Swapnil Hiremath @[email protected]
@hswapnil
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Nephrologist = kidney doc, #NephJC cofounder; Work @OttawaHospital @UOttawa ; No PhrMA conflicts; QT hater; MPH 🤷🏽♂️; He/Him/His; @FreelyFiltered panelist
unceded Algonquin Anishinabe
Joined March 2009
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Pinned Tweet
Achievement unlocked? (From the email inbox)
Related, the
@ERAkidney
podcast is now on
@ApplePodcasts
#dragonism
#CIN
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1K
Whoah
Normal vitamin D levels were *made up*
Read the whole piece from
@ginakolata
to the kicker in the end. h/t
@weddellite
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short thread - or a story rather on the use of NAC (N-acetyl cysteine) and how it has lead us astray
1/
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Guess who’s going back to the National Spelling Bee!
@SpellingBeeofCa
Can you spell O-T-T-A-W-A? Ottawa is an example of a proper noun and also the city where two of our Championship Finalists will be representing at today's competition! 🇨🇦 Cheer on Aarick Hiremath, Ayoolu Adenlolu, and Aryan Jain at SBOC's 34th Championships!
#SBOC2021
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Wow
Dept of Totally Expected but Still Welcome News
EMPAKIDNEY halted for efficacy
#Flozinators
Assemble!
@ChristosArgyrop
@mikejohansenmd
h/t
@mvaduganathan
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OMG!
We have a new BP medication after 2 decades ! And for resistant HT - really meticulous study design
Aprocitentan in
@thelancet
#AHA22
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If dialysis patients come to dialysis three times a week
Shouldn’t we give them their jabs while they are here already,
rather than ask them to book appointment with public health and wait in lines elsewhere?
High risk enough already
Why do this?
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Non COVID case report - but fascinating and important if you ask me
A few months ago we admitted a kidney transplant recipient with a rip-roaring acute rejection - after 2 years of pristine function
Anuria. Graft tenderness. The whole works. Had always been adherent
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All
#Covid_19
Kidney pages
Main
Transplant
CKD/Dialysis
Kids
AKI
& Hypertension/ACE2
All
#Nephrotwitter
community pitching in
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? Unpopular take of the hour
Though considered less important in the current academic setup, well written and thought out *case reports* are more useful clinically than the latest associative p-hacked regurgitation from a *large admin database or cohort study*
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This is my 7 year old at
@MuseumofNature
a few months ago
He’s been at school in person with this (K)N95 mask
He wears it all day
He wore it without been asked at an outdoor soccer camp, an indoor karate class & more
He can breathe easily
He knows what needs to be done
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The end of the uric acid hypothesis?
Association =|= causation
CKD-FiX:
From
@Badves
et al
&
PERL:
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Now available to pre-order in 🇨🇦 too!
Hypertension Secrets
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The urgent need to vaccinate dialysis patients
From
@anna_francis1
@vjha126
et al in
@Kidney_Int
Feat
#VisualAbstract
by
@aakashshingada
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84
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Third dose data in solid organ transplants, now from France
Antibody response up from 40% (2 doses) to 68% (3rd dose)
And Ab levels go up in all
Encouraging…
When should this become standard of care?
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Congrats to
@melhoenig
for being awarded the 2023 Donald Seldin award from the
@nkf
!
Faculty at
@BID_NephFellows
&
@harvardmed
Editor of
@AJKDonline
Core curriculum
Panelist on
@BookBurton
& the friendliest & warmest nephrologist on the planet
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@adamcifu
@JHowardBrainMD
Sure we can make all the (pragmatic) excuses.
But why not graciously accept that
@fitterhappierAJ
got it right way back when - purely based on his understanding of the immunology, as
@JHowardBrainMD
has?
Isn’t this the kind of behaviour we should encourage?
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OK I can retire now
Personal shout out to
@Nephro_Sparks
& yours truly for the
#COVIDACE2
workgroup
& Tweet on the big screen
#KidneyWk
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Be aware of the effect of your COVID
#spiked
selfies on social media to people who don’t have access to the vaccines yet (and may not for a while)
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IDEAL-ICU drops
Guess what? Early dialysis doesn’t help in AKI
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The
#NephJCkidneys
go to
DAPA-CKD: article of the year
@DrRonWald
: most Engaged Researcher
@priti899
:
@CJASN
VA of the year
@NephroP
: SoMe project of the year
@AnnaGaddy
Rookie of the year
@Stones__
&
@edgarvlermamd
for MVP
&
@womeninnephro
for Social Justice Award
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Special congrats to
@Nephro_Sparks
from
@DukeKidney
🎉🍾🙌🏽
We will say Renal, Reh-nin and prescribe baclofen all week in celebration of your award
#KidneyWk
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as promised, thread on the 2022 CAR Contrast AKi guidelines
this was a decade after the last version
1/
Yet another contrast AKI guideline
jointly published in
@CARadiologists
and
@CanJKHD
thread to come later - it is
#OpenAccess
- feel free to read and send bouquets (or brickbats) our way
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Our
@medrxivpreprint
on Paxlovid in dialysis is live
We started this in early April since BA2 meant sotrovimab wasn’t useful. We also don’t have molnupiravir in Canada
This was based on a modified dose (see Twitter discussion with
@ChristosArgyrop
) 1/
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“I don’t feel like a hero,” Jen says. “I feel helpless.”
Twelve hours in a Florida COVID-19 ICU
You can write pointless editorials & argue from ivory towers.
Or read this, do what you can, stay quiet & don’t make it worse for the rest of us
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Very nice review on contrast associated (not contrast induced) AKI in
@NEJM
Written by stalwarts in the field
Gated, but definitely worth a read 1/
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Permissive hypercreatininemia
Don't be afraid of the GFR dip with flozination
GFR slope analysis from DELIVER,
@mvaduganathan
et al
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Yet another contrast AKI guideline
jointly published in
@CARadiologists
and
@CanJKHD
thread to come later - it is
#OpenAccess
- feel free to read and send bouquets (or brickbats) our way
5
45
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our attempt at shifting the focus from sodium to potassium in hypertension
review in the
@amjhypertension
, lead by
@sriperumbuduris
with help from
@PAWellingMD
and others
now with a free link (not sure how long it will work)
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Very nice review of hypertension treatment in
@JAMA_current
on the drugs - this is perhaps already outdated given the trials that came out on Monday!
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Here it is
@NEJM
and 4th paper (or 5th?) of
#ESCCongress
the STEP trial (as
@PadwalRaj
surmised)
BP 110 - 130
vs
BP 130 - 150
in 60 - 80 years age
N = 8500
1/
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Looking at 💩 signal the discrepancy is getting worrying
Could it be vaccinated peeps not getting tested as they think they are safe?
And the delta wave is yet to come
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Braunwald says, so it has to be true!
Flozins are the statins of the 21st century
(Probably even better) Lets
#Flozinate
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Under Pressure at
@hopkinsneph
this week on resistant hypertension
Thanks
@MoAtta007
and
@KidneydrChirag
for the invite!
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I just published “Brain & Kidney: The CerebroRenal Syndrome”
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Thanks
@ASNKidney
In The Loop for featuring our commentary on protein restriction
Time to move on from old school protein restriction in CKD indeed!
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Amazing and simple
Put a lid on life threatening vascular access bleeding
@jimbog_76
@VASBImedia
@RenalAssoc
@VASAMD
@KidneyAcademy
Nifty and simple...We give these to patients - info about them here
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Long awaited and disappointing but not unexpected: ICDs don’t improve survival in dialysis h/t
@drpaddymark
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Since it’s all quite, ahem, monochromatic in Ottawa, a random sampling of flower photos from the album
Starting with a short clip from the garden
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Just finished a spiking 💉 shift
@OttawaHospital
Getting to be well oiled machine there!
We spiked 732 peeps in 4 hours
Let’s ramp it up and stamp the 🦠 out
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@DFisman
And that this keeps happening in hospitals across Canada is an utter shame
N95s
Air quality
There is so much we can do better
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The joys of a medical conference in India
Having an authentic & steaming cuppa chai ☕️ made in front of you
#ApExPathshala
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Terrible take from local media
Exhibit 43
In Ottawa we have
- highest hospitalization numbers ever in the pandemic
- worst staffing crisis that I have ever seen
And we are in a ‘good spot’?
Get off this hopium pablum train & step into the real world
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About 1 in 9 patients with COVID who were discharged alive from hospital
Required unplanned readmission or died
Within 30 days of discharge
Alberta + Ontario data From
@AmolAVerma
@DrFahadRazak
and colleagues in
@CMAJ
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The
@ISNkidneycare
Jean Hamburger award for Outstanding research in nephrology with a clinical emphasis, this year goes to
Adeera Levin!
#ISNWCN
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Hot in the heels of FIDELIO, FIGARO drops at
#ESCCongress
@NEJM
Top line result positive as expected
1/
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@drpaddymark
@kidney_boy
@NEJM
much worse than I thought
@PulmCrit
breaks it down nicely
h/t
@brownpa79
I did have a suspicion about this:
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Happy New Year
Here’s hoping for a better 2022
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+ 1 moral: we never had a mechanism for NAC benefit in AKI (beyond antioxidant hand-waving)
If we had paid attention to the enzymatic reaction - talked to clinical biochemists, you know, we could have saved ourselves millions of dollars of trial money & opportunity cost
14/
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For contrast AKI, we need a better definition
Suggestions:
Essential criteria:
- Oliguria
- Contrast exposure
Major criteria
- No sepsis
- No hypotension
- nephrogram
Minor criteria
- bland sediment
- low FENa
- arterial contrast
- high dose contrast
- no other nephrotoxin
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This is wild!
False positive urine *ethanol* test from…..flozination?
Clue here:
1/2
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‘Flatter curve does not change the area under curve’ sounds pithy
But it’s wrong
Why?
SG's words struck me because, finally, someone in the citadel leveled with the American people that we have flattened the curve but now have to deal with the fact that this disease will continue at non-NYC levels everywhere. Flatter curve does not change the area under curve 6/
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Is contrast induced nephropathy a myth?
Atleast in the ED it’s mostly a waste of time & resources to fret about it, sez
@hrosenberg33
@KrishanYadavMD
& I
vs
@DavidSavageEM
@robertohle
Fun
#CJEMdebate
in
@CJEMonline
ReadCube link:
Our stance:
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Apart from FIND-CKD (nonDM CKD) this is another cool trial in diabetic CKD from Bayer is CONFIDENCE
Flozin
+
Finerenone
vs Empagliflozin alone
vs Finerenone alone
Cool things are happening in the
#NephTrials
sphere -
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@ChristosArgyrop
@RogueRad
@daviesbj
@charlesornstein
@VinayPrasad82
Anyone who thinks they are *learning* from drug reps should read this
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New
#Hypertension
Review paper drop
from
@OttawaRenal
Fellow
@ryanjameschan
@UOttawaMed
resident Wryan Helmeczi and moi
#OpenAccess
#Free
(with
@WileyGlobal
and
@uOttawa
arrangement) - and thanks to
@Badves
for the invite
1/
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Most hilarious piece I have ever read in the
@JAMAInternalMed
Too many quotable bits to quote. Read the whole piece
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@drjohnm
Step 1: follow
@DGlaucomflecken
- and
@DShadowgazer
@DocAroundThClok
et al
Step 2: unfollow all the COVID pontificators and everyone else tweeting about masks and schools and politics and that the pandemic is done
Problem solved
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‘Kidney and Testes....are the 2 smartest organs’
‘as tight as a frog’s bladder’
‘The 🥦 section’ of an electrolyte chapter
The delightful things you will get to hear on the ‘Channel Your Enthusiasm’ podcast
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Late in 2012 my friend and colleague, Marcel discussed a perplexing case of resistant hypertension - we had even done renal denervation
1/
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Sitting next to a former Robert Narins Award recipient as the 2023 award is announced
#KidneyWk
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Fascinating tidbit about the papers (one on ACEi in
@NEJM
and now HCQ in
@TheLancet
) from the surgical outcomes collaborative on
@StatModeling
blog
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Thanks
@edgarvlermamd
&
@KidneyNews
for letting me pontificate on the topic of
@goKDIGO
& guidelines...
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hey Abnormal Saline naysayers, check out another nail in the coffin for balanced solutions
#PLUSTrial
from
@DogICUma
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Vadadustat not only fails non-inferiority
It is inferior
See
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Funded by
@NIDDKgov
Another vitamin D trial
Nothing useful happened, to no one’s surprise
(Funnily GFR slope worse with vitamin D!)
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Hey
@OttawaRenal
fellows!
Ready for the
@KidneyAide
Urea tasting with our
#NephMadness
discussion next week?
I went first, and tolerated it better than
@NephRodby
did methinks
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Swapnil Hiremath from
@OttawaRenal
On vacay at an undisclosed location so will miss this chat and catch up with
#TenTweets
later
#NephJC
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SPRINT skeptics take note!
Another verification, going down to a BP < 120 reduces MACE, CV Death and all cause mortality
External validation from China
Protocol here
@AHAScience
#AHA23
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