We keep on PD if IP STS tolerated and MBD controlled

Practice patterns have shifted for us locally, intensive dialysis was the default 15 years ago, the rationale often cited was better control of uremic markers and toxins (measured and unmeasured)

Now rarely used and mainly done for phosphate control

⚠️ Calciphylaxis is a debilitating and painful condition that is hard to treat.

▶️ Do you use daily dialysis as part of treatment? If so, what criteria do you use?

#askrenal

pubmed.ncbi.nlm.nih.gov/21872378/

doi.org/10.1093/ndt/...

Awesome infographic on genetic testing in ADPKD by Neera Dahl, @pranavgarimella.bsky.social and Fouad Chebib www.kidneynews.org/view/journal...

6/ Give me something clever to say 🤓

👇@kidneyboy.bsky.social and @grahamabra.bsky.social summarize the utility of eGFRdiff nicely

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Classic example of Alport spectrum disease in a patient with X-linked Alport syndrome. Lesions of segmental glomerulosclerosis, numerous interstitial foam cells, and atypical GBMs with lamina densa splitting, subepithelial scalloping, and thinning. #renalpath #pathsky #nephsky

Any good refs for recovery from AKI-D post liver transplant?

#AskRenal

Pragmatically, Cr eGFR with albuminuria allowing for KFRE calculation provides the majority of pts with the info they need and allows for longitudinal tracking as other docs all order Cr

Cystatin C helpful in select situations (eg frailty) and the eGFR diff a nice add when Cystatin C ordered

👏 Great discussion!
📅 Up Next: 8/5/25 we discuss the 📘HiLo trial- A RCT of phosphate targets for HD patients #NephJC
Do we finally have data to end “the great phosphate-bypass”
pubmed.ncbi.nlm.nih....

Upper end of the range had a range. Nothing to see here…

#NephJC

T1d
🔍 What drives eGFRdiff? They tested for 3 groups.
FYI!
Shrunken Pore Syndrome: Reduced filtering of larger molecules (5-30 kDa). Diagnosed when eGFRcys is < 60% of eGFRcr. Risk for mortality, CVD and contrast nephropathy. Associated with ⬆️BMI, T2DM, HTN.
What else did they miss? #NephJC

Wait one COI, Ian McCoy was my fellow :)

#NephJC

T0f
So why does this matter?
A more negative eGFRdiff (eGFRcr > eGFRcys) is linked to:
🫀 Cardiovascular disease
🧬 Frailty
💓 Heart failure
⚰️ Mortality
#NephJC

Graham Abra, nephrologist, no COI

#NephJC

This is a fascinating read for anyone interested in the current state of nephrology practice.

What are the best practices for treating patients receiving peritoneal dialysis while hospitalized? This #ASNCJASN "Kidney Case Conference: How I Treat" shares clinician perspective on protocol and procedure. kidney.pub/CJASN0783

The Double-Icodextrin Dose Randomized Controlled Trial of a Double #Icodextrin Dose for #Older Patients on Incremental Continuous Ambulatory Peritoneal Dialysis #CAPD

#VisualAbstract by @md_abdulqader83

www.kireports.org/ar...

@lobbedezt.bsky.social @clemencebechade.bsky.social

Very nice practical summary article

Amazing how far we have come with understanding the genetics behind Alport Syndrome and much of what we used to call “Thin Basement Membrane Disease”

Join us!

#Flozins in ADPKD. Interesting VA data suggesting that they may be safe and have a role in renal preservation

journals.lww.com/cjasn/fullte...

Ma’am, would you like several fiddly tests whose results about 1% of the medical community can interpret correctly followed by *maybe* a surgery or would you like a once a day pill that will probably sort things?

A bold guideline from the beginning!

“We suggest that all individuals with hypertension be screened for primary aldosteronism”

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Simple = better BP at the population level

Cheap poly pills FTW 🙌

I have saved a few some BP meds by working through the primary hyperaldo path but population health through this pathway is a pipe dream with the current work up to get to surgery

They need to know people care about what is happening and what organizations are doing to address

To be fair, this is a difficult time for advocacy w/ a fire hose of badness

Running around with hair on 🔥 is ineffective and so is silence - how to do advocacy well in this in environment is a real ?

From an individual perspective we should all be communicating with people engaged with the work

Blocking you all now.

#NephJC

We are nephrologists. Hyperkalemia is what scares endocrinologist and cardiologists.

we have the knowledge and the tools to manage this problem in this era when using the combo #NephJC

Re first sentence: we are living in an interesting data gray zone at the moment - so you start the RAASi, SGLT2i, GLP1 RA and UACR is now under 30 mg/g

We don’t have a trial that answers whether the nsMRA should now be added

#NephJC