#NephJC Transcript
Healthcare social media transcript of the #NephJC hashtag.
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See #NephJC Influencers/Analytics.
| Profile | Tweet |
|---|---|
 | Nephrology Journal Club @NephJC I’m Krithika Mohan @krithicism, nephrology fellow from Hyderabad, India , #NSMC intern 2019 and your host tonight. No COI. #NephJC |
| Nephrology Journal Club @NephJC Hello and welcome to #NephJC’s chat tonight on Reconsidering the consequences of using race to estimate kidney function published online on @jama_current By @amakaEMD @PeterPReese1 https://t.co/XO0adtA4JB |
| Nephrology Journal Club @NephJC Please introduce yourself (even if you’re lurking) and declare any COIs. Don’t forget the hashtag #NephJC |
 | Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: Hello and welcome to #NephJC’s chat tonight on Reconsidering the consequences of using race to estimate kidney function published online on @jama_current By @amakaEMD @PeterPReese1 https://t.co/XO0adtA4JB |
 | Matthew Sparks, MD @Nephro_Sparks Matt Sparks lurking tonight preparing for #NBLUniv trip #NephJC |
| Nephrology Journal Club @NephJC @Nephro_Sparks Hi Matt! welcome #nephJC |
 | TEJAS PATEL MD, FACP, FASN @GenNextMD Tejas Patel @GenNextMD in NYC #NephJC |
 | Vineet Behera @BeheraVineet Hi.. I am Vineet Behera from Mumbai.. No COI.. #nephJC |
| Nephrology Journal Club @NephJC To all the first timers out there ,here’s a quick guide on ‘How to NephJC.’ #NephJC https://t.co/uUzR9PWhR2 |
 | Anna Burgner MD MEHP @anna_burgner Hi #NephJC! Looking forward to tonight! Anna Burgner general nephrologist and APD @VUMCKidney! No COI |
| Nephrology Journal Club @NephJC @GenNextMD Hi Tejas #nephJC |
 | James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @NephJC James Novak, TPD @HFNephrology, #NSMC intern 2018, no COI. #NephJC |
 | Charbel C Khoury @Charbel_Khoury Charbel Khoury, WUSM St Louis, No COI #nephjc |
 | L. Parker Gregg @LParkerGregg1 Hi all! Parker Gregg, nephrologist in Dallas and #NSMC intern 2019. Lurking while I work on a talk. Interested to hear what everyone thinks! No COI #NephJC |
 | Amaka Eneanya, MD, MPH @AmakaEMD @NephJC @JAMA_current @PeterPReese1 Hi! Excited to discuss this topic that so many are passionate about. Will represent for @PeterPReese1 who is currently traveling. No COI. #nephjc |
 | Edgar V. Lerma 🇵🇭 @edgarvlermamd Edgar Lerma, Chicago-based Nephrologist #NephJC Photo Credit: Barry Butler Photography 📸 https://t.co/eWMVI6KFon https://t.co/tRXgNRDo2t |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil Swapnil Hiremath from @OttawaMedicine Brown Skin, no other CoI #nephjc |
| Nephrology Journal Club @NephJC @BeheraVineet Hi Vineet #nephJC |
| Nephrology Journal Club @NephJC If you aren’t familiar with them already, check out this code of conduct put together by #NephJC community @Nephro_Sparks and @SLeonMD https://t.co/b3Y4ALpGit https://t.co/xpk0LG6PbR |
 | Tiffany Caza @Tiff_Caza @NephJC Hi! I'm Tiff and I'm a renal pathologist and #NSMC intern. No COI. Looking forward to learning! #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil Author in the house! #NephJC |
| Nephrology Journal Club @NephJC @AmakaEMD @JAMA_current @PeterPReese1 Thanks for joining us today #nephJC |
 | Ian McCoy, MD, MS @NephroNinja Ian McCoy, @StanfordNeph, no COI. #nephjc |
 | Annabel Biruete 🇲🇽 @anniebelch Annabel Biruete, postdoc at @IUKidney. It's been so long since my last #NephJC... will be mostly following the discussion, excited to learn! No COI #NephJC |
 | Diana Mahbod, MD, CPE, FASN, FNKF @DiMiRenalMD Hello from #NBLUniv Looking forward to this interesting topic which definitely comes up in my private practice clinic. I’m Diana and I’m here with two of the best @nephrothaniel @NatashaNDave #NephJC https://t.co/Got4nnjCCc |
 | Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @gratefull080504 : Checkin in from Chicago COI: Protalix, Retrophin, Bayer, Gilead #nephjc |
 | Bea Concepcion @KidneyBea_n Bea Concepcion, Tx Nephrologist @VUMCKidney, back after a long hiatus! No COI #nephjc |
| Matthew Sparks, MD @Nephro_Sparks RT @NephJC: If you aren’t familiar with them already, check out this code of conduct put together by #NephJC community @Nephro_Sparks and @SLeonMD https://t.co/b3Y4ALpGit https://t.co/xpk0LG6PbR |
 | Hector Madariaga, MD FASN 🇲🇽 @HecmagsMD Hector Madariaga. No COI. Hello, everyone. From #PatriotsNation #Nephjc https://t.co/K2exEgNWGF |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: If you aren’t familiar with them already, check out this code of conduct put together by #NephJC community @Nephro_Sparks and @SLeonMD https://t.co/b3Y4ALpGit https://t.co/xpk0LG6PbR |
 | Nathaniel Reisinger @nephrothaniel Nathaniel nephrologist no conflicts tweeting from @dallas for @NBLUniv #nephjc #nbluniv What is this? A crossover episode!? |
 | Natasha N. Dave @NatashaNDave Hi I’m Natasha from @NephBCM - tweeting from @NBLUniv with @nephrothaniel and @DiMiRenalMD by my side, no COI #NephJC |
 | Eric Au @ericau @NephJC Hi Eric here - nephrologist from Sydney. no COI #nephjc #nsmc |
 | Gary Singer @GarySingerMD@med-mastodon.com @GarySingerMD Gary Singer nephrologist in STL no COI looking forward to this evening’s discussion #NephJC |
 | Laura Slattery @Slatts_1 @NephJC Laura Slattery, NSMC faculty, Ireland. Visiting the US chat from a night shift, looking forward to the discussion #NephJC |
 | Joshua Waitzman, MD PhD @Jwaitz Hi #nephjc! Josh Waitzman, research nephrology fellow @BIDMChealth lurking. No COI. Will try to follow along in between bedtime chapters of Matilda (we are on a Roald Dahl kick). |
| Nephrology Journal Club @NephJC Author in the house @AmakaEMD #nephJC |
| Nephrology Journal Club @NephJC Tonights discussion is different from the ones we’ve had before. This article is a viewpoint on the Consequences of using race to estimate kidney function https://t.co/yVhAI8SS5V @JAMA_current #NephJC |
| Natasha N. Dave @NatashaNDave RT @DiMiRenalMD: Hello from #NBLUniv Looking forward to this interesting topic which definitely comes up in my private practice clinic. I’m Diana and I’m here with two of the best @nephrothaniel @NatashaNDave #NephJC https://t.co/Got4nnjCCc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @KidneyBea_n @VUMCKidney hey Bea! Welcome back #NephJC |
 | Abhilash Koratala @KoraAbhi Abhilash aka @nephroP reporting. #NSMC intern, No COI #nephjc |
 | Amanda Leonberg @AmandaLeonberg Amanda Leonberg-Yoo, nephrologist University of Pennsylvania. No conflicts of interest @PennKidney #NephJC |
 | Sharica Brookins, MD, FASN @DrBrookinsMD Good evening. Sharica Brookins Nephrologist in Augusta, GA. No COI. Ready to engage. #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @Slatts_1 @NephJC whoah! what time is it over there? #NephJC |
 | Janewit Wongboonsin, MD, MS @janewitwong Hi. I'm Janewit. Chief resident at U of Minnesota, VA. Here to learn #nephjc |
 | Silvi Shah, MD, MS @silvishah Hi this is Silvi from U cincy. All set to head to NBLU. No coi. #nephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: Tonights discussion is different from the ones we’ve had before. This article is a viewpoint on the Consequences of using race to estimate kidney function https://t.co/yVhAI8SS5V @JAMA_current #NephJC |
| Nephrology Journal Club @NephJC Check out the brilliant summary of the article by my co-intern @Ted_FitzG https://t.co/vjlOvAKLVn #NephJC |
| Charbel C Khoury @Charbel_Khoury Hey Amaka, great article! #NephJC |
| Nephrology Journal Club @NephJC And the visual abstract by @krithicism & @kidney_boy #NephJC https://t.co/h7CIWKYe5g |
 | Rachel Hilburg, MD @RachelHilburg Rachel Hilburg, renal fellow lurking on call! #nephJC @PennKidney |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @AmandaLeonberg @PennKidney Welcome to #NephJC Amanda! - this is a @PennKidney paper indeed (also @CRICStudy - where's @jordy_bc ?) |
 | Michael Moustakakis, MD FASN @nephron129 Michael, Nephrologist, CT, USA. No COI #nephjc |
 | Katie Jones @Kat1eJones Hi, Ped neph fellow here. No COI. #NephJC |
 | Justin Davis @jbda19 @NephJC Justin #NSMC intern. Lurking today due to a transplant clinic, but my two cents are it’s an interesting paper and one wonders how it might apply to other ethnic groups, for example Indigenous populations of Aus/NZ and whether it is changing their values in a similar way. #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: And the visual abstract by @krithicism & @kidney_boy #NephJC https://t.co/h7CIWKYe5g |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: Check out the brilliant summary of the article by my co-intern @Ted_FitzG https://t.co/vjlOvAKLVn #NephJC |
| Vineet Behera @BeheraVineet RT @AmakaEMD: @NephJC @JAMA_current @PeterPReese1 Hi! Excited to discuss this topic that so many are passionate about. Will represent for @PeterPReese1 who is currently traveling. No COI. #nephjc |
| Nathaniel Reisinger @nephrothaniel RT @NephJC: Hello and welcome to #NephJC’s chat tonight on Reconsidering the consequences of using race to estimate kidney function published online on @jama_current By @amakaEMD @PeterPReese1 https://t.co/XO0adtA4JB |
 | Samaya @TarSamMD Samaya from Houston #nsmc #NephJC |
 | Marvin Gonzalez. MD, Ph.D @MarvinGonzlez16 Marvin Gonzalez, No COI. Happy to learn from all of you. #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @Kat1eJones welcome back Katie! #NephJC |
| Nephrology Journal Club @NephJC Have you read @kidney_boy ‘s blogpost - Is estimated GFR racist ? which touches upon the same subject ? https://t.co/9kHxgXtpG1 #NephJC |
| Nephrology Journal Club @NephJC Abbreviations for the chat: eGFR: estimated glomerular filtration rate CKD-EPI: Chronic kidney disease epidemiology collaboration equation MDRD: modification of diet in renal disease study KDIGO: kidney disease: improving global outcomes #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: Abbreviations for the chat: eGFR: estimated glomerular filtration rate CKD-EPI: Chronic kidney disease epidemiology collaboration equation MDRD: modification of diet in renal disease study KDIGO: kidney disease: improving global outcomes #NephJC |
 | Dr. “Dad” MD, FAAP, FASN @DrRayMD Dr. Ray here: pediatric nephrology faculty @nationwidekids & @OhioStateMed. No real COIs, but @AmakaEMD is my homie and role model. #MeharryMade #nephjc |
| Nephrology Journal Club @NephJC Let's get started Kidney function is estimated to guide medical decisions across a wide range of settings- drug dosing, safety of radiological procedures, nephrology referral,transplant listing, dialysis initiation #NephJC |
 | Khaled Shawwa @khaledshawwa Khaled Shawwa, Nephrology fellow, Rochester, MN. No COI #NephJC |
 | Marina🌳 @Marina_nefro RT @PeterPReese1: Using race to tailor clinical care is justified only if:1) that use confers substantial benefit; 2) the benefit cannot be achieved through other feasible approaches; 3) patients who refuse race categorization are accommodated fairly; and 4) the use of race is transparent. #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @nephron_krouton wellcome to #NephJC Eric! |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd Reconsidering the Consequences of Using Race to Estimate Kidney Function ca. 2019 from @JAMA_current #NephJC #Nephpearls #VisualAbstract by @krithicism 👉🏼 https://t.co/iGJkWora3a https://t.co/sxVQgCPSHY |
 | Gates Colbert, MD @DoctorGates Dallas Nephrologist. No COI, except using MDRD is essential to my practice as a Physician. But it doesn't have to be if we can find an inexpensive, exact way to measure kidney function. #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @DrBrookinsMD Welcome to #NephJC ! |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 #nephjc A lot of new faces...... again Very encouraging |
| Nephrology Journal Club @NephJC Because directly estimating kidney function at bedside isn’t feasible, various equations (MDRD, CKD-EPI) were derived based on serum creatinine to estimate the GFR #NephJC |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @HecmagsMD Home in Chicago Thank goodness #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: Because directly estimating kidney function at bedside isn’t feasible, various equations (MDRD, CKD-EPI) were derived based on serum creatinine to estimate the GFR #NephJC |
 | Anitha Vijayan @VijayanMD Anitha Vijayan, Washington University in St Louis. No COI #NephJC |
| Nephrology Journal Club @NephJC Most of us use the MDRD or CKD-EPI equations on a daily basis to calculate eGFR, but how many here have looked at the original papers? #NephJC |
| Diana Mahbod, MD, CPE, FASN, FNKF @DiMiRenalMD RT @NephJC: Because directly estimating kidney function at bedside isn’t feasible, various equations (MDRD, CKD-EPI) were derived based on serum creatinine to estimate the GFR #NephJC |
 | Airawat ऐरावत @Renaltubules Ashwasena. from Himalayas. 6.45 am. coi: loves ped nephro. #nephjc |
| Sharica Brookins, MD, FASN @DrBrookinsMD #meharrymade class of 2012! Hey doc! |
 | Joel M. Topf, MD FACP @kidney_boy Joel Topf here. Having to do domestic duty, so I’ll be in and out. #NephJC |
| Nephrology Journal Club @NephJC The adjustment of eGFR for race is well recognised. CKD - EPI has adjustments for the black race, but what about the rest of the world who were underrepresented in the study? #NephJC |
| Nephrology Journal Club @NephJC To address this, many studies applied a correction factor to the CKD-EPI equation which made it more applicable for their own population. #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @NephJC i did ! - and found a typo maybe?https://t.co/Rqtnrj4Dxm #nephjc |
 | Sophia Kostelanetz, MD MPH @SKostelanetz #nephJC Sophia here, no COI, Med-Peds physician and health equity researcher. First time on #nephJC!! |
 | Dr Theepa N.M.R @TNesam RT @edgarvlermamd: Reconsidering the Consequences of Using Race to Estimate Kidney Function ca. 2019 from @JAMA_current #NephJC #Nephpearls #VisualAbstract by @krithicism 👉🏼 https://t.co/iGJkWora3a https://t.co/sxVQgCPSHY |
| Charbel C Khoury @Charbel_Khoury Guilty ☺️ #NephJC speed read CKD-EPI but not MDRD |
| Eric Au @ericau @jbda19 @NephJC Ye interesting point - I think there has been some studies looking at CKD-Epi equation in Indigenous populations and looks like it is ok https://t.co/67pDwKAxBD #nephjc |
| Joel M. Topf, MD FACP @kidney_boy @NephJC Original papers? How many times? Every time I cite them I read them from beginning to end. Just like everybody else. #NephJC |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @NephJC Is anyone using MDRD anymore? We’ve been using CKD-EPI for ages, with standardized creatinine since 2012. But when I was a med student, we used the bedside Cockroft-Gault. #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @SKostelanetz welcome to #NephJC! |
 | Mohamed Mohamed Ahmed @Nephro_Mohamed Hi #NephJC, I am glad that I will be joining and learning today .. I am Mohamed, Tranplant Neph. fellow @musc . |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @kidney_boy @NephJC but do you also read the supplementary data? #NephJC |
| Nephrology Journal Club @NephJC CKD-EPI equations assign a high eGFR to patients who are identified as black asserting the importance of race. #NephJC |
| Sophia Kostelanetz, MD MPH @SKostelanetz Vandy is using MDRD! Don't know the exact reason |
| Khaled Shawwa @khaledshawwa RT @edgarvlermamd: Reconsidering the Consequences of Using Race to Estimate Kidney Function ca. 2019 from @JAMA_current #NephJC #Nephpearls #VisualAbstract by @krithicism 👉🏼 https://t.co/iGJkWora3a https://t.co/sxVQgCPSHY |
 | Mario Funes, MD @MarioFunesMD Mario Funes. PGY3 internal medicine in New Brunswick, NJ. Sorry I'm late. ICU stuff. No COI. #NephJC |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd Mis-applications of commonly used KIDNEY EQUATIONS - MDRD, GFR, FENa #Nephpearls #NephJC 👉🏼 https://t.co/fabUedbvCa https://t.co/qgF1n7TIp1 |
| Nephrology Journal Club @NephJC Bringing us to the next question - Is race a social construct or a biological one ? Check out this view point by Fontanarosa and colleagues https://t.co/PhuHzpcoe3 #NephJC |
| Vineet Behera @BeheraVineet RT @edgarvlermamd: Mis-applications of commonly used KIDNEY EQUATIONS - MDRD, GFR, FENa #Nephpearls #NephJC 👉🏼 https://t.co/fabUedbvCa https://t.co/qgF1n7TIp1 |
| Gary Singer @GarySingerMD@med-mastodon.com @GarySingerMD @NephJC Interesting correlation courtesy of @UpToDate #NephJC https://t.co/T24xvLLj55 |
| Joel M. Topf, MD FACP @kidney_boy @gratefull080504 Agreed found a bunch of new follows already #nephjc |
| Anitha Vijayan @VijayanMD @Charbel_Khoury Read MDRD, skimmed over CKD-Epi #nephjc |
| Joshua Waitzman, MD PhD @Jwaitz @JamesNovakNeph @NephJC Actual picture of @JamesNovakNeph #nephjc https://t.co/RPOYRiMrUu |
| Ian McCoy, MD, MS @NephroNinja @JamesNovakNeph @NephJC All electronic health records I've worked with use MDRD. #NephJC |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @SKostelanetz How retro! I’ll have to discuss with Kausik Umanath, our research director and #VUMC nephrology alumnus. #NephJC |
| Charbel C Khoury @Charbel_Khoury THIS graph is the best indicator that there are many limitations to creatinine and its estimated equations #NephJC |
| Joel M. Topf, MD FACP @kidney_boy @hswapnil @NephJC Is that a different citation? Actually couldn’t find any supplementary data for original MDRD protocol and methods paper (yeah, I went there) #nephjc |
| Nephrology Journal Club @NephJC Bonham quotes“Use of race & ethnicity as population descriptors in genomics research has potential to miscommunicate complex relationships among an individual’s identity,ancestry, socioeconomics & health, perpetuating misguided notions that discrete genetic groups exist” #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @NephJC And links provided on #NephJC summary page https://t.co/wmL5Z4qD4D ! https://t.co/TmV679b2lt |
| Eric Au @ericau @GarySingerMD @NephJC @UpToDate There is quite a bit of scatter! #nephjc |
| Vineet Behera @BeheraVineet RT @hswapnil: @NephJC And links provided on #NephJC summary page https://t.co/wmL5Z4qD4D ! https://t.co/TmV679b2lt |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: Bonham quotes“Use of race & ethnicity as population descriptors in genomics research has potential to miscommunicate complex relationships among an individual’s identity,ancestry, socioeconomics & health, perpetuating misguided notions that discrete genetic groups exist” #NephJC |
 | Natalie McCall @_NatalieMcCall Natalie McCall. Vandy. No COI. Joining a little late tonight #nephJC |
| Nephrology Journal Club @NephJC @ericau @jbda19 There are also Pakistani, Japanese, Thai, Chinese and Korean studies #nephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @Charbel_Khoury: THIS graph is the best indicator that there are many limitations to creatinine and its estimated equations #NephJC |
| Dr. “Dad” MD, FAAP, FASN @DrRayMD RT @NephJC: Bonham quotes“Use of race & ethnicity as population descriptors in genomics research has potential to miscommunicate complex relationships among an individual’s identity,ancestry, socioeconomics & health, perpetuating misguided notions that discrete genetic groups exist” #NephJC |
| Anitha Vijayan @VijayanMD @NephroNinja @JamesNovakNeph @NephJC Cockcroft Gault still used for drug dosage. Shows up in EMR as well #nephjc |
| Nephrology Journal Club @NephJC The authors contend equations to estimate GFR with race as a variable cause problems for transparency and unduly restrict access to care, yet offer only minor benefits in precision.Any comments at this stage? #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: Bringing us to the next question - Is race a social construct or a biological one ? Check out this view point by Fontanarosa and colleagues https://t.co/PhuHzpcoe3 #NephJC |
| Vineet Behera @BeheraVineet I think CKD-EPI is being used by most #nephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @Jwaitz @JamesNovakNeph @NephJC In hindsight isn’t our embracing of C-G so amazing? Derived from 290 or so 🇨🇦 white men? #NephJC https://t.co/SsvrQgJbK5 |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @NephroNinja @NephJC Our pharmacists are still using creatinine clearance, not estimated GFR, for drug dosing. But it’s not their fault; the old pharmacokinetic studies were done with CrCl and never repeated. #NephJC |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @Charbel_Khoury To me this underscores why there is an urgent need to have better tests to measure kidney function A lot of limitations with GFR Hopefully future tools will be studied in people of color too #nephJC |
| Eric Au @ericau @NephJC @jbda19 Do you know if those studies confirmed that the equation is also good to use in those populations? #nephjc |
| Nephrology Journal Club @NephJC CKD-EPI & MDRD equations were generated in large cohorts of individuals who underwent gold standard measurement of eGFR. #NephJC |
| Sophia Kostelanetz, MD MPH @SKostelanetz From an amazing American Acad. of Peds Policy statement this week "Through these underpinnings, racism became a socially transmitted disease passed down through generations, leading to the inequities observed in our population today." https://t.co/rxAqnd2UNV |
 | Prakash Gudsoorkar @gudnephron Prakash from @uofcincy . No COI #NephJC |
| Anitha Vijayan @VijayanMD @BeheraVineet I think labs are reporting MDRD gfr #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @kidney_boy @NephJC Good man Just testing you there #NephJC https://t.co/vH637msRCb |
| Khaled Shawwa @khaledshawwa @NephJC Hoping to read the ACKD issue on eGFR one day #NephJC https://t.co/GK3VWGJ5P2 |
| Nephrology Journal Club @NephJC Investigators found that black race was independently associated with a slightly higher GFR at the same creatinine level. #NephJC |
| Anitha Vijayan @VijayanMD @hswapnil @Jwaitz @JamesNovakNeph @NephJC Exactly! Still amazed that pharma continue to use it for drug development #nephjc |
| Nephrology Journal Club @NephJC @AmakaEMD In our lab, we always do #nephJC |
| Sharica Brookins, MD, FASN @DrBrookinsMD @VijayanMD @BeheraVineet I agree. #nephjc |
 | Vipin Varghese @vipvargh Vipin, MS4. Catching up late today🙃#NephJC |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @hswapnil @Jwaitz @JamesNovakNeph @NephJC Swapnil great point Hopefully new and better tests will be tested globally with people of color and women #nephJC |
| Vineet Behera @BeheraVineet RT @hswapnil: @Jwaitz @JamesNovakNeph @NephJC In hindsight isn’t our embracing of C-G so amazing? Derived from 290 or so 🇨🇦 white men? #NephJC https://t.co/SsvrQgJbK5 |
| Nephrology Journal Club @NephJC This was justified by the assertion that black individuals release more creatinine into the blood, perhaps because of more muscle mass. #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @ericau @NephJC @jbda19 I don’t think so! There’s a cottage industry of small validation studies - we cite some of them in the summary #NephJC https://t.co/yk56IWzMrA |
| Nephrology Journal Club @NephJC @ericau @jbda19 They found it to be inaccurate, which is why they developed a correction factor to the existing equation #nephJC |
 | Dr_H @AlanHawxbyMD Alan Hawxby, Transplant Surgeon at OU checking in. Howdy. #nephjc. |
| Hector Madariaga, MD FASN 🇲🇽 @HecmagsMD #nephjc |
| Gary Singer @GarySingerMD@med-mastodon.com @GarySingerMD @NephJC I have a couple patients who go to @MayoClinic every 6 months and get iothalamate GFR checked routinely - not practical in the real world #NephJC |
| Charbel C Khoury @Charbel_Khoury Question to the Epidemiologists amongst us, would it be more accurate to do a new formula that does not include race in its regression #Nephjc |
| Nephrology Journal Club @NephJC CKD-EPI includes a race coefficient that increase the eGFR by 16% in the black race ! These equations also take into account the age and sex of the individual (older individuals and women have less muscle mass) #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @VijayanMD @Jwaitz @JamesNovakNeph @NephJC Probably better to use de-indexed CKD-EPI instead? #NephJC |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @VijayanMD @hswapnil @Jwaitz @JamesNovakNeph @NephJC What are there options? New tests that measure kidney function are need if the promise of #precisionmedicine is to be fulfilled #nephJC |
 | ad @aDiigum RT @edgarvlermamd: Reconsidering the Consequences of Using Race to Estimate Kidney Function ca. 2019 from @JAMA_current #NephJC #Nephpearls #VisualAbstract by @krithicism 👉🏼 https://t.co/iGJkWora3a https://t.co/sxVQgCPSHY |
| Amaka Eneanya, MD, MPH @AmakaEMD @HecmagsMD Nice catch! #nephJC |
 | Dr. Vanessa Grubbs (she/her) @thenephrologist @NephJC I assert that if they didn’t inherently BELIEVE that race construct meant genetic difference, they would have dug further to figure out WHY. The whole muscle mass proxy was an assumption—they didn’t measure it. #NephJC |
| Anitha Vijayan @VijayanMD @AmakaEMD @NephJC Ours report based on race #nephjc |
| Sharica Brookins, MD, FASN @DrBrookinsMD @gratefull080504 @Charbel_Khoury #nephjc especially if it determines when someone can be listed or start dialysis. |
| Nephrology Journal Club @NephJC Do we have enough evidence to prove this association?#NephJC |
| Nephrology Journal Club @NephJC @AmakaEMD calculate it ourselves #nephJC |
| Annabel Biruete 🇲🇽 @anniebelch @gratefull080504 @VijayanMD @hswapnil @Jwaitz @JamesNovakNeph @NephJC I know Dr. Bruce Molitoris from @IUKidney is working on this: https://t.co/QyQDJk83AP #NephJC |
 | Aisha Shaikh @aishaikh @GarySingerMD @NephJC @MayoClinic yes, pretty much every patients gets an iothalamate clearance at Mayo Clinic #nephjc |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @Nephro_Sparks @Charbel_Khoury There is also a company FAST Biomedical based in Indianapolis that is developing a test as well #nephJC |
| Sophia Kostelanetz, MD MPH @SKostelanetz On a population level, AA have faster progression, worse outcomes, less transplants + access, etc. Yet the AA GFR corrects for a seemingly better GFR, but based on a iohexol difference we don't really understand. Great study showing its not muscle mass (Hsu et al). #NephJC |
 | Hayder Aledan @HayderAledan #nephJC Hayder Aledan, Nephrologist from Iraq, no COI |
| Nephrology Journal Club @NephJC Hsu et al in their cohort of 3000 patients did not find an association between creatinine and body composition. https://t.co/LqF8TKi8RO #NephJC |
| Ian McCoy, MD, MS @NephroNinja @AmakaEMD @NephJC The electronic health records I've used report both. I guess they don't want the computer assessing whether a patient is black or not. #NephJC |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @anniebelch @VijayanMD @hswapnil @Jwaitz @JamesNovakNeph @NephJC @IUKidney Thank you Annabel FAST Biomedical #nephJC |
| Anitha Vijayan @VijayanMD @anniebelch @gratefull080504 @hswapnil @Jwaitz @JamesNovakNeph @NephJC @IUKidney Also @medibeacon is working on non-invasive GFR measurement as well. #nephjc |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @NephJC Isn’t it the case, though, that these correction factors are tested in a validation cohort to confirm accuracy with the gold standard GFR measurement technique? #NephJC |
| Nephrology Journal Club @NephJC The authors say that classifying patients according to ancestry (not race or ethnicity) has legitimate purposes in identifying people at risk of complications from gene mutations like sickle cell trait or cystic fibrosis. #NephJC |
| Sophia Kostelanetz, MD MPH @SKostelanetz Are providers that look at a patient and decide their race for them any better than computers? In a population that is not "purely" one "race". #NephJC |
| Dr. Vanessa Grubbs (she/her) @thenephrologist @AmakaEMD @NephJC Our lab reports 2 estimates: a regular one and a “if African-American” one. I’m still wondering how black does one need to be to warrant a race adjustment. #nephJC |
| Dr. “Dad” MD, FAAP, FASN @DrRayMD @thenephrologist @NephJC I would go further to say it is a dangerous and prejudicial assumption based on stereotypical myths about black bodies that have been promulgated for generations, especially in America. Conflating science with socialization is dangerous ground. #NephJC |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @NephJC What is the evidence for this assertion? #nephJC |
 | NBLU: Renal Leaders @NBLUniv RT @DiMiRenalMD: Hello from #NBLUniv Looking forward to this interesting topic which definitely comes up in my private practice clinic. I’m Diana and I’m here with two of the best @nephrothaniel @NatashaNDave #NephJC https://t.co/Got4nnjCCc |
| NBLU: Renal Leaders @NBLUniv RT @nephrothaniel: Nathaniel nephrologist no conflicts tweeting from @dallas for @NBLUniv #nephjc #nbluniv What is this? A crossover episode!? |
| Eric Au @ericau @hswapnil @NephJC @jbda19 Thanks! Such a great #nephjc article summary - I had just read the article before this oops... |
| NBLU: Renal Leaders @NBLUniv RT @NatashaNDave: Hi I’m Natasha from @NephBCM - tweeting from @NBLUniv with @nephrothaniel and @DiMiRenalMD by my side, no COI #NephJC |
| Nephrology Journal Club @NephJC eGFR equations are distinct because they assert that organ function is different in 2 individuals who are otherwise identical except for race. #NephJC |
| NBLU: Renal Leaders @NBLUniv RT @silvishah: Hi this is Silvi from U cincy. All set to head to NBLU. No coi. #nephJC |
| Gary Singer @GarySingerMD@med-mastodon.com @GarySingerMD @thenephrologist @AmakaEMD @NephJC Amen #NephJC |
| Dr. “Dad” MD, FAAP, FASN @DrRayMD RT @NephJC: Hsu et al in their cohort of 3000 patients did not find an association between creatinine and body composition. https://t.co/LqF8TKi8RO #NephJC |
| Vipin Varghese @vipvargh RT @NephJC: Hsu et al in their cohort of 3000 patients did not find an association between creatinine and body composition. https://t.co/LqF8TKi8RO #NephJC |
| Nephrology Journal Club @NephJC @gratefull080504 Nothing concrete #nephJC |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @DrRayMD @thenephrologist @NephJC That is why I asked for the evidence behind the earlier assertion #nephJC |
| Dr. Vanessa Grubbs (she/her) @thenephrologist @AmakaEMD @NephJC However, recently we met with lab leadership to discuss changing reporting to “if low/high muscle mass” and they agreed to move it forward! #NephJC |
| Janewit Wongboonsin, MD, MS @janewitwong @VijayanMD @anniebelch @gratefull080504 @hswapnil @Jwaitz @JamesNovakNeph @NephJC @IUKidney @medibeacon This is really cool ! #nephjc |
| Ian McCoy, MD, MS @NephroNinja @GarySingerMD @NephJC @MayoClinic Hmm, why? Are they close to the transplant time accruing threshold? Is it much better than 24 hour urine collection? #nephJC |
| Dr. “Dad” MD, FAAP, FASN @DrRayMD RT @SKostelanetz: On a population level, AA have faster progression, worse outcomes, less transplants + access, etc. Yet the AA GFR corrects for a seemingly better GFR, but based on a iohexol difference we don't really understand. Great study showing its not muscle mass (Hsu et al). #NephJC |
| Nephrology Journal Club @NephJC There is more genetic variability among individuals of the same race than between racial groups according to population studies #NephJC |
| Amaka Eneanya, MD, MPH @AmakaEMD @thenephrologist @NephJC Great question - how is race determined? If it's not in the medical record (and how does it get there in the first place), are people just making judgement calls? #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @SKostelanetz Yeah & the CKD-EPI suggesting 5% higher in Chinese? Is that muscle mass? The premise seems flawed! #NephJC https://t.co/LiVCfailJe |
| Charbel C Khoury @Charbel_Khoury @AmakaEMD @NephJC I think using race is misdirected and inequitable in the age of genetics. We archaically used race to confer genetic predisposition to certain diseases but thalassemia and sickle cell are also common in mediterraneans. #NephJC |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @NephJC Interesting #nephjc |
| Amaka Eneanya, MD, MPH @AmakaEMD RT @thenephrologist: @AmakaEMD @NephJC However, recently we met with lab leadership to discuss changing reporting to “if low/high muscle mass” and they agreed to move it forward! #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @AmakaEMD: @thenephrologist @NephJC Great question - how is race determined? If it's not in the medical record (and how does it get there in the first place), are people just making judgement calls? #NephJC |
| Nephrology Journal Club @NephJC The authors question if racial categorization is used in a standardized way ? or is it generated arbitrarily to reinforce social inequality ? What are your thoughts? #NephJC |
 | David Santos @DavidSa37565535 Hello Tweeting from El Salvador #nephjc |
| Eric Au @ericau @Charbel_Khoury Hmm - thought race was included as a variable in the development of the original formula because it improved accuracy? #nephjc |
| Katie Jones @Kat1eJones @AmakaEMD @thenephrologist @NephJC I would think that the race of the patient is self-reported in most cases, yes? #nephJC |
 | Samira Farouk, MD, MSCR @ssfarouk Joining late! #NephJC |
 | indy_med @indy_med RT @NephJC: And the visual abstract by @krithicism & @kidney_boy #NephJC https://t.co/h7CIWKYe5g |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @VijayanMD @anniebelch @hswapnil @Jwaitz @JamesNovakNeph @NephJC @IUKidney @medibeacon @medibeacon is based in St.Louis #nephJC |
| Tiffany Caza @Tiff_Caza @NephJC Could there be more hyperfiltration resulting in an increased GFR for a given creatinine up until you can no longer compensate, since there is an increased prevalence of hyperfiltration risk factors such as hypertension and obesity in African Americans? #NephJC |
| Vineet Behera @BeheraVineet @AmakaEMD @thenephrologist @NephJC And how do we interpret if both parents are from different races ? #nephJC |
| Samira Farouk, MD, MSCR @ssfarouk RT @AmakaEMD: @thenephrologist @NephJC Great question - how is race determined? If it's not in the medical record (and how does it get there in the first place), are people just making judgement calls? #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @gratefull080504 @DrRayMD @thenephrologist @NephJC Joel discusses some of the data here https://t.co/04L84sxrol #nephjc |
| Anitha Vijayan @VijayanMD @Kat1eJones @AmakaEMD @thenephrologist @NephJC I thought that as well. But I think it is assumed by person sitting at the registration desk #nephjc |
| Nephrology Journal Club @NephJC If a hypothetical 50 yr old woman with creatinine 2 & no proteinuria, whose father is black, mother white,is admitted to a hospital,based on her physical appearance she may be labelled black by her clinician. #NephJC |
| Joel M. Topf, MD FACP @kidney_boy @Kat1eJones @AmakaEMD @thenephrologist @NephJC from the methods of MDRD it sounds like it was self reported #NephJC https://t.co/c32tv2sEBb |
| Sophia Kostelanetz, MD MPH @SKostelanetz @thenephrologist @NephJC The studies sited for muscle mass are very poor, and this has been refuted by Hsu et al. One of 3 prior cited studies include looking at poor AA children in the deep south in the 70s, with conclusions about lower body fat! #NephJC |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @NephJC Interesting, and suggests that the race correction is really shorthand for factors not easily assessed in clinical practice. I think the punchline is as @gratefull080504 said, and what we’ve all realized: we need better markers of kidney function than creatinine. #NephJC |
| Bea Concepcion @KidneyBea_n RT @AmakaEMD: @thenephrologist @NephJC Great question - how is race determined? If it's not in the medical record (and how does it get there in the first place), are people just making judgement calls? #NephJC |
| Amaka Eneanya, MD, MPH @AmakaEMD @Kat1eJones @thenephrologist @NephJC Nope - think of the administrative clerk or nurse that is doing assessments of patients that hit the emergency room and may be obtunded. #NephJC |
| David Santos @DavidSa37565535 What other options are available to estimate filtration apart from those formulas? #nephjc |
| Gates Colbert, MD @DoctorGates @BeheraVineet @AmakaEMD @thenephrologist @NephJC #nephjc https://t.co/pMqCgZmVzy |
| Nephrology Journal Club @NephJC Alternatively if she were asked to self identify her race, would in no way know that her answer would affect her organ function assessment . What would you do in this situation? Ask or assume? #NephJC |
| Charbel C Khoury @Charbel_Khoury Unfortunately most of the time clinicians are making the decision for the patient on their race. #Nephjc |
| Amaka Eneanya, MD, MPH @AmakaEMD @BeheraVineet @thenephrologist @NephJC Exactly! #NephJC #Questionsthatneedanswers |
| Dr. “Dad” MD, FAAP, FASN @DrRayMD This is indeed the CORE problem with using "race" as a variable in this case. Race is a subjective, social construct. #NephJC |
| Sophia Kostelanetz, MD MPH @SKostelanetz @NephJC In this same vein, at what GFR would Obama be eligible for a kidney transplant? #NephJC |
| indy_med @indy_med RT @NephJC: Tonights discussion is different from the ones we’ve had before. This article is a viewpoint on the Consequences of using race to estimate kidney function https://t.co/yVhAI8SS5V @JAMA_current #NephJC |
| Dr. Vanessa Grubbs (she/her) @thenephrologist @NephJC Agree—there is no *standardized* way to include race. To use race as a biomarker is to reinforce beliefs that blacks are somehow different than every other human on the planet. It seems lost on most that original study only included people who identified as white or black.#NephJC |
| Nephrology Journal Club @NephJC About 3% of the US population and upto a third in countries such as Brazil identify themselves as mutliracial. How does one calculate eGFR of a pt if she’s biracial,refuses to answer the question or identifies with a race different than medically recorded?? Thoughts? #NephJC |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @JamesNovakNeph @NephJC I hope that @medibeacon + FAST Biomedical are ensuring that people of color are represented proportionally to the occurrence of #kidneydisease If not, then we are not learning from our past mistakes + serving the people with #kidneydisease #nephJC |
| Joel M. Topf, MD FACP @kidney_boy @DrRayMD yet this variable social construct predicted increased GFR for a given serum creatinine. #NephJC |
| Janewit Wongboonsin, MD, MS @janewitwong As all lab have their own problem, switching to another 'correction' may ended up the same result. Are there attempts to use dynamic/mixture of parameters to determine these important decisions point, instead of using just 1 lab? #nephjc |
| Charbel C Khoury @Charbel_Khoury Absolutely! Keeping in mind that creatinine will lead to underestimation of the gfr at times, I’ve had a well built FBI agent who would have job limitation based on a creatinine based GFR, cystatinC and B2M correctes it #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @SKostelanetz @NephJC Or Kamala Harris? Indian = lower Caribbean = higher 🤷🏽♂️ #NephJC |
| Bea Concepcion @KidneyBea_n In what scenarios in clinical practice do you get a cystatin C or a 24 hour urine? #nephjc |
| Nephrology Journal Club @NephJC Estimated GFR equations have major consequences - essential medications are withheld or administered at lower doses in pts with a low eGFR. KDIGO recommends a nephrology consult if eGFR <30. #NephJC |
| Nephrology Journal Club @NephJC @SKostelanetz Exactly why using race is a problem #nephJC |
| Tiffany Caza @Tiff_Caza @NephJC Would self identification be more accurate, rather than assuming as they may know their ancestry? #NephJC |
| Ian McCoy, MD, MS @NephroNinja @SKostelanetz Good question. I guess the only way to decide would be to survey providers and computers on patient race, then plug them into the equations and see if the providers or the computers estimates are closest to measured GFRs. #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @thenephrologist @NephJC Though ~ 8% unaccounted for #NephJC https://t.co/0hnWyn6srM |
| Nephrology Journal Club @NephJC If the above hypothetical patient were considered black , her eGFR would be 33 and if white would be 28 (below the threshold of referral) #NephJC |
| Anitha Vijayan @VijayanMD @gratefull080504 @JamesNovakNeph @NephJC @medibeacon Medibeacon is testing device on patients with various skin colors to ensure accuracy.#nephjc |
| Amaka Eneanya, MD, MPH @AmakaEMD @NephJC And what if they decline identifying their race? #NephJC |
| Gary Singer @GarySingerMD@med-mastodon.com @GarySingerMD @DrRayMD Agree and issues related to biracial, multiracial and geographic (USA - North vs South, Africa, Asia) differences #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @KidneyBea_n: In what scenarios in clinical practice do you get a cystatin C or a 24 hour urine? #nephjc |
| Dr. “Dad” MD, FAAP, FASN @DrRayMD @Kat1eJones @AmakaEMD @thenephrologist @NephJC Such self-reporting only trades one reporter's subjectivity for the other's. What do we do with mixed-race patient? Who determines the veracity of their chosen grouping? Too much subjectivity for a variable involved in such fundamental calculations. #nephJC |
| Joshua Waitzman, MD PhD @Jwaitz @NephJC In the absence of evidence, maybe we should just pick "selfishly" for the pt: If listing for transplant, declare the patient non-African American and start accruing time. If deciding on biopsy, declare AA, give benefit for potential salvageable parenchyma and go for it. #nephjc |
 | JL Gabzenn @NephCCM RT @edgarvlermamd: Mis-applications of commonly used KIDNEY EQUATIONS - MDRD, GFR, FENa #Nephpearls #NephJC 👉🏼 https://t.co/fabUedbvCa https://t.co/qgF1n7TIp1 |
| JL Gabzenn @NephCCM RT @edgarvlermamd: Reconsidering the Consequences of Using Race to Estimate Kidney Function ca. 2019 from @JAMA_current #NephJC #Nephpearls #VisualAbstract by @krithicism 👉🏼 https://t.co/iGJkWora3a https://t.co/sxVQgCPSHY |
| Nephrology Journal Club @NephJC @Tiff_Caza But how would a mixed race individual identify oneself? #nephjc |
| Annabel Biruete 🇲🇽 @anniebelch @gratefull080504 @JamesNovakNeph @NephJC @medibeacon I will ask, from what I heard it is on phase 3 I believe #NephJC |
| Nephrology Journal Club @NephJC In addition, since most clinical trials exclude patients with decreased kidney functions, she would be included if she were considered black and excluded if white. #NephJC |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd CKD-EPI ca. 2009 #NephJC #Nephpearls 👉🏼 https://t.co/vi5pu2q6fv 👉🏼 https://t.co/jJCUI5s8TW https://t.co/YLpFl8FNPR |
| Nephrology Journal Club @NephJC If this hypothetical patient were encountered 5 years later with a creatinine of 2.8, her eGFR would be 18 if white and 21 if black which means that for the same creatinine, the black woman would not qualify for the transplant waitlist. #NephJC https://t.co/EaLHMDFVZi |
| Nephrology Journal Club @NephJC @Tiff_Caza Are African Americans the same as africans elsewhere ? Say Caribbean or North Africa ? #nephJC |
| Anitha Vijayan @VijayanMD @NephJC And unfortunately with MDRD, race can determine if your GFR is 33 or 29. #nephjc |
| Vineet Behera @BeheraVineet RT @edgarvlermamd: CKD-EPI ca. 2009 #NephJC #Nephpearls 👉🏼 https://t.co/vi5pu2q6fv 👉🏼 https://t.co/jJCUI5s8TW https://t.co/YLpFl8FNPR |
| Vipin Varghese @vipvargh RT @edgarvlermamd: Reconsidering the Consequences of Using Race to Estimate Kidney Function ca. 2019 from @JAMA_current #NephJC #Nephpearls #VisualAbstract by @krithicism 👉🏼 https://t.co/iGJkWora3a https://t.co/sxVQgCPSHY |
 | Wisit Cheungpasitporn MD FACP | FASN | FAST @wisit661 RT @NephJC: If you aren’t familiar with them already, check out this code of conduct put together by #NephJC community @Nephro_Sparks and @SLeonMD https://t.co/b3Y4ALpGit https://t.co/xpk0LG6PbR |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @Peralta_KHRC When I was seeing my primary care physician he said that my kidney function was fine #ADPKD now uses Total Kidney Volume as biomarker to assess kidney function It has stimulated increased pharma investment because of improved diagnostic tool #nephJC |
| Joel M. Topf, MD FACP @kidney_boy @Peralta_KHRC Cuystatin c formulas still have adjustments,ents for race #NephJC https://t.co/U3PtNS0uD0 https://t.co/xlDkATxbbU |
| Eric Au @ericau @janewitwong Or maybe a more direct measure of GFR e.g. with a nuclear medicine GFR scan? #nephJC |
| David Santos @DavidSa37565535 @NephJC @Tiff_Caza in the clinical records of my country to define our own race we define it as "mestizo" #nephjc |
| Vineet Behera @BeheraVineet RT @kidney_boy: @Peralta_KHRC Cuystatin c formulas still have adjustments,ents for race #NephJC https://t.co/U3PtNS0uD0 https://t.co/xlDkATxbbU |
| Sophia Kostelanetz, MD MPH @SKostelanetz @NephJC @Tiff_Caza South Africa and Brazil have mixed race populations. Both do not use the race correction. How are US AA different? #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @Tiff_Caza @NephJC Nope! Who exactly knows this? #NephJC |
| Nephrology Journal Club @NephJC This according to the author may perhaps be the most concerning implication of using race in eGFR equations - reducing access to transplant. Do you agree? #NephJC |
| Charbel C Khoury @Charbel_Khoury Not the B2M formula though #Nephjc @ChristosArgyrop |
| Dr. Vanessa Grubbs (she/her) @thenephrologist I have a brother who is ebony in color. I’ve been mistaken for Indian (native & south Asian) when I wore my hair straight. Does “if AA” eGFR apply to both of us? What if I told u we had same parents? (As we do) #nephJC |
| Dr. “Dad” MD, FAAP, FASN @DrRayMD @Tiff_Caza @NephJC Don't forget: "ancestry" and "race" are not the same! #nephjc |
| Dr. “Dad” MD, FAAP, FASN @DrRayMD RT @thenephrologist: I have a brother who is ebony in color. I’ve been mistaken for Indian (native & south Asian) when I wore my hair straight. Does “if AA” eGFR apply to both of us? What if I told u we had same parents? (As we do) #nephJC |
| Charbel C Khoury @Charbel_Khoury I didn't know that, it's a great point #Nephjc |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @KidneyBea_n I just ordered both to confirm what I thought was a high GFR in an 18-year-old man with no significant medical history and a creatinine of 1.2-1.4 mg/dL. #NephJC |
| L. Parker Gregg @LParkerGregg1 RT @SKostelanetz: @NephJC @Tiff_Caza South Africa and Brazil have mixed race populations. Both do not use the race correction. How are US AA different? #NephJC |
| Nephrology Journal Club @NephJC @ericau @janewitwong Isn't that also subjective? #nephJC |
| Sophia Kostelanetz, MD MPH @SKostelanetz @NephJC @Tiff_Caza We do not use race-based GFR in children (e.g. Vanderbilt uses Schwartz). Does something different happen to GFR when you turn 18? #NephJC |
| Joshua Waitzman, MD PhD @Jwaitz @ericau @janewitwong At the end of the day, we're just doing tests until we get a number that better suits our purpose. I'm guilty of doing this too with 24 hr CrCl. We should accept that these eGFR numbers have inherent error. #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @Jwaitz @NephJC What do you do for drug dosing? Accurate matters more than higher or lower being better sometimes! #NephJC |
| Joel M. Topf, MD FACP @kidney_boy @NephJC because we do not let people qualify for transplant based on serum creatinine because we all know that an unadjusted serum creatinine is a shit predictor of GFR and GFR is the marker that best summarizes kidney disease. #NephJC |
| Janewit Wongboonsin, MD, MS @janewitwong @ericau I am looking forward to read about @medibeacon here. Transdermal GFR VS nuclear scan. Still though, it is another lab; therefore, would be subjected to their own limitation #nephjc |
| Gates Colbert, MD @DoctorGates @NephJC What if we just start using proteinuria as our severity marker? It hits all comers. (goes to hide behind a tree, peeks back) #NephJC |
| Nephrology Journal Club @NephJC The authors report that supporters of the status quo may affirm that taking into account race enable precision in eGFR but historical mistreatment of racial minority argue that race based treatment needs strong justification. #NephJC |
| Amaka Eneanya, MD, MPH @AmakaEMD @Jwaitz @NephJC This supports our notion that race is not used transparently in nephrology - in all medicine actually. #NephJC |
| Aisha Shaikh @aishaikh @KidneyBea_n Typically in the elderly, in paraplegic patients (we have a spinal cord injury unit in our hospital so most patients in that unit have very low serum creatinine) and in cirrhotic patients #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @kidney_boy @Peralta_KHRC The middle one does not, Joel #NephJC |
| Dr. Vanessa Grubbs (she/her) @thenephrologist Can we ask ourselves, why is it so important that we use phenotypic differences to suggest important genetic differences EVEN AFTER SEQUENCING THE ENTIRE HUMAN GENOME DID NOT FIT INTO OUR RACE CATEGORIES?? (I’m gonna keep retweeting this until real responses. ) #nephJC |
| Nephrology Journal Club @NephJC Using race is justified only if use confers benefit, benefit cannot be achieved by other approaches, pts who reject race categorization are accommodated fairly and use of race is transparent. #NephJC |
| Charbel C Khoury @Charbel_Khoury RT @thenephrologist: Can we ask ourselves, why is it so important that we use phenotypic differences to suggest important genetic differences EVEN AFTER SEQUENCING THE ENTIRE HUMAN GENOME DID NOT FIT INTO OUR RACE CATEGORIES?? (I’m gonna keep retweeting this until real responses. ) #nephJC |
| Joel M. Topf, MD FACP @kidney_boy @hswapnil @Jwaitz @NephJC What is selfish when neurosurgery needs an MRI and the GFR is 28 for non-black and 34 for black? #NephJC |
| Charbel C Khoury @Charbel_Khoury RT @thenephrologist: Can we ask ourselves, why is it so important that we use phenotypic differences to suggest important genetic differences EVEN AFTER SEQUENCING THE ENTIRE HUMAN GENOME DID NOT FIT INTO OUR RACE CATEGORIES?? (I’m gonna keep retweeting this until real responses. ) #nephJC |
| Tiffany Caza @Tiff_Caza @hswapnil @NephJC Good points by you and everyone. Was just thinking it'd be better than making an assumption, but it's flawed either way #NephJC |
| Vineet Behera @BeheraVineet Yes cystatin c will be helpful in these cases #nephJC |
| Eric Au @ericau @Jwaitz @janewitwong Yes I guess all tests have limitations and I agree we should accept and understand these inherent errors in clinical decision making. Have also had tests repeated to get a "better" result #nephjc |
| Nephrology Journal Club @NephJC Kidney function equations fail this test therefore warranting the need for new eGFR equations with objective variables like height , weight instead of race. #NephJC |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @DoctorGates @NephJC #KDIGO guidelines would suggest we use both eGFR and proteinuria as severity indicators. They have a nice heat map. #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @SKostelanetz @NephJC @Tiff_Caza Was Schwartz validated in all populations? (Asking our of ignorance) #NephJC |
| Dr. “Dad” MD, FAAP, FASN @DrRayMD *Yeah, I'm waiting for a serious answer to this question, too!* #nephjc |
| Joel M. Topf, MD FACP @kidney_boy RT @hswapnil: @kidney_boy @Peralta_KHRC The middle one does not, Joel #NephJC |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 #nephJC What is most disturbing from this conversation is that the evidence to have a higher GFR with African Americans does not appear to have a clear and established basis Why did it take so long to get to this point + how has this impacted people of color? Hmmm...... #nephJC |
| Amaka Eneanya, MD, MPH @AmakaEMD @DavidSa37565535 @NephJC @Tiff_Caza What eGFR do you then choose with this racial category? #NephJC |
| Gary Singer @GarySingerMD@med-mastodon.com @GarySingerMD @KidneyBea_n I will order creatinine clearance and Cystatin C in younger patients with large muscle mass (body builders) and higher than expected creatinine #NephJC |
| Sophia Kostelanetz, MD MPH @SKostelanetz RT @DrRayMD: *Yeah, I'm waiting for a serious answer to this question, too!* #nephjc |
| Nephrology Journal Club @NephJC The below figure illustrates how much higher eGFR would be if assigned black emphasizing the thresholds at which clinical decisions are made . #NephJC https://t.co/GeTx6wjJd7 |
| Joshua Waitzman, MD PhD @Jwaitz @kidney_boy @hswapnil @NephJC Based on the new canadian guidelines, the answer is it doesn't matter what your GFR is when you get an MRI. Right @Wagner_Nephro? (trolling, I know) #nephjc |
| Anitha Vijayan @VijayanMD @GarySingerMD @KidneyBea_n Same #nephjc |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd Race Adjustment for Estimating GFR Is Not Always Necessary ⁉️ ca. 2012 from @nephron_journal #NephJC #Nephpearls 👉🏼 https://t.co/CrNVLupQzM https://t.co/BCOCZU6GBY |
| Vineet Behera @BeheraVineet RT @edgarvlermamd: Race Adjustment for Estimating GFR Is Not Always Necessary ⁉️ ca. 2012 from @nephron_journal #NephJC #Nephpearls 👉🏼 https://t.co/CrNVLupQzM https://t.co/BCOCZU6GBY |
| Joel M. Topf, MD FACP @kidney_boy @gratefull080504 TYhey measured the correlation of iothalamate clearance to serum creatinine in nearly 3,000 African Americans for CKD-Epi #NephJC |
| Nephrology Journal Club @NephJC The CRIC study showed that race coefficient was reduced from 20 to 3.3% when body composition variables were added to the eGFR equation #NephJC https://t.co/dcCEupBKf4 |
| Dr. “Dad” MD, FAAP, FASN @DrRayMD I might add that this conversation is a case study in the power of 1) a forum such as @NephJC to foster discussion, 2) the field of nephrology w/colleagues genuinely interested in advancing this understanding, and 3) the value of #Diversity in medical research. @AmakaEMD #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @kidney_boy @NephJC True But using skin colour for GFR estimation may be OK at population/group level (studies) The variance at individual levels + lack of face validity of skin color suggests measuring may be better than estimating? #NephJC |
| Amaka Eneanya, MD, MPH @AmakaEMD @NephJC I'm biased but absofreakinglutely #NephJC |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @NephJC We need better tests period #nephJC |
| Dr. “Dad” MD, FAAP, FASN @DrRayMD RT @gratefull080504: #nephJC What is most disturbing from this conversation is that the evidence to have a higher GFR with African Americans does not appear to have a clear and established basis Why did it take so long to get to this point + how has this impacted people of color? Hmmm...... #nephJC |
| Sophia Kostelanetz, MD MPH @SKostelanetz @NephJC What is the patient perspective/perception on using race-based GFR? #NephJC |
| Joshua Waitzman, MD PhD @Jwaitz @hswapnil @NephJC Two sig-fig measures of eGFR based on a single serum Cr give a false sense of accuracy. At some point you are just guessing 35 v 40. #nephjc |
| Nephrology Journal Club @NephJC @gratefull080504 Hence this article ! #nephJC |
| Gates Colbert, MD @DoctorGates @JamesNovakNeph @NephJC #NephJC https://t.co/tXXwlWSvUa |
| Joel M. Topf, MD FACP @kidney_boy @hswapnil @NephJC eGFR not being good at the individual level is true regardless of skin color #NephJC |
| Nephrology Journal Club @NephJC Further research is required to quantify benefits and harms of abandoning eGFR equation. For eg if race is excluded, black pts may have better access to transplant but may receive a lower antibiotic dose. #NephJC |
| Charbel C Khoury @Charbel_Khoury @NephJC Caveat though, height and weight are not the most accurate way to assess for body composition and creatinine generation #Nephjc point in case obesity sarcopenia, and the fact that CG, MDRD, and CKD-EPI have limitations with obesity |
| Tiffany Caza @Tiff_Caza @NephJC Great examples and very concerning. African Americans already have a lower donor pool (both for deceased and living related donors), so we should strive to reduce anything that would create a further disadvantage. #NephJC |
| Dr. Vanessa Grubbs (she/her) @thenephrologist @Tiff_Caza @hswapnil @NephJC Assumptions is the new “paper bag test.” I have a girlfriend who many have assumed was white. In spite of her blond hair & blue eyes, she asserts that she is black—b/c her parents were black, as were their parents. #howblackisblack #NephJC |
| Bea Concepcion @KidneyBea_n how often do you obtain a cystatin C or a 24-hour urine to see if a patient qualifies for tx referral? #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @Jwaitz @kidney_boy @NephJC @Wagner_Nephro Honestly - we shouldn’t be slavish for cutoffs at the threshold anyways irrespective of race #NephJC |
| Joshua Waitzman, MD PhD @Jwaitz @AmakaEMD @NephJC Agree 100%. Not that black patients need another barrier to transplant, but it really feels like CKD-EPI is placing one in their way. #nephjc |
| Nephrology Journal Club @NephJC If race is excluded, more black pts may be falsely labelled as having kidney disease leading to unnecessary treatment and anxiety. #NephJC |
| Gary Singer @GarySingerMD@med-mastodon.com @GarySingerMD @NephJC Does anybody use bioimpedance outside of clinical studies? #NephJC |
| Joel M. Topf, MD FACP @kidney_boy @NephJC Or less access to contrast for cardiac disease #Renalism intersects with #Racism #NephJC |
| Charbel C Khoury @Charbel_Khoury @NephJC Absolutely highly concerning, #NephJC |
| TEJAS PATEL MD, FACP, FASN @GenNextMD @Jwaitz @kidney_boy @hswapnil @NephJC @Wagner_Nephro Good luck getting affirmative response #nephjc 😃 |
| Amaka Eneanya, MD, MPH @AmakaEMD @gratefull080504 The impact is EXACTLY why we wrote this. It's time to scientifically look at the tradeoffs associated with using race in eGFR equations. The question is "Are the tradeoffs worth the precision?" #NephJC |
| Nephrology Journal Club @NephJC The eGFR equations may not be perfect, but do we have better alternatives ? Cystatin C which is independent of muscle mass & ethnicity? Or perhaps measuring 24 hour creatinine clearance instead?What do people think ? #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @NephJC Hey @AmakaEMD is our interpretation of figure correct? Found it hard to understand! Why not give eGFR for X-axis? #NephJC https://t.co/FACwDRYqOh |
| Joel M. Topf, MD FACP @kidney_boy @GarySingerMD @NephJC https://t.co/SYWZE7esbr #NephJC |
| Sophia Kostelanetz, MD MPH @SKostelanetz @NephJC How do you balance this with the possibility that they will have more appropriate access to care with one less barrier? Agree, more research needed to avoid yet another round of unintended consequences. #NephJC |
| Nephrology Journal Club @NephJC @KidneyBea_n 24 hour CrCl routinely I suppose #nephJC |
| Ian McCoy, MD, MS @NephroNinja @NephJC Is there really any nephrologist that treats an eGFR of 18 differently from an eGFR of 22? My understanding is that you can estimate GFR by any method you like (e.g., 24 hr urine collection, iothalamate, MDRD) for transplant accrual time purposes. Is this correct? #nephjc |
| Tiffany Caza @Tiff_Caza @gratefull080504 @NephJC Completely agree. We need improved biomarkers / clinical chemistry tests for more accurate prediction of renal function. #NephJC |
| Eric Au @ericau @gratefull080504 I thought it is the reasons why AA have higher GFR for the same Cr which is unclear - the equations were developed with accuracy in mind and so I thought the "correction factor" was added in to improve accuracy rather than with the intent to disadvantage anyone #nephjc |
| Dr. Vanessa Grubbs (she/her) @thenephrologist B/c America believes blacks are somehow inferior. Makes her feel better about all the wrongs. And nobody questions anything that resonates with what they believe. #realtalk #nephjc |
| Dr. “Dad” MD, FAAP, FASN @DrRayMD RT @AmakaEMD: @gratefull080504 The impact is EXACTLY why we wrote this. It's time to scientifically look at the tradeoffs associated with using race in eGFR equations. The question is "Are the tradeoffs worth the precision?" #NephJC |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @AmakaEMD and what is the evidence I grew up St.Louis Missouri so you always need to Show Me to convince me #nephJC |
| Dr. Vanessa Grubbs (she/her) @thenephrologist RT @DrRayMD: *Yeah, I'm waiting for a serious answer to this question, too!* #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @gratefull080504 That’s wrong. The difference in measured GFR is clear from MDRD and CKD-EPI studies Question is more about variance and identification of race #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @kidney_boy: @gratefull080504 TYhey measured the correlation of iothalamate clearance to serum creatinine in nearly 3,000 African Americans for CKD-Epi #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @kidney_boy: @hswapnil @NephJC eGFR not being good at the individual level is true regardless of skin color #NephJC |
| Nephrology Journal Club @NephJC Various studies have developed correction factors to CKD-EPI to make it applicable to their own population. Studies from Pakistan & Japan suggest tht the measured GFR is lower than the eGFR which is in contrast to the CKD-EPI validation suggesting 5% higher GFR in Asians. #NephJC |
| Nephrology Journal Club @NephJC @SKostelanetz Perception would vary if pts knew that their answer would affect the course of clinical care #nephJC |
| David Santos @DavidSa37565535 @AmakaEMD @DavidSa37565535 @NephJC @Tiff_Caza We usually use the white race option but sometimes the black race #nephjc |
 | Jim Myers @kidneystories RT @gratefull080504: #nephjc A lot of new faces...... again Very encouraging |
| Eric Au @ericau @gratefull080504 Though I understand it's difficult to define race and probably not the right or best way to tackle the problem as the article has pointed out #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @KidneyBea_n: how often do you obtain a cystatin C or a 24-hour urine to see if a patient qualifies for tx referral? #nephjc |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @NephJC No, not a 24-h CrCl. Spot serum and urine measurements have obvious advantages over 24-h urine collections, as for proteinuria assessment. #NephJC |
| Anitha Vijayan @VijayanMD @NephroNinja @NephJC Yes - but eGFR is commonly used as it is easy. #nephjc |
| Dr. Vanessa Grubbs (she/her) @thenephrologist @kidney_boy @gratefull080504 Are u @kidney_boy playing devil’s advocate, or do you really believe race is a valid scientific marker? #InquiringMinds #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @kidney_boy: @NephJC Or less access to contrast for cardiac disease #Renalism intersects with #Racism #NephJC |
| Joel M. Topf, MD FACP @kidney_boy RT @ericau: @gratefull080504 Though I understand it's difficult to define race and probably not the right or best way to tackle the problem as the article has pointed out #nephjc |
| Nephrology Journal Club @NephJC The author goes on to suggest that clinicians should discuss how race is used with their patients to more effectively engage in decision making. Is this something that you’re willing to do ? What are the pros and cons of this ? #NephJC |
| Gary Singer @GarySingerMD@med-mastodon.com @GarySingerMD @kidney_boy @NephJC Waiting for the @kidney_boy body comp GFR calculator ... #NephJC https://t.co/ZfOcxA5Hvw |
 | Alex Chang, MD, FASN, FAHA @alexchangmd @NephJC Routine use of cystatin could address this issue, but can it be the same price as creatinine? A more expensive cost to estimate GFR could result in other disparities #nephJC |
| Janewit Wongboonsin, MD, MS @janewitwong @NephJC @ericau I am using the analogy of, for example, MELD-Na in liver transplant listing. MELD-Na is better than MELD alone and is much better than Total bilirubin alone. It is an aggregate of lab. Avoiding the risk of limitation posed by one lab #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @ericau: @gratefull080504 I thought it is the reasons why AA have higher GFR for the same Cr which is unclear - the equations were developed with accuracy in mind and so I thought the "correction factor" was added in to improve accuracy rather than with the intent to disadvantage anyone #nephjc |
| Dr. Vanessa Grubbs (she/her) @thenephrologist Retweet #1 (as I’ve received no responses) |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @hswapnil Swapnil: Can you please expand your response? I forgot what you are responding to Thanks #nephJC |
| David Santos @DavidSa37565535 @NephJC @Tiff_Caza We do not have a clear parameter and there is always the feeling that this was probably not the option that should have been chosen #nephjc |
| Amaka Eneanya, MD, MPH @AmakaEMD @DavidSa37565535 @NephJC @Tiff_Caza Why? What is this assessment based on? #NephJC |
| Nephrology Journal Club @NephJC Although eGFR equations have helped clinicians care for kidney patients, the problems of racial classification have not been examined. #NephJC |
| Rachel Hilburg, MD @RachelHilburg question the article raises for me is not as much what to do about equations/GFR, but how can we put minds to progression risk, environmental factors, access to care, and ultimately do better at whatever "race" actually represented when these equations came about #nephJC |
| Bea Concepcion @KidneyBea_n RT @kidney_boy: @hswapnil @NephJC eGFR not being good at the individual level is true regardless of skin color #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @thenephrologist Whoah! You mean the developers of MDRD and CKD-EPI believed that? Or all the nephrologists using these equations believed that? Find it a stretch to say different GFR = inferior? #NephJC |
| Joel M. Topf, MD FACP @kidney_boy @gztvo @NephJC Oncology: What dose of chemo should we use? Nephro: Hold on while I do this test, this expensive send-out lab, and this 24-hour urine for Cr and urea to calculate a clearance. I'll tell you in a week. #NotRealistic #NephJC |
| Nephrology Journal Club @NephJC The author concludes that the value of racial labels should be measured and alternatives considered before committing to the same algorithms in the future. #NephJC |
| Dr. “Dad” MD, FAAP, FASN @DrRayMD @kidney_boy Doesn’t mean that the association is reliable, let alone fraught with unintended consequence. #NephJC |
| Sophia Kostelanetz, MD MPH @SKostelanetz @alexchangmd @NephJC Should calculate the cost of the difference in health disparity? The question with "cost", is always cost to whom. #NephJC |
| Dr. Vanessa Grubbs (she/her) @thenephrologist @Tiff_Caza @NephJC At the recent #ASNBRCU presenter spoke about how 85% of kidneys from black donors were INAPPROPRIATELY downgraded b/c of assumed APOL1 risk. This is why using race is so dangerous. It makes us lazy. Why not do real test that affects only 13% Afr.Ams? #NephJC |
 | Fitsum Asnakech Tilahun MD @fitse_t RT @NephJC: If this hypothetical patient were encountered 5 years later with a creatinine of 2.8, her eGFR would be 18 if white and 21 if black which means that for the same creatinine, the black woman would not qualify for the transplant waitlist. #NephJC https://t.co/EaLHMDFVZi |
| David Santos @DavidSa37565535 While a new formula that corrects errors is not validated, what are options to calculate eGFR without using Cystatin C? #nephjc |
| Joshua Waitzman, MD PhD @Jwaitz @hswapnil @thenephrologist Despite the known differences in GFR v eGFR based on country of origin, diet, paraplegic status, etc, the only one that plays into transplant time accrual is assoc w being black. I hadn't seen that before this paper, but I can see how black patients would see it this way. #nephjc |
| Nephrology Journal Club @NephJC Last few minutes, Any thoughts on this? Should we abandon race altogether in the eGFR equations? Or should we continue using existing equations? #NephJC |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @alexchangmd @NephJC Doesn't the accuracy justify the cost? It just seems like #kidneydisease patients have historically received the short changed with their patient care #nephJC |
| Eric Au @ericau @RachelHilburg Great point - how can we improve care to all patients regardless of race? #nephjc |
| Charbel C Khoury @Charbel_Khoury @GarySingerMD @NephJC Not in the US, however frequently used in some European and South American dialysis centers from what I understand, Fresenius has its own machine #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @gratefull080504 The MDRD and CKD-EPI studies demonstrated very clearly that GFR was different between the ‘races’ they studied see: Q is about whether this ‘race’ = skin color classification is valid & the implications #NephJC https://t.co/okkEscP1u3 |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @RachelHilburg: question the article raises for me is not as much what to do about equations/GFR, but how can we put minds to progression risk, environmental factors, access to care, and ultimately do better at whatever "race" actually represented when these equations came about #nephJC |
| Fitsum Asnakech Tilahun MD @fitse_t RT @NephJC: This according to the author may perhaps be the most concerning implication of using race in eGFR equations - reducing access to transplant. Do you agree? #NephJC |
| Joel M. Topf, MD FACP @kidney_boy @thenephrologist @gratefull080504 I really believe that eGFR works. Theses results are really impressive to me: https://t.co/AZq09xeHLb This is the ultimate validation eGFR predicts hospitalization, CV disease and death. I'm not willing to throw a tool like that away #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @alexchangmd: @NephJC Routine use of cystatin could address this issue, but can it be the same price as creatinine? A more expensive cost to estimate GFR could result in other disparities #nephJC |
| Amaka Eneanya, MD, MPH @AmakaEMD @NephJC We thought it was important to consider the alternative. Anxiety about disease diagnosis is a real phenomenon that should not be minimized. It's unclear how this could contribute to existing disparities. #NephJC. |
| Nephrology Journal Club @NephJC @kidney_boy @gztvo Maybe in selected situations such as transplant listing and HD initiation #nephJC |
| Joel M. Topf, MD FACP @kidney_boy @thenephrologist @gratefull080504 SO I believe in eGFR and race happens to be an input. #NephJC |
| Charbel C Khoury @Charbel_Khoury @NephJC I think we should continue our quest for more accurate kidney assessment for everyone as @Peralta_KHRC said (Likely and logically to be multi pronged- Kidney is too complicated Man!) #NephJC |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @NephJC To paraphrase Churchill: “CKD-EPI is the worst eGFR estimating equation, except for all the others.” What do the authors propose as an alternative? #NephJC |
| Eric Au @ericau @kidney_boy @gztvo @NephJC What would you do @kidney_boy ? Use whichever GFR number seems right and try and look out for under/over dosing esp when numbers are near critical (but prob also arbitrary) cut offs for drug dosing? #nephJC |
| Alex Chang, MD, FASN, FAHA @alexchangmd @hswapnil @gratefull080504 It’s just being used as an adjustment factor based off mathematical relationships to fit a line from research studies to estimate GFR better (on average). The problem is race is a social construct, Ill-defined and clearly can be offensive and confusing #nephJC |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @hswapnil Thank you and playing devil's advocate could the difference in environments play a factor as well.... diet, access to care etc #nephJC |
| Nephrology Journal Club @NephJC In summary, quoting Stevens LA et al “Racial differences in performance of creatinine-based estimating equation likely reflect geographic and ethnic differences rather than race per se. #NephJC |
| Dr. Vanessa Grubbs (she/her) @thenephrologist @kidney_boy @gztvo @NephJC Alternative: Let me give you this race-based drivel I just pulled out of a “study” that could do this patient harm. WE drive what is *standard.* As long as we continue accepting/defending the racist status quo, the longer it will take us to get to something valid. #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @JamesNovakNeph: @NephJC To paraphrase Churchill: @NephJC To paraphrase Churchill: “CKD-EPI is the worst eGFR estimating equation, except for all the others.” What do the authors propose as an alternative? #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @alexchangmd: @hswapnil @gratefull080504 It’s just being used as an adjustment factor based off mathematical relationships to fit a line from research studies to estimate GFR better (on average). The problem is race is a social construct, Ill-defined and clearly can be offensive and confusing #nephJC |
| Joel M. Topf, MD FACP @kidney_boy @DrRayMD agreed #NephJC |
| Nephrology Journal Club @NephJC Emphasis should be placed on investigation of filtration markers that may be less affected than creatinine by race and ethnicity” https://t.co/gs7DZMIUR4 #NephJC |
| TEJAS PATEL MD, FACP, FASN @GenNextMD @NephJC Race is stated by participant and subjective and there is no way to account for individuals who has more than one racial ancestry..should ask mean intake (meat non-meat, proportion or each..) which may affect eGFR too...#nephJC |
| Tiffany Caza @Tiff_Caza @thenephrologist @NephJC Great point. Genotyping takes time, which you wouldn't have in the deceased donor setting to know APOL1 risk allele status. So the increased points in the KDPI are often not justified. #NephJC |
| Charbel C Khoury @Charbel_Khoury @NephJC @Peralta_KHRC I think we should drop using race identifiers in our patient assessments, to limit our biases. Does it matter to our clinical management if our residents and fellows present the patient as a 80-yo AA/hispanic/arabic speaking/ person ? #NephJC |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd Evaluation of the CKD-EPI equation for estimating GFR in multiple ethnicities ca. 2011 from @Kidney_Int #NephJC #Nephpearls 👉🏼 https://t.co/kIZgG8tSCQ https://t.co/RSEOIvryx7 |
| Dr. “Dad” MD, FAAP, FASN @DrRayMD Once upon a time - in my imagination - I also did a study on 6000+ people where I demonstrated very clearly that population ice-cream consumption was related to heat stroke... limitations may have included the fact that the study was done conducted primarily in July ;-). #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @ericau @kidney_boy @gztvo @NephJC Indeed Stevens and Levey et al say so in their 2011 @Kidney_Int paper https://t.co/mpLRcjGLQp #NephJC Doesn’t sound like the words of people who are believe blacks are inferior - but of those who are trying their best to solve a vexing problem https://t.co/7e1Us9gpS9 |
| Nephrology Journal Club @NephJC Thank you for joining us today and contributing to this discussion #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @SKostelanetz @gratefull080504 Umm - the CKD-EPI validation from 2011 included a South African cohort and dis find a difference? See https://t.co/mpLRcjGLQp #NephJC |
| Dr. Vanessa Grubbs (she/her) @thenephrologist @hswapnil I know ur new to this concept @hswapnil but this is now #racism works— spout ideas of inferiority & put systems into place that reinforce it long enough and researchers don’t have to be blatantly racist. They just don’t have to question it. SAME DIFFERENCE. #NephJC |
| Aisha Shaikh @aishaikh @NephJC https://t.co/3pg1hiWPg5 #Nephjc |
| Dr. “Dad” MD, FAAP, FASN @DrRayMD @hswapnil @ericau @kidney_boy @gztvo @NephJC @Kidney_Int Agreed! No doubt these were *unintended* consequences. But they should be challenged/discussed in a healthy manner, especially when the variable being relied upon is inherently subjective (as we are here!). #nephJC |
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| Amaka Eneanya, MD, MPH @AmakaEMD @kidney_boy @gztvo @NephJC Is the incremental precision that race brings to the table worth using it? #NephJC |
| Nephrology Journal Club @NephJC @Peralta_KHRC Are you going to do that for all patients? Even for just drug dosing ? #nephJC |
| Eric Au @ericau RT @AmakaEMD: @kidney_boy @gztvo @NephJC Is the incremental precision that race brings to the table worth using it? #NephJC |
| TEJAS PATEL MD, FACP, FASN @GenNextMD @hswapnil @gratefull080504 Racial classification is not valid given subjectivity in reporting...race classification was constructed for completely different reason that dates back to Blumenbach #nephjc |
| Nephrology Journal Club @NephJC Thank you for your participation .Good night! #NephJC |
| Dr. Vanessa Grubbs (she/her) @thenephrologist @NephJC To suggest something is “affected by race/ethnicity” is to suggest race/ethnicity have biological meaning. I call bullshit! 💩💩💩 #NephJC |
| David Santos @DavidSa37565535 @AmakaEMD @NephJC @Tiff_Caza intuition maybe, you just have to choose one, there is no parameter #NephJC |
| Janewit Wongboonsin, MD, MS @janewitwong Is eGFR racist? A conclusion from nephrology journal club is as below. I have never thought about this issue before today. @umnmedresidency @VigneshWP @SongKevinY |
| Aisha Shaikh @aishaikh @NephJC Thank you! #nephjc |
| Nephrology Journal Club @NephJC @AmakaEMD @kidney_boy @gztvo Until we find a solution , do we have an inexpensive alternative ? #nephJC |
| Vipin Varghese @vipvargh RT @gratefull080504: #nephJC What is most disturbing from this conversation is that the evidence to have a higher GFR with African Americans does not appear to have a clear and established basis Why did it take so long to get to this point + how has this impacted people of color? Hmmm...... #nephJC |
| Amaka Eneanya, MD, MPH @AmakaEMD @hswapnil @ericau @kidney_boy @gztvo @NephJC @Kidney_Int I don't think any of the implications that we are now seeing were even remotely intentional. They developed these equations to best estimate kidney function at the population level. Their initial intentions should not dictate exploring this issue now. That's science. #NephJC |
| Janewit Wongboonsin, MD, MS @janewitwong @Peralta_KHRC Are there prior work that come up with something similar to MELD-Na in the prediction of ESRD outcome? #nephjc |
| Amaka Eneanya, MD, MPH @AmakaEMD @NephJC It was fun! Thanks for featuring our paper! #NephJC |
| Bea Concepcion @KidneyBea_n @NephJC @AmakaEMD eGFR is being reported as a range at the BIDMC, rather than eGFRAA and eGFR which is what we have in our lab #nephjc |
| Nephrology Journal Club @NephJC @AmakaEMD Thanks for joining us tonight @AmakaEMD ! #nephJC |
| Joel M. Topf, MD FACP @kidney_boy RT @AmakaEMD: @hswapnil @ericau @kidney_boy @gztvo @NephJC @Kidney_Int I don't think any of the implications that we are now seeing were even remotely intentional. They developed these equations to best estimate kidney function at the population level. Their initial intentions should not dictate exploring this issue now. That's science. #NephJC |
| Eric Au @ericau RT @AmakaEMD: @hswapnil @ericau @kidney_boy @gztvo @NephJC @Kidney_Int I don't think any of the implications that we are now seeing were even remotely intentional. They developed these equations to best estimate kidney function at the population level. Their initial intentions should not dictate exploring this issue now. That's science. #NephJC |
| Eric Au @ericau @KidneyBea_n @NephJC @AmakaEMD Very interesting! I wonder how/where they get the ranges from #nephjc |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 #nephJC My final comment + recommendation: I am not advocating to throw away GFR but I am advocating for advancement in improved tests if #precisionmedicine is the vision We will be unable to get there by still using EGFR as our only test 20 years from now #nephJC |
| Mohamed Mohamed Ahmed @Nephro_Mohamed (Emphasis should be placed on investigation of filtration markers that may be less affected than creatinine by race and ethnicity)#nephjc |
| Eric Au @ericau RT @gratefull080504: #nephJC My final comment + recommendation: #nephJC My final comment + recommendation: I am not advocating to throw away GFR but I am advocating for advancement in improved tests if #precisionmedicine is the vision We will be unable to get there by still using EGFR as our only test 20 years from now #nephJC |
| Dr. Vanessa Grubbs (she/her) @thenephrologist Retweet #2 b/c still no responses. |
| Dr. “Dad” MD, FAAP, FASN @DrRayMD RT @gratefull080504: #nephJC My final comment + recommendation: #nephJC My final comment + recommendation: I am not advocating to throw away GFR but I am advocating for advancement in improved tests if #precisionmedicine is the vision We will be unable to get there by still using EGFR as our only test 20 years from now #nephJC |
| Nephrology Journal Club @NephJC @KidneyBea_n @AmakaEMD Interesting ! #nephJC |
| Joel M. Topf, MD FACP @kidney_boy The numbers: 522 Tweets. 100 Participants. 2,533,326 Impressions. August 5th 2019. More #NephJC 📊 here https://t.co/ACSFNGZ2U1 via @symplur |
| Nephrology Journal Club @NephJC RT @kidney_boy: The numbers: The numbers: 522 Tweets. 100 Participants. 2,533,326 Impressions. August 5th 2019. More #NephJC 📊 here https://t.co/ACSFNGZ2U1 via @symplur |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @DrRayMD Sorry that analogy is silly MDRD CKDEPI 2009 CKD-EPI 2011 were derived and validated in multiple datasets You can disagree with premise of using race - but don’t say the study was flawed as ice cream I July 🤔 #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @AmakaEMD: @hswapnil @ericau @kidney_boy @gztvo @NephJC @Kidney_Int I don't think any of the implications that we are now seeing were even remotely intentional. They developed these equations to best estimate kidney function at the population level. Their initial intentions should not dictate exploring this issue now. That's science. #NephJC |
 | Malvinder Parmar @wittykidney @hswapnil @VijayanMD @Jwaitz @JamesNovakNeph @NephJC There are only 5 publications in pubmed showing de-indexed GFR, and only one in its title. #Nephjc you might have forgotten to put the link in your tweet🤔 https://t.co/wBtox1RUbV |
| Kevin J. Fowler Principal The Voice of the Patient @gratefull080504 @thenephrologist @kidney_boy @thenephrologist : To clear up confusion on my end what did I say to warrant this response I have been extremely blessed + I have advocated for all people to have the same opportunity as me or to level the playing the field #nephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @DrRayMD: @hswapnil @ericau @kidney_boy @gztvo @NephJC @Kidney_Int Agreed! No doubt these were *unintended* consequences. But they should be challenged/discussed in a healthy manner, especially when the variable being relied upon is inherently subjective (as we are here!). #nephJC |
| Dr. Vanessa Grubbs (she/her) @thenephrologist @kidney_boy @gratefull080504 So who has to be hurt before u would be willing to throw away a tool that contribute to #racedisparities in CKD? #NephJC |
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