cost-effectiveness though in most cases.

Oh boy…

What are the most important risk factors for suboptimal dialysis initiation? In #ASNKidney360, this article investigates within a prospective cohort study. Read more: kidney.pub/KID0895

@hswapnil.medsky.social @sbrimble.bsky.social

Risk Factors for Unplanned Dialysis Initiation: A Systematic Review of the Literature - PubMed Well-designed prospective studies to determine modifiable risk factors are needed. The lack of a consensus definition for unplanned dialysis makes research and quality improvement initiatives in this ...

We called it unplanned pubmed.ncbi.nlm.nih.gov/30899532/ but suboptimal seems more common
@sbrimble.bsky.social

That we are it seems. We are considering developing an optimal start indicator that would look at % of patients in a program starting as an outpatient, maybe “deferred” based on starting eGFR, and on their preferred modality. Probably vascular access agnostic.

Thoughts?

Bring them to Antiques Roadshow

Swap, do you think it’s all just about the 24-hr BP AUC above (and perhaps below) an optimal BP? When I get to a 3rd drug I do like to have one of them in the evening and assume the overall BP control is better but do worry about adherence.

Always respect those who put in the effort to conduct a well thought RCT. Very few of our patients choose CAPD these days. Also, If I’m reading the baseline eGFR correctly, “less dialysis” for most of the patients could have been no dialysis?

The Aldosterone Blockade for Health Improvement Evaluation in End-Stage Renal Disease (ACHIEVE) Trial: Rationale and Clinical Research Protocol - Michael Walsh, David Collister, Martin Gallagher, Patr... Background: The mineralocorticoid aldosterone may contribute to the risk of cardiovascular morbidity and mortality in patients receiving maintenance dialysis. W...

It's been a long journey but today we can share the methods and rationale for the #ACHIEVEtrial (Spiro vs placebo for patients with kidney failure receiving maintenance dialysis) and tomorrow we share the results at #era25
journals.sagepub.com/doi/10.1177/...

Bring back reserpine…

Eww…mushy chips…

Anemia guidelines flagrantly ignoring RCT evidence

As an example

Guidelines hijacked by industry for decades

The 2006 KDOQI adequacy guideline that told us to start looking for any indication to start dialysis when eGFR drops below 15 (and in some cases even earlier) has always been seared into my brain as a particularly bad recommendation.

Maybe we should put together a consensus conference or controversies in guidelines meeting in Fiji to really hash this out.

God I could not disagree more, at least with the sentiment/rationale provided (see below). Might as well have entitled it “Make American Nephrology Great Again”. I should add that is even though I have issues with how heavily industry-conflicted KDIGO can be.

some of the most striking tortured phrases i’ve seen in a while. Look here to discover what “moo warm steadiness” is
pubpeer.com/publications...

I also wonder when chlorthalidone is back, how many patients will end up being on 2 thiazides for a time.

Has to be the most heavily advertised movie in years. Makes me think they’re worried it’s going to be a flop.

I guess you can’t pass it over.