Freely Filtered, a NephJC Podcast

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

Cast:Joel TopfJennie LinSwapnil HiremathMatt SparksSamira FaroukShow Notes:Pathway 2 Trialhttps://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00257-3/fulltextNephJC discussion of Pathway2http://www.nephjc.com/pathwayThe DIAMOND Trial. Much more ambitious than I described in the podcast.https://clinicaltrials.gov/ct2/show/NCT03888066SPRINThttps://www.nejm.org/doi/full/10.1056/NEJMoa1511939Omron 907 BP cuffonly $678 from Amazon: https://www.amazon.com/Omron-HEM-907XL-IntelliSense-Professional/dp/B000FENZPSEvaluation of the Potential for Drug Interactions With Patiromer in Healthy Volunteers:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5555446/The TOPCAT Trial story: A Clinical Trial Torpedoed By Fraud and Incompetencehttps://blogs.sciencemag.org/pipeline/archives/2017/04/27/a-clinical-trial-torpedoed-by-fraud-and-incompetenceCJSAN article looking at 24-hour urine for calcium and phos with patiromerhttps://cjasn.asnjournals.org/content/14/1/103Swap’s best tweeters of #Kidney Wkaldorodrigo https://twitter.com/aldorodrigoAlex Meraz https://twitter.com/nephroguyJoshua Waitzman https://twitter.com/JwaitzKIDNEYconkidneycon.org

Cast:Joel TopfSamira FaroukJennie LinSwapnil Hiremathand special guest, Perry WilsonA clinically applicable approach to continuous prediction of future acute kidney injury. https://www.ncbi.nlm.nih.gov/pubmed/?term=A+clinically+applicable+approach+to+continuous+prediction+of+future+acute+kidney+injury#Deep Mind National Health services scandal https://www.telegraph.co.uk/technology/2017/07/03/googles-deepmind-nhs-misused-patient-data-trial-watchdog-says/KDIGO AKI guidelines (PDF) https://kdigo.org/wp-content/uploads/2016/10/KDIGO-2012-AKI-Guideline-English.pdfFrank Harrell on the value of continuous variables http://biostat.mc.vanderbilt.edu/wiki/Main/CatContinuoushttps://twitter.com/f2harrell/status/1176908371464794113?s=20Wilson’s AKI Alert trial published in The Lancet, Automated, electronic alerts for acute kidney injury: a single-blind, parallel-group, randomised controlled trial. http://www.nephjc.com/aki-alertThe NINJA trial http://www.nephjc.com/news/2016/8/3/ninja-using-technology-to-prevent-acute-kidney-injury?rq=ninjaThe end of EPICparodyEMR: https://twitter.com/EPICEMRparody/status/1178788488881299457?s=20EPICparodyEMR on Explore the Space: https://www.explorethespaceshow.com/podcasting/epicparodyemr-on-electronic-medical-records/Tweet where Nassim Nicholas Taleb calls Swap an imbecile: https://twitter.com/nntaleb/status/1178252052453089281?s=20Blood Pressure Medicines for Five Years to Prevent Death, Heart Attacks, and Strokes. https://www.thennt.com/nnt/anti-hypertensives-to-prevent-death-heart-attacks-and-strokes/NNT is SPRINT: In participants assigned to intensive BP lowering, major adverse cardiovascular events were reduced by 25% (5.2% v. 6.8%; hazard ratio [HR] 0.75, 95% confidence interval [CI] 0.64–0.89; number needed to treat [NNT] of 62 over 3 yr) and all-cause mortality was reduced by 27% (3.3% v. 4.5%; HR 0.73, 95% CI 0.60–0.90; NNT of 90 over 3 yr).NNT is highly misleading when assessing chronic disease prevention. https://www.ncbi.nlm.nih.gov/pubmed/25027390Washington University School of Medicine establishes Division of Physician-Scientists https://medicine.wustl.edu/news/school-of-medicine-establishes-division-of-physician-scientists/Physician scientists in the NEJM https://www.nejm.org/doi/full/10.1056/NEJMp1904482NYT article on Physician Scientists: https://www.nytimes.com/2019/09/23/opinion/doctor-scientist-medical-research.htmlbrussels.sprout on Instagram https://www.instagram.com/brussels.sprout/?hl=enSuperintelligence by Nick Bostrom https://www.amazon.com/Superintelligence-Dangers-Strategies-Nick-Bostrom/dp/1501227742Amazon bulk powdered cheese: https://www.amazon.com/s?k=powdered+cheese&ref=nb_sb_noss

Cast:Joel TopfJennie LinSwapnil HiremathMatt SparksShow Notes:NephJC Coverage of MENTOR: http://www.nephjc.com/news/mentorMENTOR: https://www.nejm.org/doi/full/10.1056/NEJMoa1814427KDIGO Membranous recommendations: https://kdigo.org/wp-content/uploads/2017/02/KDIGO-2012-GN-Guideline-English.pdf2017 Kidney Week Abstract: https://www.asn-online.org/education/kidneyweek/2017/program-abstract.aspx?controlId=2831149PEXIVAS: http://www.nephjc.com/news/pexivasearlyHeymann Nephritis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3042693/Susan Quaggin: https://www.feinberg.northwestern.edu/faculty-profiles/az/profile.html?xid=26269Manasi Bapat on non-inferiority trials: http://www.nephjc.com/news/2019/7/8/understanding-the-vortex-of-non-inferiority-trialsPrognosis and risk factors for idiopathic membranous nephropathy with nephrotic syndrome in Japan: https://www.sciencedirect.com/science/article/pii/S0085253815498503Nice review of Membranous by Alfaadhel and Cattrran that purports to say than CNI are the standard therapy for idiopathic membranous. (It doesn’t) https://www.ncbi.nlm.nih.gov/pubmed/27536673?dopt=AbstractPablo Garcia saves the day: https://twitter.com/PabloGarciaMD/status/1148767319323099136?s=20Larry beck’s land mark study demonstrating antiPLA2r as the antigen in idiopathic membranous. https://www.nejm.org/doi/full/10.1056/NEJMoa0810457GEMRITUX Study: https://www.ncbi.nlm.nih.gov/pubmed/27352623Jennie Lin’s How to Be a Nephrology Fellow, Choose Your Own Adventure: https://twitter.com/jenniejlin/status/1156329711057981442?s=20CJASN How to Review a Paper Podcast: https://www.asn-online.org/media/podcast/CJASN/2019_07_23_How_to_Write_a_Cons.mp3

Cast:Joel TopfJennie LinSamira FaroukSwapnil HiremathShow Notes:NephJC coverage of SONAR: http://www.nephjc.com/news/sonarSONAR in PubMed: https://www.ncbi.nlm.nih.gov/pubmed/30995972Avosentan for overt diabetic nephropathy, the ASCEND trial: https://www.ncbi.nlm.nih.gov/pubmed/20167702RADAR coverage at NephJC, May 2014: http://www.nephjc.com/atrasentanRADAR in PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24722445/Google Hangout on RADAR: https://www.youtube.com/watch?v=pkkQbb-isog&feature=youtu.beVlado Perkovic: https://twitter.com/VladoPerkovicSONAR: https://en.wikipedia.org/wiki/SonarNephmadness adaptive trial: https://ajkdblog.org/2016/03/10/nephmadness-2016-statistics-in-nephrology-region/#adaptiveKIDNEYcon adaptive trial tweet thread: https://twitter.com/hswapnil/status/1117194018331471873?s=21Excellent NEJM review on adaptive trials: https://www.nejm.org/doi/10.1056/NEJMra1510061Potential role of Adaptive trials in AKI: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4869991/BNP levels in CKD: https://cjasn.asnjournals.org/content/3/6/1644Generalizability from Wikipedia: https://en.wikipedia.org/wiki/Generalizability_theoryAnemia (and other adverse effects) of Endothelin antagonists: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5210319/Data safety monitoring boards: https://www.nidcr.nih.gov/research/human-subjects-research/interventional-studies/data-and-safety-monitoring-board-guidelinesAbbVie Allergen Merger: https://www.barrons.com/articles/abbvie-allergan-merger-pharma-deals-takeda-celgene-bristol-myers-squibb-51563890831Tangri Kidney Failure Risk Equation: https://qxmd.com/calculate/calculator_308/kidney-failure-risk-equation-4-variableFragility index paper: https://www.ncbi.nlm.nih.gov/m/pubmed/24508144/LITFL write up: https://litfl.com/fragility-index/Calculator: https://clincalc.com/Stats/FragilityIndex.aspxCANVAS Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1811744Rates of Hyperkalemia after Publication of the Randomized Aldactone Evaluation Study by David Juurlink et al.: https://www.nejm.org/doi/full/10.1056/NEJMoa040135Vinay Prasad: https://en.wikipedia.org/wiki/Vinay_PrasadClassic mouse studies looking at endothelin: https://www.jci.org/articles/view/119297/pdfhttps://www.ncbi.nlm.nih.gov/pubmed/8377387/https://diabetes.diabetesjournals.org/content/65/8/2429Nice reviews:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4698004/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4216619/Review of vascular effects:https://www.ncbi.nlm.nih.gov/pubmed/28223322

Joel TopfJennie LinMatt SparksSwapnil HiremathShow Notes: IgA Nephropathy ScoreLevi Strauss: https://www.biography.com/fashion-designer/levi-straussLevey MDRD study: https://www.ncbi.nlm.nih.gov/pubmed/10075613ADPKD Total Kidney Volume: https://www.nejm.org/doi/10.1056/NEJMoa054341Halt PKD: https://www.nejm.org/doi/full/10.1056/nejmoa1402685Tempo 3:4 Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1205511Description description of IgA nephropathy by Berger and Hiunglais: https://www.ncbi.nlm.nih.gov/pubmed/4180586The reprint in JASN in 2000 with commentary as part of the Milestones in Nephrology series: https://jasn.asnjournals.org/content/jnephrol/11/10/1957.full.pdf JASN supplies an English translation from the original French.Nice reference from JASN backing up Matt’s assertion that preeclampsia and not IgA nephropathy is the most common glomerular disease in the world: https://jasn.asnjournals.org/content/18/8/2281Description of the Singapore Army screening recruits from the Oxford Textbook of Clinical Nephrology: https://books.google.com/books?id=fVItBQAAQBAJ&lpg=PA485&ots=JRoOnUnleT&dq=singapore%20kidney%20biopsy%20army&pg=PA485#v=onepage&q&f=falseDescription of the Japanese glomerulonephritis screening program: https://cjasn.asnjournals.org/content/2/6/1360Swapnil’s studies on autopsy studies:Finland: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC501386/Japan: https://www.ncbi.nlm.nih.gov/pubmed/12753320/Nephrology Secrets, either one of the best or the best nephrology textbooks ever: https://www.amazon.com/Nephrology-Secrets-Book-Edgar-Lerma-ebook/dp/B079TSYNQW/ref=sr_1_1TESTING Trial on NephJC: http://www.nephjc.com/news/2017/8/28/testingStop-Iga Trial on NephJC: http://www.nephjc.com/iga-nephropathyTesting Trial two: Therapeutic Evaluation of Steroids in IgA Nephropathy Global Study Low Dose Study: https://clinicaltrials.gov/ct2/show/NCT01560052MEST Score versus MEST-C in NephJC: http://www.nephjc.com/news/2016/10/16/do-crescents-matter-for-iga-nephropathyNice discussion of the statistical tests during the Tweet Chat by people who know their stats (I.e. not Joel): https://twitter.com/NephJC/status/1133546750814367746Tweet-length description of IDI: https://twitter.com/kiwiskiNZ/status/1133595698929098752Assessing the performance of prediction models: a framework for traditional and novel measures. https://www.ncbi.nlm.nih.gov/pubmed/20010215/Net Reclassification Indices for Evaluating Risk-Prediction Instruments: A Critical Review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3918180/Predicting Progression in CKD: Perspectives and Precautions https://www.ajkd.org/article/S0272-6386(15)01413-4/abstractThe Article by Nancy Cook in Circulation that Jennie was talking about: Use and misuse of the receiver operating characteristic curve in risk prediction. https://www.ncbi.nlm.nih.gov/pubmed/17309939Discovery of new risk loci for IgA nephropathy implicates genes involved in immunity against intestinal pathogens https://www.nature.com/articles/ng.3118Genome-wide polygenic risk predictors for kidney disease https://www.nature.com/articles/s41581-018-0067-6Where does Matt find minutia like the grams of IgA produced a day? Here: https://www.annualreviews.org/doi/abs/10.1146/annurev-pathol-011110-130216Animal models of IgA nephropathy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4337240/Matt’s Book Originals: https://www.amazon.com/gp/product/014312885X/ref=dbs_a_def_rwt_bibl_vppi_i1Eric Neilson, Dean of Northwestern University https://www.feinberg.northwestern.edu/faculty-profiles/az/profile.html?xid=23239Brussels sprout Insta-famous dog and future dean of the medical school: https://www.instagram.com/brussels.sprout/?hl=enJosh Farkas Rantorial about Contrast Nephropathy: https://twitter.com/PulmCrit/status/1134922050794139648Swapnil’s Tweetorial about Contrast Nephropathy: https://twitter.com/hswapnil/status/1133906398096609280Tukaram’s pic of NEJM’s progression from Contrast Induced Nephropathy to Contrast Associated Nephropathy: https://twitter.com/tukaramj/status/1135214980985266178Zero sodium dialysate for heart failure? https://twitter.com/i/moments/1134811009217155072

Joel TopfJennie LinMatt SparksSamira FaroukThe strange story of Jennifer Strange.https://insiderexclusive.com/radios-deadly-stunts-the-jennifer-strange-story/Water Pokerhttps://www.thelocal.se/20120706/41878Nintendo Game Consoleshttps://en.wikipedia.org/wiki/Nintendo_video_game_consoles2019 Narins winner, Mitchel Rosner on MDMA induced hyponatremiahttps://www.ncbi.nlm.nih.gov/pubmed/18684895And Rosner again on exercise induced hyponatremia.https://cjasn.asnjournals.org/content/2/1/151The Arieff article on the dangers of severe hyponatremia: Hyponatremia, Convulsions, Respiratory Arrest, and Permanent Brain Damage after Elective Surgery in Healthy Womenhttps://www.nejm.org/doi/full/10.1056/NEJM198606123142401The Richard Sterns article on the dangers of rapid correction of hyponatremia: Osmotic Demyelination Syndrome Following Correction of Hyponatremiahttps://www.nejm.org/doi/10.1056/NEJM198606123142402The editorial by the man himself, Robert Narins: Therapy of Hyponatremiahttps://www.nejm.org/doi/full/10.1056/NEJM198606123142409The infant study showing seizures associated with rapid correction of hypernatremia.https://www.ncbi.nlm.nih.gov/pubmed/35558?dopt=AbstractFollow up study with oral rehydration.https://www.ncbi.nlm.nih.gov/pubmed/3958850?dopt=AbstractThe Linder study of adults admitted to the ICUhttps://www.ncbi.nlm.nih.gov/pubmed/18037096French study on patients presenting to the ER with hypernatremia.https://bmcnephrol.biomedcentral.com/articles/10.1186/1471-2369-15-37Study on US veterans showing poorer outcomes with slow correction of hypernatremia.https://www.ncbi.nlm.nih.gov/pubmed/21358313Cerebral edema during the treatment of DKA.https://emj.bmj.com/content/21/2/141The MIMIC 3 Database. MIMIC is an openly available dataset developed by the MIT Lab for Computational Physiology, comprising deidentified health data associated with ~40,000 critical care patients. It includes demographics, vital signs, laboratory tests, medications, and more.https://mimic.physionet.orgChalrson Comorbidity Indexhttps://www.mdcalc.com/charlson-comorbidity-index-cci#creator-insightsThe paper: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.https://www.ncbi.nlm.nih.gov/pubmed/3558716JCI article on organic brain osmnoles in response to hypernatremiahttps://www.ncbi.nlm.nih.gov/pubmed/2332498?dopt=AbstractJohn Booth on the value of MIMIC 3https://twitter.com/ThePeanutKidney/status/1128742219471642624Sri Lekha on checking labs in hypernatremiahttps://twitter.com/LTummalapalli/status/1128479041634226176Steve Coca on chunky water administrationhttps://twitter.com/scoca1/status/1128744643422769152Steve Coca musing the Cersei’s sodium levelhttps://twitter.com/scoca1/status/1128698514026975232Steve Coca swearing in High Valarlian:https://twitter.com/scoca1/status/1128629713826721792Steve Coca proving the non-existence of hypernatremia therapy being associated with brain damage through the inability of trial lawyers to find and sue doctors for this issue:https://twitter.com/scoca1/status/1128652586612080642The original paper on the Kardashian Indexhttps://genomebiology.biomedcentral.com/articles/10.1186/s13059-014-0424-0Kardashian Index Calculatorhttp://theinformationalturn.net/kardashian-index/Facebook CEO Mark Zuckerberg says the ‘future is private’https://www.theverge.com/2019/4/30/18524188/facebook-f8-keynote-mark-zuckerberg-privacy-future-2019Khenar Jhaveri et al on ‘WhatsApp’ening in nephrology traininghttps://academic.oup.com/ckj/advance-article/doi/10.1093/ckj/sfz045/5482109Mike Morrison’s video on how to rebuild the scientific posterhttps://www.youtube.com/watch?v=1RwJbhkCA58Mike’s Twitter: https://twitter.com/mikemorrison?lang=en with lot’s of examples of his design in the wild.Make your own QR code: https://www.qr-code-generator.comGoodRx: https://www.goodrx.comTen Worst Drugs for your Kidney: https://www.goodrx.com/blog/10-worst-medications-for-your-kidneys/Drugs that can falsely elevate your creatinine levels: https://www.goodrx.com/blog/drugs-cause-false-high-creatinine-levels-blood-test/Dr Orrange, not wishing to engage on Twitter in a meaningful way: https://twitter.com/Orrangemd/status/1129165083194511361

This week we discussed the CREDENCE trial published in the NEJM, on the effect of Canaglifozin on diabetic nephropathy. There was lots to discuss so it may be a long podcast.The article is available here.The NephJC summary can be read here, with links to the visual abstract, and the wrapup.Links from the show:Swapnil’s first post at AJKDblog on SGLT2i in 2014! SGLT-2 Inhibitors: Can They Prevent Diabetic Nephropathy?Lonnie Pyne’s brilliant tweetorial on proteinuria as a proposed end-point in CKD trials.Combined RAAS blockade (don’t do it)Combining ACEI and direct renin inhibitorsCombining ACEi and ARBWe repeatedly compare CREDENCE to IDNT by Ed Lewis and RENAAL by Barry BrennerYou will need to be familiar with EMPA-REG and CANVAS (links to summaries on NephJC)Why run-in periods are bad for clinical trials: Run-in Periods in Randomized TrialsImplications for the Application of Results in Clinical PracticeHispanics in the study: https://twitter.com/VladoPerkovic/status/1121078118029103105Lot of discussion on mechanisms: • The original description of phlorizin by Josef von Mering in 1800• Podocyte effects in JCI• Effect on Hyperfiltration by SGlT2i in humans• Emerging role of proximal tubule in CKD via GWAS studies• SGLT2i effect on Na/H exchangers in heart and kidney• SGLT2i interact with heart NHE1 (mouse model)• SGLT2i as the ‘betablockers’ of the kidney?Jordan Weinstein on the clinical scientists’ mechanism of SHGLT2i:https://twitter.com/drjjw/status/1121577808164159491Why subgroups should be interpreted very carefullyHost: Joel TopfDiscussants: Samira Farouk, Swapnil Hiremath, Jennie Lin and Matt Sparks.