Welcome to #TenTweetNephJC
✳️10 tweets #NephJC catch-up ✳️

In the last NephJC, we discussed interim results📊from the PROTECT trial on efficacy & safety of Sparsentan in IgAN.

New light✨on the horizon for IgAN yet?

Check out this flying summary in case you've missed the chat! 2/10
What did I miss?

3 decades of fateful trials of ERAs in PAH, HTN, DKD, FSGS & IgAN (AFFINITY,ALIGN) set the stage for

🛡️PROTECT🛡️
Sparsentan🎲Irbesartan
thelancet.com/journals/lance…

✔️Phase3⃣RCT
✔️Active-controlled
✔️Double-blind🚫

✔️18 countries🗺️
✔️134 sites🏥

The cohort⬇️

Welcome to #TenTweetNephJC for a short recap! Nephrologists warned of renalism neglecting cardiac ischemia in kidney pts. ISCHEMIA-CKD dashed hopes. Waiting for a deceased donor kidney transplant in the US is a grueling journey for +100K pts with advanced chronic kidney disease 2/10
What did I miss?
🌤️Retrospective study: asymptomatic kidney transplant candidates tested for coronary heart disease (CHD) vs non-tested pubmed.ncbi.nlm.nih.gov/36595271/
Aim: to determine the effect of CHD testing on the risk of death or acute MI within 30 days after transplant

#1
A few hours to go for the #NephJC chat on the MYTEMP trial ⏳

❓Have you ever paused to wonder how we came up with the ‘standard’ dialysate temperature of 37°C (98.6°F)???🤔

❓How does core body temperature (CBT) differ in dialysis patients from the general population?🤔 #2
👉Historical reasons for std dialysate 🌡️seem unclear

👉37°C considered avg body 🌡️in adults ⏩ arbitrarily selected as ‘neutral’ dialysate 🌡️

👉Assumed to prevent body 🌡️ changes during HD

#NephJC

pubmed.ncbi.nlm.nih.gov/15211448/

Would a new drug option for resistant hypertension get you excited? How about a superior trial design?

Time to learn about PRECISION - our twitter journal club had 720 tweets, but you can catch the highlights quickly with the regular #TenTweetNephJC thread👇 2/10
What did I miss?

We know we miss targeting many pathways that contribute to resistant hypertension, a condition with high cardiovascular morbidity.

Enter aprocitentan, a dual endothelin receptor antagonist, for it’s crack at a Phase 3 trial.

pubmed.ncbi.nlm.nih.gov/36356632/

✳️ #TenTweetNephJC ✳️

👉 where we catch you up on the week's #NephJC chat in 10 tweets 

The topic at hand was Plasma Exchange and Vasculitis: the infamous debate of to PLEX or not to PLEX in AAV

Check out this thread to see if you change your mind on this comPLEX topic 👇 What did I miss?

PLEX, with its plausible biological rationale, has been in the center of debate for management of AAV since the 1980s, with several RCTs in favor of PLEX or against it

🔸️An updated meta-analysis which included the PEXIVAS results was discussed

✳️ Welcome to #TenTweetNephJC, where we catch you up on the week's #NephJC chat in 10 tweets ✳️

The topic at hand was diuretic resistance, specifically compensatory post-diuretic sodium reabsorption (CPDSR). Let’s walk you through how it all flowed 💧 What did I miss?

We teach medical students that diuretic resistance occurs in large part due to CPDSR. While this has been validated in healthy individuals, does this hold true in patients w/ acute decomp heart failure (ADHF)?
Enter the study in question
pubmed.ncbi.nlm.nih.gov/34529781/

This weeks #TenTweetNephJC makes us sad - does taking regular acetaminophen (paracetamol) cause hypertension?

Find out below in this rapid review of the Scottish trial, as we catch up on the #NephJC take on things 👇 What did I miss?

Observational trials suggest that acetaminophen increases BP, but (unlike NSAIDs) the widespread impression remains of a safe first-line therapy for chronic pain. The largest previous RCT had n=33.

Then PATH-BP dropped last month….

pubmed.ncbi.nlm.nih.gov/35130054/

✳️ #TenTweetNephJC ✳️

Did you see in the news that they’ve transplanted a pig kidney into a human and it (sort of) worked?

That was the #NephJC chat last week - for a rapid summary check out the thread👇 What did I miss?

We need more kidneys to transplant, hence the University of Alabama is running xenotransplant research.

Porcine kidney transplantation into humans has been tried before, but this is the first study to report no hyperacute rejection.

pubmed.ncbi.nlm.nih.gov/35049121/

Welcome to #TenTweetNephJC

✳️ 10 tweets to catch-up on the most recent #NephJC ✳️

This week - when is the ideal time to start dialysis in progressive chronic kidney disease?

Later starts lower the burden on patients & use of healthcare resources, but what’s the trade-off? What did I miss?

Previous observational studies analysing outcomes by eGFR at point of dialysis initiation suffered from immortal time bias, survivor bias, and lead time bias. This trial used clever new statistical methods to avoid these flaws!

bmj.com/content/375/bm…

Return of #TenTweetNephJC

✳️Rapid #NephJC catch-up✳️

Cochrane & KDIGO recommend children with steroid-sensitive nephrotic syndrome (SSNS) take low dose pred during upper resp tract infection (URTI) to ⬇️relapse risk, based on 4 small studies - does this hold up in a big RCT? What did I miss?

We actually covered two studies this week in collaboration with @ipnajc but we can’t do both in #TenTweetNephJC! We’ll focus on the PREDNOS-2 trial.

jamanetwork.com/journals/jamap…

as we come to the end of the year, let's do a quick recap of the year in review for #NephJC

We discussed 24 topics in 2021, including
14 RCTs
6 observational studies
3 guidelines
1 book club
nephjc.com/news/?category… New this year was the #NephTrials initiative with @ISNkidneycare with 3 chats on
- Cluster RCTs
- Pragmatic RCTs
- Run in periods
More to come in 2022
nephjc.com/news/tag/nepht…

Welcome to the @NSMCInternship #tweetorial for this week’s study on a new risk prediction tool for IgA nephropathy, appearing in @JAMAInternalMed. Check out these unhappy glomeruli with mesangial IgA deposits in green from pathologyoutlines.com (1/16) Recent unsuccessful #RCT: STOP-IgA (immunosuppression+supportive care isn’t superior to supportive care alone) & TESTING (corticosteroids reduce risk of #ESRD but cause serious infections) were covered by @NephJC: nephjc.com/iga-nephropath…
and nephjc.com/news/2017/8/28… … (2/16)

1/ #Tweetorial #NephJC #Hypernatremia Reviews and guidelines say to correct hypernatremia in adults by no more than 10 mmol/L per day. This is based on little hard data, has little support in literature and may be harmful nejm.org/doi/full/10.10… 2/ What rate do you target for the correction of chronic (>48 hours or present on admission) hypernatremia #NephJC