Nephrology Journal Club
@nephjc.bsky.social
A twice monthly nephrology journal club that used to meet on Twitter. Hashtag #NephJC
www.nephjc.com
www.nephjc.com
Pinned
Dialyze Less, Recover More? AKI’s Chance to Get LIBERATE-D — NephJC
This week, we will discuss whether less is more when it comes to discontinuing dialysis in patients with AKI and a chance to recover.
www.nephjc.com
Join us for the last #NephJC of 2025, 12/16/25 at 9pm EST!🥳
How soon should we withhold dialysis in AKI?
We're discussing the LIBERATE-D trial #NephSky
This one might just change your mind 🧠🧠
Blog by @msocomd.bsky.social and @sejalplakhani.bsky.social
www.nephjc.com/news/liberated-aki
How soon should we withhold dialysis in AKI?
We're discussing the LIBERATE-D trial #NephSky
This one might just change your mind 🧠🧠
Blog by @msocomd.bsky.social and @sejalplakhani.bsky.social
www.nephjc.com/news/liberated-aki
1/10
Last #NephJC we discussed dialysis frequency in AKI-D #TenPostNephJC
We sought to answer an age-old question: Is less is really more? Or less is just simply what it is….less?
pubmed.ncbi.nlm.nih.gov/41201895/
Last #NephJC we discussed dialysis frequency in AKI-D #TenPostNephJC
We sought to answer an age-old question: Is less is really more? Or less is just simply what it is….less?
pubmed.ncbi.nlm.nih.gov/41201895/
December 19, 2025 at 12:23 PM
1/10
Last #NephJC we discussed dialysis frequency in AKI-D #TenPostNephJC
We sought to answer an age-old question: Is less is really more? Or less is just simply what it is….less?
pubmed.ncbi.nlm.nih.gov/41201895/
Last #NephJC we discussed dialysis frequency in AKI-D #TenPostNephJC
We sought to answer an age-old question: Is less is really more? Or less is just simply what it is….less?
pubmed.ncbi.nlm.nih.gov/41201895/
A new #NephJC short by @hswapnil.medsky.social
Read all about 📰BigPAK.
Can a biomarker-guided preventive care strategy reduce moderate or severe AKI after major surgery?
This one might raise a few eyebrows 🤨
#NephSky #MedSky
www.nephjc.com/news/2025/12/16/bigpak
Read all about 📰BigPAK.
Can a biomarker-guided preventive care strategy reduce moderate or severe AKI after major surgery?
This one might raise a few eyebrows 🤨
#NephSky #MedSky
www.nephjc.com/news/2025/12/16/bigpak
BigPAK or a bundle of balderdash? — NephJC
We break down the latest salvo from Zarbock et al on a supposedly wonderful ‘bundle’
www.nephjc.com
December 18, 2025 at 10:53 PM
A new #NephJC short by @hswapnil.medsky.social
Read all about 📰BigPAK.
Can a biomarker-guided preventive care strategy reduce moderate or severe AKI after major surgery?
This one might raise a few eyebrows 🤨
#NephSky #MedSky
www.nephjc.com/news/2025/12/16/bigpak
Read all about 📰BigPAK.
Can a biomarker-guided preventive care strategy reduce moderate or severe AKI after major surgery?
This one might raise a few eyebrows 🤨
#NephSky #MedSky
www.nephjc.com/news/2025/12/16/bigpak
Thank you all for joining!
I’m @notjustdialysis.bsky.social (Sridatta) signing off.
See you next year #NephJC.
🛌💙🩺
I’m @notjustdialysis.bsky.social (Sridatta) signing off.
See you next year #NephJC.
🛌💙🩺
December 17, 2025 at 3:00 AM
Thank you all for joining!
I’m @notjustdialysis.bsky.social (Sridatta) signing off.
See you next year #NephJC.
🛌💙🩺
I’m @notjustdialysis.bsky.social (Sridatta) signing off.
See you next year #NephJC.
🛌💙🩺
December 17, 2025 at 2:59 AM
December 17, 2025 at 2:58 AM
Represent the kidneys in style and get some SWAG! 😎
“I just realized, my #NephJC donation sweatshirt is the most expensive piece of clothing I own.” - @brianrifkin.bsky.social #NephSky
www.nephjc.com/merch...
“I just realized, my #NephJC donation sweatshirt is the most expensive piece of clothing I own.” - @brianrifkin.bsky.social #NephSky
www.nephjc.com/merch...
December 17, 2025 at 2:57 AM
Represent the kidneys in style and get some SWAG! 😎
“I just realized, my #NephJC donation sweatshirt is the most expensive piece of clothing I own.” - @brianrifkin.bsky.social #NephSky
www.nephjc.com/merch...
“I just realized, my #NephJC donation sweatshirt is the most expensive piece of clothing I own.” - @brianrifkin.bsky.social #NephSky
www.nephjc.com/merch...
December 17, 2025 at 2:56 AM
We are then going back to our regularly scheduled programming 1/13/26 at 9pm EST
VALIANT: Trial of Pegcetacoplan in C3 Glomerulopathy and Immune-Complex MPGN. #NephJC
www.nejm.org/doi/ful...
VALIANT: Trial of Pegcetacoplan in C3 Glomerulopathy and Immune-Complex MPGN. #NephJC
www.nejm.org/doi/ful...
December 17, 2025 at 2:55 AM
We are then going back to our regularly scheduled programming 1/13/26 at 9pm EST
VALIANT: Trial of Pegcetacoplan in C3 Glomerulopathy and Immune-Complex MPGN. #NephJC
www.nejm.org/doi/ful...
VALIANT: Trial of Pegcetacoplan in C3 Glomerulopathy and Immune-Complex MPGN. #NephJC
www.nejm.org/doi/ful...
Next up: 1/6/26, 9pm EST #NephJC
TOP TEN NEPHROLOGY STORIES OF 2025!
You voted, we tallied. Let’s discuss!
We’re going back to Twitter (yes, it is still called Twitter for those who really care), so pack your bags and join us on the “other place” as we count ‘em down.
TOP TEN NEPHROLOGY STORIES OF 2025!
You voted, we tallied. Let’s discuss!
We’re going back to Twitter (yes, it is still called Twitter for those who really care), so pack your bags and join us on the “other place” as we count ‘em down.
December 17, 2025 at 2:54 AM
Next up: 1/6/26, 9pm EST #NephJC
TOP TEN NEPHROLOGY STORIES OF 2025!
You voted, we tallied. Let’s discuss!
We’re going back to Twitter (yes, it is still called Twitter for those who really care), so pack your bags and join us on the “other place” as we count ‘em down.
TOP TEN NEPHROLOGY STORIES OF 2025!
You voted, we tallied. Let’s discuss!
We’re going back to Twitter (yes, it is still called Twitter for those who really care), so pack your bags and join us on the “other place” as we count ‘em down.
Great discussion, thanks for coming!
Please support #FOAMed and #NephJC with donations.
Your contributions keep the lights on, servers running, and memes flowing.
www.nephjc.com
Please support #FOAMed and #NephJC with donations.
Your contributions keep the lights on, servers running, and memes flowing.
www.nephjc.com
December 17, 2025 at 2:53 AM
Great discussion, thanks for coming!
Please support #FOAMed and #NephJC with donations.
Your contributions keep the lights on, servers running, and memes flowing.
www.nephjc.com
Please support #FOAMed and #NephJC with donations.
Your contributions keep the lights on, servers running, and memes flowing.
www.nephjc.com
What surprised you about this study?
Does LIBERATE-D reinforce what you already do?
Did this study make you rethink dialysis frequency?
Are there other routine dialysis orders that we should reconsider in AKI-D patients vs ESKD patients? #NephJC
Does LIBERATE-D reinforce what you already do?
Did this study make you rethink dialysis frequency?
Are there other routine dialysis orders that we should reconsider in AKI-D patients vs ESKD patients? #NephJC
December 17, 2025 at 2:52 AM
What surprised you about this study?
Does LIBERATE-D reinforce what you already do?
Did this study make you rethink dialysis frequency?
Are there other routine dialysis orders that we should reconsider in AKI-D patients vs ESKD patients? #NephJC
Does LIBERATE-D reinforce what you already do?
Did this study make you rethink dialysis frequency?
Are there other routine dialysis orders that we should reconsider in AKI-D patients vs ESKD patients? #NephJC
T3p
LIBERATE-D is good, but not definitive.
Crossovers, pragmatic design, and modest sample size mean further studies may refine necessary RRT thresholds.
However the direction is clearer→ more dialysis doesn’t mean better outcomes. #NephJC
LIBERATE-D is good, but not definitive.
Crossovers, pragmatic design, and modest sample size mean further studies may refine necessary RRT thresholds.
However the direction is clearer→ more dialysis doesn’t mean better outcomes. #NephJC
December 17, 2025 at 2:51 AM
T3p
LIBERATE-D is good, but not definitive.
Crossovers, pragmatic design, and modest sample size mean further studies may refine necessary RRT thresholds.
However the direction is clearer→ more dialysis doesn’t mean better outcomes. #NephJC
LIBERATE-D is good, but not definitive.
Crossovers, pragmatic design, and modest sample size mean further studies may refine necessary RRT thresholds.
However the direction is clearer→ more dialysis doesn’t mean better outcomes. #NephJC
T3o
Should we routinely hold HD in stable patients unless a compelling indication appears?
Should our morning rounds begin with “Does this patient need HD?” instead of “Is today a dialysis day?”
Time for a self-audit. #NephJC
Should we routinely hold HD in stable patients unless a compelling indication appears?
Should our morning rounds begin with “Does this patient need HD?” instead of “Is today a dialysis day?”
Time for a self-audit. #NephJC
December 17, 2025 at 2:50 AM
T3o
Should we routinely hold HD in stable patients unless a compelling indication appears?
Should our morning rounds begin with “Does this patient need HD?” instead of “Is today a dialysis day?”
Time for a self-audit. #NephJC
Should we routinely hold HD in stable patients unless a compelling indication appears?
Should our morning rounds begin with “Does this patient need HD?” instead of “Is today a dialysis day?”
Time for a self-audit. #NephJC
T3n
Were we asking the wrong questions?
For years we asked:
“When should we dialyze?”
LIBERATE-D asks:
“When should we not dialyze?”
That reframing is powerful.
Will you change your practice based upon this study? #NephJC
Were we asking the wrong questions?
For years we asked:
“When should we dialyze?”
LIBERATE-D asks:
“When should we not dialyze?”
That reframing is powerful.
Will you change your practice based upon this study? #NephJC
December 17, 2025 at 2:49 AM
T3n
Were we asking the wrong questions?
For years we asked:
“When should we dialyze?”
LIBERATE-D asks:
“When should we not dialyze?”
That reframing is powerful.
Will you change your practice based upon this study? #NephJC
Were we asking the wrong questions?
For years we asked:
“When should we dialyze?”
LIBERATE-D asks:
“When should we not dialyze?”
That reframing is powerful.
Will you change your practice based upon this study? #NephJC
T3m
Even after recovery, AKI-D survivors are at ⬆️risk for CKD.
Hypothesis:
Less dialysis-induced ischemia → better long-term slope?
The study wasn’t powered for this, but it is plausible.
Would this data further compel you to follow the Conservative strategy?
#NephJC
Even after recovery, AKI-D survivors are at ⬆️risk for CKD.
Hypothesis:
Less dialysis-induced ischemia → better long-term slope?
The study wasn’t powered for this, but it is plausible.
Would this data further compel you to follow the Conservative strategy?
#NephJC
December 17, 2025 at 2:48 AM
T3m
Even after recovery, AKI-D survivors are at ⬆️risk for CKD.
Hypothesis:
Less dialysis-induced ischemia → better long-term slope?
The study wasn’t powered for this, but it is plausible.
Would this data further compel you to follow the Conservative strategy?
#NephJC
Even after recovery, AKI-D survivors are at ⬆️risk for CKD.
Hypothesis:
Less dialysis-induced ischemia → better long-term slope?
The study wasn’t powered for this, but it is plausible.
Would this data further compel you to follow the Conservative strategy?
#NephJC
T3l
LIBERATE-D suggests a hybrid decision model:
🧪Use simple biochemical and physiologic triggers
🤔Layer clinician assessment on top
But will this create chaos during care hand-offs between nephrology partners?
Perhaps it is at least a reminder to try to dialyze less? #NephJC
LIBERATE-D suggests a hybrid decision model:
🧪Use simple biochemical and physiologic triggers
🤔Layer clinician assessment on top
But will this create chaos during care hand-offs between nephrology partners?
Perhaps it is at least a reminder to try to dialyze less? #NephJC
December 17, 2025 at 2:47 AM
T3l
LIBERATE-D suggests a hybrid decision model:
🧪Use simple biochemical and physiologic triggers
🤔Layer clinician assessment on top
But will this create chaos during care hand-offs between nephrology partners?
Perhaps it is at least a reminder to try to dialyze less? #NephJC
LIBERATE-D suggests a hybrid decision model:
🧪Use simple biochemical and physiologic triggers
🤔Layer clinician assessment on top
But will this create chaos during care hand-offs between nephrology partners?
Perhaps it is at least a reminder to try to dialyze less? #NephJC
T3k
Questions to be answered❓ #NephJC
Should all dialysis programs adopt the same RRT thresholds?
Should nephrologists retain full freedom to use judgment? (AI has entered the chat 🤖)
Can Conservative strategies be used on outpatients? (non-daily assessments)
Questions to be answered❓ #NephJC
Should all dialysis programs adopt the same RRT thresholds?
Should nephrologists retain full freedom to use judgment? (AI has entered the chat 🤖)
Can Conservative strategies be used on outpatients? (non-daily assessments)
December 17, 2025 at 2:46 AM
T3k
Questions to be answered❓ #NephJC
Should all dialysis programs adopt the same RRT thresholds?
Should nephrologists retain full freedom to use judgment? (AI has entered the chat 🤖)
Can Conservative strategies be used on outpatients? (non-daily assessments)
Questions to be answered❓ #NephJC
Should all dialysis programs adopt the same RRT thresholds?
Should nephrologists retain full freedom to use judgment? (AI has entered the chat 🤖)
Can Conservative strategies be used on outpatients? (non-daily assessments)
T3j
Weaknesses
🔀Crossovers
🔫Trigger thresholds partly arbitrary
🗓️No long-term follow-up
🤔Clinician-judgment variability
Not powered to determine mortality or long-term CKD risk #NephJC
Weaknesses
🔀Crossovers
🔫Trigger thresholds partly arbitrary
🗓️No long-term follow-up
🤔Clinician-judgment variability
Not powered to determine mortality or long-term CKD risk #NephJC
December 17, 2025 at 2:45 AM
T3j
Weaknesses
🔀Crossovers
🔫Trigger thresholds partly arbitrary
🗓️No long-term follow-up
🤔Clinician-judgment variability
Not powered to determine mortality or long-term CKD risk #NephJC
Weaknesses
🔀Crossovers
🔫Trigger thresholds partly arbitrary
🗓️No long-term follow-up
🤔Clinician-judgment variability
Not powered to determine mortality or long-term CKD risk #NephJC
T3i
Strengths
Large-scale, randomized evidence that a selective, criteria-driven decision tool can decrease dialysis exposure & improve outcomes.
Clear separation in RRT frequency,missing data, recovery rates in the Conventional group that matched power calculations. #NephJC
Strengths
Large-scale, randomized evidence that a selective, criteria-driven decision tool can decrease dialysis exposure & improve outcomes.
Clear separation in RRT frequency,missing data, recovery rates in the Conventional group that matched power calculations. #NephJC
December 17, 2025 at 2:44 AM
T3i
Strengths
Large-scale, randomized evidence that a selective, criteria-driven decision tool can decrease dialysis exposure & improve outcomes.
Clear separation in RRT frequency,missing data, recovery rates in the Conventional group that matched power calculations. #NephJC
Strengths
Large-scale, randomized evidence that a selective, criteria-driven decision tool can decrease dialysis exposure & improve outcomes.
Clear separation in RRT frequency,missing data, recovery rates in the Conventional group that matched power calculations. #NephJC
T3g
Earlier AKI trials consistently showed:
⭐Early dialysis does NOT improve mortality
⭐Conservative strategies are safe
⭐Many patients can avoid dialysis entirely
LIBERATE-D takes the next logical step:
Once you start dialysis, continue only when necessary.
#NephJC
Earlier AKI trials consistently showed:
⭐Early dialysis does NOT improve mortality
⭐Conservative strategies are safe
⭐Many patients can avoid dialysis entirely
LIBERATE-D takes the next logical step:
Once you start dialysis, continue only when necessary.
#NephJC
December 17, 2025 at 2:42 AM
T3g
Earlier AKI trials consistently showed:
⭐Early dialysis does NOT improve mortality
⭐Conservative strategies are safe
⭐Many patients can avoid dialysis entirely
LIBERATE-D takes the next logical step:
Once you start dialysis, continue only when necessary.
#NephJC
Earlier AKI trials consistently showed:
⭐Early dialysis does NOT improve mortality
⭐Conservative strategies are safe
⭐Many patients can avoid dialysis entirely
LIBERATE-D takes the next logical step:
Once you start dialysis, continue only when necessary.
#NephJC
T3f
Despite how central kidney recovery is to AKI-D outcomes, very few RCTs have meaningfully studied how to optimize recovery.
LIBERATE-D forces us to confront the possibility that we’ve been researching the wrong questions for decades. #NephJC
Despite how central kidney recovery is to AKI-D outcomes, very few RCTs have meaningfully studied how to optimize recovery.
LIBERATE-D forces us to confront the possibility that we’ve been researching the wrong questions for decades. #NephJC
December 17, 2025 at 2:41 AM
T3f
Despite how central kidney recovery is to AKI-D outcomes, very few RCTs have meaningfully studied how to optimize recovery.
LIBERATE-D forces us to confront the possibility that we’ve been researching the wrong questions for decades. #NephJC
Despite how central kidney recovery is to AKI-D outcomes, very few RCTs have meaningfully studied how to optimize recovery.
LIBERATE-D forces us to confront the possibility that we’ve been researching the wrong questions for decades. #NephJC
T3e
Clinician judgment was the most common trigger for dialysis in the Conservative arm.
Not labs, thresholds, or formulas.
It shows we CAN pick up subtle uremia: worsening fatigue, ⬇️alertness, respiratory changes, worsening edema- if we are attentive.
#NephJC
Clinician judgment was the most common trigger for dialysis in the Conservative arm.
Not labs, thresholds, or formulas.
It shows we CAN pick up subtle uremia: worsening fatigue, ⬇️alertness, respiratory changes, worsening edema- if we are attentive.
#NephJC
December 17, 2025 at 2:40 AM
T3e
Clinician judgment was the most common trigger for dialysis in the Conservative arm.
Not labs, thresholds, or formulas.
It shows we CAN pick up subtle uremia: worsening fatigue, ⬇️alertness, respiratory changes, worsening edema- if we are attentive.
#NephJC
Clinician judgment was the most common trigger for dialysis in the Conservative arm.
Not labs, thresholds, or formulas.
It shows we CAN pick up subtle uremia: worsening fatigue, ⬇️alertness, respiratory changes, worsening edema- if we are attentive.
#NephJC
T3d
LIBERATE-D quietly challenges us:
Is BUN > 112 mg/dL a meaningful threshold for toxicity, or just a traditional num?
BUN alone has limited predictive power for symptoms or outcomes. Yet it’s one of the most commonly used reasons for “dialyzing just to be safe.”
What’s your threshold? #NephJC
LIBERATE-D quietly challenges us:
Is BUN > 112 mg/dL a meaningful threshold for toxicity, or just a traditional num?
BUN alone has limited predictive power for symptoms or outcomes. Yet it’s one of the most commonly used reasons for “dialyzing just to be safe.”
What’s your threshold? #NephJC
December 17, 2025 at 2:39 AM
T3d
LIBERATE-D quietly challenges us:
Is BUN > 112 mg/dL a meaningful threshold for toxicity, or just a traditional num?
BUN alone has limited predictive power for symptoms or outcomes. Yet it’s one of the most commonly used reasons for “dialyzing just to be safe.”
What’s your threshold? #NephJC
LIBERATE-D quietly challenges us:
Is BUN > 112 mg/dL a meaningful threshold for toxicity, or just a traditional num?
BUN alone has limited predictive power for symptoms or outcomes. Yet it’s one of the most commonly used reasons for “dialyzing just to be safe.”
What’s your threshold? #NephJC
T3c
This study raises an uncomfortable but necessary question:
Have we, as nephrologists, become so accustomed to reflexively continuing dialysis schedules that we’ve forgotten to assess when patients are actually capable of recovery? #NephJC
This study raises an uncomfortable but necessary question:
Have we, as nephrologists, become so accustomed to reflexively continuing dialysis schedules that we’ve forgotten to assess when patients are actually capable of recovery? #NephJC
December 17, 2025 at 2:38 AM
T3c
This study raises an uncomfortable but necessary question:
Have we, as nephrologists, become so accustomed to reflexively continuing dialysis schedules that we’ve forgotten to assess when patients are actually capable of recovery? #NephJC
This study raises an uncomfortable but necessary question:
Have we, as nephrologists, become so accustomed to reflexively continuing dialysis schedules that we’ve forgotten to assess when patients are actually capable of recovery? #NephJC