Samuel Silver 🇨🇦🇮🇱
@drsamsilver
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1,934
Associate professor and nephrologist @queensu @queensuDOM . Research @ICESOntario ; #AKI and QI. Jewish, Zionist 🇨🇦 🇮🇱. Tweets and opinions are my own.
Kingston, Ontario
Joined January 2017
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I wish every time we had an unvaccinated dialysis patient that I could call to the hospital pharmacy to bring the vaccine up asap rather than asking them to go get the shot at their closest pharmacy
@QueensuDOM
@KingstonHSC
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One of our patients died while waiting for a procedure that had been delayed for months. Other patients on dialysis in tears. We took it hard too. This is the hidden effects of
#covid
that is still ongoing and will be for awhile.
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Our inpatient list is close to 60. Usually 30 is considered busy. Kidney consults usually go to the sickest patients. If not feeling well, please don’t delay care until too late.
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Great experience
@KingstonHSC
@dwmessenger
@Qemerg
5yo son falls off bunk bed at 1930. Stitched up and home by 2100. Didn’t have to even show my work badge. He got two stickers, and learned to not balance on his
@PawPatrolTweets
toys anymore. Thanks all!
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Thanks for promoting.
@CJASN
I think timely given changes in Ontario and 🇱🇷 around care coordination. Lots we can do to provide respectful and efficient care for patients on dialysis
@SEAMOKingston
@ICESOntario
@QueensuDOM
Association of Primary Care Involvement with Death or Hospitalizations for Patients Starting
#Dialysis
@drsamsilver
Editorial by Salman Ahmed MD, MPH and Mallika L. Mendu MD, MBA:
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Getting excited for first ever
@queensuim
@QueensuDOM
#NephMadness
party tonight. Fortunate to have
@DrFlashHeart
to show us the ropes.
@sarah_m_moran
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Here’s to my wife. Solo parenting today, in a pandemic, while I am on call, with no power to the house. 💋
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@DFisman
Agree, but timeliness of delivery equally important. Getting most delivered by later summer isn’t ideal. Would have been worth paying the premium like Israel did.
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Patients on dialysis...over 60 and congregate together at least 3 times per week in close quarters. Should be an explicit phase 2 group.
All the phase 2 groups are groups we'd like to see vaccinated ASAP, but we should ensure elders 60 and over in the community, as well as congregate settings are at the front of the line.
Why?
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@DrFlashHeart
@signindoc
@cameron_giles8
@moorman_neph
@JawaTasha
@ShareefAkbariMD
@thana_susan
@k_dhruv23
Hopefully next year in person. Got the spot for the trophy in the kidney clinic lobby all picked out.
@OttawaRenal
@UofTNephrology
@matthewweir
@MattLanktree
@RitaSuri27
#NephMadness
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Dr Andrew Allegretti. “Very hard emotionally to take care of patients with
#aki
and cirrhosis”. I Agree. Useful approach below
@HrsHarmony
@NKF_NephPros
#NKFClinicals
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Having a hard time with the libertarian sentiment that ok to be non-vax but then have the state/hospital/workplace pay for your rapid tests.
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@DrFlashHeart
@QueensKRU
@thana_susan
I’ve got the trophy polished and ready. 🇨🇦
@CSNSCN
@hswapnil
@RitaSuri27
@edclark75
💰💵 for kidney research
#krescent
@todd2_todd
#NephMadness
@NephMadness
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How often do patients with cirrhosis and AKI requiring dialysis recover kidney function?
@lw_peter
@drsamsilver
provide new data here ⬇️
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Learning about
#aki
and
#covid
from
@jaykoyner
@VijayanMD
@erin_barreto
Particularly relevant given third wave now in
@OntarioHealthOH
.
#aki
is very common and dialysis machines/consumables can become limited. Please stay home if you can.
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Mad respect goes to
@KingstonHSC
@QueensuDOM
patient on dialysis who just enrolled in a 3rd rct.
#disco
#safed
@PhosphateRct
. Thanks for helping advance care for future patients!
@turbo_dc
@CNTN_RCEN
@lastwalsh
@DrRonWald
do
#mytemp
and
#resolve
count too?
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Are pet neutering surgeries essential? My daughter’s dysplastic hip surgery has been postponed 5 months and counting, but apparently can get pet surgeries next day.
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@SNETCampbell
@alandrummond2
@SNETCampbell
I remember meeting you with my brothers and dad in a Boston airport after a jays series. You took the time to talk ball with us and were super nice. We still talk about it. You are one the good guys. Thanks for sharing about your journey.
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@KidneyCal
@ChanchlaniRahul
work being shown at
#KidneyWk
go ped!
@AkcanArikan
@ICESOntario
@AmitXGarg
#iceskdt
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Beginning of week, no one in our nephro division had prescribed glp agonist yet. End of week, I finally changed that. Thanks to
@QueensuDOM
nephro fellows and kidney pharmacists for the rounds.
#kidneyheartendo
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See our recent work in
@AJKDonline
Time to re-examine how often we do routine bloodwork for patients on dialysis? Is this the best use of our time?
@QueensuDOM
@DrRonWald
@DrStephenArcher
Routine Laboratory Testing Every 4 Versus Every 6 Weeks for Patients on Maintenance Hemodialysis: A Quality Improvement Project
@drsamsilver
@drdowndog
@DrRonWald
@queensu
@queensuDOM
@ICESOntario
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Amazing qi project from Cincinnati children’s. Less aki with cefepime instead of pip tazo in hsct patients. Also less vanco. Aki can be prevented.
@wepaki1964
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Covid consequences of OR cancellations. We
@KingstonHSC
placed 0 av fistulas in July and august.
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Come spend Friday afternoon with
@SarahSanghavi
and myself at
#NKFClinicals
to hear “how the experts manage common
#aki
cases. See you in the chat. Talks by
@jaykoyner
@scoca1
@onconeph
and dr Josee Bouchard. Starts 330pm est.
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3
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A great team effort and kick start to national collaboration on nephro qi
@WBeaubien
@thomas6_alison
@DanBlummy
and Claire Harris and jay Hingwala
An Environmental Scan of Canadian Quality Metrics for Patients on In-Center Hemodialysis
@drsamsilver
@CanJKHD
@CSNSCN
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Probably the most important talk I give all year. What do primary care care providers need to know about
#aki
?
#askrenal
@QueensuDOM
Next Monday - the
#Nephrology
team is back with Home Dialysis, presented by Dr. Claire Kennedy and Acute Kidney Injury in Primary Care, presented by
@drsamsilver
.
You can still register for this program and get access to past sessions -
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Enjoying king Henry’s feast x 2
@QueensKRU
dinner
@CSNSCN
good times and discussion from resident to full professor.
@QueensuDOM
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Wow! Almost 100% of
@nkf
#NKFClinicals
audience uses sick day rules for acei and arb. Am I the only contrarian?
@hswapnil
@Roxytonin
help!
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Great job
@KFLAPH
@MOHKFLA
leading the province in 5-11 vax. Both my little ones done x 2. Can we get above 90% like adults?
2/ 📢 5-11 vax/PHU
1st dose: 39% (Haldimand-N) to 71% (Kingston)
2nd dose: 19% (Peel) to 43% (Kingston, Ottawa)
🆘 Tragedy is that # 1st doses is virtually unchanged from 1 mon ago (Feb 5) & gain is even minimal in 2nd doses
1st dose Feb 5: 38% (Haldimand-N) to 71% (Kingston)
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@signindoc
@picardonhealth
@KingstonHSC
Right by my office. Very demoralizing for the health care workers. No comments from patients on dialysis being harassed on my 1-5 shift today.
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Thanks
@AJKDonline
for highlighting
#aki
@ICESOntario
#icesKDT
@QueensuDOM
work in this series. 2 articles included, also featuring
@Jenn_Flemming
This special collection of AJKD articles highlights the latest discoveries in the epidemiology, diagnosis, treatment, and prevention of acute kidney injury (AKI).
All articles are freely available until November 28, 2023:
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This is one of the best ways I have seen of breaking down how to stop dialysis in
#aki
. And I am doing a pilot trial in the area. Great job dr hsu.
@UCSFNephrology
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@DrRulanParekh
@hswapnil
@queensuim
@QueensuDOM
@DrFlashHeart
@sarah_m_moran
@UofTNephrology
@matthewweir
@lastwalsh
@umanitoba
@NavTangri
@UBCNephrology
@tharrisonmd
@SofiaAhmedMD
@UCalgaryMed
@signindoc
@dr_nikhilshah
@UAlbertaNeph
@CSNSCN
@todd2_todd
@GregKnoll99
@adeeralevin
@ChrisChanUHN
@kidneycanada
@bourneauguste
@emhendren
Amazing! Since
@QueensuDOM
nephro division head is not on Twitter, I will commit our
#NephMadness
team to make the same donation. If we lose, $$$ to
#krescent
trainee award. does
@hswapnil
need
@GregKnoll99
permission for
@OttawaRenal
?
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And the 2pm session on aki recovery controversies. Featuring
@NephroNinja
@jiahweing
Emily See and Ayse Akean Arikan.
@AsnEpc
#KidneyWk
@ASNKidney
#KidneyWk
attendees: make time on Saturday at 10 am to visit the
@AKINow
poster on improving communication after AKI! While there, sign up to join the next study.
@DianaKwong
@drsamsilver
@jiahweing
@NephroNinja
@LeslieGewin
@javo_neyra
@VijayanMD
@erin_barreto
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What’s the lowest peak cr anyone has dialyzed a patient with for clearance reasons? Actually ordered a cystatin c to try and sort this out.
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Socioeconomic status associated with worse kidney recovery after aki.
@thana_susan
hoping to look into this further with
@ICESOntario
@AmitXGarg
#iceskdt
data
#kidneywk
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Check out
@QueensuDOM
@KingstonHSC
Dr Rachel Holden on lead guitar! And giving 2 talks today
@CSNSC
. Can
@CSNSCN
book
@KingstonODNT
for the gala next year?
#CSNAGM
First up and making an impression with the judges Old Docs New Tricks
@jimbiagi
#CCTG2019
#battleofthebands
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I’ll get in the pic at our
#nephmadness
party this year when we defend our 🇨🇦 title.
Proudly holding the 2022 NephMadness trophy for top scoring Canadian group. 🇨🇦 Woohoo Queen’s!
#NephMadness
@QueensuDOM
@QueensKRU
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Our visual abstract. 1 in 4 patients die in the next year after
#AKI
. Most due to heart disease and cancer. Why is follow up for these patients so low?
@ICESOntario
@QueensuDOM
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Can someone explain why i have to pay $30 to get my 3yo daughters 3 page OR note? I could access the note in 30sec myself but
#privacy
. She is 3. I am her SDM. Me thinks too much bureaucracy here
@KingstonHSC
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There has to be a better way to detect discrimination and equity issues than reviewing old student evaluations. Big power imbalance. Many learners won’t raise those issues in evaluations. Come on
@uoftmedicine
@UofTPGME
Ontario emergency room chief who hired no women for 16 years resigns amid discrimination probe, by
@WendyGlauser
via
@globeandmail
#WomenInMedicine
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@QueensuDOM
@queensuim
nephrology dinner. Had so much fun, forgot to take picture until after drs ilescu and Osman left. Next time in Montreal
@CSNSCN
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Lol. It is on now. Time to start analyzing past brackets
#krescent
@NephMadness
@hswapnil
@RitaSuri27
@drsamsilver
@kidneycanada
@CSNSCN
@QueensuDOM
@NephMadness
@Mkey27
@DanBlummy
@mcgillu
@todd2_todd
@OttawaRenal
@DrRulanParekh
@UofTNephrology
@UAlbertaNeph
@MattLanktree
Trophy has been made and will soon be heading down the 417 for (temporary) safe keeping...
Let's ensure this becomes an annual🇨🇦
#NephMadness
tradition that raises a few extra $$$ for KRESCENT.
Congrats again to
@mcgillu
@MKey27
@RitaSuri27
@DanBlummy
!!
#NephMadness
@CSNSCN
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Let‘s not add more stress to trainees caring for patients in light of
#Covid_19
If we want healthcare workers to self isolate,
@Royal_College
needs to set a good example. This is not it.
You can defer your 2020 exam until the next sitting of the exam and receive a full refund of your exam fee, without losing an examination attempt, and without impacting your exam eligibility for subsequent attempts.
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@edclark75
@DrFlashHeart
@signindoc
@cameron_giles8
@moorman_neph
@JawaTasha
@ShareefAkbariMD
@thana_susan
@k_dhruv23
@OttawaRenal
@UofTNephrology
@matthewweir
@MattLanktree
@RitaSuri27
@mcgillu
I think there should be an official ceremony to handover over the trophy at the
@CSNSCN
annual meeting gala. Sort of like the Masters with the green jacket. Happy to donate $150 to
#krescent
win or lose.
@todd2_todd
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Good thing
@javo_neyra
is paying attention because his
@NephQI
work for aki recovery is being shown
#kindeywk
@AkcanArikan
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@AJKDonline
@edclark75
@hswapnil
@Msood99M
@DrRonWald
@OttawaMedicine
The DRAKI score goes live! Finally some help to promote shared decision making for patients still requiring dialysis upon hospital discharge.
#aki
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@CPD_FHS_QueensU
Very important to get family doctors involved in post
#aki
care. Thanks for the support.
@QueensuDOM
@DrRonWald
@javo_neyra
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This is what keeps me up at night. Teaching sick day meds is hard! Look at all the errors and dr fink’s group does this better than anyone.
@jiahweing
#kidneywk
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2
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@DrFlashHeart
@moorman_neph
@signindoc
@NephMadness
@NephGiraffe
@TeamBear22
@JawaTasha
@thana_susan
@k_dhruv23
@cameron_giles8
The lack of trash talk from
@RitaSuri27
@hswapnil
@edclark75
@UofTNephrology
is a good prognostic sign.
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@DrFlashHeart
@RitaSuri27
@edclark75
@QueensKRU
@thana_susan
@CSNSCN
@hswapnil
@todd2_todd
@NephMadness
@OttawaRenal
@CMClase
@MolnarAmber
@matthewweir
@bourneauguste
@turbo_dc
@tennankore
@McGill_DOM
And $300 donated to
#krescent
by
@QueensKRU
. Is the 🇨🇦winner going to be announced at
@CSNSCN
agm
@hswapnil
@edclark75
?
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@hswapnil
@queensuim
@QueensuDOM
@DrFlashHeart
@sarah_m_moran
@UofTNephrology
@matthewweir
@lastwalsh
@umanitoba
@NavTangri
@UBCNephrology
@tharrisonmd
@SofiaAhmedMD
@UCalgaryMed
@signindoc
@dr_nikhilshah
@UAlbertaNeph
I vote choose the song play list
@CSNSCN
annual meeting. Or all losing programs make $100 donation to
#krescent
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@elena_cp88
@ASNKidney
Thanks
@elena_cp88
I wouldn’t say over 500ml is a good predictor, but it is the best current data so far. I would use it as a trigger to start paying closer attention for recovery.
#aki
#KidneyWk
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1
8
Anyone dialyze for high ammonia in
#aki
cirrhosis? Some considerations here.
@HrsHarmony
@NKF_NephPros
#NKFClinicals
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Very important. kidney disease by icd codes is highest risk. Patients on dialysis would be much higher.
Another important figure from the study, looking at mortality within age brackets:
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@JawaTasha
@queensccm
@jgordonboyd
Thanks for the invite
@queensccm
! Lots of exciting 🇨🇦 led
#aki
studies in the icu on the way.
@CNTN_RCEN
@WBeaubien
@edclark75
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Good thread for you
@JeannieCallum
. As I said last week, just give proper diuretic doses and ditch the iv albumin. Permissive hypercreatinemia right
@scoca1
?
@KingstonHSC
#qi
#ivalbumin
@mhemam2005
@GlassockJ
@NephRodby
@askrenal
Why give albumin. To make expensive Urine? What a waste. It’s being excreted as soon as you give it
How edematous is she? What dose diuretics? What is kidney function?
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Are nephrons treating staph aureus dialysis line infections for 2 weeks or 4?
I was trained to do 4, but am seeing 2 done more and more.
Staph aureus bacteremia in 1 tweet:
1 - Almost never a contaminant
2 - Where did it come from?
3 - Where all has it gone?
4 - TTE
5 - *Consider* TEE
6 - Remove infected prosthetic material
7 - Drain all abscesses
8 - Usually 2 weeks Tx for *uncomplicated*; longer if complicated
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205
1K
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@SBdoc33
@hswapnil
@kidney_boy
@rajmehrotra1122
@ghobby
Hopefully
@PhosphateRct
will help answer some of these questions. And over 50 patients recruited
@QueensuDOM
@QueensKRU
so not that difficult to recruit. Patients get this study.
@DrRonWald
@CNTN_RCEN
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I’ve had exam scores lower than that!
Latest from
@ICESOntario
#COVID19
testing data reveal that for the week of Dec 5-11, % positivity for those aged 18-22 in Kingston, ON (KFLA PHU) was an astounding 41%! You can download the data here: 1/3
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@hswapnil
@kidneycanada
@CSNSCN
Fulfilling
@QueensuDOM
nephrology
@NephMadness
KRESCENT bet. Congrats
@Mkey27
@RitaSuri27
@DanBlummy
@mcgillu
. We will get revenge next year, with more $$$ for KRESCENT
@todd2_todd
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I mean, if I am seeing most of my patients virtually can’t
@Royal_College
figure out a way to do OSCE virtually? Can I dedicate my $1000 annual dues to this?
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@hswapnil
@jiahweing
Did my best. Not an expert like you or
@thana_susan
and
@DrFlashHeart
@queensuim
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@hswapnil
@AmJNephrol
The defn of
#aki
in many of these reports is problematic. Must look carefully at how baseline cr is defined. If using admission Cr, many cases will be missed as
#aki
has already started. This is caught in peer review but not preprints.
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Well deserved, for a leader of nephrology research in Canada.
Very very pleased to announce that
@uOttawaMed
@OttawaHospital
nephrologist and
@CSNSCN
#CJKHD
Deputy Editor Dr. Manish Sood (
@Msood99M
) was promoted to the rank of Associate Professor today. Congratulations Manish! - well deserved and keep up the good work!
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Nice rounds today
@JeannieCallum
. My “dry” January is trying for zero iv albumin on next 2 weeks of nephro service. 🤞for no hepatorenal consults.
@ChooseWiselyCA
@QueensuDOM
@KingstonHSC
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@erin_barreto
@DrRonWald
@VijayanMD
@MarliesOsterman
@ucsdnephrology
Live panel discussion after
@DrRonWald
talk. Join us to hear from experts and ask questions in the chat.
#NKFClinicals
@NKF_NephPros
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I am looking forward to the announcement that there will later be an announcement
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@hswapnil
@signindoc
@QueensKRU
@NephMadness
@DrFlashHeart
@OttawaRenal
@bourneauguste
@RitaSuri27
@dr_nikhilshah
@matthewweir
@Queens
@edclark75
@kidneycanada
@drspandeya
@CRigsMb
2 losing entires and 2 donations is fair. I just threw in a donation too because
@drspandeya
@CRigsMb
are matching. Good cause and I kind of owe
#krescent
.
@CSNSCN
#csnagm
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I miss this show so much
“You Don’t Drink Scotch”: An Appreciation of ‘Scrubs’ and the Inimitable Dr. Cox via
@ringer
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@javo_neyra
Speaking of which, our paper on patient and caregiver insight on
#AKI
just came out in
@BMJ_Open
. Should inform follow up care and quality improvement in AKI
@DrRonWald
@cansolveckd
@ICDC_Research
@ThinkKidneys
0
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Dr welihinda
@QueensuDOM
speaking at joint pharmacist-nephro session on conservative care
@CSNSCN
. Collaborative care is key to symptom mngt.
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Let’s start seeing high risk patients in follow up then. Currently, under 1 in 10 seen by nephrons.
@ThinkKidneys
@javo_neyra
@DrRonWald
Acute
#kidney
injury tends to recur after hospitalization for acute kidney injury, finds a large study from
#KPResearch
and
@UCSFMedicine
in
@AJKDonline
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And pretty good testing rates too. Thanks
@KFLAPH
, dr Moore, and all involved. Let’s keep it that way now!
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@AmitXGarg
@NivethikaJ
@LHSC
100%. A lot of us rely on
@NivethikaJ
and she is indispensable to our teams
@ICESOntario
@ChanchlaniRahul
@onconeph
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@Msood99M
@IBressendorff
@Badves
@hswapnil
@sagarnigs
Lucky for us a trial is coming soon
@DrRonWald
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@bourneauguste
@DrFlashHeart
@QueensKRU
@thana_susan
@CSNSCN
@hswapnil
@RitaSuri27
@edclark75
@todd2_todd
@NephMadness
I tried to warn
@DrFlashHeart
@thana_susan
@QueensKRU
that you can’t donate to the wait list if there are no kidneys in the donor pool. But did they listen?
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Please send to
@OntariosDoctors
Plus a third of our patients dialyze after 5pm.
See recent appear from
@ICDC_Research
researchers in
@JAMANetworkOpen
Nephrologists see the most complex patients!
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@DrFlashHeart
@sarah_m_moran
@moorman_neph
@CamGiles8
@DrSumanBehera
Was great having so many IM residents and med students involved too! fun way to highlight and promote nephrology
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Thanks
@AmitXGarg
. We now have a nurse-led post-aki clinic
@KingstonHSC
@QueensuDOM
funded by
#seamo
innovation grant. Allows us to reach more
#aki
patients. Hoping to sustain model and evaluate
@ICESOntario
soon.
The
#ICESKDT
study by
@drsamsilver
found that specialized postdischarge follow-up for AKI survivors was not associated w/ ⬇️ risk of major adverse kidney events but was w/ a ⬇️ risk of death and ⬆️ prescriptions for some cardioprotective meds. 2/
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Approach to immune checkpoint inhibitor rechallenge after
#aki
.
#NKFClinicals
@onconeph
@NKF_NephPros
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it was time in April 2020...
Is it time to shut down inter-provincial travel to slow the spread of variants? w/
@srinmurthy99
@profplum8
+ via
@cbcwhitecoat
@NightShiftMD
#COVID19
#cdnpoli
#P1
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@hswapnil
@kidneycanada
@CSNSCN
@QueensuDOM
@NephMadness
@Mkey27
@RitaSuri27
@DanBlummy
@mcgillu
@todd2_todd
@OttawaRenal
@DrRulanParekh
@UofTNephrology
@UAlbertaNeph
@matthewweir
@MattLanktree
Bonus is matching $$$ from
@CSNSCN
presidents
@drspandeya
@SevenOaksCDIC
dr Claudio rigatto. Just a few hours left!
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This is so reasonable that it will never happen.
I wish academic publishers did loyalty card points for peer reviewing their papers. So peer review 5 papers, get one of your own published open access for free. Seems fair
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Congratulations to Jocelyn Garland of
@queensu
for being awarded the specialist of the year award from the
@royal_college
!
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@Canes
how about KRESCENT training next generation of kidney research scientists.
@CSNSCN
@kidneycanada
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