#NephJC Transcript
Healthcare social media transcript of the #NephJC hashtag.
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See #NephJC Influencers/Analytics.
| Profile | Tweet |
|---|---|
 | Nephrology Journal Club @NephJC Welcome to tonight’s #NephJC. If you’ve ever stopped an ACEi/ARB during an AKI and wondered if and when to restart them and also whether that decision has any renal and mortality outcomes, today’s discussion should be fun. #NephJC |
 | Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: Welcome to tonight’s #NephJC. If you’ve ever stopped an ACEi/ARB during an AKI and wondered if and when to restart them and also whether that decision has any renal and mortality outcomes, today’s discussion should be fun. #NephJC |
 | Matthew Sparks, MD @Nephro_Sparks looking forward to the discussion. love/hate relationship with AngII. COI- 10 yrs in research lab with mouse models of AT1A-KO mice #nephjc |
 | Samira Farouk, MD, MSCR @ssfarouk Samira Farouk, transplant nephrologist @ISMMSKidney #NephJC |
 | Mario Funes, MD @MarioFunesMD Hello everyone! Mario Funes. PGY2 Internal Medicine in New Brunswick, NJ. No COI. #NephJC |
| Matthew Sparks, MD @Nephro_Sparks @MarioFunesMD Hi Mario #nephjc |
| Matthew Sparks, MD @Nephro_Sparks @SAHusainMD @ColumbiaKidney Hi Syed #nephjc |
| Mario Funes, MD @MarioFunesMD @Nephro_Sparks Hello! #NephJC |
 | Michelle Rheault @rheault_m @NephJC Michelle here. Ped Neph at UMN. COI in bio. Mostly lurking tonight. #nephjc |
 | James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph James Novak, @HFNephrology TPD and #NSMC intern 2018, no COI. #NephJC |
 | Eric Weinhandl @eric_weinhandl Eric Weinhandl, epi and biostats, @NxStage and UMN Pharmacy. I love retrospective pharmacoepi studies. #NephJC |
 | Nikhil Shah MBBS DNB(IM, Neph)🇨🇦 @dr_nikhilshah Nikhil Shah - Nephrologist @UAlbertaNeph - No CoI - #nephjc |
| Nephrology Journal Club @NephJC I am Sanjeev Nair @Nair_Sanj, a Nephrologist from Chennai & I’ll be your host this morning (tonight for all the Occidental folks). Welcome. #NephJC https://t.co/iyQkeDZ7c9 |
 | Hector Madariaga, MD FASN 🇲🇽 @HecmagsMD Hector Madariaga. Cambridge, MA. No COI. Hello, everyone! Looking forward to this exciting topic. 😃 #Nephjc https://t.co/rKNydaRYax |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil Swapnil Hiremath, from @ottawarenal No CoI Don't stop ACEi/ARB even in AKI #nephjc https://t.co/suvt8aJ0za |
| Matthew Sparks, MD @Nephro_Sparks Just want to state right out of the gate- please do not listen to anything I say tonight. All Tweets will be deleted at 10pm EST #nephjc |
 | Arvind Canchi (Conjeevaram)🇮🇳 @arvindcanchi Arvind Canchi, Nephrologist from Bangalore with my morning cuppa #nephjc. COI : I still use Acei + arb combo! https://t.co/YW0QRPcV0N |
 | Gates Colbert, MD @DoctorGates Dallas #Nephrologist. #NSMC. COI: Use ACEI/ARB everyday. Super biased on their benefits for patients. #nephjc |
| Matthew Sparks, MD @Nephro_Sparks @hswapnil @OttawaRenal don't believe it #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @eric_weinhandl Hey Eric - thanks for coming - hope you can shed more light on the stats tonight #nephjc |
| Nikhil Shah MBBS DNB(IM, Neph)🇨🇦 @dr_nikhilshah @hswapnil @OttawaRenal Really now... #nephjc |
 | Bea Concepcion @KidneyBea_n Hi all, Bea Concepcion, Tx Nephrologist @VUMCkidney, no COI #nephjc |
| Nephrology Journal Club @NephJC Glad u could make it @rheault_m @JamesNovakNeph @eric_weinhandl #nephjc |
 | Edgar V. Lerma 🇵🇭 @edgarvlermamd Edgar Lerma, Chicago-based Nephrologist #NephJC https://t.co/TKjW7ZgaJ6 |
 | Neesh Pannu @nipannu @dr_nikhilshah @hswapnil @OttawaRenal Just joining now - forgive my novice tweeting #nephjc |
| Nephrology Journal Club @NephJC Please introduce yourself and declare any COIs. Don’t forget the hashtag #NephJC |
| Nephrology Journal Club @NephJC Routine housekeeping out of the way first: We recommend you use native client in browser https://t.co/LkGCHautmO or Tweetdeck. Tchat will truncate tweets at 140 #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @Peralta_KHRC welcome Dr Peralta! Glad you could make it! #NephJC |
| Nephrology Journal Club @NephJC The paper in question is the ‘Association of Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Use With Outcomes After Acute Kidney Injury” from October’s @JAMAInternalMed https://t.co/ntbZrZGuS4 #NephJC |
| Matthew Sparks, MD @Nephro_Sparks and just FYI... @NephRodby did not take over my account #nephjc |
| Nikhil Shah MBBS DNB(IM, Neph)🇨🇦 @dr_nikhilshah RT @nipannu: @dr_nikhilshah @hswapnil @OttawaRenal Just joining now - forgive my novice tweeting #nephjc |
| Nephrology Journal Club @NephJC Hope some/all of the authors join us: @nipannu et al from @ICDC_Research #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil Author in the house! Mind your manners folks! #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: Routine housekeeping out of the way first: Routine housekeeping out of the way first: We recommend you use native client in browser https://t.co/LkGCHautmO or Tweetdeck. Tchat will truncate tweets at 140 #NephJC |
| Nikhil Shah MBBS DNB(IM, Neph)🇨🇦 @dr_nikhilshah Author in the house! @nipannu #nephjc |
| Nephrology Journal Club @NephJC This is a complex paper. But @Roxytonin’s excellent summary of this paper at https://t.co/F8rHO79bPV will help distil and sort your thoughts. #NephJC https://t.co/OKirOjvWRm |
 | Anna Burgner MD MEHP @anna_burgner Hi #nephjc!! Nephrologist @VUMCKidney no coi |
 | Mark Purcell @sparty_bean Mark Purcell, Greenville, SC, no COI #nephjc |
 | Angel Cesar Ortiz @AngelCesarOrtiz #NephJC Jajaja |
| Neesh Pannu @nipannu @hswapnil NO COI's to declare #nephjc |
 | Beje Thomas @bthomas215 Beje Thomas no COI #nephjc |
| Nephrology Journal Club @NephJC @dr_nikhilshah @UAlbertaNeph Hi @dr_nikhilshah Glad u could make it #nephjc |
| Nephrology Journal Club @NephJC @HecmagsMD Hi Hector #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: This is a complex paper. But @Roxytonin’s excellent summary of this paper at https://t.co/F8rHO79bPV will help distil and sort your thoughts. #NephJC https://t.co/OKirOjvWRm |
| Hector Madariaga, MD FASN 🇲🇽 @HecmagsMD @Nephro_Sparks But why?! 🤔 #Nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @sparty_bean welcome to #NephJC |
| Nikhil Shah MBBS DNB(IM, Neph)🇨🇦 @dr_nikhilshah @NephJC @UAlbertaNeph Its been some time but man, am i loving it to be back live!!! #nephjc |
| Nephrology Journal Club @NephJC HI @hswapnil #nephjc |
| Nephrology Journal Club @NephJC Welcome to #nephjc @Peralta_KHRC @DoctorGates @KidneyBea_n |
| Matthew Sparks, MD @Nephro_Sparks @nipannu @hswapnil welcome #nephjc |
 | Raymond Hsu @DrRaymondHsu Hi all nephrologist @ucsfnephrology #nephjc |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd Association of ACE-i or ARB use with outcomes after AKI ca. 2018 from @JAMA_current #Nephpearls #NephJC 👉🏼 https://t.co/sBNr7cPMY7 https://t.co/pmHQ6wkiqS |
| Nephrology Journal Club @NephJC Author in house ppl Welcome to #nephjc @nipannu |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @anna_burgner @VUMCKidney Hey Anna! #nephjc |
| Matthew Sparks, MD @Nephro_Sparks @sparty_bean Hi Mark #nephjc |
| Nephrology Journal Club @NephJC @edgarvlermamd good morning Edgar #Nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @DrRaymondHsu @UCSFNephrology Hey Ray - missed you at #KidneyWk #nephjc |
| Hector Madariaga, MD FASN 🇲🇽 @HecmagsMD @dr_nikhilshah @NephJC @UAlbertaNeph Who’s Nikhil? Just kidding, buddy. Good to hear from you 😃 #Nephjc |
| Nikhil Shah MBBS DNB(IM, Neph)🇨🇦 @dr_nikhilshah Hey @drseanbagshaw just saw you tweet - we are discussing AKI and the use of ACE/ARB after AKI - Neesh's JAMA paper - can you join? #nephjc https://t.co/6fEkybA2A1 |
| Matthew Sparks, MD @Nephro_Sparks @JamesNovakNeph @HFNephrology Hi Jamie #nephjc |
| Neesh Pannu @nipannu @NephJC Happy to be here #nephjc |
 | Rajesh rajan @rajeshrajan79 Hi Everyone, Rajesh Rajan, No COI #nephjc |
| Mario Funes, MD @MarioFunesMD @NephJC @nipannu Welcome to #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @rajeshrajan79 welcome to #NephJC |
| Nikhil Shah MBBS DNB(IM, Neph)🇨🇦 @dr_nikhilshah @HecmagsMD @NephJC @UAlbertaNeph Ha Ha!! I know - been a little busy - but now should be back for good!! Fingers crossed #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: Author in house ppl Welcome to #nephjc @nipannu |
| Nephrology Journal Club @NephJC WELCOME @AngelCesarOrtiz @bthomas215 @sparty_bean #nephjc |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd We do not yet know whether stopping RAAS blockade in stage 4 or 5 CKD improves outcomes ... await @STOPACEi_trial findings 📌 This was one of the controversies raised during @goKDIGO #KDIGOBPinCKD 🇬🇧 meeting #Nephpearls #NephJC 👉🏼 https://t.co/KMgogkWfVC https://t.co/xlUa2BIJGt |
 | Jay Koyner @jaykoyner hi nephjc lukring tonight - t here to learn a little about AKI from @nipannu COI- I am an AKI researcher and run a post-AKI clinic #nephjc |
| Nephrology Journal Club @NephJC Laurie @roxytonin showed that a creat rise after *starting* ACEi/ARB can be ominous - discussed on #NephJC here https://t.co/7ZVpF2sh2r |
| Matthew Sparks, MD @Nephro_Sparks 0.3 increase in creat #nephjc |
| Nephrology Journal Club @NephJC @Roxytonin But that doesn’t tell us if we should stop - or start - or restart ACEi/ARB after AKI #NephJC |
 | Suneel Udani @CaptainKidney79 Hello fellow nephrons. Mostly lurking tonight. Looking forward to interesting discussion #nephjc |
| Angel Cesar Ortiz @AngelCesarOrtiz Perlas. #NephJC |
| Nephrology Journal Club @NephJC @DrRaymondHsu @UCSFNephrology Welcome Raymond #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: @Roxytonin But that doesn’t tell us if we should stop - or start - or restart ACEi/ARB after AKI #NephJC |
| Nephrology Journal Club @NephJC RT @edgarvlermamd: Association of ACE-i or ARB use with outcomes after AKI ca. 2018 from @JAMA_current #Nephpearls #NephJC 👉🏼 https://t.co/sBNr7cPMY7 https://t.co/pmHQ6wkiqS |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @edgarvlermamd @STOPACEi_trial @goKDIGO However, a Chinese trial from 2005 showed that non-DM patients with Cr 3.5-5 and UPC >1 did better with benazepril 40 mg/d than without. #NephJC |
| Hector Madariaga, MD FASN 🇲🇽 @HecmagsMD @NephJC @Roxytonin Or “when” after AKI... #Nephjc |
| Nephrology Journal Club @NephJC @dr_nikhilshah @drseanbagshaw More the merrier..#nephjc |
| Suneel Udani @CaptainKidney79 Sorry, no COI (I’m a bit of newbie with this thing) #nephjc |
| Matthew Sparks, MD @Nephro_Sparks I think important point is the blood pressure. so much more going on than just creat changes #nephjc |
| Nikhil Shah MBBS DNB(IM, Neph)🇨🇦 @dr_nikhilshah Thanks, some other time!! Lets hope #Oilers win today. #nephjc |
| Nephrology Journal Club @NephJC Alright lets start with some background. T0: What is your usual clinical practice regarding ACEIs/ARBs in the AKI setting? Do you always stop? #NephJC |
 | Paul A Welling,@PAWellingMD@med-mastodon.com @PAWellingMD Better late than never. No COI here to learn about AKI, and give free Physiology consults #nephjc |
| Nikhil Shah MBBS DNB(IM, Neph)🇨🇦 @dr_nikhilshah RT @NephJC: Alright lets start with some background. T0: Alright lets start with some background. T0: What is your usual clinical practice regarding ACEIs/ARBs in the AKI setting? Do you always stop? #NephJC |
| Arvind Canchi (Conjeevaram)🇮🇳 @arvindcanchi RT @edgarvlermamd: Association of ACE-i or ARB use with outcomes after AKI ca. 2018 from @JAMA_current #Nephpearls #NephJC 👉🏼 https://t.co/sBNr7cPMY7 https://t.co/pmHQ6wkiqS |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @PAWellingMD welcome Paul! thanks for joining in #NephJC |
| Nephrology Journal Club @NephJC RT @edgarvlermamd: We do not yet know whether stopping RAAS blockade in stage 4 or 5 CKD improves outcomes ... await @STOPACEi_trial findings 📌 This was one of the controversies raised during @goKDIGO #KDIGOBPinCKD 🇬🇧 meeting #Nephpearls #NephJC 👉🏼 https://t.co/KMgogkWfVC https://t.co/xlUa2BIJGt |
| Nephrology Journal Club @NephJC @HecmagsMD @Roxytonin Tru that #nephjc |
| Nikhil Shah MBBS DNB(IM, Neph)🇨🇦 @dr_nikhilshah @NephJC Usual practice - stop/watch /restart #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil fellows always stop ACEi/ARB for AKI consults. I stealthily often restart....most stoppages unnecessary IMO (grade: expert opinion) #nephjc |
| Samira Farouk, MD, MSCR @ssfarouk @NephJC Usual practice is stop with low threshold to restart once clinical picture clearer #NephJC |
| Nephrology Journal Club @NephJC @PAWellingMD Welcome to #nephjc Paul |
| Nephrology Journal Club @NephJC RT @hswapnil: fellows always stop ACEi/ARB for AKI consults. I stealthily often restart....most stoppages unnecessary IMO (grade: fellows always stop ACEi/ARB for AKI consults. I stealthily often restart....most stoppages unnecessary IMO (grade: expert opinion) #nephjc |
| Angel Cesar Ortiz @AngelCesarOrtiz @NephJC Always... As a dogma #NephJC |
| Matthew Sparks, MD @Nephro_Sparks @hswapnil so creatinine increasing 4 -- 5---- 6 ---- you are starting back. interesting #nephjc |
| Nephrology Journal Club @NephJC Question 2 : If you do stop RAASi, at what point post recovery do you reconsider restarting these medications? #NephJC |
 | Graham Abra, MD @GrahamAbra Graham Abra here nephrologist, equal opportunity dialyzer, can’t stop, won’t stop the RAAS blockade #nephjc |
| Nephrology Journal Club @NephJC And once you restart ACEIs/ARBs post recovery, what is the usual practice regarding follow up for creatinine and Potassium? #NephJC |
| Matthew Sparks, MD @Nephro_Sparks i have a hard time lumping the 0.3 with the 4-5x increases. apples and oranges. #nephjc |
| Suneel Udani @CaptainKidney79 @NephJC Stop/watch and restart in outpatient follow-up. Have to prove that they will follow-up to monitor K, Cr. #nephjc |
| Arvind Canchi (Conjeevaram)🇮🇳 @arvindcanchi #nephjc |
| Nikhil Shah MBBS DNB(IM, Neph)🇨🇦 @dr_nikhilshah #nephjc |
 | Jeremie Lever, MD, PhD @JeremieLever MD/PhD student in grad school phase at UAB. First time participating in #nephjc !! AKI researcher |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @Nephro_Sparks hope you are going to delete that tweet ;-) If creat is rising despite stopping ACEi/ARB...#NephJC |
| Gates Colbert, MD @DoctorGates T0: I stop ACEI/ARB with AKI, usually suspend it so we can easily remember to restart when recovering or planning discharge. #nephjc |
| Jay Koyner @jaykoyner @hswapnil how does one restart a med stealthfuly in the day and age of EMR? #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @Nephro_Sparks: i have a hard time lumping the 0.3 with the 4-5x increases. apples and oranges. #nephjc |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph Oops...#NephJC |
| Graham Abra, MD @GrahamAbra @Nephro_Sparks @hswapnil Bold #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @JeremieLever welcome to #NephJC Jeremie! |
| Gates Colbert, MD @DoctorGates @NephJC I think this is a subjective call that will yield 100+ answers. I like the Cr to be near baseline and risk of HyperK resolved. #NephJC |
| Nephrology Journal Club @NephJC @Nephro_Sparks Important point...rather than specific numbers focus on the clinical scenario #nephjc |
| Matthew Sparks, MD @Nephro_Sparks @jaykoyner @hswapnil it is a dream... he is also giving contrast and NSAIDS #nephjc |
| Nephrology Journal Club @NephJC RT @CaptainKidney79: @NephJC Stop/watch and restart in outpatient follow-up. Have to prove that they will follow-up to monitor K, Cr. #nephjc |
| Nikhil Shah MBBS DNB(IM, Neph)🇨🇦 @dr_nikhilshah I agree - When does one start is bit of a challenge - I think it depends on why the patient was on ACEi/ARB in the first place. - What about you @nipannu #nephjc |
| Raymond Hsu @DrRaymondHsu Big pet peeve when fellows template in "avoid nephrotoxins, e.g. NSAIDS, ACEi/ARB, etc" LOL #nephjc |
| Graham Abra, MD @GrahamAbra @NephJC Labs in 1-2 weeks #NephJC |
| Nephrology Journal Club @NephJC @nipannu @dr_nikhilshah Dont forget to use #nephjc |
| Samira Farouk, MD, MSCR @ssfarouk @DoctorGates @NephJC Why near baseline? Even if AKI episode does not recover to baseline, data would suggest benefit with RAAS blockade #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @Nephro_Sparks now you are pushing your luck Sparky ...this is not #RenalJC #NephJC |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @NephJC One thing I’ve never understood is the race to restart the ACEi/ARB. These meds provide protection long-term, so what’s the hurry after an episode of AKI? On the other hand, the results from today’s study seem to cast a pall over even that practice...#NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @JamesNovakNeph: Oops...#NephJC |
| Hector Madariaga, MD FASN 🇲🇽 @HecmagsMD @NephJC My approach: Usually between 3-7 days (not evidence-base, obviously) #Nephjc |
| Neesh Pannu @nipannu @dr_nikhilshah I think this is what most of us do #nephjc |
| Nephrology Journal Club @NephJC @JeremieLever Welcome to #nephjc Jeremie. Glad to have you |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil QFT #NephJC |
| Matthew Sparks, MD @Nephro_Sparks OMG. #RenalJC is what it feels like for sure. #nephjc |
 | Pranav Garimella @pranavgarimella Pranav Garimella, @ucsdnephrology. no COI #NephJC Lurking while doing groceries |
| Matthew Sparks, MD @Nephro_Sparks People need to be patient and restart the meds 2 week checkup in my clinic. its going to be ok. #nephjc |
| Nephrology Journal Club @NephJC Next Q: At the risk of polarising the discussion even b4 we get started, where do you stand on “Sick day rules” - Evidence based practice that benefits pts or to quote @charlietomson “its a complex intervention that needs further evaluation not unthinking implementation”? #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @JamesNovakNeph: @NephJC One thing I’ve never understood is the race to restart the ACEi/ARB. These meds provide protection long-term, so what’s the hurry after an episode of AKI? On the other hand, the results from today’s study seem to cast a pall over even that practice...#NephJC |
| Raymond Hsu @DrRaymondHsu @hswapnil @jaykoyner is there evidence for potential harm of stopping ACE/ARB? #nephjc |
| Nephrology Journal Club @NephJC #NephJC https://t.co/3n6ZOr5Qvi |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd Quick #NephJC #Nephpearls poll: This poll will close in 24 hours ‼️ If you see are called to see an AKI in-patient (for acute rise in Creatinine), and they are on ACE-i or ARB, aside from the usual AKI work up, would you: |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @pranavgarimella @ucsdnephrology hey Pranav - welcome to #NephJC (missed you at #KidneyWk) |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: #NephJC https://t.co/3n6ZOr5Qvi |
| Nephrology Journal Club @NephJC This SR https://t.co/isAUcfvXfM by @roxytonin @charlietomson et al concluded that “There is no evidence of the impact of drug cessation interventions on AKI incidence during intercurrent illness in primary or secondary care” #NephJC |
| Matthew Sparks, MD @Nephro_Sparks I think if mild AKI and now threat of dialysis with good BP (or hypertension) I might be convinced to keep in going #nephjc |
| Nephrology Journal Club @NephJC This paper https://t.co/3Y1V7cFO3I from @roxytonin concludes that “Treatment with ACEI/ARB is associated with only a small increase in AKI risk while individual patient characteristics are much more strongly associated with the rate of AKI” #NephJC |
| Matthew Sparks, MD @Nephro_Sparks but if hypotension and AKI with threat of dialysis. I am stopping no matter what the study says. #nephjc |
| Suneel Udani @CaptainKidney79 IMO critical to remember that our patients do not have the dogged oversight of clinical trial subjects. If they can’t make it to a follow up appointment to have labs checked, do we really think that ACE-I/ARB is going to prevent their CKD progression? #nephjc |
| Nephrology Journal Club @NephJC @Roxytonin aka its not the *ACEi/ARB itself* - its the *patient who needs an ACEi/ARB* that is the true risk factor for AKI #NephJC |
| Arvind Canchi (Conjeevaram)🇮🇳 @arvindcanchi @NephJC @CharlieTomson Important advice this, the sick day rules. But consult your doc first on when to stop and when to restart. #nephjc |
| Graham Abra, MD @GrahamAbra I tell people to hold the RAAS on sick days and restart when taking PO reliably again #NephJC |
| Gates Colbert, MD @DoctorGates @ssfarouk @NephJC True they may not get to previous baseline. A better term would be the apparent nadir creatinine. #nephjc |
| Samira Farouk, MD, MSCR @ssfarouk @Nephro_Sparks I think key to stopping is to be vigilant to restart. Benefit unlikely to be lost after stopping for a few days or so inpatient #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @DrRaymondHsu @jaykoyner good Q. Not sure - but @methodsmanmd had ACEi/ARB in AKI as his #DreamRCT https://t.co/wtSkrBuY82 #NephJC |
| Nikhil Shah MBBS DNB(IM, Neph)🇨🇦 @dr_nikhilshah #nephjc |
| Neesh Pannu @nipannu @GrahamAbra Agreed #nephjc |
| Pranav Garimella @pranavgarimella @hswapnil @ucsdnephrology Thanks, yup I was really hoping to meet at #NephJC party, but couldn’t. That’s the problem with having #KidneyWk at home... don’t get a break from domestic chores! |
| Nephrology Journal Club @NephJC +1 #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: This SR https://t.co/isAUcfvXfM by @roxytonin @charlietomson et al concluded that “There is no evidence of the impact of drug cessation interventions on AKI incidence during intercurrent illness in primary or secondary care” #NephJC |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @Nephro_Sparks To that point, people often forget to restart the ACEi/ARB once the patient starts dialysis. FOSIDIAL and others showed LVH regression in HD patients with RAS blockade. #NephJC |
| Arvind Canchi (Conjeevaram)🇮🇳 @arvindcanchi @Nephro_Sparks That is a tad late in the day, me thinks.... #nephjc |
| Matthew Sparks, MD @Nephro_Sparks @ssfarouk let the dust settle. if you are going to restart then someone needs to see in 1-2 weeks post discharge. If they are my patient. I will do it #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil QFT #NephJC |
| Angel Cesar Ortiz @AngelCesarOrtiz RT @DrRaymondHsu: Big pet peeve when fellows template in "avoid nephrotoxins, e.g. NSAIDS, ACEi/ARB, etc" LOL #nephjc |
| Suneel Udani @CaptainKidney79 @NephJC @CharlieTomson Simple, rational rule that shouldn’t need a randomized trial for implementation. #nephjc |
| Hector Madariaga, MD FASN 🇲🇽 @HecmagsMD @Nephro_Sparks @hswapnil I’ve seen this dose prescribed by other docs... 🤨 #Nephjc |
| Jay Koyner @jaykoyner @hswapnil @DrRaymondHsu @jaykoyner @methodsmanmddont know of any harm from stopping not sure been looked at from a BP or hrt fucnt #nephjc |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @DrRaymondHsu They also call diuretics “nephrotoxins;” paradoxically, diuretics are “nephrosaviors” in venous congestion-mediated AKI (i.e, CHF). #NephJC |
| Arvind Canchi (Conjeevaram)🇮🇳 @arvindcanchi @Nephro_Sparks Oh no, I was saying that I stop early! #NephJC |
| Samira Farouk, MD, MSCR @ssfarouk @Nephro_Sparks Agree - but I think post-discharge inertia is a big problem for many #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @CaptainKidney79 @NephJC @CharlieTomson but with little evidence OTOH: It may be too late if stopped when sick Patients may be confused about which one to stop they may forget to restart good meds #NephJC |
| Jay Koyner @jaykoyner @jaykoyner @hswapnil @DrRaymondHsu but suspect lots of increased exposure to agents like hydralazine inits place ain't great #nephjc |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @HecmagsMD @Nephro_Sparks @hswapnil It’s a good proteinuria dose. Supramaximal ACEi/ARB decreases UPC without affecting BP or K. #NephJC |
| Hector Madariaga, MD FASN 🇲🇽 @HecmagsMD @DrRaymondHsu I usually list all the NSAIDs; trade name and generic...) 😬 #Nephjc |
| Arvind Canchi (Conjeevaram)🇮🇳 @arvindcanchi Great point. #Nephjc |
| Neesh Pannu @nipannu @ssfarouk @Nephro_Sparks This inertia was what we were trying to look at in fact. #nephjc |
| Nephrology Journal Club @NephJC Great points - moving on to T1 and methods. #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @Krystahllopathy welcome to #NephJC Krystal! |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @JamesNovakNeph: @DrRaymondHsu They also call diuretics “nephrotoxins;” paradoxically, diuretics are “nephrosaviors” in venous congestion-mediated AKI (i.e, CHF). #NephJC |
| Nephrology Journal Club @NephJC This was an observational cohort study using the Alberta Kidney Disease Network population based database, a resource 4 kidney disease research which uses lab data linked to a series of other administrative data sources. see more https://t.co/LA31VSIFIc #NephJC |
| Graham Abra, MD @GrahamAbra RT @edgarvlermamd: Quick #NephJC #Nephpearls poll: Quick #NephJC #Nephpearls poll: This poll will close in 24 hours ‼️ If you see are called to see an AKI in-patient (for acute rise in Creatinine), and they are on ACE-i or ARB, aside from the usual AKI work up, would you: |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @ssfarouk: @Nephro_Sparks Agree - but I think post-discharge inertia is a big problem for many #NephJC |
 | Viren Kaul, MD @virenkaul RT @DrRaymondHsu: Big pet peeve when fellows template in "avoid nephrotoxins, e.g. NSAIDS, ACEi/ARB, etc" LOL #nephjc |
| Eric Weinhandl @eric_weinhandl Part D-enrolled dialysis patients with ACEi use in Jan 2011: 24.9% Part D-enrolled dialysis patients with ACEi use in Dec 2015: 17.3% Is there a connection to stopping treatment after AKI? #NephJC |
| Angel Cesar Ortiz @AngelCesarOrtiz RT @NephJC: This paper https://t.co/3Y1V7cFO3I from @roxytonin concludes that “Treatment with ACEI/ARB is associated with only a small increase in AKI risk while individual patient characteristics are much more strongly associated with the rate of AKI” #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @jaykoyner: @jaykoyner @hswapnil @DrRaymondHsu but suspect lots of increased exposure to agents like hydralazine inits place ain't great #nephjc |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @Nephro_Sparks I thought it might have been from that Rajiv Agarwal study about lisinopril versus atenolol, both given tiw. New data are suggesting that beta-blockers are deleterious in the first 6 months of dialysis. #NephJC |
| Arvind Canchi (Conjeevaram)🇮🇳 @arvindcanchi @nipannu @ssfarouk @Nephro_Sparks For us, it is not so much the inertia as is the lack of follow up. The Pt does not return for follow up many a time. #nephjc |
| Nikhil Shah MBBS DNB(IM, Neph)🇨🇦 @dr_nikhilshah My concern about starting ACE/ARB just as the patient is leaving is - who is going to see the patient with labs in the next 2 weeks. #nephjc |
| Nephrology Journal Club @NephJC Adults ≥18 years Pts with AKI admitted b/w July 1, 2008 & March 31, 2013, or the first hospitalisation if there were many. AKI defined by comparing the peak hospital creatinine level to a baseline value taken as the mean serum creatinine in the 180 days before admission #NephJC |
| Viren Kaul, MD @virenkaul RT @NephJC: This paper https://t.co/3Y1V7cFO3I from @roxytonin concludes that “Treatment with ACEI/ARB is associated with only a small increase in AKI risk while individual patient characteristics are much more strongly associated with the rate of AKI” #NephJC |
| Nephrology Journal Club @NephJC The authors used a prescription database to assess medication use after discharge. Seems to be a validated method #NephJC |
| Neesh Pannu @nipannu @dr_nikhilshah This could be why a few studies have shown the benefit of nephrologist care post discharge #nephjc |
| Samira Farouk, MD, MSCR @ssfarouk @arvindcanchi @nipannu @Nephro_Sparks Not necessarily only nephrologist inertia - but often also from PMD side as they often see the patient first for follow up post discharge #NephJC |
| Nephrology Journal Club @NephJC RT @JamesNovakNeph: @Nephro_Sparks To that point, people often forget to restart the ACEi/ARB once the patient starts dialysis. FOSIDIAL and others showed LVH regression in HD patients with RAS blockade. #NephJC |
| Nikhil Shah MBBS DNB(IM, Neph)🇨🇦 @dr_nikhilshah RT @nipannu: @dr_nikhilshah This could be why a few studies have shown the benefit of nephrologist care post discharge #nephjc |
| Hector Madariaga, MD FASN 🇲🇽 @HecmagsMD @JamesNovakNeph @Nephro_Sparks @hswapnil When you reach that point for proteinuria control in patients, I usually add spironolactone first #Nephjc |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @Nephro_Sparks Do you think? I always thought there was something special about aldosterone blockade and LVH. #NephJC |
| Nikhil Shah MBBS DNB(IM, Neph)🇨🇦 @dr_nikhilshah @Nephro_Sparks Matt - 2nd tweet without #nephjc ?? |
| Nephrology Journal Club @NephJC @Krystahllopathy Hi Krystahl. Welcome to #nephjc. Do hit the follow button liberally. Lotsa great ppl here today |
| Nikhil Shah MBBS DNB(IM, Neph)🇨🇦 @dr_nikhilshah #nephjc |
| Nephrology Journal Club @NephJC RT @ssfarouk: @Nephro_Sparks Agree - but I think post-discharge inertia is a big problem for many #NephJC |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @HecmagsMD @Nephro_Sparks @hswapnil MRB is a great idea if BP is high, but hard to do if BP is too low on ACEi 40 mg/d. #NephJC |
 | VictorHugoG.Johnson @vikouerMD RT @NephJC: This is a complex paper. But @Roxytonin’s excellent summary of this paper at https://t.co/F8rHO79bPV will help distil and sort your thoughts. #NephJC https://t.co/OKirOjvWRm |
| Nephrology Journal Club @NephJC RT @nipannu: @ssfarouk @Nephro_Sparks This inertia was what we were trying to look at in fact. #nephjc |
| Graham Abra, MD @GrahamAbra @ccavanaugh87 @jaykoyner @hswapnil @DrRaymondHsu Super interesting. Kinda smells like renal dose dopamine... or Teen Spirit if one is a fan of 90s grunge rock #NephJC |
| Hector Madariaga, MD FASN 🇲🇽 @HecmagsMD @Krystahllopathy Welcome Krystahl to our #Nephjc Feel free to participate or ask questions |
| Neesh Pannu @nipannu @Nephro_Sparks @dr_nikhilshah stay tuned for the AFTER AKI study an RCT of follow up care after AKI currently underway in our fair province #nephjc |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd What are the risks and benefits of temporarily discontinuing medications to prevent AKI ⁉️ 📌 There is no evidence of the impact of drug cessation interventions on AKI incidence during intercurrent illness in primary/ secondary care #Nephpearls #NephJC 👉🏼 https://t.co/552bm8V0Jx https://t.co/brry6Vf5kz |
| Nephrology Journal Club @NephJC T1D: Groups: here it does get tricky for primary analysis (Table 2), grouped into ‘users’ and ‘non-users’ - for ACEi/ARB use *after* AKI hospitalization event #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @nipannu: @Nephro_Sparks @dr_nikhilshah stay tuned for the AFTER AKI study an RCT of follow up care after AKI currently underway in our fair province #nephjc |
| Matthew Sparks, MD @Nephro_Sparks @nipannu @dr_nikhilshah how bad is the AKI. and what is the protocol for blood pressure... very interesting study #NephJC |
| Nephrology Journal Club @NephJC T1E: For Table 3 analysis, they were grouped into ‘never users’ (reference) vs ‘prior users’ = ACEi/ARB stopped; ‘new users’= ACEi/ARB started; and ’continued users’ - ACEi/ARB not stopped #NephJC https://t.co/lE5uefQBCr |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: T1E: T1E: For Table 3 analysis, they were grouped into ‘never users’ (reference) vs ‘prior users’ = ACEi/ARB stopped; ‘new users’= ACEi/ARB started; and ’continued users’ - ACEi/ARB not stopped #NephJC https://t.co/lE5uefQBCr |
| Nephrology Journal Club @NephJC @eric_weinhandl Definitely is a limitation. #nephjc |
| Graham Abra, MD @GrahamAbra @pranavgarimella @LAwdishu Probably how it got burned into my psyche during med school, residence and glorious chiefdom @UCSDHealth #NephJC |
| Hector Madariaga, MD FASN 🇲🇽 @HecmagsMD @dr_nikhilshah Who will see them? PCP vs Nephrologist? Challenging when patient are discharged to rehab #Nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @eric_weinhandl @NephJC but that would be noise right? WOuld that bias the results you think? #NephJC |
| Matthew Sparks, MD @Nephro_Sparks @JamesNovakNeph https://t.co/74bWrGll9m here is Steve's cross transplant paper and we have a followup in the works looking at Cre Lox P deletion of AT1A in heart. #NephJC |
| Nikhil Shah MBBS DNB(IM, Neph)🇨🇦 @dr_nikhilshah #nephjc |
| Neesh Pannu @nipannu @NephJC @eric_weinhandl agreed - but its is a "real world study" in that sense #nephjc |
| Graham Abra, MD @GrahamAbra @HecmagsMD @dr_nikhilshah I overbook #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @nipannu: @NephJC @eric_weinhandl agreed - but its is a "real world study" in that sense #nephjc |
| Matthew Sparks, MD @Nephro_Sparks @SAHusainMD I agree with this #NephJC |
| Nephrology Journal Club @NephJC T1F: Note that the numbers in Table 2 and Table 3 are different - they are grouped differently - see our interpretation #NephJC https://t.co/CG7wGZwSUO |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: T1F: T1F: Note that the numbers in Table 2 and Table 3 are different - they are grouped differently - see our interpretation #NephJC https://t.co/CG7wGZwSUO |
| Nephrology Journal Club @NephJC T1G: The primary outcome was all-cause mortality. Secondary outcomes were hospitalisation for a renal cause, ESRD and a composite outcome of ESRD or sustained doubling of serum creatinine. Thoughts? #NephJC PIC6 |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @NephJC hey @nipannu - did we get this figure right? #NephJC |
| Eric Weinhandl @eric_weinhandl Challenging study design. "Use" could occur up to 6 mo after discharge, so the confounder set is temporally divorced from the date of treatment start/restart. Maybe the start/restart is confounded by new factors not measured. #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @eric_weinhandl: Challenging study design. "Use" could occur up to 6 mo after discharge, so the confounder set is temporally divorced from the date of treatment start/restart. Maybe the start/restart is confounded by new factors not measured. #NephJC |
| Matthew Sparks, MD @Nephro_Sparks that being said. I am aware of mouse model studies showing improved AKI with blockage. however now Ang II pressors studies showing improved kidney indices. so.... #NephJC |
| Nikhil Shah MBBS DNB(IM, Neph)🇨🇦 @dr_nikhilshah #nephjc |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @Nephro_Sparks Ah, I misunderstood your point. Yes, I would agree that AT2 blockade would be expected to provide cardiac benefits beyond those of direct-acting vasodilators in this context. #NephJC |
| Nephrology Journal Club @NephJC RT @eric_weinhandl: Challenging study design. "Use" could occur up to 6 mo after discharge, so the confounder set is temporally divorced from the date of treatment start/restart. Maybe the start/restart is confounded by new factors not measured. #NephJC |
| Neesh Pannu @nipannu @hswapnil @NephJC Your groupings are right - I don't have the paper in front of me so can't say if the numbers are #nephjc |
| Nikhil Shah MBBS DNB(IM, Neph)🇨🇦 @dr_nikhilshah RT @eric_weinhandl: Challenging study design. "Use" could occur up to 6 mo after discharge, so the confounder set is temporally divorced from the date of treatment start/restart. Maybe the start/restart is confounded by new factors not measured. #NephJC |
| Angel Cesar Ortiz @AngelCesarOrtiz RT @JamesNovakNeph: @Nephro_Sparks To that point, people often forget to restart the ACEi/ARB once the patient starts dialysis. FOSIDIAL and others showed LVH regression in HD patients with RAS blockade. #NephJC |
| Nephrology Journal Club @NephJC T2: Moving on to T2 to discuss the results #NephJC |
 | Poyan Mehr @poyanmehr Hi! Late and lurking. Biased against observational studies aiming to show causation. Otherwise not conflicted #nephjc |
 | devika nair md msci @devimol @SAHusainMD i agree as well. AKI definition also included need for dialysis due to AKI #NephJC |
| Nephrology Journal Club @NephJC T2A: Table 1 shows the baseline characteristics *before* propensity score matching: as you can see almost all covariates are different between users and non-users #NephJC https://t.co/8gexiwt2cJ |
| Nephrology Journal Club @NephJC T2B: The authors used propensity score matching to match the inherently different groups of ACEIs/ARBs users and non-users. You can read more about this statistical wizardry here https://t.co/z2TCRgVigR #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @devimol @SAHusainMD hey Devika! Welcome back to #NephJC |
| Nephrology Journal Club @NephJC T2C: eTable 2 shows covariates *after* propensity score matching - authors say balanced, but cardiovascular risks look different? #NephJC https://t.co/tSg2IrdK6S |
| Neesh Pannu @nipannu @eric_weinhandl we looked at the ACE/ARB as a time varying exposure and in sensitivity analysis looked at ACE/ARB within 90 days or after to get at this issue #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @NephJC Look at those p values! The power of large databases... #NephJC |
| Nikhil Shah MBBS DNB(IM, Neph)🇨🇦 @dr_nikhilshah RT @nipannu: @eric_weinhandl we looked at the ACE/ARB as a time varying exposure and in sensitivity analysis looked at ACE/ARB within 90 days or after to get at this issue #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: T2B: T2B: The authors used propensity score matching to match the inherently different groups of ACEIs/ARBs users and non-users. You can read more about this statistical wizardry here https://t.co/z2TCRgVigR #NephJC |
| Angel Cesar Ortiz @AngelCesarOrtiz RT @nipannu: @Nephro_Sparks @dr_nikhilshah stay tuned for the AFTER AKI study an RCT of follow up care after AKI currently underway in our fair province #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: T2C: T2C: eTable 2 shows covariates *after* propensity score matching - authors say balanced, but cardiovascular risks look different? #NephJC https://t.co/tSg2IrdK6S |
| Nephrology Journal Club @NephJC T2D: The adjusted hazard ratio (HR) for mortality associated with ACEI or ARB use after hospital discharge, compared with no ACEI or ARB use, was 0.85 (95% CI, 0.81-0.89). Thoughts? #NephJC https://t.co/IrOTNenhv8 |
| Matthew Sparks, MD @Nephro_Sparks I think we can all agree that Ang II is complicated and not one size fits all. It is a provocative study #nephjc |
| Neesh Pannu @nipannu @NephJC no difference in results using a standard regression modelling approach #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @nipannu: @NephJC no difference in results using a standard regression modelling approach #nephjc |
| Nephrology Journal Club @NephJC T2E: Mortality was lower - but why? Dunno, since AKI, congestive heart failure, hyperkalemia all *higher* in ACEi/ARB users #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @NephJC so starting or restarting ACEi/ARB judiciously is safe - and perhaps beneficial? #NephJC |
| Nephrology Journal Club @NephJC RT @hswapnil: @NephJC Look at those p values! The power of large databases... #NephJC |
 | Mayuri Trivedi @MayuriTrivedi80 RT @NephJC: T2B: T2B: The authors used propensity score matching to match the inherently different groups of ACEIs/ARBs users and non-users. You can read more about this statistical wizardry here https://t.co/z2TCRgVigR #NephJC |
| Nephrology Journal Club @NephJC T2F: Specifically for us, ESKD (defined as GFR < 15) was not much different with ACEI/ARB use (HR 0.96) #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @NephJC could it be residual confounding? ACEi/ARB stopped for a reason in patients who are too sick and dying? #NephJC |
| Neesh Pannu @nipannu @hswapnil @NephJC I think the primary conclusion is that for the most part its safe to start them back after AKI #nephjc |
| Nephrology Journal Club @NephJC T2G: There is also a subgroup analysis - GFR > 60 (vs < 60) and presence of HT (vs absence) had greater survival benefit with ACEi/ARB use #NephJC https://t.co/r7CdXsq2xc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @nipannu: @hswapnil @NephJC I think the primary conclusion is that for the most part its safe to start them back after AKI #nephjc |
 | Ross Nesbit @RossNesbit @NephJC Ross Nesbit, nephrologist at UT Medical Center in Knoxville. Super late and trying to catch up. No COI. But I’ll say that I’m a huge RAAS-I believer. And this data just proves their worth. We don’t use them for nothing. #nephjc |
| Nephrology Journal Club @NephJC T2H: No such interaction was seen for renal hospitalization see pic #NephJC https://t.co/YgciVaZCy5 |
| Matthew Sparks, MD @Nephro_Sparks @poyanmehr I can't see full paper right now... but really getting at hemodynamics and AKI subgroups/types of insults would be very interesting. #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @NephJC nice! @Nair_Sanj dived deep into the supplementary data! #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @eric_weinhandl @NephJC good question - any comments @nipannu? #NephJC |
| Ross Nesbit @RossNesbit @hswapnil @NephJC If the K is alright, normotensive, tolerating PO and Cr plateaued/downtrending? Start it back up. #nephjc |
| Neesh Pannu @nipannu @hswapnil @NephJC What we found striking is that the results matched for people that had prior vs no prior exposure if given ACE after AKI - this doesn't eliminate a confounding error but makes a more compelling argument that they might be doing something #nephjc |
| Raymond Hsu @DrRaymondHsu @NephJC hyperK & AKI higher in ACEi/ARB user is expected as they were more likely to have lab checks/utilization of care #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @nipannu: @hswapnil @NephJC What we found striking is that the results matched for people that had prior vs no prior exposure if given ACE after AKI - this doesn't eliminate a confounding error but makes a more compelling argument that they might be doing something #nephjc |
| Nephrology Journal Club @NephJC RT @hswapnil: @NephJC could it be residual confounding? ACEi/ARB stopped for a reason in patients who are too sick and dying? #NephJC |
| Nikhil Shah MBBS DNB(IM, Neph)🇨🇦 @dr_nikhilshah RT @nipannu: @hswapnil @NephJC What we found striking is that the results matched for people that had prior vs no prior exposure if given ACE after AKI - this doesn't eliminate a confounding error but makes a more compelling argument that they might be doing something #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil excellent point! #NephJC |
| Eric Weinhandl @eric_weinhandl So for those who actually do health care, do the widespread differences in Table 1 concern you? A lot of factors are very imbalanced. Does that suggest to you that many unmeasured factors are similarly imbalanced? #NephJC |
| Matthew Sparks, MD @Nephro_Sparks @RossNesbit @hswapnil @NephJC and ensure followup. #NephJC |
| Mario Funes, MD @MarioFunesMD It would be nice to see outcomes with different levels of rise in creatinine. May at a certain rise Cr risk outweigh the benefits of continue ACEi/ARB. #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @eric_weinhandl Table 1 is before matching...so expected - and somewhat concerning at the same time #NephJC |
| devika nair md msci @devimol @NephJC shows that decision to start/continue ACEi/ARB is definitely not "one-size-fits all." might need to find strategies to mitigate risk of renal-cause hospitalization in some of the above cases with a post-AKI f/u clinic #NephJC |
| Angel Cesar Ortiz @AngelCesarOrtiz RT @edgarvlermamd: Quick #NephJC #Nephpearls poll: Quick #NephJC #Nephpearls poll: This poll will close in 24 hours ‼️ If you see are called to see an AKI in-patient (for acute rise in Creatinine), and they are on ACE-i or ARB, aside from the usual AKI work up, would you: |
| Ross Nesbit @RossNesbit @Nephro_Sparks @hswapnil @NephJC Exactly. We hand deliver a BMP order to the patient when signing off. And have discharge contact for confirmation of BMP captured from our billing portion of EMR. #noBMPleftbehind #nephjc |
| Raymond Hsu @DrRaymondHsu @NephJC propensity matched fore pre-admission healthcare use not post #nephjc |
| Nephrology Journal Club @NephJC T2I: This was primary outcome analysis - lets see the secondary analysis, grouped by never use, prior use, new use, and continued use #NephJC https://t.co/vxJQGA9bNI |
| Nephrology Journal Club @NephJC T2J: This is in table 3. Note, numbers different since again the magic of propensity score matching used (but we don’t have details of the covariates in this matching) #NephJC |
| Poyan Mehr @poyanmehr @hswapnil @NephJC Only in those you consider it to be safe! (Wink wink, unmeasured confounders) #nephjc |
| Nephrology Journal Club @NephJC T2K: What does table 3 show? New use and continued use = good for survival compared to never use Prior use (ie stopping) worse for survival vs never use #NephJC https://t.co/hC5f6ccFxk |
| Jeremie Lever, MD, PhD @JeremieLever @Nephro_Sparks What is the clinical rationale for discontinuing ACEI/ARB during AKI? Is it nephrotoxicity? Are ACEI/ARB considered to be especially nephrotoxic drugs? #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: T2K: T2K: What does table 3 show? New use and continued use = good for survival compared to never use Prior use (ie stopping) worse for survival vs never use #NephJC https://t.co/hC5f6ccFxk |
| Matthew Sparks, MD @Nephro_Sparks @RossNesbit @hswapnil @NephJC you are a good physician. #YouCanTakeCareOfMyMom #NephJC |
| Nephrology Journal Club @NephJC T2L: Table 3 contd: interestingly, ESKD less with continued use - though hospitalization for renal cause higher with both continuous and new use #NephJC https://t.co/VpaNWlmyxu |
| Samira Farouk, MD, MSCR @ssfarouk Another issue to consider in light of this discussion - seems it is time to start being more aggressive with newer hyperK agents to force ACEi/ARB tolerance. Not only in CKD, but also in transplant patients on sulfa/trimethoprim #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: T2L: Table 3 contd: T2L: Table 3 contd: interestingly, ESKD less with continued use - though hospitalization for renal cause higher with both continuous and new use #NephJC https://t.co/VpaNWlmyxu |
| Nephrology Journal Club @NephJC T2M: Last table 4 - no difference if ACEi/ARB were prescribed within or after 90 days of hospitalization #NephJC https://t.co/AICQ0mx8w8 |
| Nikhil Shah MBBS DNB(IM, Neph)🇨🇦 @dr_nikhilshah RT @ssfarouk: Another issue to consider in light of this discussion - seems it is time to start being more aggressive with newer hyperK agents to force ACEi/ARB tolerance. Not only in CKD, but also in transplant patients on sulfa/trimethoprim #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil QFT #NephJC |
| Neesh Pannu @nipannu @NephJC remember that the followup time probably isn't sufficient for assessing the ESKD outcome #nephjc |
| Nephrology Journal Club @NephJC RT @nipannu: @NephJC remember that the followup time probably isn't sufficient for assessing the ESKD outcome #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @NephJC Table 3 was also after propensity matching, right @nipannu? We would have loved to see charactersitics of these 4 groups...#NephJC |
| Angel Cesar Ortiz @AngelCesarOrtiz Good point! Helping... ACEi/ARB tolerance #NephJC |
| Neesh Pannu @nipannu @hswapnil Always a risk with these retrospective cohort studies #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @nipannu @NephJC right - but you had lots of events! #NephJC |
| Nephrology Journal Club @NephJC T2N: Let’s take the issue of defining AKI: as @roxytonin points out #NephJc https://t.co/aqUlqvp2JG |
| Raymond Hsu @DrRaymondHsu It is quite odd that the secondary outcome of ESRD does not actually include initiation of maintenance dialysis #nephjc |
| Nikhil Shah MBBS DNB(IM, Neph)🇨🇦 @dr_nikhilshah RT @NephJC: T2N: Let’s take the issue of defining AKI: T2N: Let’s take the issue of defining AKI: as @roxytonin points out #NephJc https://t.co/aqUlqvp2JG |
| Neesh Pannu @nipannu @hswapnil @NephJC depends on how quickly we think ACE/ARBS work to prevent CKD progression as compared to competing risk of death #nephJC |
| Nephrology Journal Club @NephJC T2P: Then also consider: why was survival better with ACEi/ARB use? More CHF, more AKI - then what explains better survival? #NephJC |
| devika nair md msci @devimol RT @NephJC: T2N: Let’s take the issue of defining AKI: T2N: Let’s take the issue of defining AKI: as @roxytonin points out #NephJc https://t.co/aqUlqvp2JG |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @nipannu: @hswapnil @NephJC depends on how quickly we think ACE/ARBS work to prevent CKD progression as compared to competing risk of death #nephJC |
| Nephrology Journal Club @NephJC T2Q: BP typically falls in last few years of life, so ACEI/ARB deprescribing maybe appropriate & reverse causation? #NephJc |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd For inpatient AKI consults, I usually hold off 🛑 RAASi meds ... even if Crea starts to downtrend or gets near baseline levels, I usually don’t consider restarting RAASi meds “until after” I see them in my CKD Clinic 1-2 weeks later 🗓 (Opinion based) #NephJC #Nephpearls |
| Nephrology Journal Club @NephJC T2R: See this from @jamaim on BP trajectory in last 20 years #nephjc https://t.co/REaKbkqsEx |
| Ross Nesbit @RossNesbit @Nephro_Sparks Hard to argue with that strategy. Ensure the follow up/safety to restart without worrying about that potential hyperK out there going unchecked. #nephjc |
| Matthew Sparks, MD @Nephro_Sparks nice study @nipannu as you can see we all have alot to say about ACEi/ARBs so we are very happy you are studying this. #NephJC thank you for showing up and discussing a nice paper. congrats to the entire group |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @Nephro_Sparks: nice study @nipannu as you can see we all have alot to say about ACEi/ARBs so we are very happy you are studying this. #NephJC thank you for showing up and discussing a nice paper. congrats to the entire group |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @NephJC But, last table shows worse survival with ACEi/ARB resumed within 90 days. What would explain that? #NephJC |
| Nephrology Journal Club @NephJC @JAMAIM https://t.co/wRDGEXmIBP #NephJC |
| Neesh Pannu @nipannu @NephJC Given the markedly elevated risk of cardiovascular events after AKI my suspicion is that ACE/ARB is either a marker of care or it prevents cardiovascular events #nephjc |
| Matthew Sparks, MD @Nephro_Sparks @RossNesbit I just think we need people to step up to the plate and have followup upon discharge instead of just assuming someone else will do it. PostAKI care is important. #NephJC |
| Nikhil Shah MBBS DNB(IM, Neph)🇨🇦 @dr_nikhilshah And also thanks for carving out time to chat with everyone! #nephjc |
| Nephrology Journal Club @NephJC T2S: See more discussion points in @roxytonin excellent summary: https://t.co/F8rHO79bPV #NephJC |
| Neesh Pannu @nipannu @NephJC @JAMAIM thanks all - this was interesting! #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @JamesNovakNeph @NephJC good catch! Any comments on diff in survival after early ACEi/ARB start, @nipannu? (table 4) #NephJC |
| Samira Farouk, MD, MSCR @ssfarouk @Nephro_Sparks @RossNesbit Yes! And nephrologists need to be ACTIVE participants in the care plan #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @nipannu: @NephJC Given the markedly elevated risk of cardiovascular events after AKI my suspicion is that ACE/ARB is either a marker of care or it prevents cardiovascular events #nephjc |
| Matthew Sparks, MD @Nephro_Sparks @ssfarouk @RossNesbit #YouCanTakeCareOfMyMom #NephJC |
 | Samuel Silver 🇨🇦🇮🇱 @drsamsilver RT @Nephro_Sparks: @RossNesbit I just think we need people to step up to the plate and have followup upon discharge instead of just assuming someone else will do it. PostAKI care is important. #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @Nephro_Sparks @ssfarouk @RossNesbit but not me....you don't trust me Sparky #SulkingInACorner #NephJC |
| Neesh Pannu @nipannu @hswapnil @JamesNovakNeph @NephJC may speak to mechanisms of benefit - only RCT will tell us that #nephjc |
| Matthew Sparks, MD @Nephro_Sparks The numbers: 355 Tweets. 61 Participants. November 13th 2018. More #NephJC 📊 here https://t.co/OWAW78i69g via @symplur |
| Graham Abra, MD @GrahamAbra @ssfarouk Good question, the hyperK CKD pts on RAASi are a subgroup that deserve study, will giving them dual RAASi plus K binder improve outcomes? I smell a combo pill... #NephJC |
| Nikhil Shah MBBS DNB(IM, Neph)🇨🇦 @dr_nikhilshah #nephjc For me the important points were - 1) Stop/Watch/Restart 2) Pay attention to who follows up 3) Encourage restarting instead of letting it go - as there seems to be a benefit!! 4) Need to team up with PCP/community physicians 5) ACEi/ARBs - continue to be good |
| Nephrology Journal Club @NephJC Last few minutes: What’s your take home message? #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @nipannu @JamesNovakNeph @NephJC is there an RCT ongoing like this? #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: Last few minutes: Last few minutes: What’s your take home message? #NephJC |
| devika nair md msci @devimol @nipannu @NephJC agree - saw that 17% of the cohort had a CV-related cause of index hospitalization #NephJC |
| Mario Funes, MD @MarioFunesMD Great chat! Goodnight everyone! #NephJC |
| Graham Abra, MD @GrahamAbra RT @dr_nikhilshah: #nephjc For me the important points were - 1) Stop/Watch/Restart 2) Pay attention to who follows up 3) Encourage restarting instead of letting it go - as there seems to be a benefit!! 4) Need to team up with PCP/community physicians 5) ACEi/ARBs - continue to be good |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @NephJC I think @nipannu nailed it: ACEi/ARB use = likely marker of good care At least no safety signal that it makes things worse... #NephJC |
| Nephrology Journal Club @NephJC RT @dr_nikhilshah: #nephjc For me the important points were - 1) Stop/Watch/Restart 2) Pay attention to who follows up 3) Encourage restarting instead of letting it go - as there seems to be a benefit!! 4) Need to team up with PCP/community physicians 5) ACEi/ARBs - continue to be good |
| Nikhil Shah MBBS DNB(IM, Neph)🇨🇦 @dr_nikhilshah RT @hswapnil: @NephJC I think @nipannu nailed it: @NephJC I think @nipannu nailed it: ACEi/ARB use = likely marker of good care At least no safety signal that it makes things worse... #NephJC |
| Suneel Udani @CaptainKidney79 @Nephro_Sparks @RossNesbit Simple rule: if we stop a medicine (RAAS blockade, diuretics, even antibiotics), we have to be involved at least until it has been resumed safely (assuming still needed) or we have helped monitor response to alternative. Our duty is to the patient, not just their kidneys #nephjc |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @hswapnil @NephJC @nipannu Maybe we should wait at least 3 months to restart ACE/ARB after AKI, based on Table 4. #NephJC |
| Angel Cesar Ortiz @AngelCesarOrtiz @ssfarouk @Nephro_Sparks @RossNesbit @nefrocmnlr We should consider any of this strategies. Important to conclude about the following. We should see this inpatient AKI consults in few week later to consider restarting any meds. #NephJC |
| Suneel Udani @CaptainKidney79 RT @CaptainKidney79: @Nephro_Sparks @RossNesbit Simple rule: @Nephro_Sparks @RossNesbit Simple rule: if we stop a medicine (RAAS blockade, diuretics, even antibiotics), we have to be involved at least until it has been resumed safely (assuming still needed) or we have helped monitor response to alternative. Our duty is to the patient, not just their kidneys #nephjc |
| Ross Nesbit @RossNesbit @GrahamAbra @ssfarouk Or in this case, combo packets? 😉 #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @Nephro_Sparks @ssfarouk @RossNesbit Phew. I promise I won't give her contrast (unless needed)...or NSAIDs (unless really needed to avoid baclofen/tramadol). #NephJC |
| Nephrology Journal Club @NephJC RT @hswapnil: @NephJC I think @nipannu nailed it: @NephJC I think @nipannu nailed it: ACEi/ARB use = likely marker of good care At least no safety signal that it makes things worse... #NephJC |
| Nephrology Journal Club @NephJC If you haven’t, please sign up for our weekly newsletter https://t.co/5aumn8qL85 #NephJC |
| Matthew Sparks, MD @Nephro_Sparks @AngelCesarOrtiz @ssfarouk @RossNesbit @nefrocmnlr I always want to see them in a few weeks post discharge. It is always a gloriously fun visit. #NephJC |
| Nephrology Journal Club @NephJC Join my co-intern @stones_ for the EU chat tomorrow at 8 pm GMT #NephJC |
| Nephrology Journal Club @NephJC Goodnight everybody! #NephJC |
| Eric Weinhandl @eric_weinhandl ACEi/ARB use and beta blocker use are so intertwined in CKD-4/5. I'm not sure that pharmacoepi studies can assess one without simultaneously assessing the other. Covariate adjustment may not be enough. Unfortunately, such analysis is not easy. #NephJC |
| Matthew Sparks, MD @Nephro_Sparks @CaptainKidney79 @RossNesbit #YouCanTakeCareOfMyMom #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @eric_weinhandl: ACEi/ARB use and beta blocker use are so intertwined in CKD-4/5. I'm not sure that pharmacoepi studies can assess one without simultaneously assessing the other. Covariate adjustment may not be enough. Unfortunately, such analysis is not easy. #NephJC |
 | Sreejith Parameswaran @SreejithDr @arvindcanchi @NephJC I do stop in almost all instances of #AKI, but retstart at the earliest, once renal function recovers / stabilise #NephJC. |
| Nephrology Journal Club @NephJC Amen #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: If you haven’t, please sign up for our weekly newsletter https://t.co/5aumn8qL85 #NephJC |
| Ross Nesbit @RossNesbit @Nephro_Sparks @AngelCesarOrtiz @ssfarouk @nefrocmnlr I often tell people that: Will see them in office for follow up - and see them wearing regular clothes instead of a gown. #nephjc |
| Arvind Canchi (Conjeevaram)🇮🇳 @arvindcanchi @NephJC Excellent hosting of the #NephJC today @nair_sanj. Way to go!! |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil thanks everyone! @nipannu for joining in @sanj_nair for hosting this herd of sparky cats...and all of you #nephjc |
| Matthew Sparks, MD @Nephro_Sparks @RossNesbit @AngelCesarOrtiz @ssfarouk @nefrocmnlr it is great #NephJC https://t.co/AVWDgdYTU0 |
 | Raj Mehta @raj_mehta RT @edgarvlermamd: Association of ACE-i or ARB use with outcomes after AKI ca. 2018 from @JAMA_current #Nephpearls #NephJC 👉🏼 https://t.co/sBNr7cPMY7 https://t.co/pmHQ6wkiqS |
| Samira Farouk, MD, MSCR @ssfarouk @Nephro_Sparks @RossNesbit For anyone who watches @BritishBakeOff...the @Nephro_Sparks #YouCanTakeCareofmyMom is the new Paul Hollywood handshake #NephJC |
| Raj Mehta @raj_mehta RT @NephJC: The paper in question is the ‘Association of Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Use With Outcomes After Acute Kidney Injury” from October’s @JAMAInternalMed https://t.co/ntbZrZGuS4 #NephJC |
| Angel Cesar Ortiz @AngelCesarOrtiz RT @dr_nikhilshah: #nephjc For me the important points were - 1) Stop/Watch/Restart 2) Pay attention to who follows up 3) Encourage restarting instead of letting it go - as there seems to be a benefit!! 4) Need to team up with PCP/community physicians 5) ACEi/ARBs - continue to be good |
| Matthew Sparks, MD @Nephro_Sparks RT @NephJC: The paper in question is the ‘Association of Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Use With Outcomes After Acute Kidney Injury” from October’s @JAMAInternalMed https://t.co/ntbZrZGuS4 #NephJC |
| Matthew Sparks, MD @Nephro_Sparks @cjchiu @aoglasser @OHSUIMRes Asking... “should we stop the ACEi?” #NephJC |
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