Joel Topf

I agree. I would love to be able to believe the null hypothesis but the investigators were unable to get good differentiation between the groups for me to believe that they showed anything.

We spend a lot of time and energy fussing about hyponatremia in hospital medicine, and it appears that spending even more time fussing about it does not improve patient outcomes #hospmed

The game here is separating out people at high risk of CPM. If no malnutrition, liver disease, hypokalemia, alcohol use disorder, I say let it rip

Spoiler: the giant algorithm IS the standard of care

Finally. The Hyponatremia Intervention Trial is published The Hyponatremia Interventional Trial (HIT) has been published in NEJM Evidence. The results were unveiled at the Late-Breaking and High-Impact Clinical Trials session at ASN Kidney Week 2024 in Sa…

Finally the Hyponatremia Intervention Trial is published and it is a big disappointment

pbfluids.com/2026/03/fina...

#NephMadness 2026: Animal House Region Submit your picks! | @NephMadness | @nephmadness.bsky.social | NephMadness 2026 Selection Committee Member: Autumn Harris  At NC State University, Dr. Autumn Harris investigates how kidneys regulat…

#AnimalHouse is back on #NephMadness

They’re dializing the dogs 🐶 , they’re dializing the cats 🐱 ! #NephSky

ajkdblog.org/2026/03/01/n...

a picture of a robot with the words " the machines are taking over " on it ALT: a picture of a robot with the words " the machines are taking over " on it

Isn’t #AI winning #NephMadness the prequel to the Terminator movies 🍿 🎦?? #NephSky

ajkdblog.org/2026/03/01/n...

All at once, everyone is anti-war from the comfort of American apartments. A country filled with people who do not know what it is like to have bombs dropped on them. Who have never had their internet cut during protests so the world cannot see what is happening. Who have never lived under a regime where dissent can get you killed. Where dancing can get you arrested. Where showing your hair can get you beaten. Where tomorrow is never guaranteed. And now those same voices are telling Iranians how to feel.

Yes, I am anti-war with Iran. I did not think that needed clarification. The only people who truly benefit from war are the billionaires who profit from it. But being anti-war does not require mourning a dictator. The Iranian people have been desperate for years. A kind of desperation that no American can fully understand. The authoritarian control enforced by the Islamic Revolutionary Guard Corps is not just a human rights violation. It is a human rights catastrophe. A sustained system of repression designed to silence, imprison, torture, and kill its own population.

I am not claiming bombs equal liberation. But it is also not accurate to pretend that we are currently free and stable. We are already subjugated. Subjugated by our own regime. When conversations fixate on hypothetical future chaos while refusing to acknowledge present oppression, they erase what is already happening to us.

But watching those deaths immediately weaponized to invalidate Iranian grief and Iranian relief is something else entirely. Watching people who were silent when tens of thousands of Iranians were brutally killed suddenly find their voices now, and use those voices not to mourn universally, but to undermine Iranian pain, exposes a selective morality that is difficult to ignore. How privileged you must be to betray your people when hundreds of children were killed today

Everyone should read this

“All at once, everyone is anti-war from the comfort of American apartments. A country filled with people who do not know what it is like to have bombs dropped on them. Who have never had their internet cut during protests so the world cannot see what is happening...”

This week's cover @thelancet.com

We have beaten the pharmacy into submission and now the fellows add phos to CRRT routinely without drama...but adding sterile water for CRRT with hyponatremia, that is a different kettle of fish

Declined to respond? WTF

Searching drugs.com for penisomab. There is no result but the website offers to ask an AI agent.

The drugs.com AI claims that penisonomab is a medication used to treat DLBCL.

Asking the AI if penisomomab is a real. It responds that no, it is made up.

The drugs.com AI is working spectacularly well

I've tried it a few times. I haven't found a patient with a good response. What about you Stephen?

Jerome Adams & @JeromeAdamsMD X.com As a former U.S. Surgeon General who held an active medical license and practiced medicine while in the role (at Walter Reed and aboard the USS Comfort) it is incomprehensible that the Senate is even considering a nominee for this role who lacks any active license and has never practiced unsupervised. 7:49 PM • 2/25/26 • 369 Views

Trump’s first-term Surgeon General speaks out against Trump’s current nominee for the job, Casey Means

But you can't post to Doximity. You can comment but can't generate new posts. They are more a newspaper with a comment section, than a true platform for user generated content.

This is what I'm talking about regarding the anti-iron bias among the ESA pushers writing the guidelines.

These KDIGO #NephJC are always a heavy lift. Don't forget @brianrifkin.bsky.social and @hswapnil.medsky.social and @nephroseeker.medsky.social for their contributions

Completely agree. This may give me the fortitude to stop transfusing. But many other doctors touch these patients and it only takes the weakest link to transfuse. I will be happy to talk about KDIGO, but I would prefer to come armed with DATA rather than an opinion #NephJC

And next Sunday the beginning of #NephMadness!

Who's psyched?

#NephJC

Amen #NephJC

Boy transfuse for Hgb < 7 is so ingrained in physician behavior. It will be inter3esting how far this goes. My guess is it goes no where. You want to change behavior you will need to bring some RCT data #NephJC

The things that have changed or most influenced my approach to anemia are:

Daniel Coyne
DRIVE 2
PIVOTAL
CHOIR/CREATE/TREAT

(No KDOQI or KDIGO guideline)
#NephJC

a man in a purple vest and bow tie is making a funny face . Alt: a man in a purple vest and bow tie is making a funny face .

With the lack of grade 1 recs, my answer is NOTHING #NephJC

you might be right, that's a deep cut. 1998? #NephJC

I am pretty confident it is the ESA, not the Hgb that drives those negative outcomes. The studies that looked at achieved Hgb showed higher hgb were associated with better outcomes. #NephJC

I mostly ignore it and will advise non-dialysis CKD patients to start oral iron and send them back to their primary with instructions to investigate for iron loss (C-scope) #NephJC

Nope

#NephJC

Outside of research, I have never prescribed a HIF-PHI. Failed drug class.

#NephJC

I need them to complain of fatigue and have a Hgb south of 9 for me to start it. I need a patient complaint to treat. I try not to treat a number. #NephJC