#NephJC Transcript
Healthcare social media transcript of the #NephJC hashtag.
– ().
See #NephJC Influencers/Analytics.
| Profile | Tweet |
|---|---|
 | Nephrology Journal Club @NephJC Its 9 pm! Welcome to tonight’s discussion on mannitol in hemodialysis #NephJC https://t.co/uGGm6xJ3jV |
| Nephrology Journal Club @NephJC Your host tonight is @hswapnil from @OttawaRenal, so better make sure you have read the supplement https://t.co/NCNIyen6fG #NephJC |
| Nephrology Journal Club @NephJC Please introduce yourself & declare any conflicts of interest (COIs) & Don’t forget the hashtag, it’s #NephJC |
 | Edgar V. Lerma 🇵🇭 @edgarvlermamd Edgar Lerma, Chicago-based Nephrologist #NephJC Photo Credit: Barry Butler Photography 📸 https://t.co/eWMVI6KFon https://t.co/aWoW6g19BK |
 | Swapnil Hiremath @hswapnil@bsky.social @hswapnil Swap aka Swapnil Hiremath from @OttawasDofM #NephJC cofounder No CoI This handle for snarky tweets Pic from @jpeltzer https://t.co/GkrpRqrOtT |
 | Ian McCoy, MD, MS @NephroNinja Ian from Palo Alto. No COI. #Nephjc |
| Nephrology Journal Club @NephJC Ho Edgar, Mario and Ian! #nephjc |
 | Dr. Divya Bajpai 🇮🇳 @divyaa24 Hi Divya here from Mumbai. Excited to join a #NephJC chat hosted by @hswapnil No COI |
 | Harish Seethapathy @BetterCallSeeth Harish, Renal Fellow @MGHKidneys #NSMC Graduate! No COI. #NephJC |
| Nephrology Journal Club @NephJC PSA: Try the native client in browser (https://t.co/LkGCHacSvg) or Tweetdeck (Tchat will truncate your tweets at 140 characters) #NephJC |
 | Krithika Mohan @krithicism Hi ,this is Krithika Mohan, Nephrology fellow from India, no COI #NephJC |
 | nilu desai @niludesai1 Nilu Desai from case western, no coi #nephjc |
 | Jefferson L. Triozzi, M.D. @nepherson @NephJC Jefferson Triozzi, PGY-3, @BCM_InternalMed , no COI #NephJC |
 | Vipin Varghese @vipvargh Vipin Varghese tuning in from New Orleans! #NephJC |
 | Michelle Starr MD MPH @mcstarr1 Michelle Starr, pediatric nephrologist @IUPedsKidney - looking forward to the topic. No COI #nephjc |
| Nephrology Journal Club @NephJC Hi Divya and Harish - and Nilu, Jefferson and Krithika! Harish: anyone from @BWHKidney here? #nephjc |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd Hypertonic Mannitol for the Prevention of Intradialytic Hypotension: A Randomized Controlled Trial ca. 2019 from @AJKDonline @waikarss #NephJC #Nephpearls 👉🏼 https://t.co/N2wnomGUdl https://t.co/rshGBpoJ8a |
| Nephrology Journal Club @NephJC Tonight, we are discussing the pilot RCT from @AJKDOnline on mannitol in HD Link https://t.co/TXkykZhA6X #NephJC |
 | Mario Funes, MD @MarioFunesMD Mario Funes. PGY3 IM from New Jersey. 1 week till match day. No COI. #NephJC |
 | Vandana Dua Niyyar @vandyniyyar @NephJC #NephJC This is Vandana Niyyar. On call @ the hospital, so will be in and out. No COI other than previous research (a long time ago) with cool dialysate. |
 | Tiffany Caza @Tiff_Caza @NephJC Hey everyone! I'm Tiff, a member of pod ⚡ and a kidney pathologist. Looking forward to learning. No COI. Will probably be lurking. #NephJC |
| Nephrology Journal Club @NephJC @mcstarr1 @IUPedsKidney Hi Michelle! Hows attending year? You have been a publishing machine lately....#NephJC |
| Nephrology Journal Club @NephJC Abbreviations: IDH = intradialytic hypotension T1 will be methods and T2 results as always with a T3 as a free for all as always #NephJC |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd Check out this blog post written by @TrishaKPatelDO @ACMCIMRes #NephJC #Nephpearls Utility of Hypertonic Mannitol for the Prevention of Intradialytic Hypotension (IDH) https://t.co/HvojPy9QYo via @AJKDonline |
| Nephrology Journal Club @NephJC Vandana, Krystal and Tiffany! Thats a strong NSMC representation here tonight #nephjc |
 | Eric Au @ericau @NephJC Hi, Eric - nephrologist from Sydney. No COI. #NSMC 2019 intern #nephjc |
| Nephrology Journal Club @NephJC Haven’t read the paper? Check out the excellent summary from @Slatts_1 https://t.co/L6LWKatAC0 #NephJC |
 | Mo Alzubaidi @NephrosisMo Mo Alzubaidi joining from Columbia, SC. #nephjc https://t.co/Th5c41wqHa |
| Mario Funes, MD @MarioFunesMD RT @NephJC: Haven’t read the paper? Check out the excellent summary from @Slatts_1 https://t.co/L6LWKatAC0 #NephJC |
| Nephrology Journal Club @NephJC And the #VisualAbstract from @edgarvlermamd created for the @AJKDOnline blog from @TrishaKPatelDO https://t.co/sacZwwk3kY #NephJC https://t.co/dLkoLL8Q3A |
 | Kartik Kalra MD,FNKF,FASN @kkalra_22 Hello ! Kartik Kalra @kkalra_22 , Renal Fellow @PITTRenal . No COI. Looking forward to the discussion. #nephjc @NephJC |
| Michelle Starr MD MPH @mcstarr1 @NephJC @IUPedsKidney Attending life and the Midwest are both outstanding. Thanks for the support, fortunate that a few projects matched each other in timing! #nephjc |
| Nephrology Journal Club @NephJC Hi Mo, Vipin, Kartik and Eric! (what time is it there Eric?) #nephjc |
| Nephrology Journal Club @NephJC T0 warup twitter poll coming up #nephjc |
| Nephrology Journal Club @NephJC T0: What is your go to method for tackling intradialytic hypotension in HD? Twitter Poll time #NephJC |
| Eric Au @ericau RT @NephJC: T0: What is your go to method for tackling intradialytic hypotension in HD? Twitter Poll time #NephJC |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd Intradialytic Hypotension (IDH): Nadir SBP < 90 👉🏼 strongest association with ⬆️ mortality 📌 Poor long-term Outcomes 📌 ⬆️ mortality 📌 Myocardial stunning 📌 Incidence is highest in those with low pre-HD BP 📌 ⬆️ risk of access thrombosis #NephJC #Nephpearls https://t.co/nFN3sNI3gn |
 | Mohamed Mohamed Ahmed @Nephro_Mohamed @NephJC Hi , I am Mohamed|Transplant Fellow MUSC. No COI..#NephJC |
| Nephrology Journal Club @NephJC If you say midodrine, read this from @RenalFellowNtwk https://t.co/zkQrEBfXMZ #NephJC |
| Krithika Mohan @krithicism RT @edgarvlermamd: Intradialytic Hypotension (IDH): Intradialytic Hypotension (IDH): Nadir SBP < 90 👉🏼 strongest association with ⬆️ mortality 📌 Poor long-term Outcomes 📌 ⬆️ mortality 📌 Myocardial stunning 📌 Incidence is highest in those with low pre-HD BP 📌 ⬆️ risk of access thrombosis #NephJC #Nephpearls https://t.co/nFN3sNI3gn |
| Nephrology Journal Club @NephJC and @GregKnoll99 has shown albumin to not be very useful https://t.co/wcOiSXUZVr in @JASN_News #NephJC |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd Intradialytic Hypotension (IDH): Strategies to help prevent Hypotension during dialysis #NephJC #Nephpearls https://t.co/x3h1iUaOYf |
 | Aisha Shaikh @aishaikh Hi, Aisha from NYC. No COI. On In-patient service - finishing my notes. Will be lurking tonight #NephJC |
| Nephrology Journal Club @NephJC on cool dialysate we may have an answer in a few years from https://t.co/4OjWf2QpIl #NephJC |
| Nephrology Journal Club @NephJC Follow up T0: This paper in @CJASN https://t.co/vzKiK0yuE8 talks about all these strategies...but do we have any evidence? #NephJC https://t.co/sx09ub5NTY |
| Dr. Divya Bajpai 🇮🇳 @divyaa24 RT @edgarvlermamd: Intradialytic Hypotension (IDH): Intradialytic Hypotension (IDH): Strategies to help prevent Hypotension during dialysis #NephJC #Nephpearls https://t.co/x3h1iUaOYf |
| Nephrology Journal Club @NephJC @aishaikh hey Aisha - we need a tweetorial ion this topic later from the #NephJCKidneys MVP! #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: T0: What is your go to method for tackling intradialytic hypotension in HD? Twitter Poll time #NephJC |
| Nephrology Journal Club @NephJC anyone use mannitol routinely? Desperately? #nephjc |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd Intradialytic hypotension in an otherwise stable patient from @UpToDate #NephJC #Nephpearls https://t.co/GHVF7nIWM7 |
| Nephrology Journal Club @NephJC Why mannitol? Same authors reported some benefit in this observational study https://t.co/tL4EPwvR59 in @AmJNephrol in 2012 #NephJC https://t.co/4ql3eJiTkq |
 | Jim Paulo Sarsagat @jimsarsagat RT @edgarvlermamd: Hypertonic Mannitol for the Prevention of Intradialytic Hypotension: Hypertonic Mannitol for the Prevention of Intradialytic Hypotension: A Randomized Controlled Trial ca. 2019 from @AJKDonline @waikarss #NephJC #Nephpearls 👉🏼 https://t.co/N2wnomGUdl https://t.co/rshGBpoJ8a |
| Kartik Kalra MD,FNKF,FASN @kkalra_22 RT @edgarvlermamd: Intradialytic Hypotension (IDH): Intradialytic Hypotension (IDH): Nadir SBP < 90 👉🏼 strongest association with ⬆️ mortality 📌 Poor long-term Outcomes 📌 ⬆️ mortality 📌 Myocardial stunning 📌 Incidence is highest in those with low pre-HD BP 📌 ⬆️ risk of access thrombosis #NephJC #Nephpearls https://t.co/nFN3sNI3gn |
| Nephrology Journal Club @NephJC @TrishaKPatelDO Hey Trisha - great blog post on @AJKDOnline! and welcome to #NephJC |
 | Gerren Hobby @ghobby Gerren Hobby. Joining late. No COI. #NephJC |
| Nephrology Journal Club @NephJC @Nephro_Mohamed Hi Mohamed, welcome back! #nephjc |
| Ian McCoy, MD, MS @NephroNinja Any evidence of differential effect of mannitol versus albumin versus saline? #NephJC |
| Dr. Divya Bajpai 🇮🇳 @divyaa24 @NephJC Have heard about its use by my seniors at the institute. But never used it personally #nephjc |
| Nephrology Journal Club @NephJC @ghobby welcome to #NephJC - guess you are not a fan of saline for IDH? <pun intended> |
| Nephrology Journal Club @NephJC Good question MT @NephroNinja: Any evidence of differential effect of mannitol versus albumin versus saline? #NephJC |
| Nephrology Journal Club @NephJC Great start. Moving on to T1 and methods in 2 mins. #NephJC |
 | Trisha K Patel, DO @TrishaKPatelDO Joining #nephjc for a very interesting discussion about IDH, I am an IM PGY2 from Chicago land area- still learning how to tweet. Pardon me! |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd Management of Intradialytic Hypotension from @CJASN #NephJC #Nephpearls 👉🏼 https://t.co/atHfFjVPDr https://t.co/RcmVI4uhMU |
| Nephrology Journal Club @NephJC from T0 poll - looks like midodrine, cool dialsayte and stopping UF are popular - no fans of albumin here #NephJC |
| Mario Funes, MD @MarioFunesMD @TrishaKPatelDO Welcome to #NephJC! Another internal medicine resident in the house! You’ll learn quickly if you continue to attend the chats! |
 | Jeremie Lever, MD, PhD @JeremieLever Jeremie Lever, MS3 @UABSOM no COI #NephJC |
| Nephrology Journal Club @NephJC @JeremieLever @UABSOM welcome to #NephJC Jeremie! |
| Nephrology Journal Club @NephJC T1: Methods: designed as a pilot/feasibility studies. These are typically done to see if its feasible to use intervention, iron out kinks in protocol etc. *Not* for efficacy #NephJC |
| Dr. Divya Bajpai 🇮🇳 @divyaa24 @NephJC Albumin : Costly and difficult to procure here #nephjc |
| Mohamed Mohamed Ahmed @Nephro_Mohamed RT @edgarvlermamd: Management of Intradialytic Hypotension from @CJASN #NephJC #Nephpearls 👉🏼 https://t.co/atHfFjVPDr https://t.co/RcmVI4uhMU |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd Short-term (6 weeks) use of sertraline reduces IDH in some patients 📌 “Possible” mechanism: Sertraline-induced attenuation of the paradoxical sympathetic withdrawal that may underlie IDH in some patients w/ ESKD #NephJC #Nephpearls 👉🏼 https://t.co/seTRF4m3zh https://t.co/tj47cy2Ukr |
| Nephrology Journal Club @NephJC @divyaa24 probably for good! We waste a lot of money on that stuff...#NephJC |
| Nephrology Journal Club @NephJC RT @edgarvlermamd: Management of Intradialytic Hypotension from @CJASN #NephJC #Nephpearls 👉🏼 https://t.co/atHfFjVPDr https://t.co/RcmVI4uhMU |
 | Jay Koyner @jaykoyner #nephjc jay koyner nephrologist from Chicago. No coi. Just lurking tonight. |
| Nephrology Journal Club @NephJC Hence no power/sample size calculation is needed. Totally legit. Often a convenience sample of 50 or 100 patients. Other outcomes: show its possible to recruit patients, measure recruitment rate #NephJC |
| Nephrology Journal Club @NephJC @jaykoyner hi Jay (they did have 7 patients with AKI in there FWIW) #NephJC |
| Harish Seethapathy @BetterCallSeeth Fun fact about this study which highlights a quirk of our fellowship program @MGHKidneys @BWHKidney For those who do not know, our 1st year of fellowship is split equally between two sites in Boston - 6 months each at BWH & MGH #nephjc |
| Harish Seethapathy @BetterCallSeeth There are 'noticeable' differences in clinical practice at both sites (even though a large proportion of faculty were trained in the joint program) One such difference is mannitol use for IDH #nephjc https://t.co/xBhMBgABx0 |
| Harish Seethapathy @BetterCallSeeth Finnian, the lead author of this paper and (very) smart Irish nephrologist was surprised. He went from mandatory mannitol prescriptions (1st three Rx) at one site in December to none at the other site in January. #nephjc https://t.co/jzkmQz0HE3 |
| Nephrology Journal Club @NephJC In this case they do report that 50 patients would allow 80% power for 11 m Hg decline in SBP..but that doesn’t seem to have driven the sample size (Swap’s interpretation) #NephJC |
| Nephrology Journal Club @NephJC RT @BetterCallSeeth: Fun fact about this study which highlights a quirk of our fellowship program @MGHKidneys @BWHKidney For those who do not know, our 1st year of fellowship is split equally between two sites in Boston - 6 months each at BWH & MGH #nephjc |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd The Impact of Midodrine on Outcomes in Patients with Intradialytic Hypotension from @AmJNephrol @denaecohen #NephJC #Nephpearls #VisualAbstract by @kidney_boy 👉🏼 https://t.co/LY6YRWmSlB https://t.co/UdJUKDuktG |
| Nephrology Journal Club @NephJC RT @BetterCallSeeth: There are 'noticeable' differences in clinical practice at both sites (even though a large proportion of faculty were trained in the joint program) One such difference is mannitol use for IDH #nephjc https://t.co/xBhMBgABx0 |
| Nephrology Journal Club @NephJC See more on pilot feasibiity studies here https://t.co/UW8yuS1I4c #NephJC |
 | Katie Jones @Kat1eJones #NephJC Katie, Ped neph fellow joining late. No COI. |
| Nephrology Journal Club @NephJC @Kat1eJones Hi Katie - welcome back to #NephJC |
| Jay Koyner @jaykoyner @NephJC Thanks to those 7 patients for participating but need more dedicated info In AKI-RRT patients. #nephjc |
| Nephrology Journal Club @NephJC T1: patient population? You would think prevalent HD patients prone to IDH, right? Wrong! #NephJC |
| Harish Seethapathy @BetterCallSeeth That led to this retrospective study https://t.co/5aR7xS5P01 I guess he was not satisfied with the answer (or the lack of it)😂 I wonder what he thinks now #nephjc |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd Approach to Midodrine Therapy in ESKD Patients With IDH ca. 2001 from @AJKDonline #NephJC #Nephpearls 👉🏼 https://t.co/A3WPdgFvlu https://t.co/b7werAMJXn |
| Ian McCoy, MD, MS @NephroNinja Why weren't prevalent ESRD patients included? Is the effect of mannitol thought to be different in patients initiating dialysis? #NephJC |
 | Ross Morton @signindoc RT @NephJC: T0: What is your go to method for tackling intradialytic hypotension in HD? Twitter Poll time #NephJC |
| Nephrology Journal Club @NephJC @BetterCallSeeth very nice story! thanks for the back story on this Harish #NephJC |
| Krithika Mohan @krithicism RT @edgarvlermamd: The Impact of Midodrine on Outcomes in Patients with Intradialytic Hypotension from @AmJNephrol @denaecohen #NephJC #Nephpearls #VisualAbstract by @kidney_boy 👉🏼 https://t.co/LY6YRWmSlB https://t.co/UdJUKDuktG |
| Nephrology Journal Club @NephJC T1: The study included patients who were newly started on HD. Progressive CKD - or even AKI provided they fulfilled eligibility #NephJC |
| Vipin Varghese @vipvargh RT @BetterCallSeeth: Fun fact about this study which highlights a quirk of our fellowship program @MGHKidneys @BWHKidney For those who do not know, our 1st year of fellowship is split equally between two sites in Boston - 6 months each at BWH & MGH #nephjc |
| Nephrology Journal Club @NephJC @NephroNinja I suspect based on @BetterCallSeeth story - this was based on clinical observation #NephJC |
| Nephrology Journal Club @NephJC Other eligibility criteria: #NephJC Note severe volume overload + vasopressor use as exclusion https://t.co/EvpxY14ZM5 |
| Nephrology Journal Club @NephJC RT @BetterCallSeeth: That led to this retrospective study https://t.co/5aR7xS5P01 I guess he was not satisfied with the answer (or the lack of it)😂 I wonder what he thinks now #nephjc |
| Nephrology Journal Club @NephJC RT @jaykoyner: @NephJC Thanks to those 7 patients for participating but need more dedicated info In AKI-RRT patients. #nephjc |
 | Tita Rax @titaraxy RT @edgarvlermamd: Hypertonic Mannitol for the Prevention of Intradialytic Hypotension: Hypertonic Mannitol for the Prevention of Intradialytic Hypotension: A Randomized Controlled Trial ca. 2019 from @AJKDonline @waikarss #NephJC #Nephpearls 👉🏼 https://t.co/N2wnomGUdl https://t.co/rshGBpoJ8a |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd Midodrine for intradialytic hypotension: Mechanisms ✅ Vasoconstriction of the arteriolar system ✅ Facilitating the return of blood from the splanchnic venous system thereby lessening the fall in cardiac output #NephJC #Nephpearls 👉🏼 https://t.co/43pjN9Ao9a https://t.co/eOVPVhEE9B |
 | Nathaniel Reisinger @nephrothaniel RT @edgarvlermamd: Intradialytic Hypotension (IDH): Intradialytic Hypotension (IDH): Nadir SBP < 90 👉🏼 strongest association with ⬆️ mortality 📌 Poor long-term Outcomes 📌 ⬆️ mortality 📌 Myocardial stunning 📌 Incidence is highest in those with low pre-HD BP 📌 ⬆️ risk of access thrombosis #NephJC #Nephpearls https://t.co/nFN3sNI3gn |
 | Junaid Ali Khan @Junaid16979 RT @edgarvlermamd: Intradialytic Hypotension (IDH): Intradialytic Hypotension (IDH): Nadir SBP < 90 👉🏼 strongest association with ⬆️ mortality 📌 Poor long-term Outcomes 📌 ⬆️ mortality 📌 Myocardial stunning 📌 Incidence is highest in those with low pre-HD BP 📌 ⬆️ risk of access thrombosis #NephJC #Nephpearls https://t.co/nFN3sNI3gn |
| Nephrology Journal Club @NephJC @jaykoyner we are doing (another) albumin RCT in AKI https://t.co/D042VaZlZu - do you think mannitol should be formally tested in AKI too? #NephJC |
| Nephrology Journal Club @NephJC T1: Intervention was mannitol Mannitol 20% mannitol (0.25 g/kg/h; up to a maximum dose of 75 g per session) Control: saline, equivalent amount #NephJC All in opaque bags, so double blind |
| Dr. Divya Bajpai 🇮🇳 @divyaa24 @NephJC In my limited experience pts with AKI and Incident dialysis pt are more prone for IDH. Once they attain their dry wt in first 3months or so then they do better. So I'm happy with these participants, but feel shouldn't mix AKI with CKD progression #nephjc |
| Nephrology Journal Club @NephJC Though it’s not clear, it seems like mannitol/saline were given for first 3 sessions only, which were protocolized for HD orders - is that how everyone read it too? #NephJC Any comments @BetterCallSeeth? |
| Nephrology Journal Club @NephJC RT @divyaa24: @NephJC In my limited experience pts with AKI and Incident dialysis pt are more prone for IDH. Once they attain their dry wt in first 3months or so then they do better. So I'm happy with these participants, but feel shouldn't mix AKI with CKD progression #nephjc |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd @NephJC @TrishaKPatelDO @AJKDonline Hey #NephJC folks @TrishaKPatelDO is a PGY2 @ACMCIMRes and is an aspiring nephrologist #NephForward https://t.co/8bonlb1xLh |
| Nephrology Journal Club @NephJC RT @edgarvlermamd: @NephJC @TrishaKPatelDO @AJKDonline Hey #NephJC folks @TrishaKPatelDO is a PGY2 @ACMCIMRes and is an aspiring nephrologist #NephForward https://t.co/8bonlb1xLh |
| Nephrology Journal Club @NephJC Outcomes: primary was decline in SBP: pre-lowest SBP. Secondary was IDH (20 mm Hg drop) + lots of exploratory SBP definitions + lots of biomarkers #NephJC |
| Nephrology Journal Club @NephJC Swap's Pet peeve: these are inappropriate for a pilot/feasibility trial. Outcomes *should* be: recruitment rate; feasibility of protocol implementation etc. Not efficacy outcomes. Sigh. #NephJC |
| Dr. Divya Bajpai 🇮🇳 @divyaa24 How much saline did the placebo group receive? #NephJC |
 | Ralph Nader, MD, FASN @Ralph__Nader RT @NephJC: And the #VisualAbstract from @edgarvlermamd created for the @AJKDOnline blog from @TrishaKPatelDO https://t.co/sacZwwk3kY #NephJC https://t.co/dLkoLL8Q3A |
 | TEJAS PATEL MD, FACP, FASN @GenNextMD @BetterCallSeeth #nephjc |
| Nephrology Journal Club @NephJC @divyaa24 same volume as calculated mannitol would be - anyone find mention of exact amount? #nephjc |
| Ian McCoy, MD, MS @NephroNinja @BetterCallSeeth @NephJC Interesting. I've always thought that idea of using mannitol for new starts was to decrease the risk of dialysis dysequilibrium. Not sure why the effect on IDH would change after 3 sessions. #NephJC |
| Dr. Divya Bajpai 🇮🇳 @divyaa24 Hyponatremia is pretty common in pts with incident hd and aki, so excluding them decrease generalization? #NephJC |
| Harish Seethapathy @BetterCallSeeth @NephJC The theory being acute starts are at higher risk when the Qb/Qd is being ramped up. #nephjc |
| Nephrology Journal Club @NephJC @NephJC @divyaa24 it says 'equivalent volume of 0.9% saline solution; maximum 375 mL' so probably too little to matter? #nephjc |
 | El_Nefro @NefrologoCancun RT @edgarvlermamd: Intradialytic Hypotension (IDH): Intradialytic Hypotension (IDH): Strategies to help prevent Hypotension during dialysis #NephJC #Nephpearls https://t.co/x3h1iUaOYf |
| Nephrology Journal Club @NephJC RT @divyaa24: Hyponatremia is pretty common in pts with incident hd and aki, so excluding them decrease generalization? #NephJC |
| Nephrology Journal Club @NephJC Funding not mentioned, apart from that first author has a @NIDDK K grant. Presumably internal funding? #NephJC |
| Nephrology Journal Club @NephJC RT @NephroNinja: @BetterCallSeeth @NephJC Interesting. I've always thought that idea of using mannitol for new starts was to decrease the risk of dialysis dysequilibrium. Not sure why the effect on IDH would change after 3 sessions. #NephJC |
| Nephrology Journal Club @NephJC RT @BetterCallSeeth: @NephJC The theory being acute starts are at higher risk when the Qb/Qd is being ramped up. #nephjc |
| Nephrology Journal Club @NephJC @BetterCallSeeth exactly - similar hypothesis behind the DDS prevention. Sorta #NephJC |
 | Michelle Rheault @rheault_m @NephJC Michelle, Ped Neph UMN joining late. I blame the weather. ❄️ #NephJC [Narrator: It hasn’t started snowing yet] |
| Nephrology Journal Club @NephJC @niddk sorry @NIDDKgov funding #NephJC |
| Ian McCoy, MD, MS @NephroNinja I think nadir < 90 mmHg might be a better IDH definition/outcome. Clinically this worries me more than a drop from 170 to 150. #NephJC |
| Nephrology Journal Club @NephJC Any other questions about methods? #NephJC |
| Nephrology Journal Club @NephJC @rheault_m Hey Michelle (also @mcstarr1 and @Kat1eJones are on) Is IDH a big concern in peds? #NephJC |
| Jay Koyner @jaykoyner @NephJC I think it’s dangerous to assume that folks with AKI-RRT would respond the same as those with ESRd. Too often we equate these with each other but it’s not the same. #aki #critcareneph #notalldialysisisthesame #nephjc |
| Nephrology Journal Club @NephJC RT @NephroNinja: I think nadir < 90 mmHg might be a better IDH definition/outcome. Clinically this worries me more than a drop from 170 to 150. #NephJC |
| Nephrology Journal Club @NephJC RT @jaykoyner: @NephJC I think it’s dangerous to assume that folks with AKI-RRT would respond the same as those with ESRd. Too often we equate these with each other but it’s not the same. #aki #critcareneph #notalldialysisisthesame #nephjc |
| Vipin Varghese @vipvargh RT @jaykoyner: @NephJC I think it’s dangerous to assume that folks with AKI-RRT would respond the same as those with ESRd. Too often we equate these with each other but it’s not the same. #aki #critcareneph #notalldialysisisthesame #nephjc |
| Nephrology Journal Club @NephJC @divyaa24 it definitely would. but probably concerned with adverse events in these patients? #NephJC |
| Nephrology Journal Club @NephJC T2: Results coming up #nephjc |
| Ian McCoy, MD, MS @NephroNinja Although > 20 mmHg drop in SBP was relatively common (43% in placebo group), drop below 90 mmHg was surprisingly rare. Were clinicians given instructions on limiting UF? #NephJC |
| Dr. Divya Bajpai 🇮🇳 @divyaa24 @NephJC @rheault_m @mcstarr1 @Kat1eJones Yes I want to ask that too. IDH is common in our pediatric AKI pts. #nephjc |
| Michelle Rheault @rheault_m @NephJC @mcstarr1 @Kat1eJones Can see in kids who drink too much and we have to remove a lot of fluid. Crit line helps to mitigate. #nephjc |
| Nephrology Journal Club @NephJC T2: Study flow in figure 1. Impressive numbers: 82 assessed over 4 years, 65 eligible and only 13 declined #NephJC https://t.co/YVjZo6Hxhf |
| Ian McCoy, MD, MS @NephroNinja @jaykoyner @NephJC Any reason in particular you think these populations would respond differently to mannitol for IDH? #NephJC |
| Michelle Rheault @rheault_m @divyaa24 @NephJC @mcstarr1 @Kat1eJones Agree, IDH probably more common in AKI than our ESKD kids. #NephJC |
| Dr. Divya Bajpai 🇮🇳 @divyaa24 @jaykoyner @NephJC Agree. Aki and incident ESKD behave very differently #nephjc |
| Nephrology Journal Club @NephJC @NephroNinja @jaykoyner different etiology of hypotension...often pressors on board ..#NephJC |
| Michelle Starr MD MPH @mcstarr1 @NephJC @rheault_m @Kat1eJones Depends on the kid. Kids with minimal UOP where we have to UF aggressively it can be challenging. Crit lines and cool diasylate have been helpful for those kids. #nephjc |
| Nephrology Journal Club @NephJC Table 1: do these look like patients you start on HD? #NephJC They do look younger than my patients! https://t.co/te1cvRRZ7B |
| Nephrology Journal Club @NephJC Also, urea and weight higher in mannitol group (ignore the p values in table 1. Ugh) #NephJC https://t.co/f55dRofw7T |
| Jefferson L. Triozzi, M.D. @nepherson @NephJC The intervention group is 13kg lighter than the placebo; not statistically significant...but might affect outcome because lower body weight is an independent risk factor for IDH. #NephJC |
| Michelle Starr MD MPH @mcstarr1 @Kat1eJones @NephJC @rheault_m Small kids/babies with AKI have the largest problem, in my (short) experience. Why smaller machines like Aquadex or Carpediem are constantly on our mind! #nephjc |
| Nephrology Journal Club @NephJC RT @TRIOZZIJL: @NephJC The intervention group is 13kg lighter than the placebo; not statistically significant...but might affect outcome because lower body weight is an independent risk factor for IDH. #NephJC |
| Katie Jones @Kat1eJones @NephJC Not very close at all. Haha. Such is the #pedneph life. #nephjc |
| Nephrology Journal Club @NephJC @TRIOZZIJL indeed - statistical significance in table 1 is a big fallacy. Stay away from p values in table 1 unless you want #EpiTwitter outcry! #NephJC |
| Nephrology Journal Club @NephJC So what happened? Decline in SBP small at 3.9 mm Hg, not significant - as expected! Underpowered for this effect IMO See figure 2 #NephJC https://t.co/eX9p9Cneam |
| Michelle Rheault @rheault_m @NephJC Unless you approach everyone in the unit for a study, you’re likely to cherry-pick the youngest, healthiest patients. #NephJC |
| Nephrology Journal Club @NephJC RT @rheault_m: @NephJC Unless you approach everyone in the unit for a study, you’re likely to cherry-pick the youngest, healthiest patients. #NephJC |
| Jay Koyner @jaykoyner @NephJC @NephroNinja Exactly, different hemodynamics different physiology, different inflammatory Milleu #differentpopulations #nephjc |
| Nephrology Journal Club @NephJC RT @jaykoyner: @NephJC @NephroNinja Exactly, different hemodynamics different physiology, different inflammatory Milleu #differentpopulations #nephjc |
| Nephrology Journal Club @NephJC @rheault_m and that will affect the trial's ....generalizability say it @NephJC_Podcast fans! #NephJC |
| Nephrology Journal Club @NephJC What about the secondary outcomes? Table 2 now...lots of interesting data here #NephJC https://t.co/XaDUQqkBR4 |
| Nephrology Journal Club @NephJC Would mannitol cause any badness? Hard to say with an N of 52, but doesn’t seem so from table S5 #NephJC https://t.co/dbJ2YvYNYb |
| Harish Seethapathy @BetterCallSeeth @rheault_m @NephJC Unlikely they cherry picked. They likely approached everyone who could be potentially included #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil Whoah! Those look impressive to me #NephJC |
| Harish Seethapathy @BetterCallSeeth @NephJC @divyaa24 Though the cut off they used was 130. Only 7/82 had a Na less than that. #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @BetterCallSeeth @rheault_m @NephJC Possible - the age does look younger than a typical HD patient here hence the comment #NephJC |
| Nephrology Journal Club @NephJC RT @BetterCallSeeth: @NephJC @divyaa24 Though the cut off they used was 130. Only 7/82 had a Na less than that. #nephjc |
| Michelle Rheault @rheault_m @BetterCallSeeth @NephJC Didn’t mean to imply these authors did. Just important to know what the whole pool of patients was and why some were approached or not approached. It’s an issue in every trial. #nephjc |
| Nephrology Journal Club @NephJC Lots of other biomarker exploration if that’s your thing in the supplement #NephJC anyone see anything interesting in those numbers? https://t.co/De2kN1E1uU |
| Nephrology Journal Club @NephJC check this poll out too #NephJC and hi @LTummalapalli ! |
| Nephrology Journal Club @NephJC Is the secondary outcome good enough to warrant ....practice change? #NephJC |
| Nephrology Journal Club @NephJC Great discussion, T3 coming up - what happens next #NephJC |
 | Wisit Cheungpasitporn MD FACP | FASN | FAST @wisit661 RT @NephJC: T0: What is your go to method for tackling intradialytic hypotension in HD? Twitter Poll time #NephJC |
 | Sean Barnes (he/him), MD, MBA @DrSeanBarnes RT @SapnaKmd: Sentinel Article Review by @JHPICUFellows @JessLaRosaMD kicks off with @PedCritCareMed paper from Gist et al. @BasuND22 https://t.co/J4TelzeLCz #PedsICU #nephJC @HopkinsPICU https://t.co/3EiQhF58wZ |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @NephroNinja Oops - meant to RT table 2 Too many balls up in the air #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil This is impressive @NephroNinja #NephJC |
| Nephrology Journal Club @NephJC Will you start using Mannitol? If so only at initiation of HD or even otherwise? #nephjc check @LTummalapalli twitter poll |
| Nephrology Journal Club @NephJC If you are still not keen on Mannitol not, why not? #NephJC |
| Nephrology Journal Club @NephJC Should mannitol be used/tried in AKI patients on HD with HIRRT ? https://t.co/PugrjW94OD #nephjc what say @jaykoyner @DrRonWald ? |
| Nephrology Journal Club @NephJC Ideally this pilot/feasibility should lead to a definitive, properly powered RCT of mannitol #NephJC |
| Ian McCoy, MD, MS @NephroNinja @NephJC This study was underpowered for efficacy outcomes, so wouldn't change my practice. Also worry about nephrotoxicity from mannitol in AKI-D. #NephJc |
| Nephrology Journal Club @NephJC RT @NephroNinja: @NephJC This study was underpowered for efficacy outcomes, so wouldn't change my practice. Also worry about nephrotoxicity from mannitol in AKI-D. #NephJc |
| Nephrology Journal Club @NephJC What should be the outcome of a large mannitol RCT in HD? #NephJC twitter poll PROM = patient reported outcome measure (eg QoL, cramps) |
| Nephrology Journal Club @NephJC @NephroNinja and is BP/IDH an outcome that matters? SHouldn't it be clinical outcomes? Would you agree a large RCT of mannitol seems like a good idea? #NephJC |
| Nephrology Journal Club @NephJC If there is a large RCT of mannitol what should be the population? #NephJC twitter poll |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: If there is a large RCT of mannitol what should be the population? #NephJC twitter poll |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: What should be the outcome of a large mannitol RCT in HD? #NephJC twitter poll PROM = patient reported outcome measure (eg QoL, cramps) |
| Nephrology Journal Club @NephJC Are you interested in trying this in peds @rheault_m ? #NephJC Is there any data on mannitol use in peds? |
| Nephrology Journal Club @NephJC @BetterCallSeeth - how has practice changed at @BWHKidney & @MGHKidneys based on this now? Are there plans for a large RCT? #nephjc |
| Ian McCoy, MD, MS @NephroNinja @NephJC AKI-D recovery? Residual function? Some combo of dizziness, cramps, angina? Agree that BP change/IDH not patient-centered. Mortality is probably a bridge too far. #nephjc |
| Jay Koyner @jaykoyner @NephJC @DrRonWald Hard to say - reasonable to study it but other maneuvers to try first in my opinion. #aki #nephjc |
| Nephrology Journal Club @NephJC RT @NephroNinja: @NephJC AKI-D recovery? Residual function? Some combo of dizziness, cramps, angina? Agree that BP change/IDH not patient-centered. Mortality is probably a bridge too far. #nephjc |
| Michelle Rheault @rheault_m @NephJC There are usually other things I can do short of giving mannitol. Just adds more volume I have to remove. Not convinced. #nephjc |
| Nephrology Journal Club @NephJC Thanks for joining us today and for contributing to this rich discussion, and a special thank you to @BetterCallSeeth @NephroNinja + @jaykoyner & @rheault_m for input #NephJC |
| Nephrology Journal Club @NephJC If you haven’t, please sign up for our weekly newsletter https://t.co/5aumn8ImwF #NephJC |
| Nephrology Journal Club @NephJC Want yourself some #NephJC merch? Click here https://t.co/eOqYlnH0Ou |
| Nephrology Journal Club @NephJC Join @Krithicism and then @Stones_ for the Asia and EU chats tomorrow as well #NephJC |
| Jay Koyner @jaykoyner @NephJC @BetterCallSeeth @NephroNinja @rheault_m Happy to help. But really was trying to lurk and learn #nephjc #HappyThanksgiving to those celebrating |
| Nephrology Journal Club @NephJC RT @jaykoyner: @NephJC @BetterCallSeeth @NephroNinja @rheault_m Happy to help. But really was trying to lurk and learn #nephjc #HappyThanksgiving to those celebrating |
| Nephrology Journal Club @NephJC Until next time...goodnight! & Consider mannitol as another tool in your IDH toolkit...perhaps, or until the large RCT is done! #nephjc |
| Nephrology Journal Club @NephJC RT @rheault_m: @NephJC There are usually other things I can do short of giving mannitol. Just adds more volume I have to remove. Not convinced. #nephjc |
 | epibot @epi_twit RT @NephJC: @TRIOZZIJL indeed - statistical significance in table 1 is a big fallacy. Stay away from p values in table 1 unless you want #EpiTwitter outcry! #NephJC |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd @NephJC @rheault_m Not just yet... Will go through this checklist ✅ first Intradialytic Hypotension (IDH): Strategies to help prevent Hypotension during dialysis #NephJC #Nephpearls https://t.co/9md2zH50Re |
| Nephrology Journal Club @NephJC RT @edgarvlermamd: @NephJC @rheault_m Not just yet... Will go through this checklist ✅ first Intradialytic Hypotension (IDH): Strategies to help prevent Hypotension during dialysis #NephJC #Nephpearls https://t.co/9md2zH50Re |
| Harish Seethapathy @BetterCallSeeth @NephJC @BWHKidney @MGHKidneys Actually just emailed him to ask exactly this 10 minutes back! Will update here. My guess is both sides will point to this study to justify use or no use and we will remain status quo! #nephjc |
| Katie Jones @Kat1eJones RT @NephJC: If you haven’t, please sign up for our weekly newsletter https://t.co/5aumn8ImwF #NephJC |
 | ONaikMD @ONaikMD RT @edgarvlermamd: @NephJC @rheault_m Not just yet... Will go through this checklist ✅ first Intradialytic Hypotension (IDH): Strategies to help prevent Hypotension during dialysis #NephJC #Nephpearls https://t.co/9md2zH50Re |
 | Jenn @Jentan7477 RT @NephJC: Until next time...goodnight! & Consider mannitol as another tool in your IDH toolkit...perhaps, or until the large RCT is done! #nephjc |
| Katie Jones @Kat1eJones This is great! Will be much more excited to see this in my inbox than the 63,739,294 holiday sales advertisements! #nephjc |
 | Urmila Anandh @AnandhUrmila #nephjc Hi Urmila nephrologist from Hyderabad. No COI. Lurking at best. |
| Jenn @Jentan7477 RT @NephJC: Want yourself some #NephJC merch? Click here https://t.co/eOqYlnH0Ou |
#NephJC content from Twitter.