Freely Filtered, a NephJC Podcast

The Filtrate:Joel TopfSwapnil HiremathSophia AmbrusoAC GomezWith 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 TopfShow Notes:Late Braking and High Impact Clinical Trial press releaseJAMA Internal MedicineMyTEMP 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, PhDTransplant Ambassador ProgramKidney 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 SecretionsSwapnil 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)

The Filtrate:Joel TopfJennie LinJosh WaitzmanWith Special Guest:AC Gomez MedPeds nephrology fellow at Mass General/Brigham and Boston Children’s | TwitterGentian Hall Assistant Professor of Medicine Duke Department of MedicineEditor:Sophia AmbrusoShow Notes:APOL1 review by the OG Scientists APOL1 Nephropathy: From Genetics to Clinical ApplicationsMYH9 and APOL1 connection: The population genetics of chronic kidney disease: insights from the MYH9–APOL1 locusMartin Pollack LabVertex LabWorldwide Frequencies of APOL1 Renal Risk Variants (NEJM)Kidney Disease-Associated APOL1 Variants Have Dose-Dependent, Dominant Toxic Gain-of-FunctionEnd-Stage Renal Disease in African Americans With Lupus Nephritis Is Associated With APOL1Apolipoprotein L1 Risk Variants Associate with Systemic Lupus Erythematosus-Associated Collapsing GlomerulopathyHEK293 Cells WikipediaTubular SecretionsJosh: From Serial and the New York Times: The RetrievalsJennie: 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 MadeAC: Talking to the FDA about SGLT2i TweetJoel: NephJC 2023 Fund drive

Bicarbonate did not slow the loss of GFR in this well done Swiss, single-blind study of transplant patients.The Filtrate:Joel TopfNayan AroraSwapnil HiremathPirya YenebereWith Special Guest:Nav Tangri nephrologist and epidemiology at the University of ManitobaEditor:Nayan AroraShow Notes:Arsenal FCThe 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 negativeBiCARB 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 StudyWesson, 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)31388-1The Valor CKD trial is still unpublished. But here is the press release. VALOR-CKD design manuscriptThe study of the night: Sodium bicarbonate for kidney transplant recipients with metabolic acidosis in Switzerland: a multicentre, randomized, single-blind, placebo-controlled, phase 3 trialNephJC | PubMed | LancetAlkali 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 SecretionsSwap The Three-Body Problem (novel) | NetflixNayan Women’s World CupTangri English Premier Soccer and InflationPriya Silo on Apple TVJoel Live Podcast recording at ASN Kidney

The Filtrate:Joel TopfNayan AroraSophia AmbrusoWith 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 YenebereShow Notes:Diuretic Therapy review by. Craig Brater NEJMThe manuscript in JAMA | NephJCMetoprolol 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 TrialEffects of Oral Tolvaptan in Patients Hospitalized for Worsening Heart Failure The EVEREST Outcome TrialSophia ended up placing fifth in NephMadness 2023. (Link)Joel finished 697thAfter 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 SecretionsNayan: Louise Penny A World of Curiosities: A Novel (Amazon)Sadiya: Ted Lasso season threeSophia:The Last of Us on HBO and SNL skit Mario Cart as Prestige DramaBoback: Duolingo for Japanese

The Filtrate:Joel TopfSwapnil HiremathJosh WaitzmanNayan AroraSophia AmbrusoWith Special Guest:Megan Prochaska Assistant professor of medicine at University of Chicago John Asplin Medical Director Consultant LithoLink (Twitter)Editor:Joel TopfShow Notes:The LithoLink websiteStone Camp tweetPrevention of Repeated Episodes of Kidney Stones in Adults: A Clinical Practice Guideline From the American College of Physicians (link)NOSTONE in the NEJM and NephJCFred Coe Google Scholar | YouTube | BlogHypercalcuria. Curhan et al. 24-h uric acid excretion and the risk of kidney stones PubMedEQUIL2 software to evaluate urinary super saturation Anna Zisman Racial Differences in Risk Factors for Kidney Stone Formation (CJASN)Potassium Citrate on GoodRxMoonstone NutritionPotassium 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 SecretionsSwap: Star Wars: Thrawn Series by Timothy Zahn (Penguin Random House)Josh: Little League Megan: Renal related podcastsSophia Renal Stone Camp and ABCKidney.comNayan: Ted Lasso Robert Galbraithand The Comoran Strike Novels (home page)John: Fred Coe’s BlogJoel: Spiderman across the Spider-Verse (Wikipedia)

The Filtrate:Joel TopfSwapnil HiremathJosh WaitzmanSophia AmbrusoWith 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 AmbrusoShow Notes:#NephMadness 2023: Thrombotic Microangiopathy RegionTMA Review article in the NEJM from 2014: Syndromes of Thrombotic MicroangiopathyDr. Anuja Java Co-chairs Working Group in an International Committee for Revising aHUS NomenclatureNephrology Secrets 4th Edition at AmazonUniversity of Iowa Genetic testing for aHUSEarly 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 DiscoveryNephMadness PodcrawlTubular SecretionsSwap: Neuromancer and the works of William Gibson (@GreatDismal)Sophia: The Magicians on NetflixAnna: Recommends nephrology. Says it is awesome. Anuja: Dope Sick on Hulu and Women in Nephrology mentor programJosh: Mobituaries with Mo Rocca. Specifically “Death of a Banana”Joel: Ivory by TapBot

The podcast discusses the NephMadness PodCrawl where various medical podcasts cover topics like mineralcorticoid receptor antagonists, kidney transplant, heart failure devices, thrombotic microangiopathy, IgA nephropathy, transitions in nephrology care, onconephrology, and transgender health and CKD.

The Filtrate:Joel TopfSwapnil HiremathNayan AroraSophia AmbrusoWith Special Guest:Amit Garg @AmitXGarg, Nephrologist at Western University, London, and lead PI of the MYTEMP trial. Editor:Joel TopfShow Notes:MyTEMP in pubmed: Personalised cooler dialysate for patients receiving maintenance haemodialysis (MyTEMP): a pragmatic, cluster-randomised trialMyTEMP Summary on NephJC It’s really cold in OntarioThe NephTrials blog summary on Pragmatic TrialsThe pragmatic TiME trial on longer time on dialysis (ahem, sabotaged by site investigators like Joel who cut dialysate time) Dember et al in JASNPoor 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 NDT47% of centres from a DOPPS study of 273 centers routinely use of lower dialysate temperature, Dasgupta et al in JASNHow 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 CJKHDHow 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 MedPeritoneal dialysis numbers in Ontario are high, Blake et al in PDI, though with ~ 60% CVC rates, Blake et al in Kidney360Dialysate Magnesium #DreamRCT from Swap, NephTrials discussion of DialMagStatistical analysis plan of MyTEMP, Dixon et al in CJKHDTubular SecretionsSwap: Watch Everything, Everywhere All At Once on PrimeNayan: 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 DenverAmit: The wrestling team at Western U from 1990-91Joel: House of the Dragon on HBO Max

The Filtrate:Joel TopfSwapnil HiremathJordy Cohen With Special Guest:Laurie Tomlinson. @Roxytonin Nephrologist at University Hospitals Sussex and research hero of Jordy. Editor: Priya Yenebere Show Notes:STOP-ACE in pubmed: Renin-Angiotensin System Inhibition in Advanced Chronic Kidney DiseaseSTOP-ACE Summary in NephJC Prior data showing preservation of renal function by stopping ACEi: The impact of stopping inhibitors of the renin-angiotensin system in patients with advanced chronic kidney diseaseEfficacy and Safety of Benazepril for Advanced Chronic Renal Insufficiency: NEJMDr. Tomlinson’s article on creatinine changes in RASi from 2017: Serum creatinine elevation after renin-angiotensin system blockade and long term cardiorenal risks: cohort study NephJC | PubMed Accuracy of eGFR at low GFR: A new equation to estimate glomerular filtration rateStrong opinions, loosely held. “Permissive AKI” with treatment of heart failure. Editorial by Chirag Parish and Steven CocaThe rational for NICE avoiding RASi in black patients: Hypertension and ethnic groupAASK trial showing superiority of RASi in African Americans. JAMAALLHAT post-hoc analysis of outcomes by self-reported race. JAMA | PubMedSophisticated Swedish observational study that Swap loved. Stopping Renin-Angiotensin System Inhibitors in Patients with Advanced CKD and Risk of Adverse Outcomes: A Nationwide StudyTarget Trials in Nephrology Dr Edouard Fu grand rounds at Ottawa Nephrology, YouTubeTarget Trial EmulationA Framework for Causal Inference From Observational Data by Miguel Hernán in JAMATubular SecretionsJordy: Third season of His Dark Materials on HBOSwap: Movies by Wes Anderson on Disney PlusLaurie: The Book, “Nearly All the Men in Lagos are Mad”Jordy: How Medicine Works and When It Doesn't: Learning Who to Trust to Get and Stay Healthy | AmazonJoel EO | NYT Review

The Filtrate:Joel TopfSwapnil HiremathJosh WaitzmanSophia AmbrusoPriya Yenebere With Special Guest:Brendon Neuen, Secretariat of the SGLT2 Trialists Consortium and cool guy on Twitter. Editor: Sophia AmbrusoShow Notes:Joel’s Conflict of Interest Statement. Sophia is also conflicted with Astra Zeneca and Brendon with everybody in the SGLT2i space.Joel starts off with a history of SGLT2iEMPA-REG Outcomes. First!CANVAS. OMG this signal is reproducible!CREDENCE (🎧). It works in a dedicated population at high risk of kidney disease. And in a study designed for renal end-points.DAPA-CKD (🎧). It’s not just for diabetics!EMPA-Kidney. It works at really low GFR. And without albuminuria. And again in non-diabetics.SGLT Inhibitors for Type 1 Diabetes: Proceed With Extreme CautionClick to find the supplement (requires a subscription)Differences in definition in the decreased renal function component of the composite primary outcomes.EMPA-Kidney 40%DAPA-Kidney 50%CREDENCE doubling of serum CrUsability Testing of a Sick-Day Protocol in CKD (Pubmed)New Guidelines for Statistical Reporting in the Journal (link, commentary on said guidelines by Frank Harrell)CKD outcomes and the FDA: Change in Albuminuria and GFR as End Points for Clinical Trials in Early Stages of CKD: A Scientific Workshop Sponsored by the National Kidney Foundation in Collaboration With the US Food and Drug Administration and European Medicines AgencyThe Peripheral on Amazon PrimeUnsealed the Tylenol Murders PodcastProject Hail Mary by Andrew WeirLizzy McAlpine Singer Song WriterRachel Maddow Presents: UltraTwitter chaos continues. Get your Med-Mastodon handle