Discover and read the best of Twitter Threads about #TenTweetNephJC
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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!
✳️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⬇️
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⬇️
3/10
1 tweet methods
n=406
270 weeks (114+156 weeks open label with SGLT2i!)
➡️Carefully selected population for nil significant cardio/cerebro-vascular or hepatic disease
➡️On MLD/50% MLD of RAASi
➡️1:1 randomisation
➡️Stratification as per eGFR & proteinuria
➡️MMRM statistics
1 tweet methods
n=406
270 weeks (114+156 weeks open label with SGLT2i!)
➡️Carefully selected population for nil significant cardio/cerebro-vascular or hepatic disease
➡️On MLD/50% MLD of RAASi
➡️1:1 randomisation
➡️Stratification as per eGFR & proteinuria
➡️MMRM statistics
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
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
3/10
1 tweet methods
⏪ Retrospective cohort study, USRDS, 2000-2014
✅ 79334 Adults, 1st time kidney transplant
✅ CHD testing 12 months before transplant
🛠️ Instrumental analysis variable - less biased by confounding than standard methods @Husamjz
1 tweet methods
⏪ Retrospective cohort study, USRDS, 2000-2014
✅ 79334 Adults, 1st time kidney transplant
✅ CHD testing 12 months before transplant
🛠️ Instrumental analysis variable - less biased by confounding than standard methods @Husamjz
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👇
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/
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/
3/10
1 tweet methods
✅ Multi-center, blinded, randomised, parallel-group
✅ Elaborate run-in (figure) to give all amlod + HCTZ + valsartan, and then exclude pseudoresistant hypertension
✅ Does adding aprocitentan to regime improve unattended automated office BP 🆚 placebo?
1 tweet methods
✅ Multi-center, blinded, randomised, parallel-group
✅ Elaborate run-in (figure) to give all amlod + HCTZ + valsartan, and then exclude pseudoresistant hypertension
✅ Does adding aprocitentan to regime improve unattended automated office BP 🆚 placebo?
✳️ #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 👇
👉 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
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
1 tweet methods
✅ updated systematic review & meta-analysis
✅ RCTs of patients with AAV or pauci-immune RPGN receiving PLEX and ≥12mo. follow-up
✅ Outcome measures were at least one of: mortality, ESKD, serious infection, relapse, AE or health-related QoL
✅ updated systematic review & meta-analysis
✅ RCTs of patients with AAV or pauci-immune RPGN receiving PLEX and ≥12mo. follow-up
✅ Outcome measures were at least one of: mortality, ESKD, serious infection, relapse, AE or health-related QoL
✳️ 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 💧
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/
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/
1 tweet methods
✅Single center, prospective, observational study, with a randomized sub-cohort
✅Evaluating mechanisms of diuretic resistance in patients with ADHF on IV loops 💉
✅Supervised urine collection pre and post diuresis
✅Primary outcome = level of CPDSR
✅Single center, prospective, observational study, with a randomized sub-cohort
✅Evaluating mechanisms of diuretic resistance in patients with ADHF on IV loops 💉
✅Supervised urine collection pre and post diuresis
✅Primary outcome = level of CPDSR
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 👇
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/
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/
1 Tweet Methods
✔️ Single-centre, double-blind, placebo-controlled, crossover study
✔️ 4g/day acetaminophen (the standard UK dose) 🆚 placebo
✔️ 2 weeks active or placebo ➡️ 2 weeks washout ➡️ 2 weeks on opposite treatment
✔️ Primary outcome = change in 24 hour ambulatory BP
✔️ Single-centre, double-blind, placebo-controlled, crossover study
✔️ 4g/day acetaminophen (the standard UK dose) 🆚 placebo
✔️ 2 weeks active or placebo ➡️ 2 weeks washout ➡️ 2 weeks on opposite treatment
✔️ Primary outcome = change in 24 hour ambulatory BP
✳️ #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👇
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/
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/
1 tweet methods
✅Family of a 57 y.o. man with brain death gave consent
✅Pig with 6 human genes knocked in & 4 pig genes knocked out
✅Negative crossmatch
✅Descendant underwent induction immunosuppression, bilateral native nephrectomy, & implantation of two porcine kidneys
✅Family of a 57 y.o. man with brain death gave consent
✅Pig with 6 human genes knocked in & 4 pig genes knocked out
✅Negative crossmatch
✅Descendant underwent induction immunosuppression, bilateral native nephrectomy, & implantation of two porcine kidneys
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?
✳️ 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…
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…
1 tweet methods
✅ Observational cohort study from 🇸🇪
✅ 10,290 patients with CKD in Swedish registry
✅ Target trial emulation using “cloning, censoring & weighting” method used to avoid biases mentioned above
✅ Observational cohort study from 🇸🇪
✅ 10,290 patients with CKD in Swedish registry
✅ Target trial emulation using “cloning, censoring & weighting” method used to avoid biases mentioned above
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?
✳️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…
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…
1 tweet methods
✅ 122 centres in UK
✅ Prospective, double-blind, placebo-controlled RCT
✅ Children aged 1-18, with 2 or more SSNS relapses in last year
✅ 6 days low dose pred, or placebo, at start of URTI
✅ Did they get proteinuria +++ or worse over next fortnight?
✅ 122 centres in UK
✅ Prospective, double-blind, placebo-controlled RCT
✅ Children aged 1-18, with 2 or more SSNS relapses in last year
✅ 6 days low dose pred, or placebo, at start of URTI
✅ Did they get proteinuria +++ or worse over next fortnight?
