Freely Filtered, a NephJC Podcast

The Filtrate: Joel Topf Swapnil Hiremath With Special Guest: Michelle Hladunewich, Nephrologist at the University of Toronto Mir Melamed, Maternal-Fetal Medicine at the University of Toronto Editor Simon Topf Show Notes Priscilla Smith’s letter: Dear Joel and the Freely Filtered team, I am a long-time fan of your podcast and was looking forward to hearing your recently aired discussion of the Praecis study of sflt1:PlGF use in preeclampsia. Preeclampsia and renal disease in pregnancy are areas that many nephrologists report a lack of knowledge or confidence in discussing and managing. I am a nephrologist who has been co-leading a renal pregnancy clinic in London while writing a PhD on progression of renal disease in pregnancy. I have had the immense privilege of working with experts and key opinion leaders in preeclampsia research both in the UK and internationally. As you know, preeclampsia is a serious and significant condition contributing to global maternal mortality and is also associated with future CKD and CVD risk so is both relevant and important within our professional group. Sadly, I found myself disappointed by the episode and felt it was a missed opportunity. I appreciate that you had difficulties obtaining appropriate experts to join the discussion, but perhaps it would have been better to delay production. While you all valiantly proceeded to discuss this important study, the topic is complex and there appeared to be a lack of understanding of the surrounding literature and pathogenesis of preeclampsia. Sadly, the maternal medicine expert’s comments at the end of the podcast added little as she seemed determine to negate any benefit from the results despite declaring she had no experience or expertise in the use of these biomarkers. There are many people who understand the clinical aspects of preeclampsia as well as having direct experience of the use and utility of these biomarkers who would have been able to contribute much to your conversation. I look forward to future discussions of renal disease in pregnancy on your podcast and would be happy to suggest some expert panellists if you ever find yourself stuck. Kind regards, Priscilla Excess placental soluble fms-like tyrosine kinase 1 (sFlt1) may contribute to endothelial dysfunction, hypertension, and proteinuria in preeclampsia (JCI 2003) sFlt background: Pathogenesis of Preeclampsia and Therapeutic Approaches Targeting the Placenta (PubMed) PlGF background: Perspectives on the Use of Placental Growth Factor (PlGF) in the Prediction and Diagnosis of Pre-Eclampsia: Recent Insights and Future Steps (PubMed) The PRAECIS trial (NephJC | NEJM Evidence)

We had a great NephJC get together. We recorded the whole event and packaged it into a podcast. Musical entertainment Tim Yau (@Maximal_Change) Too Sweet by Hozier Fairy Tale of New York by written Jem Finer and Shane MacGowan. Hear it performed by the Pogues. Interview of Tom Mueller Tom Mueller author of How to Make a Killing Jade Teakall@jmteakell Graham Abra@GrahamAbra Interview of Tom Mueller Tom Mueller author of How to Make a Killing Jade Teakall @jmteakell Graham Abra @GrahamAbra NephMadness logo reveal NephJC Kidneys NephJC blog post NephJC Manuscript of the Year: Flow accepted by Meg Jardine Manjula Kurella Tamura, winner of the 2015 NephMadness, oh and author of NEJM manuscripts and subject of a NYT article. NephJC Visual Abstract of the Year: Corina Teodusiu, creator of the Flozinator logo NephJC Social Justice Award: ISN petition to the WHO on Kidney Health Most Engaged Scientist Award: Michelle Rheault Rookie of the Year: Milagros Flores MVP: Christina Popa NephJC Founders Award: Joshua Waitzman Nathan Hellman Social Media Project of the Year: Edgar Lerma and the ASN Visual Abstract Team More Music with Tim Saginaw, Michigan as performed by Johny Cash Betty, written by Taylor Swift The Kidney Connection Freely Filtered Kidney Week Draft Previous drafts 2021 ASN Kidney Week Draft 2022 ASN Kidney Week Draft 2023 ASN Kidney Week Draft List of all the simultaneous publications from Kidney Week 2024 Sophia: SMART Trial (Link goes to the new KidneyCompass podcast that interview lead author Hiddo Heerspink Jordy’s editorial in the European Heart Journal. Link Josh: APPLAUSE Alternative Complement Pathway Inhibition with Iptacopan in IgA Nephropathy in the NEJM APPLAUSE results announcement at The World Congress of Neophrology in Buenos Aries Iptapocan is a factor B inhibition Jordy: POISE-3 with simultaneous publication in KI Mentions she wanted to pick KAT-AKI because she worked with Perry Wilson. Per Nayan, Amit Garg is the Beyonce of Nephrology Accord Trial (NEJM) Joel: HSK21541 for Pruritus Correction link to source (graph) Nayan: FINEARTS-HF with simultaneous publication in JACC BARACH-D: Low-dose spironolactone and cardiovascular outcomes in moderate stage chronic kidney disease: a randomized controlled trial (Nature Medicine) Swapnil comes out as a SpiroStan TOPCAT funny business PATHWAY-2 Trial (NephJC coverage) Swap: K Bath and cardiac arrhythmia with simultaneous publication in Kidney International CAST: A study that rocked the cardiology world and became the poster child for evidence-based medicine (Link) Tubular Secretions Swap: Late breaking and high impact sessions Nayan: Intro to… Joel: Student poster on blood pressure technique Jordy: The Penguin. A couple of mentee posters Sophie: Tracks her sessions on paper. Josh: Quiz and Questionaire session with JC Velez, Bea Concepcione, Anna Burgner, Roger Rodby.

The Filtrate: Jennie Lin Joel Topf Josh Waitzman Swapnil Hiremath With Special Guests Pedro Teixeira Jay Koyner Editor Sophia Ambruso Show Notes The article: A Randomized Trial of Intravenous Amino Acids for Kidney Protection NephJC Summary KDIGO Clinical Practice Guideline for Acute Kidney Injury (PDF) Steve Coca study Evaluation of Short-Term Changes in Serum Creatinine Level as a Meaningful End Point in Randomized Clinical Trials (PubMed) Using Nephrocheck to prevent AKI: Prevention of cardiac surgery-associated AKI by implementing the KDIGO guidelines in high risk patients identified by biomarkers: the PrevAKI randomized controlled trial (PubMed) Brenner’s Review of protein intake and renal hemodynamics: Dietary Protein Intake and the Progressive Nature of Kidney Disease: — The Role of Hemodynamically Mediated Glomerular Injury in the Pathogenesis of Progressive Glomerular Sclerosis in Aging, Renal Ablation, and Intrinsic Renal Disease (NEJM) Husain-Syed a look at preoperative renal functional reserve and risk of AKI: Preoperative Renal Functional Reserve Predicts Risk of Acute Kidney Injury After Cardiac Operation (PubMed) Dana Fuhrman review of renal functional reserve: The Role of Renal Functional Reserve in Predicting Acute Kidney Injury (PubMed) Use of SGLT2i prevented AKI in the placebo controlled trials. Clinical Adverse Events Associated with Sodium-Glucose Cotransporter 2 Inhibitors: A Meta-Analysis Involving 10 Randomized Clinical Trials and 71 553 Individuals (PubMed) Assessment of P values for demographic data in randomized controlled trials (PubMed) Tubular Secretions Swapnil The Lord of the Rings: Rings of Power Season 2 on Amazon Prime (Wikipedia) Josh Fortnite (Website) Pedro CRRT Academy at University of Alabama Birmingham (Website) Jay Koyner Slow Horses on AppleTV (Wikipedia) Jennie Linn #KidneyWk Run Club Friday 10/25 at 6:15 am PST Meet in front of Sally’s Fish House ~2 miles. Easy pace (10-12 min/mile) (Strava) Joel Topf Your Honor on Netflix (Wikipedia)

The Filtrate: Joel Topf Swapnil Hiremath Sophia Ambruso AC Gomez With 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 Topf Show Notes: Late Braking and High Impact Clinical Trial press release JAMA Internal Medicine MyTEMP 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, PhD Transplant Ambassador Program Kidney 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 Secretions Swapnil 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 Topf Jennie Lin Josh Waitzman With Special Guest: AC Gomez MedPeds nephrology fellow at Mass General/Brigham and Boston Children’s | Twitter Gentian Hall Assistant Professor of Medicine Duke Department of Medicine Editor: Sophia Ambruso Show Notes: APOL1 review by the OG Scientists APOL1 Nephropathy: From Genetics to Clinical Applications MYH9 and APOL1 connection: The population genetics of chronic kidney disease: insights from the MYH9–APOL1 locus Martin Pollack Lab Vertex Lab Worldwide Frequencies of APOL1 Renal Risk Variants (NEJM) Kidney Disease-Associated APOL1 Variants Have Dose-Dependent, Dominant Toxic Gain-of-Function End-Stage Renal Disease in African Americans With Lupus Nephritis Is Associated With APOL1 Apolipoprotein L1 Risk Variants Associate with Systemic Lupus Erythematosus-Associated Collapsing Glomerulopathy HEK293 Cells Wikipedia Tubular Secretions Josh: From Serial and the New York Times: The Retrievals Jennie: 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 ruin Gentian: Vivien Thomas wikipedia. HBO Movie: Something the Lord Made AC: Talking to the FDA about SGLT2i Tweet Joel: 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 Topf Nayan Arora Swapnil Hiremath Pirya Yenebere With Special Guest: Nav Tangri nephrologist and epidemiology at the University of Manitoba Editor: Nayan Arora Show Notes: Arsenal FC The 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 negative BiCARB 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 Study Wesson, 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)31388-1 The Valor CKD trial is still unpublished. But here is the press release. VALOR-CKD design manuscript The study of the night: Sodium bicarbonate for kidney transplant recipients with metabolic acidosis in Switzerland: a multicentre, randomized, single-blind, placebo-controlled, phase 3 trial NephJC | PubMed | Lancet Alkali 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 Secretions Swap The Three-Body Problem (novel) | Netflix Nayan Women’s World Cup Tangri English Premier Soccer and Inflation Priya Silo on Apple TV Joel Live Podcast recording at ASN Kidney

The Filtrate: Joel Topf Nayan Arora Sophia Ambruso With 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. Link Editor: Priya Yenebere Show Notes: Diuretic Therapy review by. Craig Brater NEJM The manuscript in JAMA | NephJC Metoprolol 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 Trial Effects of Oral Tolvaptan in Patients Hospitalized for Worsening Heart Failure The EVEREST Outcome Trial Sophia ended up placing fifth in NephMadness 2023. (Link) Joel finished 697th After 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 Secretions Nayan: Louise Penny A World of Curiosities: A Novel (Amazon) Sadiya: Ted Lasso season three Sophia:The Last of Us on HBO and SNL skit Mario Cart as Prestige Drama Boback: Duolingo for Japanese

The Filtrate: Joel Topf Swapnil Hiremath Josh Waitzman Nayan Arora Sophia Ambruso With Special Guest: Megan Prochaska Assistant professor of medicine at University of Chicago John Asplin Medical Director Consultant LithoLink (Twitter) Editor: Joel Topf Show Notes: The LithoLink website Stone Camp tweet Prevention of Repeated Episodes of Kidney Stones in Adults: A Clinical Practice Guideline From the American College of Physicians (link) NOSTONE in the NEJM and NephJC Fred Coe Google Scholar | YouTube | Blog Hypercalcuria. Curhan et al. 24-h uric acid excretion and the risk of kidney stones PubMed EQUIL2 software to evaluate urinary super saturation Anna Zisman Racial Differences in Risk Factors for Kidney Stone Formation (CJASN) Potassium Citrate on GoodRx Moonstone Nutrition Potassium 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 Secretions Swap: Star Wars: Thrawn Series by Timothy Zahn (Penguin Random House) Josh: Little League Megan: Renal related podcasts Sophia Renal Stone Camp and ABCKidney.com Nayan: Ted Lasso Robert Galbraithand The Comoran Strike Novels (home page) John: Fred Coe’s Blog Joel: Spiderman across the Spider-Verse (Wikipedia)

The Filtrate: Joel Topf Swapnil Hiremath Josh Waitzman Jordy Cohen With Special Guest: Areef ishani lead author and Chief of Medicine VA Minneapolis Editor: Nayan Arora Show Notes: MRFIT switches diuretics and finds better outcomes. Swapnil shows how many studies he is familiar with by spewing out a string of them. Chlorthalidone wins: ALLHAT, MRFIT, SPRINT, HYVET, CLICK (not mentioned by Swap but by Jordy later) HCTZ loses: HOPE3, ACCOMPLISH Diuretic half-lifes NEJM review Edarbyclor: Azilsartan and Chlorthalidone $240/month as per GoodRx Nice mention of late study originator Frank Lederle. Please see his article in Annals about his diagnosis of pancreatic cancer. Moving. Network analysis of HCTZ vs chlorthalidone Antihypertensive efficacy of hydrochlorothiazide vs chlorthalidone combined with azilsartan medoxomil by George Bakris Synopsis of the 2020 U.S. Department of Veterans Affairs/U.S. Department of Defense Clinical Practice Guideline: The Diagnosis and Management of Hypertension in the Primary Care Setting (Annals of Internal Medicine) Testing for Primary Aldosteronism and Mineralocorticoid Receptor Antagonist Use Among U.S. Veterans: A Retrospective Cohort Study by Jordy Cohen Study showing better risk reward ratio of low dose than high dose thiazide diuretics. Treatment of hypertension in the elderly: I. Blood pressure and clinical changes. Results of a Department of Veterans Affairs Cooperative Study. Tubular Secretions Swapnil Louise Penny author of book upon which the Amazon Prime series, Three Pines is based on. Jordy Last of Us series on HBO Josh Channel Your Enthusiasm A Very Special Episode: Meet the Glaucomfleckens Areef The Body: A Guide for Occupants Joel NephMadness (this did not age well)

The Filtrate: Joel Topf Swapnil Hiremath Josh Waitzman Sophia Ambruso With 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 Ambruso Show Notes: #NephMadness 2023: Thrombotic Microangiopathy Region TMA Review article in the NEJM from 2014: Syndromes of Thrombotic Microangiopathy Dr. Anuja Java Co-chairs Working Group in an International Committee for Revising aHUS Nomenclature Nephrology Secrets 4th Edition at Amazon University of Iowa Genetic testing for aHUS Early 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 Discovery NephMadness Podcrawl Tubular Secretions Swap: Neuromancer and the works of William Gibson (@GreatDismal) Sophia: The Magicians on Netflix Anna: Recommends nephrology. Says it is awesome. Anuja: Dope Sick on Hulu and Women in Nephrology mentor program Josh: Mobituaries with Mo Rocca. Specifically “Death of a Banana” Joel: Ivory by TapBot

Welcome to the NephMadness PodCrawl The idea behind a podcrawl is for a variety of podcasts to coordinate on timing and topic to push a theme and get each other’s listeners to explore all of the podcasts. One of the first goals behind NephMadness was to build a community and in the early years of Twitter, NephMadness was central to the formation of #NephTwitter and defining the ethos that makes our online community kind, intelligent, vibrant, and interesting. The NephMadness Podcrawl hopes to inspire and grow the nephrology podcast community in the same way. For 2023, our second year, the PodCrawl has assembled the Avengers of Medical Pods! Go to NephMadness.com/podcrawl for more information and links to all of the podcasts! The Curbsiders gets the skinny on mineralcorticoid receptor antagonists Core IM will be covering Kidney Transplant in their classic Five Pearl format The CardioNerds will be covering the effect of Heart Failure Devices on Kidney Health Freely Filtered will try to understand thrombotic microangiopathy ISN Global Kidney Care goes deep on IgA nephropathy The Cribsiders look at transitions, first the Peditrics to Adult nephrology transition and then from living to death with palliative nephrology Fellow on Call will be covering Onconephrology And finally, The Nephron Segment looks at Transgender Health and CKD

The Filtrate: Joel Topf Swapnil Hiremath Nayan Arora Sophia Ambruso With Special Guest: Amit Garg @AmitXGarg, Nephrologist at Western University, London, and lead PI of the MYTEMP trial. Editor: Joel Topf Show Notes: MyTEMP in pubmed: Personalised cooler dialysate for patients receiving maintenance haemodialysis (MyTEMP): a pragmatic, cluster-randomised trial MyTEMP Summary on NephJC It’s really cold in Ontario The NephTrials blog summary on Pragmatic Trials The pragmatic TiME trial on longer time on dialysis (ahem, sabotaged by site investigators like Joel who cut dialysate time) Dember et al in JASN Poor 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 NDT 47% of centres from a DOPPS study of 273 centers routinely use of lower dialysate temperature, Dasgupta et al in JASN How 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 CJKHD How 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 Med Peritoneal dialysis numbers in Ontario are high, Blake et al in PDI, though with ~ 60% CVC rates, Blake et al in Kidney360 Dialysate Magnesium #DreamRCT from Swap, NephTrials discussion of DialMag Statistical analysis plan of MyTEMP, Dixon et al in CJKHD Tubular Secretions Swap: Watch Everything, Everywhere All At Once on Prime Nayan: 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 Denver Amit: The wrestling team at Western U from 1990-91 Joel: House of the Dragon on HBO Max

The Filtrate: Joel Topf Swapnil Hiremath Jordy 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 Disease STOP-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 disease Efficacy and Safety of Benazepril for Advanced Chronic Renal Insufficiency: NEJM Dr. 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 rate Strong opinions, loosely held. “Permissive AKI” with treatment of heart failure. Editorial by Chirag Parish and Steven Coca The rational for NICE avoiding RASi in black patients: Hypertension and ethnic group AASK trial showing superiority of RASi in African Americans. JAMA ALLHAT post-hoc analysis of outcomes by self-reported race. JAMA | PubMed Sophisticated Swedish observational study that Swap loved. Stopping Renin-Angiotensin System Inhibitors in Patients with Advanced CKD and Risk of Adverse Outcomes: A Nationwide Study Target Trials in Nephrology Dr Edouard Fu grand rounds at Ottawa Nephrology, YouTube Target Trial EmulationA Framework for Causal Inference From Observational Data by Miguel Hernán in JAMA Tubular Secretions Jordy: Third season of His Dark Materials on HBO Swap: Movies by Wes Anderson on Disney Plus Laurie: 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 | Amazon Joel EO | NYT Review

The Filtrate: Joel Topf Swapnil Hiremath Josh Waitzman Sophia Ambruso Priya Yenebere With Special Guest: Brendon Neuen, Secretariat of the SGLT2 Trialists Consortium and cool guy on Twitter. Editor: Sophia Ambruso Show 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 SGLT2i EMPA-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 Caution Click 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 Cr Usability 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 Agency The Peripheral on Amazon Prime Unsealed the Tylenol Murders Podcast Project Hail Mary by Andrew Weir Lizzy McAlpine Singer Song Writer Rachel Maddow Presents: Ultra Twitter chaos continues. Get your Med-Mastodon handle

The Filtrate: Joel Topf Swapnil Hiremath Nayan Arora Sophia Ambruso Editor: Nayan Arora Show Notes: Joel’s Conflict of Interest Statement The 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 Pharmaceuticals The CONFIRM Trial Terlipressin plus Albumin for the Treatment of Type 1 Hepatorenal Syndrome in NephJC Clinical Practice Session Leveraging Social Media to Create, Learn, Teach, Advocate, and Dispel Misinformation The 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 up Stop ACEi CLARITY Angiotensin receptor blockers for the treatment of covid-19: pragmatic, adaptive, multicentre, phase 3, randomised controlled trial Effects of Pantoprazole on Kidney Outcomes: Post Hoc Analyses From the COMPASS Randomized Controlled Trial by Lonnie Pyne, et al No Stone: Hydrochlorothiazide for the Prevention of Kidney Stone Recurrence by Daniel Foster, et al MyTEMP: Personalised cooler dialysate for patients receiving maintenance haemodialysis (MyTEMP): a pragmatic, cluster-randomised trial Clinical 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 Nephrology Attracting Osteopathic Medical Students Into Nephrology Hasan Minhaj’s joke at the expense of DOs TRANSFORM-HF: Torsemide vs. Furosemide in Treating Patients With HF Point-of-Care Ultrasound in Nephrology specifically VExUS

The Filtrate: Joel Topf Jordy Cohen Nayan Arora Sophia Ambruso Special 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 Review Cardiologist Sues Epic Over Copyright Infringement Outcomes 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 Topf Swapnil Hiremath Nayan Arora Priya Yenebere Special 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 NephJC Linazolid 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 Creatinine Vancomycin-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 Sepsis Proposed 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 Open Applications 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 study Protective effect of piperacillin against nephrotoxicity of cephaloridine and gentamicin in animals PulmCrit – Myth-busting the conditional nephrotoxicity of piperacillin-tazobactam by Josh Farkas Sharp Objects on Good Reads Bandon Dunes The Ocean Course at Kiawah Island Golf Resort Be Real follow me: BeRe.al/kidney_boy SNL spoof of BeReal

The Filtrate: Joel Topf Swapnil Hiremath Jennie Lin Special Guests: Priya Yenebere @PriRenalAKI Transplant nephrologist at Indiana University School of Medicine. She is a current NSMC Intern. J Pedro Teixeira @NephCrit_NM ICU Nephrologist at the University of New Mexico. Editor: Priya Yenebere Show Notes: Critical Care Nephrology Critical Care Nephrology: Core Curriculum 2020 by Benjamin R Griffin, Kathleen D Liu, and J Pedro Teixeira. Critical Care Rheumatology Dual-Trained Rheumatologists Take Multidisciplinary Approach to Their Patients Med-Peds to Nephrology Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock by Emanuel Rivers ProMISe: Trial of Early, Goal-Directed Resuscitation for Septic Shock ARISE: Goal-Directed Resuscitation for Patients with Early Septic Shock ProCESS: A Randomized Trial of Protocol-Based Care for Early Septic ShockThe Filtrate: Rinaldo Bellomo and micro circulatory disorders as cause of AKI in sepsis. Septic acute kidney injury: new concepts Comparison of Two Fluid-Management Strategies in Acute Lung Injury (FACTT) The negative trial we accept as a positive trial because of the secondary outcomes. The prime minister of Finland was caught on the dance floor. This is a bad thing? (NY Times) Deferred Consent: A New Approach for Resuscitation Research on Comatose Patients Lactate conversion MediCalc The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) Mottling score is a strong predictor of 14-day mortality in septic patients whatever vasopressor doses and other tissue perfusion parameters Critical Care Reviews Podcast: CLASSIC Trial Results Presentation What is the most George Constanza-esque reason you broke up with someone? (reddit) Bonferroni correction The Importance of Fluid Management in Acute Lung Injury Secondary to Septic Shock Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery in the NEJM. RELIEF, NephJC discussion Effect of an Early Resuscitation Protocol on In-hospital Mortality Among Adults With Sepsis and Hypotension: A Randomized Clinical Trial in JAMA FEAST Trial: Mortality after Fluid Bolus in African Children with Severe Infection Rings of Power on Amazon Prime Why the Hobbit trilogy sucked Industry on HBO Sandman 2022 on Netflix Where did Liverpool FC go wrong with the 2021/2022 Premier League? (Quora) CRRT Academy at University of Alabama with 2020 Robert G. Narins Award Recipient: Ashita Tolwani, MD, MS (YouTube) Life as a Nephrologist podcast on CritCare Nephrology Continuous KRT: A Contemporary Review by J. Pedro Teixeira, Javier A. Neyra and Ashita Tolwani University of New Mexico Nephrology Program. Apply to their fellowship. The Pledge Drive is over, but you can always support NephJC. NephJC is a 501(3)c registered non-profit and all donations are tax deductible in the US.

The Filtrate: Joel Topf Swapnil Hiremath Josh Waitzman Sophia Ambruso Special 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. Link Editor: Sophia Ambruso Donate to NephJC Get 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-fan If 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 mg Meta analysis of high versus low sodium diet pulled from Heart due to duplicated and missing data. Retraction Watch. 65 mmol of sodium is 1500 mg The 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 diuretics PREDIMED 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) Diet Medical Therapy for Heart Failure With Reduced Ejection Fraction: The CHAMP-HF Registry Interpreting 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 disease Cardiologist Sues Epic Over Copyright Infringement 6-minute walking test: a useful tool in the management of heart failure patients Frank Harrell on Statistical Errors in the Medical Literature ANCOVA...

The Filtrate: Joel Topf Swapnil Hiremath Josh Waitzman Jordy Cohen Special Guest: Sean Barbour. Clinical Associate Professor, Division of Nephrology, University of British Columbia Chair, BC Glomerulonephritis Committee and Network, BC Renal Editor: Joel Topf Show 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 JAMA STOP-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 Wikipedia Prior 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 nephropathy Another, earlier, Italian study: Corticosteroids in IgA nephropathy: a randomised controlled trial Chinese study: Combination therapy of prednisone and ACE inhibitor versus ACE-inhibitor therapy alone in patients with IgA nephropathy: a randomized controlled trial Original 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 5 A 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! Treif Geographic Differences in Genetic Susceptibility to IgA Nephropathy: GWAS Replication Study and Geospatial Risk Analysis The MEST score provides earlier risk prediction in lgA nephropathy DAPA-IgA: A pre-specified analysis of the DAPA-CKD trial demonstrates the effects of dapagliflozin on major adverse kidney events in patients with IgA nephropathy Swap and Josh fight about SGLT2i in IgA Nephropathy Significance 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 Swap Star Trek: Strange New Worlds Origins of Renal Physiology: Fellows 2022 Medical Students: Kidney TREKS Application of the International IgA Nephropathy Prediction Tool one or two years post-biopsy (Kidney International) The Triple Crown in Virginia