jefferson triozzi

Fun fact, metformin and biguanides come from the purple lilac flower

🤣
Well metformin was discovered first, so…

Standard metformin practice is:

GFR 45+. No changes
GfR 30-45. Decrease dose
(but don’t initiate new therapy)
GFR <30. Discontinue

But maybe some low risk patients with CKD IV are losing a benefit by discontinuing their metformin?

Stopping Versus Continuing Metformin in Patients With Advanced CKD: A Nationwide Scottish Target Trial Emulation Study Despite a lack of supporting evidence, current guidance recommends against the use of metformin in people with advanced kidney impairment. This observational study compared the outcomes of patients wi...

We often stop metformin when eGFR < 30 (CKD stage 4). In this observational study of 4,278 patients with type 2 diabetes and CKD stage 4, stopping metformin (40.1% of patients) was associated with lower 3-year survival (63.7% vs 70.5%). Time for an RCT? #MedSky #NephSky www.ajkd.org/article/S027...

Metformin associated lactic acidosis is real… but that warning really came from phenformin (one of the OG biguanides which was pulled from the market).

Or if you’re CKD IV and you get really sick and develop lactic acidosis for other reasons, metformin is probably not helping matters…but should that keep us from prescribing. Risk vs Benefit varies!!!

NIH lawyer arguing that slashing indirect costs will allow for more direct costs for research.

Do you believe him?

Nice! Thank you

What p-value threshold do you use for PheWAS. Especially if performing multiple PheWASes in a single study?

Link broken now.

What p-value threshold do you use for PheWAS?

Maybe a better name than “CKM” is “MKC”

Metabolic➡️Kidney➡️Cardiovascular

Cardio 🔗 Kidney 🔗 Metabolic

Learning lots at WCIRDC in Los Angeles!

Steroid Initiation Among Boys and Young Men After Muscle-Building Supplement Use This cohort study examines the prospective association between muscle-building supplement use among boys and young men and subsequent initiation of anabolic-androgenic steroids.

jamanetwork.com/journals/jam...

Going a bit bro-science here:🏋️‍♂️🏋️‍♂️ a study reports gym supplements as gateway to anabolic steroids with an 8x higher odds. BUT: low cases (n=18), wide CI (2.6 -26.7), mixed definitions (protein shakes are a gateway drug?) & potential confounders. Observation ≠ causation #criticalreading
Link below:👇

#CKM

Um… diuretics?!

Urinary Metal Levels, Cognitive Test Performance, and Dementia This cohort study examines urinary metal levels, cognitive measures, and dementia diagnosis in individuals with and without apolipoprotein ε4 alleles.

Ah darn. Can you edit blusky posts?

jamanetwork.com/journals/jam...

Higher metal in your urine associated with lower cognitive function. In #JAMA @jama.com

🧠 A pee test for brain health?

Models adjusted for age, sex, race, location, edu, eGFR, smoking, BMI

Interesting association but studies like this are subject to residual confounding!

jamanetwork.com/2827187

In #JAMA: a randomized trial shows daily procalcitonin measurements in sepsis to guide antibiotic discontinuation was safe and effective. (And CRP didn’t help…) @jama.com

jamanetwork.com/journals/jama/fullarticle/2828036

#antibiotics #sepsis #biomarkers

In conclusion:
💥I don't use albumin/diuretic combinations because the literature doesn't support the practice
💥I think the overfill hypothesis predominates
💥An exception may be minimal change disease (particularly children) which is typically an abrupt presentation

Very simplistic explanation and it's MUCH more complicated than this, but a nice way to think about creatinine dilution with decompensated heart failure and convince people that a creatinine rise with decongestion is not actual kidney injury
#nephsky #cardsksy

Thanks for posting this!

SGLT2 inhibitors will be subject to Medicare price negotiations

www.nytimes.com/2023/08/29/u...