Joel Topf

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

PIVOTAL did not show harm

DRIVE demonstrated safety till 1200

I don’t stop till 1200

This recommendation shows an anti-iron and pro-ESA bias

#NephJC

the lowest ferritins I have ever seen are in dialysis patients that are intolerant to IV iron. Orals really don't work in dialysis. #NephJC

COuldn't have said it better myself.
Patients hate it
It doesn't work
Give patients the good stuff
#NephJC

This is topic 1b not a 1B graded suggestion, because the data I'm seeing that this is a make believe problem. Further damning of iron by ESA pushers.

#ShowMeTheEvidence
#NephJC

Ferritin < 100 gets IV from me regardless of the TSAT.

If the ferritin is > 300 it is no iron no matter what the TSAT is?

Does not seem to follow the findings if DRIVE II

#NephJC

This is what I do in both CKD and dialysis. Nice to see my treatment patterns backed up by the guidelines. #NephJC

Love it. #NephJC

I check Hgb in dialysis patients monthly. I doubt it improves outcomes. #NephJC