#NephJC transcript

Healthcare Social Media Transcript

From: Tue Apr 28 17:00:00 PDT 2015
To: Wed Apr 29 17:00:00 PDT 2015

What is #NephJC? Who were the influencers during this time period? #NephJC analytics


Healthcare Conference  - Healthcare Tweet Chats  -  Healthcare Analytics

markcourtney10
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RT @CSNSCN: Nice plug for the #CSN15 from the @nephjc Crew! http://t.co/zXRVHjRCt8 Thanks #nephjc guys!
mlgumz
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RT @kidney_boy: If you are planning on joining tonight’s #NephJC, you would be well served to read: http://t.co/kflfcIgn5G AKA the rationale.
methodsmanmd
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RT @kidney_boy: If you are planning on joining tonight’s #NephJC, you would be well served to read: http://t.co/kflfcIgn5G AKA the rationale.
christosargyrop
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RT @hswapnil: Still doing rounds in the #dialysis unit. Will I make it in time for the #nephjc chat? http://t.co/KbfE6NKlWj
christosargyrop
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@hswapnil I am doing dad rounds in the play ground during #nephjc
methodsmanmd
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#nephjc http://t.co/ZB98ME99op
hswapnil
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@Toaster_Pastry @kidney_boy you are always welcome! #nephjc
nephjc
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tchat.io booted up and ready #nephjc
nephjc
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1 minute #nephjc
nephjc
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It’s 9 pm EDT. Welcome to #NephJC This should be a great discussion! http://t.co/WeOWFea1m1
nephjc
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Please introduce yourselves. I’m Joel (@Kidney_boy) Topf, clinical nephrologist from Detroit. #NephJC
nephjc
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Please mention any conflicts of interest. COI: I’m addicted to my phone. #NephJC
hswapnil
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Swapnil Hiremath, nephrologist in @ottawahospital and @uottawamed. #nephJC co-founder...no CoI
methodsmanmd
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F. Perry Wilson (@methodsmanmd), research Nephrologist @yale. The, uh, author. #nephjc
nephjc
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Hey Swap, thanks for racing through dialysis rounds to get here. #nephjc
methodsmanmd
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No COI #nephjc
hswapnil
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@NephJC phone or #applewatch now? #jealous #nephjc
nephjc
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Helow Dr. Wilson, thanks for coming. #nephjc
doc_faubel
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sarah. nephrologist in Denver. but in Chicago right now! no COI. #nephjc
methodsmanmd
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@NephJC wouldn't miss it. I'll try not to speak unless spoken to. #nephjc
nephjc
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Hello Dr. Faubel, thanks for making it. #nephjc
langoteamit
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Amit Langote, Nephrology Fellow , Ottawa. In middle of EMS call , will be following chat. #nephjc
hswapnil
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no CoI for Dr Wilson except: first author on paper we are discussing..thanks for making it, Perry! RT@methodsmanmd: No COI #nephjc
nephjc
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Amit, sorry I missed you in Montreal. #nephjc
hecmagsmd
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Hector Madariaga. Nephrology fellow; SUNY Upstate. No COI. Hi all :) #nephjc
nephjc
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Remember to add #NephJC to every tweet you want to be part of the discussion and part of the recorded journal club.
doc_faubel
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happy to be here. Planning to use the paper for my journal club at U CO! #nephjc
nephjc
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Hello Hector! #nephjc
suzannenorby
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Hello, Suzanne Norby from Rochester, MN #nephjc
hswapnil
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@SuzanneNorby thanks for making it Suzanne! #nephjc
nephjc
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Dr. Norby, thanks for coming! #nephjc
nephjc
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#NephJC recommends using http://t.co/SEeRXFq2L9 or TChat.io to follow the chat. See a how to guide here: http://t.co/5jPXTxBvMx
drraymondhsu
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hello! nephrologist in sf. no COI #nephjc
edgarvlermamd
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Edgar Lerma, Chicago based Nephrologist #NephJC
nephjc
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Raymond, long time, great to have you back! #nephjc
nephjc
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Edgar, glad you could make it. What's happening to your Bulls? #nephjc
nephro_sparks
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Matt Sparks, Nephrologist, Durham, NC no COI #nephjc
hswapnil
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@DrRaymondHsu hey Ray! nice to see you back.. #nephjc
nephjc
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Sparks. #nephjc
nephjc
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Remember to sign up for the NephJC once a week (or less) newsletter and follow us on twitter. #NephJC http://t.co/5aumn8qL85
nephjc
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One of the core goals of #NephJC is to build a personal learning network, so make sure you hit the follow button early and often.
nephjc
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Topic zero:  When you see a new AKI consult, how often do you wish you had been called earlier? What would you do with that time? #NephJC
akbari_ayub
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Hello all, Ayub Akbari from Ottawa Canada #nephJC
hswapnil
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@akbari_ayub hey Ayub! glad you could make it! #nephjc
nephjc
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Hello Ayub, I think we met at the meeting, am I remembering correctly? #nephjc
nephro_sparks
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@akbari_ayub Hey Ayub. glad you could join #nephjc
christosargyrop
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#nephjc Christos Argyropoulos, Nephrologist, Albuquerque, NM
nephro_sparks
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@edgarvlermamd Hey Edgar #nephjc
nephjc
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Christos, fresh from the playground! #nephjc
hswapnil
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@ChristosArgyrop nice to see you back, Christos... #nephjc
nephro_sparks
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@ChristosArgyrop Christos is in the house #nephjc
kidney_boy
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RT @NephJC: Topic zero:  When you see a new AKI consult, how often do you wish you had been called earlier? What would you do with that time? #NephJC
langoteamit
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Topic Zero : quite often , wud stop nephrotoxic meds, and fluid challenge if pre renal #nephjc
nephro_sparks
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@doc_faubel Hey Sarah. glad you could join! #nephjc
hecmagsmd
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T0: Most of the time. I would have had time to order renal US, get UA, DC nephrotoxins, give IVFs, etc (although residents do it) #nephjc
doc_faubel
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T0. usually like to get a call earlier. often no work up has been initiated. feels like starting behind. #nephjc
christosargyrop
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#nephjc Topic zero: In volume overloaded pts I'd wish they call me early. Creatinine does not kill AKI pts, H2O does
hswapnil
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T0: Often I have wished that I was called earlier....but only thing really is fluid challenge - which mostly the team has done. #nephjc
suzannenorby
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T0: Would be nice to be consulted 1-2 days earlier in many cases. Would adjust med doses, remove nephrotoxins, optimize in general #nephjc
nephro_sparks
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T0: I feel like with a chart review we (as nephro consult) always find things we wish were done differently #nephjc
kidney_boy
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@LangoteAmit Agree, a lot of my recommendations feel like “Horse has left the barn recs” i.e. remove the ketoralac you already gave #NephJC
drraymondhsu
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T0: maybe 30-50%? usually wished they gave more fluid or less fluid/diuresed more #nephjc
nephjc
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RT @ChristosArgyrop: #nephjc Topic zero: In volume overloaded pts I'd wish they call me early. Creatinine does not kill AKI pts, H2O does
suzannenorby
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@doc_faubel HI Sara, great to see you here! #nephjc
akbari_ayub
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Most of the time, I am called appropriately #nephjc
hswapnil
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QFT@ChristosArgyrop: T0: In volume overloaded pts I'd wish they call me early. Creatinine does not kill AKI pts, H2O does #nephjc
nephro_sparks
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@hswapnil T0: Stop ACEi ARB, stop NSAIDS, change dose of antibiotics, fluid challenge #nephjc
hecmagsmd
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RT @ChristosArgyrop: #nephjc Topic zero: In volume overloaded pts I'd wish they call me early. Creatinine does not kill AKI pts, H2O does
langoteamit
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Hate to hear that Sx teM stopped ACEi in AM of consult, but continued 3 days post op #nephjc
doc_faubel
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@SuzanneNorby @doc_faubel yes great to see you as well! #nephjc
hswapnil
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Aree with @akbari_ayub: Most of the time, I am called appropriately #nephjc
hswapnil
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Guess in Ottawa, medical/surgical teams know how to manage AKI without calling #nephro! #nephjc
nephro_sparks
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T0- I see a lot of aggressive ACEi and ARB titration in house, prefer to do this as outpatient. #nephjc
nephjc
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What is the optimal time to call a consult? After the creatinine bumps or after the hypotension 48 hours before the cr bumps? #nephjc
nephro_sparks
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RT @kidney_boy: @LangoteAmit Agree, a lot of my recommendations feel like “Horse has left the barn recs” i.e. remove the ketoralac you already gave #NephJC
hswapnil
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RT @NephJC: What is the optimal time to call a consult? After the creatinine bumps or after the hypotension 48 hours before the cr bumps? #nephjc
doc_faubel
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T0: fluid challenge not always good if obviously established AKI. often too much fluid given by the time we are consulted #nephjc
hecmagsmd
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@LangoteAmit Is there any evidence that stopping ACEis improve renal outcomes? #nephjc
nephro_sparks
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@doc_faubel T0: not saying to give it all the time. but if hypovolemic and needed. often time given too late IMO #nephjc
gerimedjc
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RT @NephJC: Remember to sign up for the NephJC once a week (or less) newsletter and follow us on twitter. #NephJC http://t.co/5aumn8qL85
nephjc
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Interested in Wilson's experience with the timing of his consults? (especially given the results of the study.) #nephjc
langoteamit
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@HekmagsMD may be not , bt probably enough evidence tht prevents urgent HD for hyperK #nephjc
nephro_sparks
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@HekmagsMD @LangoteAmit e.g. severe diarrhea in hospital and ACEi or ARB continued. I would stop #nephjc
hswapnil
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+1 (and excellent Q) @HekmagsMD: @LangoteAmit Is there any evidence that stopping ACEis improve renal outcomes? #nephjc
nephjc
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I smell a #DreamRCT RT @HekmagsMD: @LangoteAmit Is there any evidence that stopping ACEis improve renal outcomes? #nephjc
drraymondhsu
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RT @NephJC: I smell a #DreamRCT RT @HekmagsMD: @LangoteAmit Is there any evidence that stopping ACEis improve renal outcomes? #nephjc
methodsmanmd
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@NephJC I like being called earlier - fellows generally don't. We have data that renal consult improves outcomes. #nephjc
doc_faubel
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stopping ACE probably std of care. there is a paper on "incipient AKI" from Yale (I think) that suggests continuing them #nephjc
christosargyrop
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#nephjc By the time creatinine is red the damage has been done. Urine output is more useful (and nephros should not bitch re early consult)
nephjc
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Canadian Concept of SADMAN of drugs to stop when ill, includes ACEi/ARB. Clever idea. #nephjc
hswapnil
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Only thing different in this prior non-RCT was amount of IVF: http://t.co/qjMFuk7kVf (see @kiwiskinz letter too) #nephjc
hecmagsmd
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RT @Nephro_Sparks: @HekmagsMD @LangoteAmit e.g. severe diarrhea in hospital and ACEi or ARB continued. I would stop #nephjc
hecmagsmd
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RT @LangoteAmit: @HekmagsMD may be not , bt probably enough evidence tht prevents urgent HD for hyperK #nephjc
s_brimble
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RT @NephJC: Canadian Concept of SADMAN of drugs to stop when ill, includes ACEi/ARB. Clever idea. #nephjc
hswapnil
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RT @NephJC: I smell a #DreamRCT RT @HekmagsMD: @LangoteAmit Is there any evidence that stopping ACEis improve renal outcomes? #nephjc
doc_faubel
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here is link on continuing ACE: http://t.co/gA1UTBArgn #nephjc
nephjc
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RT @doc_faubel: here is link on continuing ACE: http://t.co/gA1UTBArgn #nephjc
hecmagsmd
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:) @NephJC: I smell a #DreamRCT RT @HekmagsMD: @LangoteAmit Is there any evidence that stopping ACEis improve renal outcomes? #nephjc
nephro_sparks
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RT @doc_faubel: here is link on continuing ACE: http://t.co/gA1UTBArgn #nephjc
langoteamit
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RT @NephJC RT @doc_faubel: here is link on continuing ACE: http://t.co/fes1XeFDDV #nephjc #nephjc
nephjc
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Moving on to the study in question... #nephjc
nephjc
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Topic one: Pts were randomized to alert/no alert. Since the intervention was done on care givers, should they have been randomized? #NephJC
hswapnil
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RT @doc_faubel: here is link on continuing ACE: http://t.co/gA1UTBArgn #nephjc
christosargyrop
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@NephJC #nephjc impossible IRB
hecmagsmd
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RT @hswapnil: Only thing different in this prior non-RCT was amount of IVF: http://t.co/qjMFuk7kVf (see @kiwiskinz letter too) #nephjc
hecmagsmd
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RT @doc_faubel: here is link on continuing ACE: http://t.co/gA1UTBArgn #nephjc
medquestioning
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@hswapnil Thats a paywall article for us #FamilyMedicine folks. Help me out! #nephjc
kidney_boy
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RT @NephJC: Topic one: Pts were randomized to alert/no alert. Since the intervention was done on care givers, should they have been randomized? #NephJC
nephjc
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Why do you say that? RT @ChristosArgyrop: @NephJC #nephjc impossible IRB
jentan7477
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RT @NephJC: Topic one: Pts were randomized to alert/no alert. Since the intervention was done on care givers, should they have been randomized? #NephJC
medquestioning
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@doc_faubel can you share the article from Yale on AKI and keeping ACEi? How low do they go? #NephJC
hswapnil
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#nephjc https://t.co/RcKxHaLF0c
nephjc
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@MedQuestioning DM @Kidney_boy #nephjc
methodsmanmd
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@MedQuestioning @doc_faubel Pretty sure the article is just perspective. We're doing this analysis in alert cohort, actually. #nephjc
suzannenorby
https://pbs.twimg.com/profile_images/757667709165318145/oF7c1v_6_normal.jpg
T1: difficult to randomize caregivers with all the transitions of care. Maybe care teams or services? #nephjc
doc_faubel
https://pbs.twimg.com/profile_images/534413974788243456/Dnfeg_tE_normal.jpeg
@MedQuestioning @doc_faubel http://t.co/gA1UTBS27V #nephjc
christosargyrop
https://pbs.twimg.com/profile_images/651970285759893504/x41jvvLk_normal.jpg
@NephJC #nephjc ARB are toxins, animal studies inconclusive (if available) and benefit of continuing during AKI nill but perceives risk high
methodsmanmd
https://pbs.twimg.com/profile_images/519119829404381184/x1PkcJBf_normal.jpeg
@SuzanneNorby Exactly - too many people interact with pts. Works for provider outcome (like ordering tests), not patient outcome. #nephjc
edgarvlermamd
https://pbs.twimg.com/profile_images/2297302029/image_normal.jpg
Interesting perspective on minimizing INCIPIENT AKI: LRS, RAS Blockers, Diuretics #NephJC http://t.co/vMAIhPmHM8 http://t.co/OiifOLK2Wd
medquestioning
https://pbs.twimg.com/profile_images/592510143738281985/CJQXHgnF_normal.jpg
@methodsmanmd @NephJC If the expectation is rapid recovery from clear cause of increased Cr can the hospitalist do just as well? #NephJC
hswapnil
https://pbs.twimg.com/profile_images/730502747754139649/hP6Q9DDQ_normal.jpg
@ChristosArgyrop check out this RCT: http://t.co/6kkunNRCfT (ACEi hold in Ci-AKI prevention) #nephjc
nephro_sparks
https://pbs.twimg.com/profile_images/552496649495273472/UA46V1Ye_normal.jpeg
from the Yale "AKI" paper- "...preferably be treated with... lactated Ringer's... rather than with normal saline." #nephjc
edgarvlermamd
https://pbs.twimg.com/profile_images/2297302029/image_normal.jpg
What is INCIPIENT AKI? #Nephpearls #NephJC http://t.co/vMAIhPmHM8 http://t.co/lp8v4DFeeS
methodsmanmd
https://pbs.twimg.com/profile_images/519119829404381184/x1PkcJBf_normal.jpeg
@MedQuestioning @methodsmanmd @NephJC I'm sure. #nephjc
hswapnil
https://pbs.twimg.com/profile_images/730502747754139649/hP6Q9DDQ_normal.jpg
like a cluster RCT? @SuzanneNorby: T1: difficult to randomize caregivers with all the transitions. Maybe care teams or services? #nephjc
hecmagsmd
https://pbs.twimg.com/profile_images/555936314122842113/5A3PrkXC_normal.jpeg
RT @Nephro_Sparks: from the Yale "AKI" paper- "...preferably be treated with... lactated Ringer's... rather than with normal saline." #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
@methodsmanmd @SuzanneNorby but seems like the GOAL was to change provider behavior. #nephjc
doc_faubel
https://pbs.twimg.com/profile_images/534413974788243456/Dnfeg_tE_normal.jpeg
@methodsmanmd @MedQuestioning @doc_faubel yes - this is definitely opinion. animal data do suggest ACE could be helpful. #nephjc
edgarvlermamd
https://pbs.twimg.com/profile_images/2297302029/image_normal.jpg
Effect of RAS Blockade on Peritubular Blood Flow #Nephpearls #NephJC http://t.co/vMAIhPmHM8 http://t.co/9z0fvHGqH2
jaykoyner
https://pbs.twimg.com/profile_images/651800506654945280/T_jfv8F__normal.jpg
sorry to be late to the party - jkoyner nephrologist chicago no COI #nephjc
christosargyrop
https://pbs.twimg.com/profile_images/651970285759893504/x41jvvLk_normal.jpg
@NephJC #nephjc Well from a sample size perspective no, but physicians got edu on AKI prevention from their alert pts (decrease eff size)
drraymondhsu
https://pbs.twimg.com/profile_images/743669111754940416/jPZuw-St_normal.jpg
T1: @methodsmanmd did you consider cluster randomization by teams/units? #nephjc
nephro_sparks
https://pbs.twimg.com/profile_images/552496649495273472/UA46V1Ye_normal.jpeg
I think I know what my #DreamRCT will be #nephjc
hswapnil
https://pbs.twimg.com/profile_images/730502747754139649/hP6Q9DDQ_normal.jpg
RT @DrRaymondHsu: T1: @methodsmanmd did you consider cluster randomization by teams/units? #nephjc
edgarvlermamd
https://pbs.twimg.com/profile_images/2297302029/image_normal.jpg
Spectrum of injury in AKI #Nephpearls #NephJC http://t.co/vMAIhPmHM8 http://t.co/ZayhnUHxUN
drraymondhsu
https://pbs.twimg.com/profile_images/743669111754940416/jPZuw-St_normal.jpg
to avoid contamination that is #nephjc
methodsmanmd
https://pbs.twimg.com/profile_images/519119829404381184/x1PkcJBf_normal.jpeg
@DrRaymondHsu @methodsmanmd Yup. Just not feasible at Penn. Teams change too much - residents/interns/attendings on diff schedules. #nephjc
nephro_sparks
https://pbs.twimg.com/profile_images/552496649495273472/UA46V1Ye_normal.jpeg
RT @methodsmanmd: @DrRaymondHsu @methodsmanmd Yup. Just not feasible at Penn. Teams change too much - residents/interns/attendings on diff schedules. #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
define contamination for me. #Fuzzy RT @DrRaymondHsu: to avoid contamination that is #nephjc
hswapnil
https://pbs.twimg.com/profile_images/730502747754139649/hP6Q9DDQ_normal.jpg
#nephjc https://t.co/yaMinkaFUq
medquestioning
https://pbs.twimg.com/profile_images/592510143738281985/CJQXHgnF_normal.jpg
@doc_faubel @methodsmanmd By animal you mean Interns and MS4? #sarcasm. Sry. But honestly do you think the animal data translates #NephJC
christosargyrop
https://pbs.twimg.com/profile_images/651970285759893504/x41jvvLk_normal.jpg
@SuzanneNorby #nephjc The only possible exception is liver dz where spironolactone may help substantially w volume management
methodsmanmd
https://pbs.twimg.com/profile_images/519119829404381184/x1PkcJBf_normal.jpeg
@DrRaymondHsu Expected contamination - actually modeled it. Alert effect of increasing dialysis waned over trial. #nephjc
doc_faubel
https://pbs.twimg.com/profile_images/534413974788243456/Dnfeg_tE_normal.jpeg
@MedQuestioning @doc_faubel @methodsmanmd yes. I honestly think animal data translates if applied and understood properly. #nephjc
medquestioning
https://pbs.twimg.com/profile_images/592510143738281985/CJQXHgnF_normal.jpg
RT @edgarvlermamd: Spectrum of injury in AKI #Nephpearls #NephJC http://t.co/vMAIhPmHM8 http://t.co/ZayhnUHxUN
nephro_sparks
https://pbs.twimg.com/profile_images/552496649495273472/UA46V1Ye_normal.jpeg
RT @doc_faubel: @MedQuestioning @doc_faubel @methodsmanmd yes. I honestly think animal data translates if applied and understood properly. #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
How they could 2x blind the study? A group gets AKI alerts & the pts have AKI, the other group gets alerts but pts dont have AKI? #NephJC
medquestioning
https://pbs.twimg.com/profile_images/592510143738281985/CJQXHgnF_normal.jpg
RT @edgarvlermamd: Effect of RAS Blockade on Peritubular Blood Flow #Nephpearls #NephJC http://t.co/vMAIhPmHM8 http://t.co/9z0fvHGqH2
jaykoyner
https://pbs.twimg.com/profile_images/651800506654945280/T_jfv8F__normal.jpg
@doc_faubel always thinks the animal data translates - and usually it does - when looked at appropriately #nephjc
christosargyrop
https://pbs.twimg.com/profile_images/651970285759893504/x41jvvLk_normal.jpg
RT @doc_faubel: @MedQuestioning @doc_faubel @methodsmanmd yes. I honestly think animal data translates if applied and understood properly. #nephjc
hecmagsmd
https://pbs.twimg.com/profile_images/555936314122842113/5A3PrkXC_normal.jpeg
RT @edgarvlermamd: Effect of RAS Blockade on Peritubular Blood Flow #Nephpearls #NephJC http://t.co/vMAIhPmHM8 http://t.co/9z0fvHGqH2
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
Power analysis: not that ambitious: ⬇︎Death 10⟶9% ⬇︎dialysis 5⟶4% ⬆︎pts without ⬆︎in AKI stage 50⟶56% (90% power, N=2,400) #NephJC
drraymondhsu
https://pbs.twimg.com/profile_images/743669111754940416/jPZuw-St_normal.jpg
@methodsmanmd cool! fancy...so providers started to ignore alerts towards end of study? #nephjc
suzannenorby
https://pbs.twimg.com/profile_images/757667709165318145/oF7c1v_6_normal.jpg
@ChristosArgyrop @nephjc When hyperkalemia isn't an issue spironolactone can be helpful, agree #nephjc
qurainihussain
https://pbs.twimg.com/profile_images/744283499302117376/d5tBF46K_normal.jpg
RT @Nephro_Sparks: from the Yale "AKI" paper- "...preferably be treated with... lactated Ringer's... rather than with normal saline." #nephjc
doc_faubel
https://pbs.twimg.com/profile_images/534413974788243456/Dnfeg_tE_normal.jpeg
@jaykoyner @doc_faubel thanks jay. not enough room on twitter to go into my usual rant on the topic! #nephjc
nephro_sparks
https://pbs.twimg.com/profile_images/552496649495273472/UA46V1Ye_normal.jpeg
RT @DrRaymondHsu: @methodsmanmd cool! fancy...so providers started to ignore alerts towards end of study? #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
@doc_faubel @jaykoyner and we are grateful for that. JK #nephjc
hswapnil
https://pbs.twimg.com/profile_images/730502747754139649/hP6Q9DDQ_normal.jpg
contamination = controls also get intervention (or vice versa) nice review: http://t.co/jAycgaE3aq in @bmj_latest (open) #nephjc
drraymondhsu
https://pbs.twimg.com/profile_images/743669111754940416/jPZuw-St_normal.jpg
RT @hswapnil: contamination = controls also get intervention (or vice versa) nice review: http://t.co/jAycgaE3aq in @bmj_latest (open) #nephjc
hecmagsmd
https://pbs.twimg.com/profile_images/555936314122842113/5A3PrkXC_normal.jpeg
RT @hswapnil: contamination = controls also get intervention (or vice versa) nice review: http://t.co/jAycgaE3aq in @bmj_latest (open) #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
KDIGO Cr based criteria for AKI: http://t.co/1WREDHaISN #NephJC http://t.co/rDedfTGe0K
hecmagsmd
https://pbs.twimg.com/profile_images/555936314122842113/5A3PrkXC_normal.jpeg
RT @doc_faubel: @jaykoyner @doc_faubel thanks jay. not enough room on twitter to go into my usual rant on the topic! #nephjc
methodsmanmd
https://pbs.twimg.com/profile_images/519119829404381184/x1PkcJBf_normal.jpeg
@DrRaymondHsu @methodsmanmd Yeah. Which was good since they seemed to result in more dialysis earlier on. #nephjc
nephro_sparks
https://pbs.twimg.com/profile_images/552496649495273472/UA46V1Ye_normal.jpeg
Why not do the alerts for one month.... then off then on again? #nephjc
jaykoyner
https://pbs.twimg.com/profile_images/651800506654945280/T_jfv8F__normal.jpg
@NephJC @doc_faubel her rant on this is appropriate and fantastic and most importantly and spot on - but a rant nontheless #nephjc
hswapnil
https://pbs.twimg.com/profile_images/730502747754139649/hP6Q9DDQ_normal.jpg
RT @Nephro_Sparks: Why not do the alerts for one month.... then off then on again? #nephjc
methodsmanmd
https://pbs.twimg.com/profile_images/519119829404381184/x1PkcJBf_normal.jpeg
@Nephro_Sparks Nice thought. Worry about seasonal changes, not really "random". #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
Even if it didn’t work this is seriously cool! #NephJC http://t.co/R9irdz3104
drraymondhsu
https://pbs.twimg.com/profile_images/743669111754940416/jPZuw-St_normal.jpg
@methodsmanmd nice. so it's probably more that the control group became more self-alerted overtime...like sepsis bundles #nephjc
hswapnil
https://pbs.twimg.com/profile_images/730502747754139649/hP6Q9DDQ_normal.jpg
RT @NephJC: Even if it didn’t work this is seriously cool! #NephJC http://t.co/R9irdz3104
medquestioning
https://pbs.twimg.com/profile_images/592510143738281985/CJQXHgnF_normal.jpg
RT @NephJC: KDIGO Cr based criteria for AKI: http://t.co/1WREDHaISN #NephJC http://t.co/rDedfTGe0K
doc_faubel
https://pbs.twimg.com/profile_images/534413974788243456/Dnfeg_tE_normal.jpeg
so, what is the bottom line on the randomization topic? #nephjc
hswapnil
https://pbs.twimg.com/profile_images/730502747754139649/hP6Q9DDQ_normal.jpg
RT @DrRaymondHsu: @methodsmanmd nice. so it's probably more that the control group became more self-alerted overtime...like sepsis bundles #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
Bottom line is the randomization was compromised by real world considerations but doesn't seriously harm the study. Agree? #nephjc
drraymondhsu
https://pbs.twimg.com/profile_images/743669111754940416/jPZuw-St_normal.jpg
T1 seems randomization very well done - like the medical/surgical and icu/not strata #nephjc
hswapnil
https://pbs.twimg.com/profile_images/730502747754139649/hP6Q9DDQ_normal.jpg
We all have our own ideas about the ideal study after the fact, kudos to @methodsmanmd and team for doing this in the first place! #nephjc
kidney_boy
https://pbs.twimg.com/profile_images/817201108808593408/BLKlnv3k_normal.jpg
Was the any concern that this program would be come self-aware? Was this addressed by the IRB? #NephJC #SkyNet http://t.co/ExYDBpbmv4
nephro_sparks
https://pbs.twimg.com/profile_images/552496649495273472/UA46V1Ye_normal.jpeg
RT @hswapnil: We all have our own ideas about the ideal study after the fact, kudos to @methodsmanmd and team for doing this in the first place! #nephjc
hswapnil
https://pbs.twimg.com/profile_images/730502747754139649/hP6Q9DDQ_normal.jpg
Agree @NephJC: Bottom line is the randomization was compromised by real world considerations but doesn't seriously harm the study. #nephjc
perlazambrano
https://pbs.twimg.com/profile_images/530387028874375169/aD-s5_DH_normal.jpeg
RT @NephJC: KDIGO Cr based criteria for AKI: http://t.co/1WREDHaISN #NephJC http://t.co/rDedfTGe0K
drraymondhsu
https://pbs.twimg.com/profile_images/743669111754940416/jPZuw-St_normal.jpg
i was going to say in T0 that surgical vs medical timing of consult differ quite a bit #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
Topic two: The primary outcome was renal function at 7 days. Too soon? Other concerns about the methods? #NephJC
franloachamin
https://pbs.twimg.com/profile_images/447648196031152128/iSjgnGBC_normal.jpeg
RT @edgarvlermamd: Effect of RAS Blockade on Peritubular Blood Flow #Nephpearls #NephJC http://t.co/vMAIhPmHM8 http://t.co/9z0fvHGqH2
christosargyrop
https://pbs.twimg.com/profile_images/651970285759893504/x41jvvLk_normal.jpg
@edgarvlermamd #nephjc I believe there was a CTsurg study about 7 yrs ago that showed this does not work
akbari_ayub
https://pbs.twimg.com/profile_images/720034415548743680/gd4fyeeY_normal.jpg
Agree with Swapnil #nephjc
hswapnil
https://pbs.twimg.com/profile_images/730502747754139649/hP6Q9DDQ_normal.jpg
RT @NephJC: Topic two: The primary outcome was renal function at 7 days. Too soon? Other concerns about the methods? #NephJC
franloachamin
https://pbs.twimg.com/profile_images/447648196031152128/iSjgnGBC_normal.jpeg
RT @edgarvlermamd: Interesting perspective on minimizing INCIPIENT AKI: LRS, RAS Blockers, Diuretics #NephJC http://t.co/vMAIhPmHM8 http://t.co/OiifOLK2Wd
hecmagsmd
https://pbs.twimg.com/profile_images/555936314122842113/5A3PrkXC_normal.jpeg
RT @hswapnil: We all have our own ideas about the ideal study after the fact, kudos to @methodsmanmd and team for doing this in the first place! #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
who agreed with me, who agreed with @MethodsManMD RT @akbari_ayub: Agree with Swapnil #nephjc
hecmagsmd
https://pbs.twimg.com/profile_images/555936314122842113/5A3PrkXC_normal.jpeg
Agree! RT @DrRaymondHsu: i was going to say in T0 that surgical vs medical timing of consult differ quite a bit #nephjc
methodsmanmd
https://pbs.twimg.com/profile_images/519119829404381184/x1PkcJBf_normal.jpeg
@kidney_boy the system kept spitting out a 216 digit number... #nephjc
edgarvlermamd
https://pbs.twimg.com/profile_images/2297302029/image_normal.jpg
@HekmagsMD @LangoteAmit No compelling evidence for starting/stopping ACE-I precontrast http://t.co/eB9YhUxIet #NephJC http://t.co/d309su1kHh
franloachamin
https://pbs.twimg.com/profile_images/447648196031152128/iSjgnGBC_normal.jpeg
RT @edgarvlermamd: @HekmagsMD @LangoteAmit No compelling evidence for starting/stopping ACE-I precontrast http://t.co/eB9YhUxIet #NephJC http://t.co/d309su1kHh
christosargyrop
https://pbs.twimg.com/profile_images/651970285759893504/x41jvvLk_normal.jpg
@methodsmanmd #nephjc I dont think that a single center study could be done in a way other than the way this study was done
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
@methodsmanmd @kidney_boy This reference? http://t.co/fQh70k5tbE #nephjc
medquestioning
https://pbs.twimg.com/profile_images/592510143738281985/CJQXHgnF_normal.jpg
RT @edgarvlermamd: @HekmagsMD @LangoteAmit No compelling evidence for starting/stopping ACE-I precontrast http://t.co/eB9YhUxIet #NephJC http://t.co/d309su1kHh
methodsmanmd
https://pbs.twimg.com/profile_images/519119829404381184/x1PkcJBf_normal.jpeg
@NephJC @methodsmanmd @kidney_boy To the awesome movie "pi". #inspiration #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
Primary outcome
langoteamit
https://pbs.twimg.com/profile_images/618996490665488384/RYS5ZWFm_normal.jpg
RT @methodsmanmd: @NephJC @methodsmanmd @kidney_boy To the awesome movie "pi". #inspiration #nephjc
methodsmanmd
https://pbs.twimg.com/profile_images/519119829404381184/x1PkcJBf_normal.jpeg
RT @NephJC: Primary outcome
hswapnil
https://pbs.twimg.com/profile_images/730502747754139649/hP6Q9DDQ_normal.jpg
RT @NephJC: Primary outcome
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
That’s weird. Wouldn’t have expected that. #NephJC http://t.co/PL9tYBbAw3
methodsmanmd
https://pbs.twimg.com/profile_images/519119829404381184/x1PkcJBf_normal.jpeg
@NephJC It's an artifact of the VERY sensitive KDIGO definition. You pick up these blips. #nephjc
christosargyrop
https://pbs.twimg.com/profile_images/651970285759893504/x41jvvLk_normal.jpg
@NephJC #nephjc I would have considered an analysis of secular trends be4 and after the study to explore contamination.
hswapnil
https://pbs.twimg.com/profile_images/730502747754139649/hP6Q9DDQ_normal.jpg
@NephJC regression to mean? or it picked up many mild AKI (hence the negative result) #nephjc
hswapnil
https://pbs.twimg.com/profile_images/730502747754139649/hP6Q9DDQ_normal.jpg
RT @methodsmanmd: @NephJC It's an artifact of the VERY sensitive KDIGO definition. You pick up these blips. #nephjc
drraymondhsu
https://pbs.twimg.com/profile_images/743669111754940416/jPZuw-St_normal.jpg
T2 the primary outcome is not just Cr at day 7 right? @methodsman did a cool ranking outcome involving dialysis,death,&Cr #nephjc
kidney_boy
https://pbs.twimg.com/profile_images/817201108808593408/BLKlnv3k_normal.jpg
@methodsmanmd When you did your feasibility studies did you see that cr wouldn’t rise after the Dx of AKI? #NephJC
methodsmanmd
https://pbs.twimg.com/profile_images/519119829404381184/x1PkcJBf_normal.jpeg
@hswapnil @NephJC Pretty sure the latter. #nephjc
christosargyrop
https://pbs.twimg.com/profile_images/651970285759893504/x41jvvLk_normal.jpg
@NephJC #nephjc also control vs contemporary practitioners/AKI pts who were not in the study
hswapnil
https://pbs.twimg.com/profile_images/730502747754139649/hP6Q9DDQ_normal.jpg
@DrRaymondHsu @METHODSMANmd did do it! remembering from #nephJC live, ray?
methodsmanmd
https://pbs.twimg.com/profile_images/519119829404381184/x1PkcJBf_normal.jpeg
@kidney_boy @methodsmanmd We expected 50% would have no further rise, which we got. (1/2) #nephjc
methodsmanmd
https://pbs.twimg.com/profile_images/519119829404381184/x1PkcJBf_normal.jpeg
@kidney_boy @methodsmanmd There was debate about including sicker, but risk of alerting on people where it was obv already (2/2). #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
A whole mess of NS p values for secondary outcomes. How do you spell Bonferroni? #NephJC http://t.co/R4JIEpm4F5
hswapnil
https://pbs.twimg.com/profile_images/730502747754139649/hP6Q9DDQ_normal.jpg
@methodsmanmd @NephJC - so if you say 'very sensitive' @goKdigo defn...do you mean it is not clinically useful? #nephjc
doc_faubel
https://pbs.twimg.com/profile_images/534413974788243456/Dnfeg_tE_normal.jpeg
Ive been attending on medicine a lot lately. AKI on medicine service often stabilizes and gets better. not so on nephrology service. #nephjc
methodsmanmd
https://pbs.twimg.com/profile_images/519119829404381184/x1PkcJBf_normal.jpeg
Here's the ranking scheme for primary outcome. #nephjc http://t.co/DK3d1QuNjn
drraymondhsu
https://pbs.twimg.com/profile_images/743669111754940416/jPZuw-St_normal.jpg
RT @methodsmanmd: Here's the ranking scheme for primary outcome. #nephjc http://t.co/DK3d1QuNjn
hswapnil
https://pbs.twimg.com/profile_images/730502747754139649/hP6Q9DDQ_normal.jpg
@doc_faubel like this reference: http://t.co/a4OSwGVd1u (we get sicker patients - selection bias?) #nephjc
nephro_sparks
https://pbs.twimg.com/profile_images/552496649495273472/UA46V1Ye_normal.jpeg
@doc_faubel on gen med right now. seems like we (nature that is) are AKI curing machines as well #nephjc
drraymondhsu
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@methodsmanmd did you consider only using the 50% rise criterion re: "over"-sensitive kdigo #nephjc
hswapnil
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RT @methodsmanmd: Here's the ranking scheme for primary outcome. #nephjc http://t.co/DK3d1QuNjn
nephjc
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RT @Nephro_Sparks: @doc_faubel on gen med right now. seems like we (nature that is) are AKI curing machines as well #nephjc
christosargyrop
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@NephJC #nephjc Bonferroni or FDR not applicable as the tests are related
akbari_ayub
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Most AJI in primary care also gets better without nephrologist #nephjc
edgarvlermamd
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T0: When I was a resident/fellow, 1 of my goals was for my Attending not to have anything else to order - diagnostic or therapeutic #NephJC
franloachamin
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RT @kidney_boy: If you are planning on joining tonight’s #NephJC, you would be well served to read: http://t.co/kflfcIgn5G AKA the rationale.
methodsmanmd
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@hswapnil I think KDIGO AKI guidelines are troublesome. Random variation can lead to false AKI, particularly at high creat. #nephjc
hswapnil
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RT @methodsmanmd: @hswapnil I think KDIGO AKI guidelines are troublesome. Random variation can lead to false AKI, particularly at high creat. #nephjc
nephjc
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Did @goKdigo got it wrong, too sensitive RT @Nephro_Sparks: on gen med right now. seems like humans are AKI curing machines #nephjc
doc_faubel
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@hswapnil @doc_faubel yup. #nephjc
suzannenorby
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@methodsmanmd @kidney_boy Real world challenge = distinguishing b/w obvious to neph (esp in hindsight) & under the radar to many #nephjc
nephro_sparks
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RT @SuzanneNorby: @methodsmanmd @kidney_boy Real world challenge = distinguishing b/w obvious to neph (esp in hindsight) & under the radar to many #nephjc
hswapnil
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"don't just do something, stand there' seems to apply! @akbari_ayub: Most AKI in primary care also gets better without nephrologist #nephjc
nephjc
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Topic 3: No difference in tx between the two groups. Should the alerts have been part of a comprehensive early AKI tx protocol? #NephJC
hswapnil
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RT @SuzanneNorby: @methodsmanmd @kidney_boy Real world challenge = distinguishing b/w obvious to neph (esp in hindsight) & under the radar to many #nephjc
doc_faubel
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@Nephro_Sparks @doc_faubel wait a minute! maybe it is because we are the attendings and understand AKI! #nephjc
medquestioning
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RT @hswapnil: @methodsmanmd @NephJC - so if you say 'very sensitive' @goKdigo defn...do you mean it is not clinically useful? #nephjc
nephro_sparks
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@doc_faubel That is what I keep telling the team. AKI runs in fear when we walk in the room #nephjc
hswapnil
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RT @NephJC: Topic 3: No difference in tx between the two groups. Should the alerts have been part of a comprehensive early AKI tx protocol? #NephJC
jaykoyner
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RT @Nephro_Sparks: @doc_faubel That is what I keep telling the team. AKI runs in fear when we walk in the room #nephjc
hecmagsmd
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RT @hswapnil: "don't just do something, stand there' seems to apply! @akbari_ayub: Most AKI in primary care also gets better without nephrologist #nephjc
hswapnil
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RT @Nephro_Sparks: @doc_faubel That is what I keep telling the team. AKI runs in fear when we walk in the room #nephjc
hecmagsmd
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RT @Nephro_Sparks: @doc_faubel That is what I keep telling the team. AKI runs in fear when we walk in the room #nephjc
drraymondhsu
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I #heart everyone who gripe about kdigo guidelines #nephjc
nephro_sparks
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T3: I thought there would a least be more U/S ordered... #nephjc
hswapnil
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Pretend it's your therapeutic touch! @Nephro_Sparks: That is what I keep telling the team. AKI runs in fear when we walk in the room #nephjc
hswapnil
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RT @DrRaymondHsu: I #heart everyone who gripe about kdigo guidelines #nephjc
drraymondhsu
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sorry if any authors present here #oops #nephjc
hswapnil
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#nephjc https://t.co/UftGm8HgMl
hswapnil
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#nephjc https://t.co/PT5OMQQUIt
nephjc
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@Nephro_Sparks or more creatinines #nephjc
jaykoyner
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what if serum creatinine based alerts are too late to act on? those that are going to get better will and those that dont wont #nephjc
doc_faubel
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@hswapnil @Nephro_Sparks I will. I greatly believe good understanding leads to good doctoring and benefits patients. #nephjc
hswapnil
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@jaykoyner Ahh! perhaps you want #nephrocheck...or NGAL, then? #nephjc
drraymondhsu
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T3 well I wonder if these outcomes are aiming too high to start with #nephjc
nephjc
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No COI my ass RT @jaykoyner: what if serum creatinine based alerts are too late to act on? #nephjc
medquestioning
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RT @edgarvlermamd: T0: When I was a resident/fellow, 1 of my goals was for my Attending not to have anything else to order - diagnostic or therapeutic #NephJC
hecmagsmd
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RT @hswapnil: @jaykoyner Ahh! perhaps you want #nephrocheck...or NGAL, then? #nephjc
medquestioning
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RT @hswapnil: "don't just do something, stand there' seems to apply! @akbari_ayub: Most AKI in primary care also gets better without nephrologist #nephjc
hswapnil
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what do you think of using biomarkers to identify kidney injury @methodsmanmd? #nephjc
nephro_sparks
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T3: if no difference in Tx... then did alert add anything... or were they ignored? #nephjc
doc_faubel
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not sure if alert was even acted upon. how many even got a U/A? was it 1 in 4? #nephjc
jaykoyner
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@NephJC I dont have a COI - personal belief - but no nothing to gain - just wondering what folks think? #nephjc
suzannenorby
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@DrRaymondHsu @methodsmanmd Reviewers might have criticized that for not using contemporary definition of AKI #nephjc
nephjc
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@jaykoyner sorry #nephjc
nephro_sparks
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T3: any attempt to survey the MDs to see if they valued the alerts? #nephjc
methodsmanmd
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@hswapnil I want something we can roll out to any hospital, that makes a difference. Not feasible to measure NGAL in everyone. #nephjc
nephro_sparks
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RT @DrRaymondHsu: T3 well I wonder if these outcomes are aiming too high to start with #nephjc
drraymondhsu
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@SuzanneNorby Yes agree but to expect mortality difference for very mild aki is lofty #nephjc
jaykoyner
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@hswapnil - what if you looked at alerts in those with Scr AKI and elevated biomarkers? 2 signals pointing to high risk #nephjc
hswapnil
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RT @methodsmanmd: @hswapnil I want something we can roll out to any hospital, that makes a difference. Not feasible to measure NGAL in everyone. #nephjc
nephro_sparks
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RT @doc_faubel: @hswapnil @Nephro_Sparks I will. I greatly believe good understanding leads to good doctoring and benefits patients. #nephjc
medquestioning
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RT @doc_faubel: @hswapnil @Nephro_Sparks I will. I greatly believe good understanding leads to good doctoring and benefits patients. #nephjc
franloachamin
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#nephjc AKI