Freely Filtered, a NephJC Podcast

The Filtrate:Joel TopfSwapnil HiremathSamira FaroukMatt SparksAnd special guests:Sadiya Kahn a heart failure specialist at Northwestern University. @HeartDocSadiyaandPaul Welling a professor of medicine and nephrology at Johns Hopkins. @PAWellingMDShow Notes:The Study: https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.120.045691Coverage at NephJC: http://www.nephjc.com/news/sglt2mechanismDiuretics for heart failure NEJM Review article: https://www.nejm.org/doi/full/10.1056/nejmra1703100Don’t say renal: https://www.kidney-international.org/article/S0085-2538(20)30233-7/fulltext?mobileUi=0Sanjiv “We pronounce HFpEF huff-puff” Shah, MD https://www.feinberg.northwestern.edu/faculty-profiles/az/profile.html?xid=16814 and https://asecho.org/wp-content/uploads/2016/02/Shah-HFpEF.pdfHuff Puff is like fetch. It is not going to happen. https://www.youtube.com/watch?v=Pubd-spHN-0Did he have buttons? https://ajkdblog.org/2019/06/17/muscle-relaxant-use-in-dialysis/Rate My Room: https://twitter.com/ratemyskyperoom?lang=enReview on Renal Glucosuria from CJASN: https://cjasn.asnjournals.org/content/5/1/133 and another from the National Organizations of Rare Disorders: https://rarediseases.org/rare-diseases/renal-glycosuria/Mechanism of Impaired Natriuretic Response to Furosemide during Prolonged Therapy: https://pubmed.ncbi.nlm.nih.gov/2811065/Two studies that showed drops in BNP with SGLT2iDAPA HF: https://www.nejm.org/doi/full/10.1056/NEJMoa1911303DEFINE HF showing nice reduction BNP with dapagliflozen: https://pubmed.ncbi.nlm.nih.gov/31524498/?dopt=AbstractCopeptin, what is it? https://pubmed.ncbi.nlm.nih.gov/18291667/?dopt=AbstractSIADH treatment with empagliflozen: https://jasn.asnjournals.org/content/31/3/615.abstract and it is JASN not CJASN. My bad.EVEREST. Tolvaptan for heart failure: https://jamanetwork.com/journals/jama/fullarticle/206251Remdesivir placebo controlled RCT: https://www.nejm.org/doi/full/10.1056/NEJMoa2007764Joel’s Remdesivir study: https://www.nejm.org/doi/full/10.1056/NEJMoa2007016Remdesivir for 5 or 10 Days in Patients with Severe Covid-19: https://www.nejm.org/doi/full/10.1056/NEJMoa2015301Swap showing a lot of skepticism to the Lancet HCQ data even before the retraction (which happened after this recording) https://www.the-scientist.com/news-opinion/lancet-retracts-surgispheres-study-on-hydroxychloroquine-67613Baclofen is dangerous https://www.kidney-international.org/article/S0085-2538(20)30552-4/abstract

The Filtrate:Joel TopfSwapnil HiremathMatt SparksAnd special guests:Joshua Waitzman, third year nephrology fellow at Beth IsraelHarold “Harv” Feldman. Editor in Chief at AJKD and national study chair of CRIC and principal investigator of the Scientific and Data Coordinating Center of the CRIC Study. https://www.dbei.med.upenn.edu/bio/harold-i-feldman-md-msceShow Notes:CRIC: Chronic Renal Insufficiency Cohort http://www.cristudy.org/NSAID Studies at NephJC:Precision: http://www.nephjc.com/news/2017/1/20/hwgrko70d3z88djtjcmzvwpzlirm6c?rq=precisionArmy of NSAIDs: http://www.nephjc.com/news/nsaids and the podcast (from before the name Freely Filtered, http://www.nephjc.com/freelyfiltered/2019/3/24/nephjc-drive-time-001-an-army-of-nsaids)And this week’s study: CRIC: http://www.nephjc.com/news/nsaids-vs-opioidsMethods at 16:55Matt had to get a mouse study 🐁 in, so here it is: Renal Abnormalities And An Altered Inflammatory Response In Mice Lacking Cyclooxygenase Ii https://www.nature.com/articles/378406a0The Beth Israel Flex, “The first time I read the paper…”Results at 32:46Discussion 48:13Josh King on opioids being nephrotoxic: https://twitter.com/nephrotox/status/1260400636253921281?s=20This Week in CovidThe fight over round spikey things.German autopsy study showing SARS-CoV2 in the kidney: https://www.nejm.org/doi/full/10.1056/NEJMc2011400Kidney International walking back some previous declarations of what they are seeing on EM: https://twitter.com/Kidney_Int/status/1263641195416150018?s=20MedRxIV on AKI with COVID-19 at Mount Sinai Medical Center: https://www.medrxiv.org/content/10.1101/2020.05.04.20090944v1Juan Carlos discussing etiologies of AKI in COVID-19 outbreak in New Orleans.https://kidney360.asnjournals.org/content/early/2020/05/13/KID.0002652020Triple combination of interferon beta-1b, lopinavir–ritonavir, and ribavirin in the treatment of patients admitted to hospital with COVID-19: an open-label, randomised, phase 2 trial https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31042-4/fulltextFriend of the Podcast, Kenar Jhaveri and his data on COVID19 and AKI in Kidney International. https://www.kidney-international.org/article/S0085-2538(20)30532-9/fulltext

The Filtrate:Joel TopfSwapnil HiremathSamira FaroukJennie LinMatt SparksAnd special guests:David J. Cohen: Professor of Medicine at the University of Missouri-Kansas City and Director of Cardiovascular Research at Saint Luke’s Mid America Heart Institute. In addition, he is Medical Director of the Medical Economics and Technology Assessment Group at Mid America Heart Institute. He was previously Associate Director of Interventional Cardiology at Beth Israel Deaconess Medical Center where he was also Associate Professor of Medicine at Harvard Medical School and Director of Economics and Quality of Life Research at the Harvard Clinical Research Institute. He is on Twitter at @djc795Keith Bellovich: Chief Medical Officer Ascension St John. He is also on the board of directors of the renal physician association where he currently the treasurer/secretary.Show Notes:Ischemia CKD trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1915925The most famous figure in nephrology: https://jasn.asnjournals.org/content/10/7/1606(This figure was originally published in AJKD, but is now behind a paywall, hence the JASN link https://www.ajkd.org/article/S0272-6386(98)00339-4/pdf)Should Statins Be Banned from Dialysis? https://jasn.asnjournals.org/content/28/6/1675Ischemia trial (not CKD) https://www.nejm.org/doi/full/10.1056/NEJMoa1915922Courage trial from 2007: https://www.nejm.org/doi/full/10.1056/NEJMoa070829Drug eluting stents approved in 2003: https://en.wikipedia.org/wiki/Drug-eluting_stentCéline Dion, Courage: https://www.youtube.com/watch?v=WN-ZHOHmvcwDr. Farouk hanging with her close personal friend Ms. Dion: https://twitter.com/ssfarouk/status/1246448332039471107https://twitter.com/ssfarouk/status/1235935956152311808A lot of the enrollment of CKD-Ischemia was from Asia, 25%Methods: 19:40Avoiding the Oculostenotic Reflex: https://www.acc.org/membership/sections-and-councils/fellows-in-training-section/section-updates/2016/02/12/16/29/avoiding-the-oculostenotic-reflexBeta blockers in dialysis patients: https://www.ncbi.nlm.nih.gov/pubmed/10201019Mehran Score: https://www.mdcalc.com/mehran-score-post-pci-contrast-nephropathyUltra-low contrast coronary angiography and zero-contrast percutaneous coronary intervention for prevention of contrast-induced nephropathy: step-by-step approach and review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6727230/Capsulology 32:30Antiplatelet treatment of STEMI with P2Y12 inhibitors https://en.wikipedia.org/wiki/P2Y12#Antiplatelet_treatment_of_STEMIImpact of concomitant use of proton pump inhibitors and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4826890/Jennie is an intermediate metabolizer so she will be sluggish to activate P2Y12 inhibitor pro-drugs (which is just about all of them) https://www.mdmag.com/conference-coverage/acc-2018/realtime-genetic-data-impacts-physician-prescribing-behavior-following-stent-proceduresSt John's Wort Supplements Endanger the Success of Organ Transplantation: https://jamanetwork.com/journals/jamasurgery/fullarticle/212243Results 37:10Frank Harrell https://twitter.com/f2harrellHis blog: https://www.fharrell.comDiscussion 46:56Samira does not work at NYU.The Argument for Abolishing Cardiac Screening of Asymptomatic Kidney Transplant Candidates https://pubmed.ncbi.nlm.nih.gov/31492488/Coronary-Artery Revascularization before Elective Major Vascular Surgery. The CARP study https://www.nejm.org/doi/full/10.1056/NEJMoa041905A Single Ventilator for Multiple Simulated Patients to Meet Disaster Surge https://onlinelibrary.wiley.com/doi/pdf/10.1197/j.aem.2006.05.009Joel’s enthusiasm for Remdesivir: The COVID Diaries 3: Ladies and Gentleman, I think this tweet is going to get me in trouble… http://pbfluids.com/2020/05/the-covid-diaries-3-the-tweet-heard-round-the-world/Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31022-9/fulltextNIH Clinical Trial Shows Remdesivir Accelerates Recovery from Advanced COVID-19 https://www.niaid.nih.gov/news-events/nih-clinical-trial-shows-remdesivir-accelerates-recovery-advanced-covid-19

The Filtrate:Joel TopfSwapnil HiremathSamira FaroukJennie LinMatt SparksAnd special guests:Agnes Fozo: John L. Shapiro Chair of Pathology at Vanderbilt University and on Twitter: https://twitter.com/AgnesFogoHua Su: Professor of Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaOsama El Shamy: Home Therapy Fellow at Mount Sinai and on Twitter: https://twitter.com/osamaelshamy88Chirag Parikh: Director of Nephrology Johns Hopkins and on Twitter: https://twitter.com/KidneydrChiragShow Notes:Mark Denison, Corona virus expert. https://www.vumc.org/viiii/person/mark-r-denison-md and on Twitter: https://twitter.com/DenisonLabDiscussion on Twitter that the 3electron microgrpahs may show clathrin coated pits rather than Conorna virus. https://twitter.com/vighnesh_w/status/1250880961463513088?s=20Chris Larsen’s case of collapsing glomerulopathy in a patient with COVID-19 https://www.kireports.org/article/S2468-0249(20)31172-4/abstractOsler's rule: States that a neurological defect has to be related to a specific lesion, in contrast to Hickam's dictum, which states that the neurological defect can be due to several lesions.Altered Lipid Metabolism in Recovered SARS Patients Twelve Years after Infection. https://www.ncbi.nlm.nih.gov/pubmed/28831119We don’t record (or roll) on the sabath https://www.youtube.com/watch?v=GPo9OBrIOi4Using a dialysis machine to make CRRT dialysate, the Tweet: https://twitter.com/KidneydrChirag/status/1249867795602583554Derek Fine, Parikh’s partner in crime: https://www.hopkinsmedicine.org/profiles/results/directory/profile/0007605/derek-fine and on Twitter: https://twitter.com/DerekFineMDTablo Machine makes its own dialysate. It does not look like a cooler. https://www.outsetmedical.com/tablo/Is Canada a communist country? https://www.quora.com/Is-Canada-a-communist-countryLokelma is not a sponsor of Freely FilteredComplications and Catheter Survival With Prolonged Embedding of Peritoneal Dialysis Catheters https://pubmed.ncbi.nlm.nih.gov/18281722/Ontario Nursing Homes,”It felt like a war zone” https://www.pri.org/stories/2020-04-24/it-felt-war-zone-coronavirus-tears-through-canada-nursing-homes

Cast:Joel TopfSwapnil HiremathSamira FaroukJennie LinMatt SparksAnd special guest Joshua WaitzMartin Pollak: http://www.nasonline.org/member-directory/members/20033579.htmlJosh Waitz @jwaitz100 Days of COVID-19: https://www.voanews.com/episode/100-days-covid-19-4236811MinTac: http://www.nephjc.com/news/mintacMy magical experience with minimal change disease. This is not the actual tweet, but a dramatization: http://pbfluids.com/2020/04/the-magic-of-treating-minimal-change-disease/Non-inferiority, NephJC: http://www.nephjc.com/news/2019/7/8/understanding-the-vortex-of-non-inferiority-trialsNon-inferiority, through the looking glass: https://pubmed.ncbi.nlm.nih.gov/21539749/Kevin Fowler on Tacrolimus side effects: https://twitter.com/gratefull080504/status/1247697780736512000?s=20Mt Sinai is converting some transplant patients from tacrolimus to belatecept: https://www.nejm.org/doi/full/10.1056/nejmoa1506027CAPSULOLOGY: Open the “Images” tab https://www.webmd.com/drugs/2/drug-10097-6108/tacrolimus-oral/tacrolimus-oral/detailsTacrolimus for your cat and dog dry eye needs: https://vcahospitals.com/know-your-pet/tacrolimus-ophthalmic-in-dogsWHO, NSAIDs, and double negatives: https://twitter.com/kidney_boy/status/1240452941187821570?s=20CJASN stands for the Clinical Journal of the American Society of Nephrology. The C does not stand for Canada. Sorry Swap.Conversion calculator from old world (SI) units, mg/mole Cr, to freedom units (gram protein / gram creatinine): http://www.scymed.com/en/smnxps/psdjf223.htmMichelle Rheault about starting the clock to relapse tweet: https://twitter.com/rheault_m/status/1247703322200596483?s=20Marvin Gonzalez calls for larger studies: https://twitter.com/MarvinGonzlez16/status/1247701186972733442?s=20Acute PD for COVID-19 is discussed in this article from CJASN: https://cjasn.asnjournals.org/content/early/2020/04/03/CJN.03750320PD for AKI, the experience from Brazil https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3525422/The lead author, Daniela Ponce is really the world authority on PD and AKI: https://www.ncbi.nlm.nih.gov/pubmed/?term=Ponce%20D%5BAuthor%5D&cauthor=true&cauthor_uid=22641732Nursing home outbreaks in Durham: https://www.newsobserver.com/news/coronavirus/article241975401.htmlPrison outbreak: https://www.npr.org/2020/04/06/827922287/inmates-staff-on-edge-as-covid-19-spreads-through-federal-prisonsOttawa COVID-19: https://ottawacitizen.com/news/local-news/covid-19-long-term-care-outbreaks-continue-devastating-spread-across-ontario/West Coast herd immunity: https://www.ksbw.com/article/new-study-investigates-californias-possible-herd-immunity-to-covid-19/32073873#The History of HIV associated Nephropathy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3494840/Racial breakdown of NYC coronavirus deaths reveals ‘disparities,’ de Blasio says https://nypost.com/2020/04/08/de-blasio-releases-racial-breakdown-data-of-coronavirus-deaths/Michelle Rheault is tired: https://twitter.com/rheault_m/status/1248371721356402689?s=20KidneyCon Lite! Saturday April 18 from 9-11. Kidney Pathology workshop.Lunch Doodles with Mo Willems: https://youtu.be/7KBkUyE6MOwDr Glaucomflecken and Telehealth: https://twitter.com/DGlaucomflecken/status/1247709538322657282?s=20NephSim for kindergartner’s https://nephsim.comNephSim live: https://twitter.com/Neph_SIM/status/1247637727048327170?s=20

Loeb’s Laws of Medicine or Loeb’s Rules of TherapeuticsRobert Frederick Loeb (March 14, 1895-October 21, 1973) was a famous American Physician who provided some very simple common sense approach to treating patients know as:1. If what you are doing is doing good, keep doing it.2. If what you are doing is not doing good, stop doing it.3. If you do not know what to do, do nothing.4. Never make the treatment worse than the disease.The last ‘law’ in present times is often replaced with:“If at all possible, keep your patient out of the operating room.”Or“Above all, never let a surgeon get your patient.”This is a decent reference for this: https://www.ncbi.nlm.nih.gov/books/NBK13258/Dr. Glaucomflecken gives some tips for attending trying to go back to the ICU: https://twitter.com/DGlaucomflecken/status/1238954558140772354?s=20Francis Deng and going back to become an internist: https://twitter.com/francisdeng/status/1245475268158009349?s=20JCI article on using convalescent serum for treating disease: https://www.jci.org/articles/view/138003Human trial of convalescent serum from JAMA: https://jamanetwork.com/journals/jama/fullarticle/2763983 It works! (in uncontrolled, observational trials)Monkeys develop protective antibodies: https://www.biorxiv.org/content/10.1101/2020.03.13.990226v1Time course for antibodies and viral clearance in SARS-CoV2 from Nature: https://www.nature.com/articles/s41586-020-2196-xPeripheral blood monocyte proeonomics: https://www.biorxiv.org/content/10.1101/2020.03.31.019216v1.full.pdfCytokine storm in the New York Times. Check mate Rheumatologists: https://www.nytimes.com/2020/04/01/health/coronavirus-cytokine-storm-immune-system.htmlDr. Anthony Chang and Thrombi on COVID biopsies: https://twitter.com/ChangUCanSpare/status/1240686922332160001?s=20ASN April 2 Webinar on dialysis and COVID-19 with Anitha Vijayan (among others): https://www.asn-online.org/ntds/resources/Webcast_2020_04_02_COVID-19.mp4UK data on length of ventilatory support (ICNARC): https://t.co/WB1ZnODRFF?amp=1Swap forgot Michele Mokrzycki’s name. Her name is Michele.Samira’s elementary school shampoo: https://www.influenster.com/reviews/pert-plus-classic-clean-2-in-1-shampoo-conditionerProlonged Intermittent Renal Replacement Therapy (PIRRT): https://www.ncbi.nlm.nih.gov/pubmed/27113696MDCalc COVID-Resource Center: https://www.mdcalc.com/covid-19Acute PD for COVID-19 is discussed in this article from CJASN: https://cjasn.asnjournals.org/content/early/2020/04/03/CJN.03750320PD for AKI, the experience from Brazil https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3525422/The lead author, Daniela Ponce is really the world authority on PD and AKI: https://www.ncbi.nlm.nih.gov/pubmed/?term=Ponce%20D%5BAuthor%5D&cauthor=true&cauthor_uid=22641732NEJM ACE2 review article that Matt didn’t read or peer review: https://www.nejm.org/doi/full/10.1056/NEJMsr2005760NephJC COVID site: http://www.nephjc.com/covid19

NephJC’s COVID-19 and the Kidney PatientCast:Joel TopfSwapnil HiremathSamira FaroukJennie LinMatt SparksShow Notes:The NephJC Page on ACE2 and COVID-19Nature Letter showing AER2’s central role in lung injury (in mice). This was SARS from 2005.Losartan RCT in COVID-19; University of Minnesota:Outpatient NCT04311177Inpatient NCT04312009France's health ministry says NSAIDs may be bad in COVID-19 coverage by CNNWHO Tweets its position on NSAIDs.Early case report on COVID-19 and (heart) transplantMatt’s question to Twitter about cytokine stormASN Webinar on dialysis and COVID-19NephJC page on dialysis and COVID-19Dimitrios G. Oreopoulos, one of the giants of peritoneal dialysisTwitter Self Care BotTweetorial on Zoom by SamiraChristos Argyropoulos the Nostradamus of COVID-19

Plasma Exchange and Glucocorticoids in Severe ANCA-Associated VasculitisSummary on NephJCCast:Joel TopfSwapnil HiremathSamira FaroukJennie LinJordy CohenShow Notes:55th ERS-EDTA Congress, late breaking and high impact trials. June 2018The CJASN Review recommended by JennieMEPEX studyC5a antagonist, Avacopan in ANCA-Associated VasculitisThe fragility index as described in JAMA SurgeryMichael Walsh looks at the Fragility Index in 399 trials in medical literatureThe EVOLVE trial of Cinacalcet. Age-adjusted HR results in statistically significant results for primary outcome, but was not defined as the primary endpoint. Patients were one year older in the cinacalcet group; older age known to increase mortality in dialysis patients. Wiki Journal Club.Ron Falk and his irresponsible editorial.Cochrane Systematic Review and Meta-analysis of Anti‐cytokine targeted therapies for ANCA‐associated vasculitisNephMadness is now in full swing at the AJKDblog!

Just the dudes gathered to talk about the JAMA Internal Medicine Meta Analysis on Gadolinium in CKD stage 4 and 5.Risk of Nephrogenic Systemic Fibrosis in Patients With Stage 4 or 5 Chronic Kidney Disease Receiving a Group II Gadolinium-Based Contrast AgentA Systematic Review and Meta-analysis.Summary on NephJCCast:Joel TopfSwapnil HiremathMatt SparksShow Notes:Swap has a disclosure!He was an author on the Canadian Association of Radiology guidelines on use of Gad in CKD.Grobner’s original paper reporting the association between gadolinium and NSF.Matt’s article on alternatives to gadolinium in MRI:Diagnostic value of alternative techniques to gadolinium-based contrast agents in MR neuroimaging—a comprehensive overviewUsing Ferumoxytol as an MRI contrast agent.Saurabh Jha’s editorial (@RogueRad) for NephMadness when Gadolinium in CKD 4 was a team in 2018.PEXIVAS was an abstract in 2018 and was not published until 2020.A Cultural History of Rock-Paper-ScissorsMichelle’s recent case of NSF in a child (in case you thought this disease was gone)Removing Gad with dialysis.Matt’s tubular secretion: Biorender.comJohn Mandrola Expert or not an expert?JACC Case Reports on the Kardashian IndexRobert Cardiff’s editorial on the Kardashian Index in JACC Case Reports.Bryan Vartabedian blog post on Robert Cardiff’s editorialAnd NephMadness is coming! Friday March 13, 2020!

Cast:Joel TopfJennie LinSwapnil HiremathMatt SparksShow Notes:The NephJC discussion can be found here.The study was published in the NEJM.NephJC summary of the AJKD systematic review of uremic pruritusAtul Gawande on itching.Pinnacle MountainComprehensive review on toxicodendron dermatitis: poison ivy, oak, and sumac.KIDNEYconTom Oates 12 days of Poems on Twitter