Raj Mehta

NephJC Shorts: Should we Screen for Kidney Disease? — NephJC Should we screen for CKD?

should we screen for CKD in the general population?

Finally, flozins, finerenone and GLP1s allow a good cost-effectiveness case

www.nephjc.com/news/2025/7/... for #NephJC shorts

Time to stop just being dialysis-ologists and flozinate, glipinate!

#NephSky

Heard from #AHRQ that the entire grants staff has been let go! They are unable to issue funds for grants already funded, let alone fund new grants. This is outrageous and will make Americans poorer and sicker. Why? A brief thread about just some recent AHRQ-funded research: #MedSky #HealthPolicy

This is what we were waiting for. A direct comparison between apixaban and rivaroxaban for the treatment of acute VTE. Apixaban reduces bleeding risk in the first 3 months by >50%!

Practice changing investigator-initiated RCT.

#ISTH2025

Is generative artificial intelligence capable of clinical reasoning? What does it mean for a computer to think like a doctor? This question has vexed physicians working on clinical reasoning artificial intelligence (AI) for more than 70 years. The first generation of p...

Is generative #AI capable of clinical reasoning?
Our new piece @thelancet.bsky.social open-access
@adamrodmanmd.bsky.social
www.thelancet.com/journals/lan...

Rubio terminated 5800 USAID contracts – more than 90% of its foreign aid programs – in defiance of the courts.

Here’s a list of just some of the lifesaving awards that were terminated. Nearly all were Congressionally mandated. They’ve saved millions of lives. 🧵

A randomized trial of tailored A.I.-guided ablation of atrial fibrillation vs standard-of-care, anatomical ablation demonstrated superiority of AI guidance
www.nature.com/articles/s41...

I wrote a book The Creative Destruction of Medicine (2013, title adopted after Schumpeter).

This title of the book for what we are now seeing in the U.S. is just The Destruction of Medicine.

Indirects support infrastructure for translational research and clinical trials. Look for clinical trials to be paused or halted because universities will no longer have funds to keep them open. This will be devastating for cancer patients at NCI-designated comprehensive cancer centers, for example.

I have a piece half-done on the entire world of indirect costs. It's too big an endeavor to finish now, in the middle of the night, when this problem *that was always a live grenade with a half-pulled pin* is suddenly a topic du jour. Shit of a thing.

Here are some highlights.

GPT-4 assistance for improvement of physician performance on patient care tasks: a randomized controlled trial - Nature Medicine In a prospective study involving 92 physicians from multiple institutions, access to large language model assistance on top of conventional resources increased a score expressing the quality of their ...

A randomized trial of GPT-4 vs 92 physicians with or without this #AI LLM for performance on patient care tasks.
AI improved physician performance, on par with AI alone (based on 5 clinical vignettes) nature.com/articles/s41...

Figure 2. Sodium Content on Packaging in a Basket of Food Products in the Agincourt-Bushbuckridge by Wave and Legislative Target

From JAMA Cardiology:

South African regulations limiting sodium in processed foods were associated with reductions in sodium consumption and blood pressure among rural adults aged 40 years or older.

ja.ma/4hMWyUW

#CardioSky

Editorial commentary title in AJKD by Bill Mitch and colleagues ‘Revisiting Protein Restrictions in Early CKD: Did we get it wrong’?

In @ajkd.bsky.social

www.ajkd.org/article/S027...

Revisiting protein restriction: did they get it wrong?

Yes they did it wrong.

But they don’t admit that in this commentary, sadly 😕

At 12-month follow-up, primary outcome data were available for 846 (90%) patients. Treatment failure occurred in 153 (34%) of 452 patients in the antibiotic group, compared with 28 (7%) of 394 in the appendicectomy group (difference 26·7%, 90% CI 22·4–30·9).

Finally!

Antibiotics are not non-inferior to appendectomy despite a generous 20% non-inferiority margin

They are actually inferior: www.thelancet.com/journals/lan... in the @thelancet.bsky.social

#MedSky

The potential importance of reactivation of herpes simplex virus type 1 (HSV-1) as a contributing factor to developing Alzheimer's disease
www.science.org/doi/10.1126/...

AI in medicine: preparing for the future while preserving what matters 2025 is here and medicine has continued to move away from the utopian vision of our admission essays for medical school. We are spending countless hours on electronic health records scrolling through ...

Published an opinion piece in @bmj.com with @raj-mehta.bsky.social. I bet no one has opinions about the topic.

www.bmj.com/content/388/...

Effect of Three Different Daily Protein Intakes in a Two-Meal Eating Pattern on Protein Turnover in Middle Age and Older Adults: A Randomized Controlled Trial Reduced meal frequency patterns have become popular for weight loss, maintenance, and improving cardiometabolic health. The extended fasting windows w…

A protein intake of 1.5 g/kg/day enhances net protein balance in older adults on a two-meal eating pattern.

by Church DD, Hirsch KR (...) Ferrando AA et 5 al. in J Nutr #MedSky

📖 read the article:

We need some of these phrases for nephrology!

Kidney failure = Filter futility

Peritoneal dialysis = Abdominal cleaning

Hyponatremia = Salt shortage

Adam Curtis Title Card: We Too Are Trapped In A System. Text over a background of a large office building

THREAD

This Is The Story Of The The Pernicious Rise of AI-Generated Papers and their Online Impact

An Incomplete History Told In The Voice of Documentarian Adam Curtis
1/31

IMO the key finding is that the best LLMs (i.e. chatgpt) are able to perform with minimum bias even if those biases may be present in the training data.

Lowering rate of error and bias is critical to safe deployment and efficiency gains.

It's an EBM level advancement that we can't ignore.

This is a really neat article, but also akin to a massive meta-analysis that lumps together a lot of very different papers.

Study confirms general views that:
(1) instruction prompt matters
(2) Large model >> Small models

Generative language models exhibit social identity biases - Nature Computational Science Researchers show that large language models exhibit social identity biases similar to humans, having favoritism toward ingroups and hostility toward outgroups. These biases persist across models, trai...

🚨New in Nature Computational Science! 🚨

Do large language models (LLMs) exhibit social identity biases like humans?

(co-lead by @tiancheng.bsky.social, together with @steverathje.bsky.social, Nigel Collier, @profsanderlinden.bsky.social, and Jon Roozenbeek)
1/
www.nature.com/articles/s43...

The data speaks for itself

BPROAD: Sprinting down the BP Road in DIabetes — NephJC This week, we will discuss hopefully the final story of intensive BP lowering. BPROAD is a larger version of ACCORD without the glycemic control arm. Dive in.

#MedSky #NephSky

🛣️ BPROAD takes the known path of ACCORD trial, minus glycemic control

🎯Question to address: should we aim for a BP of 120 or 140 in patients with diabetes?

#NephJC summary by @shahsonride.bsky.social and @madihaaziz.bsky.social

www.nephjc.com/news/bproad

The Art of Uncertainty: How to Navigate Chance, Ignorance, Risk and Luck

An incredible review by @richard-lehman.bsky.social

bjgplife.com/the-art-of-u...

The Art of Uncertainty: How to Navigate Chance, Ignorance, Risk and Luck

A book that needs to be part of every doctor's lifelong learning. Huge riches hinted at in my little review, which is mostly about uncertainty in general practice:
bjgplife.com/the-art-of-u...
@marydixonwoods.bsky.social @johnlauner.bsky.social

This should be a pretty good indication to any medical journal out there that Bluesky is the ideal platform to post your publications.

Unlike Threads and X, pub links aren’t throttled by the algorithm here. #Medsky

For the 1st time on #BlueSky, we release a FULL issue of Annals of Family Medicine! The November/December 2024 issue is AVAILABLE NOW!

Our video preview has an exclusive glimpse into our latest issue and the newest research in #PrimaryCare #Medsky #FMsky

www.annfammed.org/content/22/6...

Does #randomization ensures balance of risk factors between groups? Consider this:

In Denmark 860 individuals were randomly allocated to either intervention or control. Individuals were unaware of their allocation. No intervention took place. Mortality was higher in the intervention group (p=0.003)

Forest plot of kidney outcomes with GLP1RAs

New today - @thelancet.bsky.social DM/Endo

GLP1RAs and kidney/CV outcomes - SR from @sunilbadve.bsky.social Tuttle, Perkovic et al

www.thelancet.com/journals/lan... ($🔒)

- with/out DM
- kidney outcomes (not albuminuria)

I don’t want to quote dunk on that person, but GLP-1ra drugs are so effective that the FDA is literally allowing compounding pharmacies to defy patent law because so many people can benefit from them and can’t get them due to low supply