#NephJC transcript

Healthcare Social Media Transcript

From: Tue May 12 17:00:00 PDT 2015
To: Wed May 13 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

hswapnil
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T-58 minutes to #nephjc Let's get the work done! http://t.co/PbPHmbecRQ
nephro_sparks
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who is joining for the chat tonight? http://t.co/XvknK5S4O0 #hepatorenal #nephjc
kidney_boy
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Please explain to me why we call it HRS type 1 & 2 instead of HRS bad, and not so bad. Different types or just different severity? #NephJC
kidney_boy
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If HRS is essentially irreversible pre-renal azotemia, why don't we see it in CHF or cholera? Something ain't right about that #nephjc
kidney_boy
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@wittykidney: @kidney_boy one acute and the other sub-acute, so different severity and prognosis” #nephJC
kidney_boy
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@wittykidney in the rest of medicine we call those stages, not types. #NephJC said the #pedantic and #crankynephrologist
nephjc
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testing...are we ready? 5 mins to go #nephjc
kidney_boy
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Was this study blinded? #StillReadingTheMethods #nephjc
nephjc
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RT @kidney_boy: Was this study blinded? #StillReadingTheMethods #nephjc
nephjc
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Welcome to #NephJC 26! We will be discussing a rarity for nephrology, a positive RCT. Check out http://t.co/n68IQiKuEx for background
nephro_sparks
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Matt Sparks, Nephrologist, Durham, NC- no COI #hepatorenal #nephjc
bilalsaleem791
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#nephjc - I see Terlipressin rocking the next NephMadness ( if one is to trust this study )
nephjc
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I am Swapnil Hiremath, nephrologist from @uOttawaMed and #nephjc cofounder, hosting the EST version of the #NephJc chat. No CoI
nephjc
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Please introduce yourself, along with locations, affiliations and any relevant CoI #NephJC
kidney_boy
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Hello Bilal! Welcome back to #nephjc
nephro_sparks
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RT @bilalsaleem791: #nephjc - I see Terlipressin rocking the next #NephMadness
nephjc
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Hey Matt and Bilal, welcome! (Guess Joel is still reading the paper!) - oh, there you are! #nephjc
edgarvlermamd
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Edgar Lerma, Chicago based Nephrologist #NephJC
nephjc
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While peeps are warming up, thanks to our GMT chat co-host Francesco @caioqualunque for suggesting this and the summary write up #nephjc
sleonmd
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Scherly Leon Nephrology Fellow SUNY Downstate in Brooklyn, NY. Hello all. #nephjc
drdeborahfisher
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@Nephro_Sparks joining as token GI #nephjc
bilalsaleem791
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It is my honor, to be (Not on-call &) here #nephjc
sleonmd
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RT @Nephro_Sparks: RT @bilalsaleem791: #nephjc - I see Terlipressin rocking the next #NephMadness
nephjc
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@edgarvlermamd Ho Edgar! loking forward to some nifty algorithms from #Nephpearl central! and Hi Scherly! #nephjc
kidney_boy
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Joel Topf, Nephrologist and in honor of hepatorenal syndrome I am washing down 800 mg of ibuprofen with a shot of scotch #nephjc
nephro_sparks
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the sinking feeling when you get a consult for AKI in a patient with cirrhosis #nephjc
hecmagsmd
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Hector Madariaga. Renal fellow. SUNY Upstate. Syracuse NY #nephjc
dr_nikhilshah
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Nikhil Shah, Nephrology Fellow, Univ of Alberta, Edmonton, Canada. #NSMC Intern #nephjc
nephjc
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@DrDeborahFisher @Nephro_Sparks Fantastic, thanks for joining in! #nephjc
sleonmd
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RT @Nephro_Sparks: the sinking feeling when you get a consult for AKI in a patient with cirrhosis #nephjc
nephjc
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Ho Nikhil and Hector! great #NSMC turnout tonight #nephjc
nephro_sparks
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@DrDeborahFisher Yes! Duke GI in the house!! #nephjc
hecmagsmd
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@kidney_boy had an early start! #nephjc
edgarvlermamd
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AKI in Cirrhosis: Prerenal, Hepatorenal, ATN #Nephpearls #NephJC http://t.co/IM5sqKUQkw http://t.co/aSo9TKcYSc
wittykidney
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Malvinder Parmar, Nephro, no COI didn't have access to full paper so may some simple questions #nephjc
bilalsaleem791
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A nephrology fellow from St John hospital, Detroit. #nephjc
kidneydocfla
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Ashok Sastry here from sarasota,florida..nephrologist who sees my fair share of HRS #nephjc
hecmagsmd
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RT @NephJC: Ho Nikhil and Hector! great #NSMC turnout tonight #nephjc
dr_nikhilshah
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@Nephro_Sparks Depends on who calls, if it is the staff - there is still hope, if its the resident - the kidneys are toast! #nephjc
nephro_sparks
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where is @RyanMadanickMD #nephjc
sleonmd
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RT @edgarvlermamd: AKI in Cirrhosis: Prerenal, Hepatorenal, ATN #Nephpearls #NephJC http://t.co/IM5sqKUQkw http://t.co/aSo9TKcYSc
nephjc
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Simple Qs are always welcome, Mal! and Ashok - first timer from Florida Nephrologist, welcome! #nephjc
nephjc
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One of the purposes of the #NephJC chats is to grow your #PLN ( http://t.co/BTOdYsWsi1) - so hit the follow button often
dr_nikhilshah
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Hello #NSMC Masters . May you drink in piss! #nephjc
edgarvlermamd
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Diagnostic Criteria for Hepatorenal Syndrome #Nephpearls #NephJC http://t.co/pQeNcx20wC http://t.co/OivfDeb0a7
kidney_boy
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@kidneydocfla had my 20 year WSU medical school reunion last week-end. #nephjc
nephjc
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RT @edgarvlermamd: AKI in Cirrhosis: Prerenal, Hepatorenal, ATN #Nephpearls #NephJC http://t.co/IM5sqKUQkw http://t.co/aSo9TKcYSc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
For more background, check out the nice overview of recent #hepatorenal defn from @davidbaird86 & @paulphel http://t.co/DHFjYV69SV #nephjc
sleonmd
https://pbs.twimg.com/profile_images/517086639966138369/yTFiuwut_normal.jpeg
RT @edgarvlermamd: Diagnostic Criteria for Hepatorenal Syndrome #Nephpearls #NephJC http://t.co/pQeNcx20wC http://t.co/OivfDeb0a7
drdeborahfisher
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RT @edgarvlermamd: Diagnostic Criteria for Hepatorenal Syndrome #Nephpearls #NephJC http://t.co/pQeNcx20wC http://t.co/OivfDeb0a7
edgarvlermamd
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Specific Therapies for Hepatorenal Syndrome in patients with Cirrhosis #Nephpearls #NephJC http://t.co/TpdqSq80YS http://t.co/NkHCAX3G2y
nephro_sparks
https://pbs.twimg.com/profile_images/552496649495273472/UA46V1Ye_normal.jpeg
RT @NephJC: For more background, check out the nice overview of recent #hepatorenal defn from @davidbaird86 & @paulphel http://t.co/DHFjYV69SV #nephjc
sleonmd
https://pbs.twimg.com/profile_images/517086639966138369/yTFiuwut_normal.jpeg
RT @NephJC: For more background, check out the nice overview of recent #hepatorenal defn from @davidbaird86 & @paulphel http://t.co/DHFjYV69SV #nephjc
nephjc
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We recommend using a client such as tchat.io or http://t.co/rFoH4MVMzu to capture all the tweets tagged #nephjc (Click on links to expand)
drdeborahfisher
https://pbs.twimg.com/profile_images/711373561001320448/6XsWaIH5_normal.jpg
RT @NephJC: For more background, check out the nice overview of recent #hepatorenal defn from @davidbaird86 & @paulphel http://t.co/DHFjYV69SV #nephjc
sleonmd
https://pbs.twimg.com/profile_images/517086639966138369/yTFiuwut_normal.jpeg
RT @edgarvlermamd: Specific Therapies for Hepatorenal Syndrome in patients with Cirrhosis #Nephpearls #NephJC http://t.co/TpdqSq80YS http://t.co/NkHCAX3G2y
nephjc
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anyone else lurking, feel free to jump in and introduce yourself... #nephjc
hecmagsmd
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@dr_nikhilshah hmmm no!. But hello!! :) #nephjc
nephro_sparks
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however, my main issue with tchat.io is that you cannot see pictures and will not automatically fill in #nephjc
kidneydocfla
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@kidney_boy mine is in 2021, hopefully terlipressin may be available by then #nephjc
edgarvlermamd
https://pbs.twimg.com/profile_images/2297302029/image_normal.jpg
Algorithm for treatment of Hepatorenal Syndrome Type 1 #Nephpearls #NephJC http://t.co/pQeNcx20wC http://t.co/PYqU8goA4Z
drdeborahfisher
https://pbs.twimg.com/profile_images/711373561001320448/6XsWaIH5_normal.jpg
RT @edgarvlermamd: Specific Therapies for Hepatorenal Syndrome in patients with Cirrhosis #Nephpearls #NephJC http://t.co/TpdqSq80YS http://t.co/NkHCAX3G2y
mina_el_naguib
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RT @kidney_boy: Joel Topf, Nephrologist and in honor of hepatorenal syndrome I am washing down 800 mg of ibuprofen with a shot of scotch #nephjc
nephro_sparks
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@HekmagsMD @dr_nikhilshah hey hector and nikhil. good to see you #NSMC #nephjc
nephjc
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If you are not using tchat.io or http://t.co/rFoH4MVMzu, make sure you add #nephjc to every tweet to be included in the chat!
drraymondhsu
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hi folks, nephrologist in san francisco here #nephjc
drdeborahfisher
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RT @edgarvlermamd: Algorithm for treatment of Hepatorenal Syndrome Type 1 #Nephpearls #NephJC http://t.co/pQeNcx20wC http://t.co/PYqU8goA4Z
steveschoi
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@Nephro_Sparks Usually enough ascites on board that you'll float. #NephJC
edgarvlermamd
https://pbs.twimg.com/profile_images/2297302029/image_normal.jpg
Algorithm for treatment of Hepatorenal Syndrome Type 2 #Nephpearls #NephJC http://t.co/pQeNcx20wC http://t.co/wCWfn1HEXl
nephjc
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@DrRaymondHsu Ho Ray, thanks for making it again! #nephjc
drdeborahfisher
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RT @NephJC: If you are not using tchat.io or http://t.co/rFoH4MVMzu, make sure you add #nephjc to every tweet to be included in the chat!
nephro_sparks
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@RyanMadanickMD @DPAC well have fun. will miss you at #nephjc
dr_nikhilshah
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@Nephro_Sparks @HekmagsMD @dr_nikhilshah Thx Matt, Joel, Swapnil #nephjc
hecmagsmd
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RT @Nephro_Sparks: @HekmagsMD @dr_nikhilshah hey hector and nikhil. good to see you #NSMC #nephjc
anakinramd
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Fernanda, med student from Mexico, just lurking #nephjc
nephjc
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@steveschoi @Nephro_Sparks Awesome, we have another hepatologist joining in . Thanks for coming in tonight Steve! #nephjc
kidney_boy
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I remember when I was a resident, everyone that got HRS died. People seem to do a lot better now. #nephjc
hecmagsmd
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@AnakinraMD Bienvenida! #nephjc
drdeborahfisher
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@steveschoi @Nephro_Sparks yay don't forget #nephjc
nephro_sparks
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yes @stevechoi is joining #nephjc
nephjc
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@AnakinraMD Hey Fernanda, lurk as much as you wish, and feel free to ask a Q if you want to #nephjc
nephro_sparks
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sorry that is @steveschoi #nephjc
drdeborahfisher
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RT @NephJC: @steveschoi @Nephro_Sparks Awesome, we have another hepatologist joining in . Thanks for coming in tonight Steve! #nephjc
bilalsaleem791
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@kidney_boy it's a bad consult for the nephrologist... Boring and slow #nephjc
nephjc
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T0: how do you diagnose #hepatorenal syndrome (= HRS today) ? Like any other AKI or using these criteria? #NephJC http://t.co/oXF3L6V8ym
anakinramd
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@NephJC Thanks, I will #nephjc
nephro_sparks
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.@steveschoi I'll do what I can. Hepatologists best seen and not heard? #nephjc
nephjc
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RT @kidney_boy: I remember when I was a resident, everyone that got HRS died. People seem to do a lot better now. #nephjc
steveschoi
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@DrDeborahFisher @Nephro_Sparks Oops! Will do. #NephJC
wittykidney
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Somewhat paradox, ⬆️ sensitivity of renal circ to vasocontrictors, & using same to treat #nephJC
nephjc
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T0: one of the HRS criteria is 1g/kg albumin infusion http://t.co/oXF3L6V8ym Do all do that? #NephJC http://t.co/Fadewh13hX
kidney_boy
https://pbs.twimg.com/profile_images/817201108808593408/BLKlnv3k_normal.jpg
@bilalsaleem791 now that we have something to offer besides transplant it is a better consult. #nephjc
dr_nikhilshah
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@kidney_boy They still die, only slower than before! #nephjc
sleonmd
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RT @dr_nikhilshah: @kidney_boy They still die, only slower than before! #nephjc
edgarvlermamd
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Acute-on-Chronic Liver Failure: Currently Available Devices #Nephpearls #NephJC @Medscape http://t.co/w56Fgp0tTP http://t.co/LjIjic3iJA
kidney_boy
https://pbs.twimg.com/profile_images/817201108808593408/BLKlnv3k_normal.jpg
When I was a resident the algorithm was confirm HRS and then if not a transplant candidate, then offer comfort care. #nephjc
nephjc
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RT @kidney_boy: When I was a resident the algorithm was confirm HRS and then if not a transplant candidate, then offer comfort care. #nephjc
sassypharmd
https://pbs.twimg.com/profile_images/540706072671965185/V2Lp1Gkj_normal.jpeg
RT @kidney_boy: Joel Topf, Nephrologist and in honor of hepatorenal syndrome I am washing down 800 mg of ibuprofen with a shot of scotch #nephjc
drdeborahfisher
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@NephJC when it is available #NephJC
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
Algo now - T0: the approach to manage HRS from http://t.co/oXF3L7cJpU #nephJC Mainly vasoconstrictors + alb http://t.co/RyxHso8Zv2
thinkalot
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RT @Nephro_Sparks: the sinking feeling when you get a consult for AKI in a patient with cirrhosis #nephjc
dr_nikhilshah
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@nephjc we have seen too much albumin as cause of AKI - Serum albumin from 20 to 60 in 2 days - Zero GFR! #nephjc
kidney_boy
https://pbs.twimg.com/profile_images/817201108808593408/BLKlnv3k_normal.jpg
That’s a lot of survival out past 90 days. #NephJC @dr_nikhilshah http://t.co/KHzoXv2ieY
nephjc
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so T0: what is your choice of vasocontrictor? has anyone exp. with terlipressin? or just midodrine/octreotide? #nephjc
nephjc
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RT @dr_nikhilshah: @nephjc we have seen too much albumin as cause of AKI - Serum albumin from 20 to 60 in 2 days - Zero GFR! #nephjc
hecmagsmd
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T0. They do use albumin, but I feel they don't rule out other AKI causes in cirrhotic pts. #nephjc
nephro_sparks
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T0- often get a consult that says... we have given like 4 L of NS and urine Na is <10 still #nephjc
dr_nikhilshah
https://pbs.twimg.com/profile_images/801651738524598272/d9uOVZ_9_normal.jpg
@NephJC T0- Back in India - mostly Terlipressin + albumin, Here mostly Midodrine-Oct+Alb #nephjc
xw90
https://pbs.twimg.com/profile_images/786778910054899712/Ig5hDtHg_normal.jpg
RT @edgarvlermamd: Algorithm for treatment of Hepatorenal Syndrome Type 1 #Nephpearls #NephJC http://t.co/pQeNcx20wC http://t.co/PYqU8goA4Z
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
isn't UNa useless in HRS? @dr_nikhilshah: @NephJC T0- Back in India - mostly Terlipressin + albumin, Here mostly Midodrine-Oct+Alb #nephjc
sleonmd
https://pbs.twimg.com/profile_images/517086639966138369/yTFiuwut_normal.jpeg
RT @HekmagsMD: T0. They do use albumin, but I feel they don't rule out other AKI causes in cirrhotic pts. #nephjc
kidney_boy
https://pbs.twimg.com/profile_images/817201108808593408/BLKlnv3k_normal.jpg
I'm a midodrine and octreotide believer #nephjc
nephro_sparks
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@HekmagsMD T0- sometimes the results of the workup show +proteinuria or +hematuria and cannot do biopsy because of INR #nephjc
xw90
https://pbs.twimg.com/profile_images/786778910054899712/Ig5hDtHg_normal.jpg
RT @edgarvlermamd: AKI in Cirrhosis: Prerenal, Hepatorenal, ATN #Nephpearls #NephJC http://t.co/IM5sqKUQkw http://t.co/aSo9TKcYSc
kidney_boy
https://pbs.twimg.com/profile_images/817201108808593408/BLKlnv3k_normal.jpg
RT @HekmagsMD: T0. They do use albumin, but I feel they don't rule out other AKI causes in cirrhotic pts. #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
isn't UNa useless in HRS? @Nephro_Sparks: often get a consult that says... we have given like 4 L of NS and urine Na is <10 still #nephjc
kidneydocfla
https://pbs.twimg.com/profile_images/703096133652860930/KYWSchc__normal.jpg
Was there data looking at outcomes of type one and type two HRS pts separately?#nephjc
hecmagsmd
https://pbs.twimg.com/profile_images/555936314122842113/5A3PrkXC_normal.jpeg
So true! RT @Nephro_Sparks: T0- often get a consult that says... we have given like 4 L of NS and urine Na is <10 still #nephjc
wittykidney
https://pbs.twimg.com/profile_images/553936695637606401/GNV7JM5x_normal.jpeg
Previous studies, equivocal & recent REVERSE trial was also, see ot here's #NephJC http://t.co/esOhsLndJm
drdeborahfisher
https://pbs.twimg.com/profile_images/711373561001320448/6XsWaIH5_normal.jpg
@kidney_boy of what is available in U.S. It appears the best #nephjc
nephro_sparks
https://pbs.twimg.com/profile_images/552496649495273472/UA46V1Ye_normal.jpeg
@NephJC this is the consult we receive #nephjc
nephro_sparks
https://pbs.twimg.com/profile_images/552496649495273472/UA46V1Ye_normal.jpeg
RT @DrDeborahFisher: @kidney_boy of what is available in U.S. It appears the best #nephjc
kidney_boy
https://pbs.twimg.com/profile_images/817201108808593408/BLKlnv3k_normal.jpg
Urine sodium will be low in cirrhosis in ATN, HRS and pre-renal azotemia. As useless as a brain in a gastroenterologist. JK. #nephjc
dr_nikhilshah
https://pbs.twimg.com/profile_images/801651738524598272/d9uOVZ_9_normal.jpg
@NephJC @Nephro_Sparks Urine Na - Being examined in a total urine volume of 150 ml in 24 hours - I dont think its the best idea! #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
RT @wittykidney: Previous studies, equivocal & recent REVERSE trial was also, see ot here's #NephJC http://t.co/esOhsLndJm
drraymondhsu
https://pbs.twimg.com/profile_images/743669111754940416/jPZuw-St_normal.jpg
T0 I think it's assumed that HRS clinical dx was made (r/o'ed other causes) #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
QFT: for midodrine/octreotide @DrDeborahFisher: @kidney_boy of what is available in U.S. It appears the best #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
RT @kidney_boy: Urine sodium will be low in cirrhosis in ATN, HRS and pre-renal azotemia. As useless as a brain in a gastroenterologist. JK. #nephjc
wittykidney
https://pbs.twimg.com/profile_images/553936695637606401/GNV7JM5x_normal.jpeg
@NephJC what r the differences between 2 #nephJC what about desmopressin? See vasopressin analogues http://t.co/T8l29tUFGq
kidneydocfla
https://pbs.twimg.com/profile_images/703096133652860930/KYWSchc__normal.jpg
@kidney_boy the combo buys me a couple days to let palliative care team to help me and overworked town hepatologist #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
So let's move on to the real article now: http://t.co/rrtYKZBrxQ #nephjc T1: incl type 1 or severe type 2 HRS (Cr > 2.5). Quite reasonable?
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
Details of today's RCT from http://t.co/sZaqBRxn1o: https://t.co/PoBa4RblKS #nephjc
edgarvlermamd
https://pbs.twimg.com/profile_images/2297302029/image_normal.jpg
Hepatorenal Syndrome: Precipitating Factors #Nephpearls #NephJC http://t.co/UvAHYNtJkp
wittykidney
https://pbs.twimg.com/profile_images/553936695637606401/GNV7JM5x_normal.jpeg
@DrDeborahFisher @Nephro_Sparks @kidney_boy desmopressin is available everywhere and has longest T1/2 #nephjc
hecmagsmd
https://pbs.twimg.com/profile_images/555936314122842113/5A3PrkXC_normal.jpeg
Sepsis, ATN, pre-renal, CI-AKI, AIN... far more common causes of AKI in cirrhotic patients, than HRS itself. #nephjc
steveschoi
https://pbs.twimg.com/profile_images/378800000387690636/6241db5e727e6d138900f89887923114_normal.jpeg
RT @DrDeborahFisher: @kidney_boy of what is available in U.S. It appears the best #nephjc
nephro_sparks
https://pbs.twimg.com/profile_images/552496649495273472/UA46V1Ye_normal.jpeg
RT @HekmagsMD: Sepsis, ATN, pre-renal, CI-AKI, AIN... far more common causes of AKI in cirrhotic patients, than HRS itself. #nephjc
sleonmd
https://pbs.twimg.com/profile_images/517086639966138369/yTFiuwut_normal.jpeg
RT @edgarvlermamd: Hepatorenal Syndrome: Precipitating Factors #Nephpearls #NephJC http://t.co/UvAHYNtJkp
medquestioning
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RT @kidney_boy: Joel Topf, Nephrologist and in honor of hepatorenal syndrome I am washing down 800 mg of ibuprofen with a shot of scotch #nephjc
nephjc
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QFT! @HekmagsMD: Sepsis, ATN, pre-renal, CI-AKI, AIN... far more common causes of AKI in cirrhotic patients, than HRS itself. #nephjc
edgarvlermamd
https://pbs.twimg.com/profile_images/2297302029/image_normal.jpg
Bacterial Translocation & Cytokine Overprodroduction/ Hepatorenal Syndrome #Nephpearls #NephJC http://t.co/T0R47iZSwN http://t.co/J3NMIOp7sq
drraymondhsu
https://pbs.twimg.com/profile_images/743669111754940416/jPZuw-St_normal.jpg
T1 cutoff value for Cr criteria is somewhat arbitrary, but prob necessary for study purposes #nephjc
drdeborahfisher
https://pbs.twimg.com/profile_images/711373561001320448/6XsWaIH5_normal.jpg
#nephjc I think you can't assume other diagnoses r/o @steveschoi ? There is a certain amount of freak out w/ cirrhosis . Call renal and GI!
dr_nikhilshah
https://pbs.twimg.com/profile_images/801651738524598272/d9uOVZ_9_normal.jpg
@edgarvlermamd Large volume paracentesis - Someone needs to talk to Interventional Radiology - 4-6 lit each sitting!! #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
for T1 - we will look at the methods a bit more closely...starting with dosing of mifdodrine/octreotide (control) vs terlipressin #nephjc
wittykidney
https://pbs.twimg.com/profile_images/553936695637606401/GNV7JM5x_normal.jpeg
@edgarvlermamd agree, development of kidney dysfunction in HRS #nephjc http://t.co/Y3aQE8NsCw
edgarvlermamd
https://pbs.twimg.com/profile_images/2297302029/image_normal.jpg
Afferent mechanisms of Na retention in cirrhosis and Hepatorenal Syndrome #Nephpearls #NephJC http://t.co/HJ4vHT2Sqq http://t.co/kAiCHGTPpy
drdeborahfisher
https://pbs.twimg.com/profile_images/711373561001320448/6XsWaIH5_normal.jpg
RT @wittykidney: @DrDeborahFisher @Nephro_Sparks @kidney_boy desmopressin is available everywhere and has longest T1/2 #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
RT @DrRaymondHsu: T1 cutoff value for Cr criteria is somewhat arbitrary, but prob necessary for study purposes #nephjc
steveschoi
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@DrDeborahFisher Then the battle begins between housestaff. #NephJC
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
T1: both intervention (#terlipressin) & control titrated up based on response (⬆️ if creat improved by 25%, q 48 hours) #nephJC
nephro_sparks
https://pbs.twimg.com/profile_images/552496649495273472/UA46V1Ye_normal.jpeg
RT @DrDeborahFisher: #nephjc I think you can't assume other diagnoses r/o @steveschoi ? There is a certain amount of freak out w/ cirrhosis . Call renal and GI!
nephro_sparks
https://pbs.twimg.com/profile_images/552496649495273472/UA46V1Ye_normal.jpeg
@DrDeborahFisher @steveschoi maybe we need a combined hepatorenal fellowship #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
t1: do you agree with titrating up based on creatinine? why not clinical response/diuresis? #nephjc
hecmagsmd
https://pbs.twimg.com/profile_images/555936314122842113/5A3PrkXC_normal.jpeg
RT @Nephro_Sparks: @DrDeborahFisher @steveschoi maybe we need a combined hepatorenal fellowship #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
RT @Nephro_Sparks: @DrDeborahFisher @steveschoi maybe we need a combined hepatorenal fellowship #nephjc
sleonmd
https://pbs.twimg.com/profile_images/517086639966138369/yTFiuwut_normal.jpeg
RT @Nephro_Sparks: @DrDeborahFisher @steveschoi maybe we need a combined hepatorenal fellowship #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
T1: definition of response is interesting. Complete response if Cr < 1.5, partial if >50% fall in creat (but greater than 1.5) #nephJC.
nancyadi
https://pbs.twimg.com/profile_images/817762932708745216/pFQkp7fe_normal.jpg
RT @edgarvlermamd: Afferent mechanisms of Na retention in cirrhosis and Hepatorenal Syndrome #Nephpearls #NephJC http://t.co/HJ4vHT2Sqq http://t.co/kAiCHGTPpy
dr_nikhilshah
https://pbs.twimg.com/profile_images/801651738524598272/d9uOVZ_9_normal.jpg
Question - Where does the consult come from most commonly - ICU or Liver ward. Would that have outcome implications? #nephjc
nephjc
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RT @dr_nikhilshah: Question - Where does the consult come from most commonly - ICU or Liver ward. Would that have outcome implications? #nephjc
nephro_sparks
https://pbs.twimg.com/profile_images/552496649495273472/UA46V1Ye_normal.jpeg
T1: how is this titrating up done in prior studies? #nephjc
kidney_boy
https://pbs.twimg.com/profile_images/817201108808593408/BLKlnv3k_normal.jpg
No. I dose adjust based on diuresis RT @NephJC: t1: do you agree with titrating up based on creatinine? why not clinical response? #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
good Q: does anyone know? @Nephro_Sparks: T1: how is this titrating up done in prior studies? #nephjc
nephjc
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RT @kidney_boy: No. I dose adjust based on diuresis RT @NephJC: t1: do you agree with titrating up based on creatinine? why not clinical response? #nephjc
drdeborahfisher
https://pbs.twimg.com/profile_images/711373561001320448/6XsWaIH5_normal.jpg
@NephJC is this standard or typical for AKI or AonCKI studies? I'm guessing not? #NephJC
hecmagsmd
https://pbs.twimg.com/profile_images/555936314122842113/5A3PrkXC_normal.jpeg
@dr_nikhilshah The majority of the cases I have seen, pts are in the ICU. #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
T0: Also, would you uptitrate midodrine/octreotide if BP normal? #nephjc
wittykidney
https://pbs.twimg.com/profile_images/553936695637606401/GNV7JM5x_normal.jpeg
@dr_nikhilshah often if type 1 will be in ICU and will have implications, can't use vasocontrictor infusions on most medical wards #nephjc
nephro_sparks
https://pbs.twimg.com/profile_images/552496649495273472/UA46V1Ye_normal.jpeg
maybe @steveschoi knows re titrating dose (based on creat or clinical response) #nephjc
drraymondhsu
https://pbs.twimg.com/profile_images/743669111754940416/jPZuw-St_normal.jpg
i thought classically we titrate midodrine to MAP but maybe that's outdated? #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
Unusual - but often AKI not reversible @DrDeborahFisher: is this standard or typical for AKI or AonCKI studies? I'm guessing not? #NephJC
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
RT @DrRaymondHsu: i thought classically we titrate midodrine to MAP but maybe that's outdated? #nephjc
dr_nikhilshah
https://pbs.twimg.com/profile_images/801651738524598272/d9uOVZ_9_normal.jpg
@wittykidney @dr_nikhilshah Then it will mostly be Midodrine, Octro and Albumin - Would you move the patient to ICU now for Terli?? #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
T1: though time of outcome not clear, drugs for 14 days if no response. Any rescue allowed for non-responders. Outpt follow up 3 mth #nephJC
steveschoi
https://pbs.twimg.com/profile_images/378800000387690636/6241db5e727e6d138900f89887923114_normal.jpeg
@Nephro_Sparks Good question. Often, which is easier and more practical to track? #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
T1: analysis - sample size needed 43 in each to achieve 60% response w/ terlipressin vs 30% w/ mido/octreotide #nephJC But,
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
T1: interim analysis when half N achieved & stopping rule if p < 0.01. ? Power not adjusted for this interim analysis #NephJC
drdeborahfisher
https://pbs.twimg.com/profile_images/711373561001320448/6XsWaIH5_normal.jpg
RT @steveschoi: @Nephro_Sparks Good question. Often, which is easier and more practical to track? #nephjc
kidney_boy
https://pbs.twimg.com/profile_images/817201108808593408/BLKlnv3k_normal.jpg
@DrDeborahFisher in HRS I would consider partial response development of non-oliguria and complete response a drop in Cr. #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
RT @steveschoi: @Nephro_Sparks Good question. Often, which is easier and more practical to track? #nephjc
dr_nikhilshah
https://pbs.twimg.com/profile_images/801651738524598272/d9uOVZ_9_normal.jpg
RT @kidney_boy: @DrDeborahFisher in HRS I would consider partial response development of non-oliguria and complete response a drop in Cr. #nephjc
nephjc
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RT @kidney_boy: @DrDeborahFisher in HRS I would consider partial response development of non-oliguria and complete response a drop in Cr. #nephjc
nephro_sparks
https://pbs.twimg.com/profile_images/552496649495273472/UA46V1Ye_normal.jpeg
this is just a pet peeve of mine. but I really dislike the bar graphs. particularly in a clinical paper. #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
RT @Nephro_Sparks: this is just a pet peeve of mine. but I really dislike the bar graphs. particularly in a clinical paper. #nephjc
hswapnil
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T1: the interim analysis looks a bit underpowered #nephjc http://t.co/KOI5frxZPI http://t.co/JNhez8qpVg
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
T1: any other pet (or otherwise) peeves with methods? lack of blinding? Outcomes assessment? #nephjc
steveschoi
https://pbs.twimg.com/profile_images/378800000387690636/6241db5e727e6d138900f89887923114_normal.jpeg
@kidney_boy @DrDeborahFisher This is practical and relevant for housestaff. #nephjc
drraymondhsu
https://pbs.twimg.com/profile_images/743669111754940416/jPZuw-St_normal.jpg
RT @Nephro_Sparks: this is just a pet peeve of mine. but I really dislike the bar graphs. particularly in a clinical paper. #nephjc
drdeborahfisher
https://pbs.twimg.com/profile_images/711373561001320448/6XsWaIH5_normal.jpg
@NephJC does an a priori planned interim analysis stopping rule need an adjustment if the study was in fact stopped? #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
RT @DrDeborahFisher: @NephJC does an a priori planned interim analysis stopping rule need an adjustment if the study was in fact stopped? #nephjc
drraymondhsu
https://pbs.twimg.com/profile_images/743669111754940416/jPZuw-St_normal.jpg
@Nephro_Sparks the bar graphs remind me of all those contrast nephropathy trial papers from early 2000s #nephjc
nephro_sparks
https://pbs.twimg.com/profile_images/552496649495273472/UA46V1Ye_normal.jpeg
RT @DrDeborahFisher: @NephJC does an a priori planned interim analysis stopping rule need an adjustment if the study was in fact stopped? #nephjc
drdeborahfisher
https://pbs.twimg.com/profile_images/711373561001320448/6XsWaIH5_normal.jpg
RT @kidney_boy: @DrDeborahFisher in HRS I would consider partial response development of non-oliguria and complete response a drop in Cr. #nephjc
kidney_boy
https://pbs.twimg.com/profile_images/817201108808593408/BLKlnv3k_normal.jpg
T1, they block randomized type 1 and type 2 but didn't give results in those groups. #nephjc
drdeborahfisher
https://pbs.twimg.com/profile_images/711373561001320448/6XsWaIH5_normal.jpg
RT @steveschoi: @kidney_boy @DrDeborahFisher This is practical and relevant for housestaff. #nephjc
dr_nikhilshah
https://pbs.twimg.com/profile_images/801651738524598272/d9uOVZ_9_normal.jpg
T0 - Why such a skewed M:F ratio in the Terli - But cant think of any implication. #nephjc
kidney_boy
https://pbs.twimg.com/profile_images/817201108808593408/BLKlnv3k_normal.jpg
Since they didn't mention blinding procedures, I'll assume they were unblinded. #nephjc
othinkagain
https://pbs.twimg.com/profile_images/651120651030298624/j6iBJAu8_normal.jpg
RT @wittykidney: @NephJC what r the differences between 2 #nephJC what about desmopressin? See vasopressin analogues http://t.co/T8l29tUFGq
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
@DrDeborahFisher Point is, was p < 0.01 for stopping robust? usual stats would require p <0.001 eg to stop at interim stage #nephjc
nephro_sparks
https://pbs.twimg.com/profile_images/552496649495273472/UA46V1Ye_normal.jpeg
@DrRaymondHsu kinda like wearing oakley sunglasses. looks cool but they hide too much #nephjc
nephjc
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RT @kidney_boy: T1, they block randomized type 1 and type 2 but didn't give results in those groups. #nephjc
drdeborahfisher
https://pbs.twimg.com/profile_images/711373561001320448/6XsWaIH5_normal.jpg
@NephJC not blinded correct? Would have been difficult but you wonder about other care that could have impacted outcome #nephjc
nephro_sparks
https://pbs.twimg.com/profile_images/552496649495273472/UA46V1Ye_normal.jpeg
RT @NephJC: @DrDeborahFisher Point is, was p < 0.01 for stopping robust? usual stats would require p <0.001 eg to stop at interim stage #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
that sounds right, so you read methods? @kidney_boy: Since they didn't mention blinding procedures, I'll assume they were unblinded. #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
RT @DrDeborahFisher: @NephJC not blinded correct? Would have been difficult but you wonder about other care that could have impacted outcome #nephjc
kidney_boy
https://pbs.twimg.com/profile_images/817201108808593408/BLKlnv3k_normal.jpg
@Nephro_Sparks @DrRaymondHsu Oakley sunglasses ≠ cool #nephjc
hecmagsmd
https://pbs.twimg.com/profile_images/555936314122842113/5A3PrkXC_normal.jpeg
RT @wittykidney: @NephJC what r the differences between 2 #nephJC what about desmopressin? See vasopressin analogues http://t.co/T8l29tUFGq
nephro_sparks
https://pbs.twimg.com/profile_images/552496649495273472/UA46V1Ye_normal.jpeg
@kidney_boy @Nephro_Sparks @DrRaymondHsu referring to the 80's #nephjc
kiwiskinz
https://pbs.twimg.com/profile_images/1626233482/JohnPickeringOnTrikkeCr.JPG_normal.jpg
RT @NephJC: @DrDeborahFisher Point is, was p < 0.01 for stopping robust? usual stats would require p <0.001 eg to stop at interim stage #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
blinding, lack of power aside, let's move on to the results for T2, after all its a positive RCT! #nephjc
kidney_boy
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Agree. They were cool in the 80's (P=0.002) RT @Nephro_Sparks: @kidney_boy @Nephro_Sparks @DrRaymondHsu referring to the 80's #nephjc
jaytalw
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Jay Talwalkar, Hepatologist, Rocheser, MN - no COI #nephjc
nephjc
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Hey @kiwiskiNZ, would like to hear your input on stats (AKI and stats expert POV) #nephjc
wittykidney
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@kidney_boy need to be clear how many of those enrolled were type 2 #nephjc
kidney_boy
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Hello Jay! #nephjc
nephro_sparks
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RT @kidney_boy: Agree. They were cool in the 80's (P=0.002) RT @Nephro_Sparks: @kidney_boy @Nephro_Sparks @DrRaymondHsu referring to the 80's #nephjc
drdeborahfisher
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@NephJC who was sponsor? Often stopping rules are sponsor (or ethics board ) generated. #nephjc
nephjc
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Ho Jay, thanks for joining in! Another hepatologist in the house #nephjc
nephro_sparks
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RT @DrDeborahFisher: @NephJC who was sponsor? Often stopping rules are sponsor (or ethics board ) generated. #nephjc
nephjc
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Seems it was the institute @DrDeborahFisher: @NephJC who was sponsor? Often stopping rules are sponsor (or ethics board ) generated. #nephjc
kidneydocfla
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@kidney_boy @NephJC now id love to see the data in the type one group vs type two separately #nephjc
nephro_sparks
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totally agree RT @kidneydocfla: @kidney_boy @NephJC now id love to see the data in the type one group vs type two separately #nephjc
nephjc
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T2: trial flow: pretty good recruitment from figure 1 49 randomized from eligible 66! #nephjc http://t.co/HlDDlBcltx
jaytalw
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Sorry for joining late - had to finish cutting the lawn #nephjc
anakanaschofiel
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Oh goody the Nephrologists are up and at it and my timeline is full of > .09 and dodgy looking graphs. No lurkers! #nephjc
kidney_boy
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@wittykidney almost all of them were type 1. #nephjc http://t.co/IXLXfM5qVs
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
RT @kidneydocfla: @kidney_boy @NephJC now id love to see the data in the type one group vs type two separately #nephjc
jaytalw
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In liver circles, the major beef with HRS trials is that terlipressin (or any drug) hasn't improved survival #nephjc
nephjc
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T2: results table 1: reasonable spread of baseline characteristics. (Aside - those p = NS in an RCT table 1!) #nephjc http://t.co/gtlIBhfhJT
drdeborahfisher
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RT @kidney_boy: @wittykidney almost all of them were type 1. #nephjc http://t.co/IXLXfM5qVs
drdeborahfisher
https://pbs.twimg.com/profile_images/711373561001320448/6XsWaIH5_normal.jpg
RT @NephJC: T2: trial flow: pretty good recruitment from figure 1 49 randomized from eligible 66! #nephjc http://t.co/HlDDlBcltx
drdeborahfisher
https://pbs.twimg.com/profile_images/711373561001320448/6XsWaIH5_normal.jpg
RT @Nephro_Sparks: totally agree RT @kidneydocfla: @kidney_boy @NephJC now id love to see the data in the type one group vs type two separately #nephjc
sleonmd
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RT @JayTalw: In liver circles, the major beef with HRS trials is that terlipressin (or any drug) hasn't improved survival #nephjc
kidney_boy
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@JayTalw but HRS is just a symptom of the underlying pathology. Just buying time for liver recovery or transplant. #nephjc
drdeborahfisher
https://pbs.twimg.com/profile_images/711373561001320448/6XsWaIH5_normal.jpg
RT @JayTalw: In liver circles, the major beef with HRS trials is that terlipressin (or any drug) hasn't improved survival #nephjc
drdeborahfisher
https://pbs.twimg.com/profile_images/711373561001320448/6XsWaIH5_normal.jpg
RT @JayTalw: In liver circles, the major beef with HRS trials is that terlipressin (or any drug) hasn't improved survival #nephjc
nephjc
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T2: recruitment looks very fortuitous and successful...I have never managed that great a recruitment. #nephjc
drraymondhsu
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RT @kidney_boy: @JayTalw but HRS is just a symptom of the underlying pathology. Just buying time for liver recovery or transplant. #nephjc
nephjc
https://pbs.twimg.com/profile_images/662057138684952577/2ZnKmQ3p_normal.png
RT @kidney_boy: @JayTalw but HRS is just a symptom of the underlying pathology. Just buying time for liver recovery or transplant. #nephjc
nephro_sparks
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@NephJC starting to make my blood boil swap #nephjc
hecmagsmd
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RT @JayTalw: In liver circles, the major beef with HRS trials is that terlipressin (or any drug) hasn't improved survival #nephjc
nephjc
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T2: main result: trial halted at 1st interim analysis since p < 0.01! Anyone see that coming? #NephJC http://t.co/Wzop1lY111
kidney_boy
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@NephJC in what way? It took 4years and 8 hospitals to get 50 patients. #nephjc
drdeborahfisher
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@JayTalw except for transplant hardly any intervention improves survival #nephjc decompensated #cirrhosis
nephjc
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@Nephro_Sparks and bar graphs too! (Sorry) #nephjc
jaytalw
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Many HRS patients not LT candidates...so then what? #nephjc
steveschoi
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@NephJC A motivated population. #nephjc
drdeborahfisher
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@NephJC p values in table 1 of an RCT a definite pet peeve #nephjc
hecmagsmd
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RT @DrDeborahFisher: @JayTalw except for transplant hardly any intervention improves survival #nephjc decompensated #cirrhosis
nephro_sparks
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@JayTalw this makes it that much more difficult #nephjc
jaytalw
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Once serum creatinine above 3, it seems like HRS becomes "fixed" and nothing but LT will fix it #nephjc
drdeborahfisher
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RT @kidney_boy: @JayTalw but HRS is just a symptom of the underlying pathology. Just buying time for liver recovery or transplant. #nephjc
sleonmd
https://pbs.twimg.com/profile_images/517086639966138369/yTFiuwut_normal.jpeg
RT @DrDeborahFisher: @JayTalw except for transplant hardly any intervention improves survival #nephjc decompensated #cirrhosis
nephjc
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@kidney_boy right, but of 66 eligible, 49 randomized...just very good at consenting and enrolling. (usually 1/3rd is condiered good) #nephjc
steveschoi
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RT @DrDeborahFisher: @JayTalw except for transplant hardly any intervention improves survival #nephjc decompensated #cirrhosis
drraymondhsu
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T2 are these results consistent with prior terlipressin studies? #nephjc
nephro_sparks
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@JayTalw then a separate issue comes up. are u REALLY sure it is HRS #nephjc
dr_nikhilshah
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T2 - many deaths in the TERLI group in first week-10 days #nephjc
jaytalw
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Anecdotally, my colleagues in Europe say that terlipressin works only 30-40% of the time. There are treatment failures #nephjc
kidney_boy
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@JayTalw In this study average Cr was 3.6/3.8 at study entry and they had a good (great) response rate. #nephjc
drdeborahfisher
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RT @steveschoi: @NephJC A motivated population. #nephjc
nephjc
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Q for the hepatologists in the house: @DrRaymondHsu: T2 are these results consistent with prior terlipressin studies? #nephjc
nephjc
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quite possible: (good enrollment) @steveschoi: @NephJC A motivated population. #nephjc
wittykidney
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@DrRaymondHsu no but partially, first really +ve study #nephjc
kidneydocfla
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@kidney_boy @NephJC they shouldve just come down to sarasota it would've been an embarrassment of riches..so to speak #nephjc
jaytalw
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@kidney_boy Does make you wonder if they had HRS or AKI with delayed reversal #nephjc
kidney_boy
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RT @JayTalw: @kidney_boy Does make you wonder if they had HRS or AKI with delayed reversal #nephjc
nephjc
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RT @JayTalw: @kidney_boy Does make you wonder if they had HRS or AKI with delayed reversal #nephjc
hecmagsmd
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RT @Nephro_Sparks: @JayTalw then a separate issue comes up. are u REALLY sure it is HRS #nephjc
kidney_boy
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We want kidney biopsies! RT @Nephro_Sparks: @JayTalw then a separate issue comes up. are u REALLY sure it is HRS #nephjc
sleonmd
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RT @kidney_boy: We want kidney biopsies! RT @Nephro_Sparks: @JayTalw then a separate issue comes up. are u REALLY sure it is HRS #nephjc
nephjc
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T2: was it the change in blood pressure or #terlipressin? See figure 3 #nephjc http://t.co/LKu5yYUl4F
nephjc
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RT @kidney_boy: We want kidney biopsies! RT @Nephro_Sparks: @JayTalw then a separate issue comes up. are u REALLY sure it is HRS #nephjc
drraymondhsu
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@wittykidney thanks! seems too good given such small sample size. maybe some really weren't HRS #skeptic #nephjc