Freely Filtered, a NephJC Podcast

The Filtrate:Joel TopfSwapnil HiremathNayan AroraSophia AmbrusoEditor: Nayan AroraShow Notes:Joel’s Conflict of Interest StatementThe Draft Board EMPA-Kidney is “off the board”Lunch Symposium on Current and Future Approaches to the Diagnostic Assessment and Management of AKI in Patients with Cirrhosis provided by an educational grant from Mallinckrodt PharmaceuticalsThe CONFIRM Trial Terlipressin plus Albumin for the Treatment of Type 1 Hepatorenal Syndrome in NephJCClinical Practice Session Leveraging Social Media to Create, Learn, Teach, Advocate, and Dispel MisinformationThe BEST-Fluids Trial: A Randomized Controlled Trial of Balanced Crystalloid Solution vs. Saline to Prevent Delayed Graft Function in Deceased Donor Kidney Transplantation - Michael G. Collins, Magid Fahim, Elaine Pascoe, Carmel Hawley, David W. Johnson, Philip A. Clayton, Steven J. Chadban (ClinicalTrials.gov)The Late Breaking and High Impact Trials Session line upStop ACEiCLARITY Angiotensin receptor blockers for the treatment of covid-19: pragmatic, adaptive, multicentre, phase 3, randomised controlled trialEffects of Pantoprazole on Kidney Outcomes: Post Hoc Analyses From the COMPASS Randomized Controlled Trial by Lonnie Pyne, et alNo Stone: Hydrochlorothiazide for the Prevention of Kidney Stone Recurrence by Daniel Foster, et alMyTEMP: Personalised cooler dialysate for patients receiving maintenance haemodialysis (MyTEMP): a pragmatic, cluster-randomised trialClinical Practice Session Best of NephJC“We'd Now Like To Open The Floor To Shorter speeches disguised as questions.”ASN Task Force on the Future of NephrologyAttracting Osteopathic Medical Students Into NephrologyHasan Minhaj’s joke at the expense of DOsTRANSFORM-HF: Torsemide vs. Furosemide in Treating Patients With HFPoint-of-Care Ultrasound in Nephrology specifically VExUS

The Filtrate:Joel TopfJordy CohenNayan AroraSophia AmbrusoSpecial Guests:Boback Ziaeian @boback Assistant Professor of Medicine David Geffen School of Medicine at UCLA returns for his second episode (SODIUM-HF). His Google Schoolar page is better than yours. David Ellison @dhekidney is professor of medicine at Oregon Health Science University and head of the Oregon Clinical & Translational Institute. Show Notes:Ultrafiltration in Decompensated Heart Failure with Cardiorenal Syndrome (The CARESS Trial)Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure (The UNLOAD trial)Diuretic Strategies in Patients with Acute Decompensated Heart Failure (The DOSE Trial)Diuretic Strategies for Loop Diuretic Resistance in Acute Heart Failure (The 3T Trial)Sequential nephron blockade with a thiazide diuretic has a 1 B-NR (non-radomized) grade in the AHA/ACC Heart Failure Guidelines (7.2)Three important acute decompensated heart failure with SGLT2i:1. Sotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure (SOLOIST-WHF Trial)2. The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure: a multinational randomized trial (The EMPULSE Trial)3. Effects of Early Empagliflozin Initiation on Diuresis and Kidney Function in Patients With Acute Decompensated Heart Failure (EMPAG-HF)Interpreting the Kansas City Cardiomyopathy Questionnaire in Clinical Trials and Clinical Care: JACC State-of-the-Art ReviewCardiologist Sues Epic Over Copyright InfringementOutcomes associated with a strategy of adjuvant metolazone or high-dose loop diuretics in acute decompensated heart failure: a propensity analysis.Acetazolamide to increase natriuresis in congestive heart failure at high risk for diuretic resistance (PubMed)Efficacy and Safety of Spironolactone in Acute Heart Failure (ATHENA Trial)Joel with a video on acetazolamide for altitude sickness. The Butchering Art: Joseph Lister's Quest to Transform the Grisly World of Victorian Medicine(Amazon)

The Filtrate:Joel TopfSwapnil HiremathNayan AroraPriya YenebereSpecial Guests:Todd Miano, PharmD, PhD @Miano81 Assistant Professor of Epidemiology, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine.Show Notes:Early Pip/Tazo article showing nephrotoxicity. Covered by NephJCLinazolid vs Vanco RCT showing excess AKI with Vanco. Yes Vance is a lot less toxic than it was in the Mississippi mud days but your attending telling you it is no longer nephrotoxic is wrong. Linezolid in methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a randomized, controlled study and Vancomycin and the Risk of AKI: A Systematic Review and Meta-Analysis.Vancomycin-Associated Acute Kidney Injury with a Steep Rise in Serum CreatinineVancomycin-Associated Cast Nephropathy: Reality or Fantasy?Molecular Epidemiology of SepsiS in the ICU (MESSI) prospective cohort. Learn about it her: A multibiomarker-based outcome risk stratification model for adult septic shock*Cystatin C in acute kidney injury Changing Definitions of SepsisProposed new definitions of AKI incorporating biomarkers: Recommendations on Acute Kidney Injury Biomarkers From the Acute Disease Quality Initiative Consensus Conference. A Consensus Statement in JAMA Network OpenApplications of propensity score methods in observational comparative effectiveness and safety research: where have we come and where should we go?The effect of glucocorticoids on serum cystatin C in identifying acute kidney injury: a propensity-matched cohort studyProtective effect of piperacillin against nephrotoxicity of cephaloridine and gentamicin in animalsPulmCrit – Myth-busting the conditional nephrotoxicity of piperacillin-tazobactam by Josh FarkasSharp Objects on Good ReadsBandon Dunes The Ocean Course at Kiawah Island Golf ResortBe Real follow me: BeRe.al/kidney_boySNL spoof of BeReal

Topics include fluid resuscitation in sepsis, deferred consent in research, lactate conversion, sepsis definitions, and the impact of IV fluids on acute kidney injury. They also touch on a negative trial with positive outcomes, the Prime Minister of Finland dancing, and the value of physical trophies in the virtual world of nephrology social media.

The Filtrate:Joel TopfSwapnil HiremathJosh WaitzmanSophia AmbrusoSpecial Guests: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 third time (why sdo we keep inviting her back?)Sadiya Khan @heartDocSadiya Assistant Professor of Medicine (Cardiology) and Preventative Medicine at Northwestern Feinberg School of Medicine. LinkEditor: Sophia AmbrusoDonate to NephJCGet your Freely Filtered Mug by becoming a Freely Filtered Fan, all proceeds go to NephJC. All donations are tax deductible in the U.S.http://www.nephjc.com/new-products/freely-filtered-fanIf you want to support NephJC to a different tune than $200, take a look at the NephJC September Pledge Drive page. Show Notes:2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure says:Restricting dietary sodium is a common nonpharmacological treatment for patients with HF symptomatic with congestion, but specific recommendations have been based on low-quality evidence. Concerns about the quality of data regarding clinical benefits or harm of sodium restriction in patients with HF include the lack of current pharmacological therapy, small samples without sufficient racial and ethnic diversity, questions about the correct threshold for clinical benefit, uncertainty about which subgroups benefit most from sodium restriction, and serious questions about the validity of several RCTs in this area. However, there are promising pilot trials of sodium restriction in patients with HF. The AHA currently recommends a reduction of sodium intake to <2300 mg/d for general cardiovascular health promotion; however, there are no trials to support this level of restriction in patients with HF. Sodium restriction can result in poor dietary quality with inadequate macronutrient and micronutrient intake. Nutritional inadequacies have been associated with clinical instability, but routine supplementation of oral iron, thiamine, zinc, vitamin D, or multivitamins has not proven beneficial. The DASH diet is rich in antioxidants and potassium, can achieve sodium restriction without compromising nutritional adequacy when accompanied by dietary counseling, and may be associated with reduced hospitalizations for HF.This is 2a Class of Recommendation (moderate strength) with a C-LoD level of evidence (Limited data).Study acronym: the Study Of Dietary Intervention Under 100 Milimoles in Heart Failure. 100 mmol of sodium is 2300 mgMeta analysis of high versus low sodium diet pulled from Heart due to duplicated and missing data. Retraction Watch.65 mmol of sodium is 1500 mgThe trial design papers: Design and Region-Specific Adaptation of the Dietary Intervention Used in the SODIUM-HF Trial: A Multicentre Study and Rationale and design of the Study of Dietary Intervention Under 100 MMOL in Heart Failure (SODIUM-HF)3-day food diaries underestimate sodium intake vs 24 hour urine - and this is worse for patients on loop diuretics: Evaluation of 2 methods for sodium intake assessment in cardiac patients with and without heart failure: the confounding effect of loop diureticsPREDIMED trial of Mediterranean diet: retracted, republished, still trusted? DASH Diet trial where they gave food to the participants Effects on Blood Pressure of Reduced Dietary Sodium and the Dietary Approaches to Stop Hypertension (DASH) DietMedical Therapy for Heart Failure With Reduced Ejection Fraction: The CHAMP-HF RegistryInterpreting the Kansas City Cardiomyopathy Questionnaire in Clinical Trials and Clinical Care: JACC State-of-the-Art Review Development and evaluation of the Seattle Angina questionnaire: A new functional status measure for coronary artery diseaseCardiologist Sues Epic Over Copyright Infringement6-minute walking test: a useful tool in the management of heart failure patientsFrank Harrell on Statistical Errors in the Medical LiteratureANCOVA versus change from baseline: more power in randomized studies, more bias in nonrandomized studiesA-HeFT: Combination of Isosorbide Dinitrate and Hydralazine in Blacks with Heart FailureTOPCAT: Spironolactone for Heart Failure with Preserved Ejection FractionSSaSS: Effect of Salt Substitution on Cardiovascular Events and DeathMini Cooper SE Electric hardtop 2 door Taylor Swift can't stop emitting CO2 with her private plane. The Captain (miniseries)Nope.The Mystery of Why Some People Don’t Get CovidFor All Mankind (TV series)

The Filtrate:Joel TopfSwapnil HiremathJosh WaitzmanJordy CohenSpecial Guest:Sean Barbour. Clinical Associate Professor, Division of Nephrology, University of British Columbia Chair, BC Glomerulonephritis Committee and Network, BC RenalEditor:Joel TopfShow Notes:NephJC Summary of TESTING: Re-TESTING Steroids for IgA Nephropathy (have you ever noticed how good the titles for the NephJC summaries are?)TESTING in JAMASTOP-IgA NephJC Summary: Don't just do something, stand there. Another great title, this one from from a long time ago.The British Columbia GN network really owes its existence to TESTING: An overview of the British Columbia Glomerulonephritis network and registry: integrating knowledge generation and translation within a single framework (PubMed)Dunning–Kruger effect WikipediaPrior Art for steroids in IgA nephropathy:Italian study: Randomized controlled clinical trial of corticosteroids plus ACE-inhibitors with long-term follow-up in proteinuric IgA nephropathyAnother, earlier, Italian study: Corticosteroids in IgA nephropathy: a randomised controlled trialChinese study: Combination therapy of prednisone and ACE inhibitor versus ACE-inhibitor therapy alone in patients with IgA nephropathy: a randomized controlled trialOriginal TESTING publication from 2017, also in JAMA. Oh, and we covered that in NephJC too, IgA Nephropathy: Testing Steroids Again.NephJC also talked about Sean Barbour’s risk score for IgA Nephropathy: Summary | Freely Filtered Podcast episode 5A Controlled Trial of Fish Oil in IgA Nephropathy in the NEJM!Stevens-Johnson Syndrome. “When to see a doctor Stevens-Johnson syndrome requires immediate medical attention. Seek emergency medical care if you experience signs and symptoms of this condition.” 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 Agency (PubMed)Adaptive Trials in NephMadness 2016 with Selection Committee Member, Perry Wilson!TreifGeographic Differences in Genetic Susceptibility to IgA Nephropathy: GWAS Replication Study and Geospatial Risk AnalysisThe MEST score provides earlier risk prediction in lgA nephropathyDAPA-IgA: A pre-specified analysis of the DAPA-CKD trial demonstrates the effects of dapagliflozin on major adverse kidney events in patients with IgA nephropathySwap and Josh fight about SGLT2i in IgA NephropathySignificance of serum galactose deficient IgA1 as a potential biomarker for IgA nephropathy: A case control study (PubMed)FDA approves first drug to decrease urine protein in IgA nephropathy, a rare kidney disease. FDA has granted accelerated approval for  budesonide delayed release capsules to reduce proteinuria in adults with primary IgA nephropathy at risk of rapid disease progression. It has not been established whether budesonide delayed release capsules slow kidney function decline in patients with IgA nephropathy. Targeted-release budesonide versus placebo in patients with IgA nephropathy (NEFIGAN): a double-blind, randomised, placebo-controlled phase 2b trial (Lancet)Omicron in Ontario.Prescribing Nirmatrelvir/Ritonavir for COVID-19 in Advanced CKD by SwapStar Trek: Strange New WorldsOrigins of Renal Physiology: Fellows 2022 Medical Students: Kidney TREKSApplication of the International IgA Nephropathy Prediction Tool one or two years post-biopsy (Kidney International)The Triple Crown in Virginia

The Filtrate:Joel TopfNayan AroraSophia AmbrusoSwapnil HiremathJosh WaitzmanSpecial Guest:Natalie Bello Director of Hypertension Research at Cedars SinaiEditor:Nayan AroraShow Notes:NephJC summary of CHAPCHiPS TV showCHIPS study: Less-Tight versus Tight Control of Hypertension in PregnancyPrevention, Diagnosis, and Management of Hypertensive Disorders of Pregnancy: a Comparison of International Guidelines (Pubmed)SFLT in preeclampsia from where else but NephMadness and here.Aspirin Use to Prevent Preeclampsia and Related Morbidity and MortalityUS Preventive Services Task Force Recommendation Statement (JAMA)The NNT for aspirin in pregnancy is like a relationship on Facebook, it’s complicated. Astrologic signs as predictor of aspirin effectiveness in Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group (Pubmed) ACOG revises the guidelines on hypertension: Clinical Guidance for the Integration of the Findings of the Chronic Hypertension and Pregnancy (CHAP) StudyMeta-analysis showing treating blood pressure in pregnancy didn’t help. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy.

The Filtrate:Joel TopfNayan AroraSophia AmbrusoSwapnil HiremathSpecial Guest:Jade TeakallJeff Perl, Great Twitter handle, PD_PerlsEditor:Joel TopfShow Notes:ISPD 2022 Peritonitis GuidelinesNephJC DiscussionDimitrios Oreopoulos obituary in JASN. Peritoneal Dialysis International: Journal of the International Society for Peritoneal DialysisThe draft board: Google DocThe PROMPT Study showing delayed peritonitis treatment increases the risk of treatment failure: The Relationship Between Presentation and the Time of Initial Administration of Antibiotics With Outcomes of Peritonitis in Peritoneal Dialysis Patients: The PROMPT StudyEmbedded PD catheters: Complications and catheter survival with prolonged embedding of peritoneal dialysis cathetersNikhil Shah asking questions about fungal prophylaxisQuestion 1Question 2Icodextrin antibiotic compatibility: Stability and compatibility of antibiotics in peritoneal dialysis solutions or in Tweet Form.Nikhil Shah on having antibiotics at homeTweet thread about the things we do for little reason regarding getting people listed for transplant.Regarding the trend in duration of antibiotics: Duration of Antibiotic Therapy: Shorter Is Better‘Spelling the Dream’ Review: Netflix’s Inspiring Spelling Bee Doc Is an Unexpected Rallying CryABC KidneyHome Dialysis University was May 1, 2The Grand Canyon, second largest hole in the ground.

The Filtrate:Joel TopfJoshua WaitzmanNayan AroraJennie LinSophia AmbrusoSpecial Guest:Paul A Welling Editor:Sophia AmbrusoShow Notes:NephJC Summary on SSaSSPaul Welling’s tweetorial on the potassium switchThe 2016 Canadian Hypertension guidelines were the first to suggest adding potassium: Hypertension Canada's 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of HypertensionSwapnil’s Potassium Trial: Diet or additional supplement to increase potassium intake: protocol for an adaptive clinical trialWhen Food Firms Cut The Salt, What Do They Put In Instead? From NPR.Effect of increased potassium 🍌 intake on cardiovascular risk factors and disease: systematic review and meta-analysesEffect of lower sodium🧂 intake on health: systematic review and meta-analysesEstimated population wide benefits and risks in China of lowering sodium through potassium enriched salt substitution: modelling studyFDA Issues Final Guidance Regarding Use of an Alternate Name for Potassium Chloride in Food LabelingDavid Ellison and Paul Welling’s reviewing the NEJM: Insights into Salt Handling and Blood PressureNephTrials on Cluster Randomized Trials: http://www.nephjc.com/news/clusterct Nu-Salt (KCl) 3 oz for $4.97 at Amazon (no afiliate link because we don’t have our act together) Salt for Life looks like it is 75% KCl 25% NaCl and it is 11.99 for 10.5 oz at Amazon (see above disclaimer)Bridgerton, only 8 episodes for Season 2Inhibition of nonalcoholic fatty liver disease in mice by selective inhibition of mTORC1: The Paper | The TweetKansas wins March MadnessWork in Josh’s lab. Get in touch: jswaitzm@bidmc.harvard.eduOpen Educational Resources (OER)NKF Spring Clinical Meeting 2022Little Podocye

The Filtrate:Joel TopfJoshua WaitzmanNayan AroraJordy CohenSpecial Guest:Josh Mezrich Editor:Nayan AroraShow Notes:When Death Becomes Life: Notes from a Transplant Surgeon. AmazonAm J Transplant 2022 Jan 20. doi: 10.1111/ajt.16930. PMID: 35049121Coverage on NephJCFirst transplant of a pig into a human. NYU transplant. Keith Reemtsma’s experience with chimpanzees transplantation: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1408776/?page=1 Infection of human cells by an endogenous retrovirus of pigsUnited Therapeutics page on xenokidney.Article by Starzl on the early days of kidney transplant, including David Humes experiment grafting kidneys to the arms and grafts of patients. The Early Days of TransplantationPatient in Groundbreaking Heart Transplant DiesHeterotopic heart transplantation: where do we stand?Denton Cooley and the first artificial heart transplantFor the First Time in North America, a Woman Gives Birth After Uterus Transplant From a Deceased DonorBlacksburg company raised genetically modified pig for first heart transplant into humanChristiaan Barnard and the first human-to-human heart transplantMaking The Impossible Possible: A Conversation With Martine Rothblatt. The founder of United Therapeutics and SiriusXMPaige Porrett, M.D., Ph.D. first authorJayme Locke, M.D., MPH senior authorLouise Penny author pageThe Four QuestionsChutzpod!Joshua Malina, not the new cantor at Temple Israel.Primitive Technology YouTube Channel