sbrimble.bsky.social
@sbrimble.bsky.social
Many can’t tolerate all 4 so think some rational sequencing makes sense. For most people I’m going to see, SGLT2i makes the most sense as the first add-on. 6-month goal makes sense to me.
December 1, 2025 at 1:29 PM
Many can’t tolerate all 4 so think some rational sequencing makes sense. For most people I’m going to see, SGLT2i makes the most sense as the first add-on. 6-month goal makes sense to me.
Agreed - my graph has been iterative, starting with dapa and only a couple of days ago coming across the losartan paper. We are updating the Kidneywise toolkit for primary care and some do not feel we should suggest any drug over another.
December 1, 2025 at 9:23 AM
Agreed - my graph has been iterative, starting with dapa and only a couple of days ago coming across the losartan paper. We are updating the Kidneywise toolkit for primary care and some do not feel we should suggest any drug over another.
For fun I created this. Retrieved data from DAPA-CKD on change in eGFR over time in 2 arms. Then looked at other drugs, adjusting for differences in placebo progression rates between trials. Then started at median eGFR for DAPA-CKD. Time to eGFR of 8. Pseudo-science perhaps but interesting
December 1, 2025 at 1:49 AM
For fun I created this. Retrieved data from DAPA-CKD on change in eGFR over time in 2 arms. Then looked at other drugs, adjusting for differences in placebo progression rates between trials. Then started at median eGFR for DAPA-CKD. Time to eGFR of 8. Pseudo-science perhaps but interesting
Anecdotally every patient I see on these drugs gets AKI/pseudo-AKI. I’m sure it’s not ascertainment bias…😏
November 7, 2025 at 6:50 PM
Anecdotally every patient I see on these drugs gets AKI/pseudo-AKI. I’m sure it’s not ascertainment bias…😏
Also industry scientists with tremendous resources behind them. I’m really not sure what the answer is to your question. Most research has no tangible impact but agree the skills and knowledge acquired are often transferable. Questionable cost-effectiveness though in most cases.
September 28, 2025 at 6:03 PM
Also industry scientists with tremendous resources behind them. I’m really not sure what the answer is to your question. Most research has no tangible impact but agree the skills and knowledge acquired are often transferable. Questionable cost-effectiveness though in most cases.
Reposted by sbrimble.bsky.social
We called it unplanned pubmed.ncbi.nlm.nih.gov/30899532/ but suboptimal seems more common
@sbrimble.bsky.social
@sbrimble.bsky.social
Risk Factors for Unplanned Dialysis Initiation: A Systematic Review of the Literature - PubMed
Well-designed prospective studies to determine modifiable risk factors are needed. The lack of a consensus definition for unplanned dialysis makes research and quality improvement initiatives in this ...
pubmed.ncbi.nlm.nih.gov
July 30, 2025 at 2:44 AM
We called it unplanned pubmed.ncbi.nlm.nih.gov/30899532/ but suboptimal seems more common
@sbrimble.bsky.social
@sbrimble.bsky.social
That we are it seems. We are considering developing an optimal start indicator that would look at % of patients in a program starting as an outpatient, maybe “deferred” based on starting eGFR, and on their preferred modality. Probably vascular access agnostic.
Thoughts?
Thoughts?
July 30, 2025 at 1:37 AM
That we are it seems. We are considering developing an optimal start indicator that would look at % of patients in a program starting as an outpatient, maybe “deferred” based on starting eGFR, and on their preferred modality. Probably vascular access agnostic.
Thoughts?
Thoughts?
Bring them to Antiques Roadshow
July 7, 2025 at 7:23 PM
Bring them to Antiques Roadshow
Swap, do you think it’s all just about the 24-hr BP AUC above (and perhaps below) an optimal BP? When I get to a 3rd drug I do like to have one of them in the evening and assume the overall BP control is better but do worry about adherence.
July 2, 2025 at 10:31 PM
Swap, do you think it’s all just about the 24-hr BP AUC above (and perhaps below) an optimal BP? When I get to a 3rd drug I do like to have one of them in the evening and assume the overall BP control is better but do worry about adherence.
Always respect those who put in the effort to conduct a well thought RCT. Very few of our patients choose CAPD these days. Also, If I’m reading the baseline eGFR correctly, “less dialysis” for most of the patients could have been no dialysis?
June 18, 2025 at 10:38 AM
Always respect those who put in the effort to conduct a well thought RCT. Very few of our patients choose CAPD these days. Also, If I’m reading the baseline eGFR correctly, “less dialysis” for most of the patients could have been no dialysis?
Bring back reserpine…
May 29, 2025 at 4:02 PM
Bring back reserpine…
Eww…mushy chips…
April 22, 2025 at 10:29 PM
Eww…mushy chips…
Reposted by sbrimble.bsky.social
As an example
Guidelines hijacked by industry for decades
Guidelines hijacked by industry for decades
April 16, 2025 at 5:04 PM
As an example
Guidelines hijacked by industry for decades
Guidelines hijacked by industry for decades
The 2006 KDOQI adequacy guideline that told us to start looking for any indication to start dialysis when eGFR drops below 15 (and in some cases even earlier) has always been seared into my brain as a particularly bad recommendation.
April 16, 2025 at 4:09 PM
The 2006 KDOQI adequacy guideline that told us to start looking for any indication to start dialysis when eGFR drops below 15 (and in some cases even earlier) has always been seared into my brain as a particularly bad recommendation.
Maybe we should put together a consensus conference or controversies in guidelines meeting in Fiji to really hash this out.
April 16, 2025 at 3:52 PM
Maybe we should put together a consensus conference or controversies in guidelines meeting in Fiji to really hash this out.
God I could not disagree more, at least with the sentiment/rationale provided (see below). Might as well have entitled it “Make American Nephrology Great Again”. I should add that is even though I have issues with how heavily industry-conflicted KDIGO can be.
April 16, 2025 at 3:32 PM
God I could not disagree more, at least with the sentiment/rationale provided (see below). Might as well have entitled it “Make American Nephrology Great Again”. I should add that is even though I have issues with how heavily industry-conflicted KDIGO can be.
I also wonder when chlorthalidone is back, how many patients will end up being on 2 thiazides for a time.
April 13, 2025 at 2:29 PM
I also wonder when chlorthalidone is back, how many patients will end up being on 2 thiazides for a time.
Has to be the most heavily advertised movie in years. Makes me think they’re worried it’s going to be a flop.
April 12, 2025 at 11:39 PM
Has to be the most heavily advertised movie in years. Makes me think they’re worried it’s going to be a flop.