Freely Filtered, a NephJC Podcast

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

The Filtrate:Joel TopfJoshua WaitzmanNayan AroraSophia AmbrusoJordy CohenSpecial Guest:Kelly HyndmanEditor:Joel TopfPodCrawlMonday, March 14: The Curbsiders An Internal Medicine Podcast…for the Internist. This episode will focus on the Cardiorenal region with Game Maker, Joel Topf @Kidney_Boy, and Selection Committee Member, Sadiya Khan @HeartDocSadiya. Listen on Apple or SpotifyTuesday, March 15: The Drs. WashingtonThe Drs. Washington are three sister physicians who discuss their story and the stories of minority physicians, tips for students interested in careers in medicine, and health-related topics. In this episode, Katie Rizzolo @katierizzolo and Dinushika Mohottige @DMohottige discuss social and physical determinants of health as well as governmental and institutional initiatives that affect health inequities in nephrology.Listen on Apple or SpotifyWednesday, March 16: The CribsidersOn this pediatric podcast, go deep into the Neonatal AKI bracket with the writer, Michelle Starr @mcstarr1. Listen on Apple or SpotifyThursday, March 17: Up My Nursing GameUp My Nursing Game is an educational nursing podcast that uses expert interviews to address common nursing questions and pitfalls. It offers free CE credits through VCU Health. This episode featuring Bourne Auguste @bourneauguste and Daniel Weiner @DanTheKidneyMan will focus on blood pressure and Dialysis. Listen on Apple or SpotifyFriday, March 18: Best Science (BS) MedicineThe Best Science Medicine podcast is all about helping primary care clinicians incorporate the best available evidence into their practice in order to help facilitate shared decision-making. In this episode, Game Makers Samira Farouk @ssfarouk and Matthew Sparks @Nephro_Sparks discuss the tricky issue of albuminuria – who to monitor, what to monitor, and who to treat. They spend a lot of time dribbling and end up deciding that nothing is a slam dunk, so stay until the end for a real buzzer beater.Listen on Apple or SpotifySaturday, March 19: Freely FilteredThe Filtrate break down the Animal House region with Selection Committee Member Kelly Hyndman @DrKeeksPhD.Listen on Apple or SpotifyShow Notes:Kelly Hyndman is an Assistant Professor of Medicine in the Section of Cardio-Renal Physiology and Medicine, Division of Nephrology, at the University of Alabama at Birmingham. She has trained both in comparative physiology and kidney physiology labs and is currently a principal investigator of a basic science lab with research interests in novel mechanisms of fluid-electrolyte balance.From Fish to Philosopher by Homer Smith. Review from 1954 in JAMA.#BlueRibbonFailMarine Iguana Visual Abstract by SophieThe OctonautsThe Oregon TrailCRIC StudyAnimal House 2022 blog post by Tiffany TruongGiraffes sleep 4.6 hours a day. Behavioural sleep in the giraffe (Giraffa camelopardalis) in a zoological gardenTobias WangPeter BieGimli the Corgi GiraffeManBearPig from South ParkMike TysonEmus, not mammelsClimate Change Threats on Black Bears in CaliforniaAs Winter Warms, Bears Can’t Sleep. And They’re Getting Into Trouble.Fat Bear Week has a champion: All hail 480 OtisStillsuit in DuneFreely Filtered 042: Nephrin Antibodies Cause Minimal Change Disease. Wait...What?A molecular mechanism explaining albuminuria in kidney diseaseAmerican Heart Association Hypertension Podcast with Swapnil Hiremath and Carolyn ThomasLink to all the AHA podcastsThe Trojan horse Affair podcastCurbsiders #321 Hypertension FAQ with Jordy CohenThe Alpinist

The Filtrate:Joel TopfJennie LinJoshua WaitzmanNayan AroraSophia AmbrusoSpecial Guest:Astrid Weins (@AstridWeins) renal pathologist at the Brigham and Woman’s Hospital and Harvard Medical SchoolEditor:Nayan AuroraShow Notes:Summary of minimal change disease according to the orthodoxy: Light microscopy of renal biopsy specimens from patients with MCD shows minimal to no change; however, electron microscopy reveals the effacement of podocyte foot processes. To add to the conundrum, immunofluorescent staining of biopsy specimens is negative, and no immune complexes are evident.Minimal change disease and idiopathic FSGS: manifestations of the same diseaseNew Views of the Glomerulus: Advanced Microscopy for Advanced DiagnosisImaging of the Porous Ultrastructure of the Glomerular Epithelial Filtration SlitAutoantibodies against podocytic UCHL1 are associated with idiopathic nephrotic syndrome relapses and induce proteinuria in miceFishing ExpeditionKoch's postulatesMeasles in the Nephrotic SyndromeNEPTUNE: NEPhrotic syndrome sTUdy NEtworkCongenital nephrotic syndrome and recurrence of proteinuria after renal transplantationMost of these patients have a homozygous truncating mutation (Fin-major mutation) in the nephrin gene (NPHS1), leading to total absence of the major podocyte protein, nephrin. After RTx, these patients develop anti-nephrin antibodies resulting in nephrotic range proteinuria.Nephrotic syndrome relapse in a boy with COVID-19Minimal Change Disease After First Dose of Pfizer-BioNTech COVID-19 Vaccine: A Case Report and Review of Minimal Change Disease Related to COVID-19 VaccineDr. Laurence Beck and the discovery of Phospholipase A2 Receptor as Target Antigen in Idiopathic Membranous Nephropathy as published in the NEJM.Cheer Season 2 now on NetflixCloud Cuckoo Land: A Novel by Anthony DoerrWinter Surfing in Massachusetts?!

The Filtrate:Joel TopfSwapnil HiremathMatt SparksEditor:Joel TopfShow Notes:The 2010 RFN Top Nephrology StoriesThe 2021 NephJC Top Nephrology StoriesNumber 10: AKIKI AKIKI 2 in The LancetAKIKI 2 in NephJC AKIKI 2 on Freely FilteredNumber 9: Effect of Salt Substitution on Cardiovascular Events and DeathThe Salt Substitute and Stroke Study (SSaSS) in the NEJM The Salt Substitute and Stroke Study (SSaSS) in NephJC FDA Issues Final Guidance Regarding Use of an Alternate Name for Potassium Chloride in Food LabelingNumber 8: AURORA, voclosporin for Lupus NephritisEfficacy and safety of voclosporin versus placebo for lupus nephritis (AURORA 1) in the LancetAURORA 1 on NephJCAURORA 1 on Freely FilteredNumber 7: FIGARO trial of finerenone for CV outcomesCardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes in the NEJMRates of Hyperkalemia after Publication of the Randomized Aldactone Evaluation Study by David JuurlinkJoel’s intermissionFDA RejectionsTricida’s VeverimerRoxadustatBardoxoloneTenapanorNumber 6: Pig Kidney Transplant.As covered in the New York TimesClinical Pig Kidney Xenotransplantation: How Close Are We? from JASNNumber 5: KDIGO Blood Pressure GuidelinesKDIGO GuidelinesAs discussed in NephJCAnd on Freely FilteredMatt’s article on ACCORD he wrote for RFN as a fellowNumber 4: Chlorthalidone for Hypertension in Advanced Chronic Kidney Disease (CLICK)CLICK in the NEJMCLICK on NephJCCLICK on Freely FilteredNumber 3: Dapagliflozin helps IgA nephropathyThe LancetFDA OKs First Proteinuria Drug for IgA Nephropathy: delayed released budesonideNumber 2: New eGFR formulas, now race free.New Creatinine- and Cystatin C–Based Equations to Estimate GFR without Race in the NEJMNumber 16: Fixing ADPKD in miceRenal plasticity revealed through reversal of polycystic kidney disease in mice in Nature GeneticsPress release from YaleNumber 1: KDIGO GN GuidelinesPDF in Kidney InternationalNephJC DiscussionLast Month in Nephrology skeptical of all the Rituximab Tubular SecretionsOvercooked! All You Can EatLego Porsche 911Lego Baby Yoda (Grogu)Beyblades