Discover and read the best of Twitter Threads about #NKFclinicals
Most recents (24)
Lab guy from Yale up next Joe El Khoury He is on YouTube. Episode 1 was on pseudohyponatemia
209 subscribers. Clinical Chemistry with Joe El-Khoury
209 subscribers. Clinical Chemistry with Joe El-Khoury
Despite calling it “laboratory error”, a lot of the problem happens long before the sample gets to the lab. #NKFClinicals
Sometimes Fist clenching
Sometimes Tourniquet
in the NEJM 1990
Sometimes Tourniquet
in the NEJM 1990
Seasonal temp effects on potassium #NKFClinicals
Starting with pseudohyponatremia
These are real cases
The osmolality was 294, so there is a huge gap. 44ish
Implies Artifactual decrease in sodium
Her triglycerides were >6000 #NKFClinicals
These are real cases
The osmolality was 294, so there is a huge gap. 44ish
Implies Artifactual decrease in sodium
Her triglycerides were >6000 #NKFClinicals
Note the different between HCO3 and tCO2 should be closer than 19 and 9. #NKFClinicals
His lecture begins, “Consider the patients’ lived experience” #NKFClinicals
Dr: “Labs look good”
Patient: “but doctor why do I feel like crap”
Dr: “Labs look good”
Patient: “but doctor why do I feel like crap”
Dialysis is a 4-6 hour time commitment. There is no other chronic condition that takes a greater commitment by patients.
One way to help patients is give them a choice of modality.
#NKFClinicals
One way to help patients is give them a choice of modality.
#NKFClinicals
I presented a poster at #NKFClinicals. This came from working with ViforCSL on the KALM-1 and KALM-2 meta-analysis of the pivotal trials of difelikefalin for CKD associated pruritus (CKDaP). About a year ago we brainstomed what other lessons could we could pull from the data.
A question we had was how quickly do people respond to the drug, or put more practically, if you start a patient on difelikefalin and a month later they are still having intense itch, how likely will it be that they still could respond?
Look at the only figure on the poster and focus on the bars, this gives the fraction of people who will ultimately respond to difelikefalin who have responded at 4 weeeks, 8 weeks and 12 weeks.
Tim @Maximal_Change Yau talking about Bridging the Generation Gap:Undertanding the Millennial and GenZ mind to optimize Med Ed. #NKFClinicals
Boomer 1946 to 1964. They have a landline. They read a newspaper. #NKFClinicals
Gen X 1965-1980 Saw the transition from traditional to digital media #NKFClinicals
Nayan @captainchloride Aurora calls his own number to speak on stopping RASi. #NKFClinicals
The debate comes from worrying about EGFR decline, hyperkalemia vs CV health, mortality benefit, kidney benefit #NKFClinicals
In CRIC in propensity matched evaluation of RASi users vs no RASI in CKD 4/5. No difference in outcomes, Kidney Medicine 2020 Aurora. #NKFClinicals
Next up Implications of lower BP thresholds in patients with advanced CKD by Paul Drawz. Starts with a question
Effects of intensive BP lowering in patients with advanced CKD likely include:
A) Prevention of ESRD
B) Increased risk of AKI
C) Increased fall risk
D) Increased risk of infection
A) Prevention of ESRD
B) Increased risk of AKI
C) Increased fall risk
D) Increased risk of infection
Low BP targets and renal outcomes #NKFClinicals
Slipped into the Optimizing antihypertensives medications selection in hemodialysis patients with Jennifer Flythe. #NKFClinicals
Treating blood pressure in HD reduces outcomes (just barely) #NKFClinicals
Next up fellow Channeler, @AnnaGaddy to talk about urine Chemistries to Predict and Monitor Response to Diuretics. She’s an Assistant Professor of Medicine. #NKFClinicals
Interesting topics #NKFClinicals
Heart failure is a disease of inadequate sodium homeostasis. #NKFClinicals
Diuretics try to bring down ECF while in the long term patient returns to Na in = Na out (sodium intake is the dotted line)
Diuretics try to bring down ECF while in the long term patient returns to Na in = Na out (sodium intake is the dotted line)
Next up is Dr. Uribarri to savage the urinary anion gap. Sorry @Dan_Batlle.
The urine anion gap is not real, but allows you to see what is not measured. There is no gap. Cations must equal anions.
Since 24 urine Na, K, Cl equal their dietary intake, then the urine anion gap must reflect relative dietary intake not ammonia in the urine. #NKFClinicals
Pisse Prophecy workshop. First up Richard Sterns. He failed to release his slides. That sucks. @NKF should disinvite speakers that don’t release their slides. They are here to teach. #NKFClinicals
The BUMP: Basic Urine Metabolic Profile. I’m going to start ordering daily BUMPs. #NKFClinicals
All you need is the BUMP!
Getting to the Heart of Kidney Disease session moderated by @jenniejlin and @RupalMehtaMD first up: Medication Landscape in Cardio-Renal Disease Robert Lee Page Pharm D #NKFClinicals
Starts off with the pearl the heart pumps blood top the kidney. Now on to new heart failure guidelines using all the l pillars and you get 73% reduction in mortality #NKFClinicals
Level of evidence in CKD is pretty much absent. #NKFClinicals
Hey @DanTheKidneyMan won the Lazarus award for research in dialysis and he gets to give the Lazarus Award. #NKFClinicals
Dan starts out thanking the @NKF and exploring how happy he is to see everyone.
He is going to talk about Covid and dialysis, vaccinations and treatment. #NKFClinicals
Here for the Late-Breaking Abstracts #NKFClinicals
First up Matt Weir for the CKD outcomes in the DIAMOND Trial #NKFClinicals
Following Dr Chang, is @PaulPalevsky, president of the @nkf
Starts talking about the meeting desert we have just crossed. #NKFClinicals
Starts talking about the meeting desert we have just crossed. #NKFClinicals
It is more fun to be here in person rather than squares on a computer screen. #NKFClinicals
Next up is Kirsten Johansen from U of Minnesota on Emerging therapies for CKD-related anemia. She starts with a question. This is a nightmare question and will not be participating. She mocks the audience for answering wrong. #NKFClinicals
Big list of trials so you can keep the trials straight #NKFClinicals
After showing data that the HIF stabilizers raise the hemoglobin she gets to the MACE data. First up Roxa. (Emoji, my addition) #NKFClinicals
Next up is Wendy St Peter Pharm D on the Challenges in Anemia Management. She starts with a Polling Question
Spoiler, according to table mate @nephrologyPharm, MSL for Amgen it is A. #NKFClinicals
Quick tour through Beserab CREATE, CHOIR, TREAT. Meta analysis #NKFClinicals
Pathophysiology of CKD Anemia and Strategies four Making Treatment Decisions with Steve Fishbane
COI: I’m a huge Fishbane fan 🤩 #NKFClinicals
COI: I’m a huge Fishbane fan 🤩 #NKFClinicals
Starting with a poll #NKFClinicals
Spoiler, its hepcidin. #NKFClinicals
Brad Rovin from The Ohio State University. Hmm are they in the #FrozenFour? No. No they re not #GoBlue #NKFClinicals
Brad is a fill in for Samir Parik
He has massive COI all over the place. Every drug. Every company. #NKFClinicals
He has massive COI all over the place. Every drug. Every company. #NKFClinicals
Starts out with a case. Cr up from 0.6 to 1.2. 3500 mg of protein. Biopsy is WHO 4 and 5. She does not respond to MMF and steroids. Then does not respond to CYT. What to do?
Beware of getting on the roulette wheel of immunosuppression
Beware of getting on the roulette wheel of immunosuppression
Lupus Lupus Lupus talk two: Dawn Caster, the moderator, calls her own number and is going to speak on New Options and Brighter Future. #NKFClinicals
Patient call. Had to miss a chunk of her talk. Sorry #ClinicalNephrologistProblems #NKFClinicals
We target proteinuria because reducing proteinuria is associated with good outcomes. Turns out, people whose kidneys heal have better outcomes. #NKFClinicals
Lupus Lupus Lupus #NKFClinicals
Dr Jeyabalan from MGH on the wealth of new data in LN and SLE #NKFClinicals
50% of SLE with renal involvement
5-20% of LN develop ESRD
10 year survival goes from 46 to 95% if disease remission is achieved #NKFClinicals
5-20% of LN develop ESRD
10 year survival goes from 46 to 95% if disease remission is achieved #NKFClinicals
MOE: Phosphorus or Phosphate
👉 PROXIMAL Tubule: Main site for regulation of phosphate (some is reabsorbed with Na and H20; most is regulated by change in FGF23)
👉 DISTAL Tubule: Main site for regulation of calcium and potassium
#NKFClinicals #Nephpearls #CKDMBD
👉 PROXIMAL Tubule: Main site for regulation of phosphate (some is reabsorbed with Na and H20; most is regulated by change in FGF23)
👉 DISTAL Tubule: Main site for regulation of calcium and potassium
#NKFClinicals #Nephpearls #CKDMBD
Active Intestinal Phosphate Transport and Passive Intestinal Phosphate (Paracellular) Transport
📌 Note that in these tight junctions, there are 5 groups of proteins that regulate this: occludens, claudins, JAMA, E-cadherin, desmosomes
#NKFClinicals #Nephpearls
📌 Note that in these tight junctions, there are 5 groups of proteins that regulate this: occludens, claudins, JAMA, E-cadherin, desmosomes
#NKFClinicals #Nephpearls
💥Happening now: Dialysis vascular access emergencies at @nkf Meeting
Rapidly enlarging AV access pseudoaneurysms @bharvioza
Steal Syndrome @aurbanes
AV Access related malignancy @JeremyCraneMD
HD CVC related R atrial thrombus @SaadTheodore #NKFClinicals
Rapidly enlarging AV access pseudoaneurysms @bharvioza
Steal Syndrome @aurbanes
AV Access related malignancy @JeremyCraneMD
HD CVC related R atrial thrombus @SaadTheodore #NKFClinicals
Rapidly enlarging pseudoaneurysms by @bharvioza
