nephjc.bsky.social
A twice monthly nephrology journal club that used to meet on Twitter. Hashtag #NephJC
www.nephjc.com
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➡️Up next 6/26/25 in conjunction with the @theisn.org we will discuss CAPTIVATE: an adaptive, registry-based, platform trial built for CKD
👋 #NephJC #Skytorial by @brianrifkin.bsky.social
Join us @nephjc.bsky.social
See you soon! www.nephjc.com
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10/10
Final #Nephjc thoughts
Perhaps it is not the nudge itself, but the message. @brianrifkin.bsky.social and @hswapnil.medsky.social reimaging a more effective method to entice SGLT2i and ACEi/ARB use 📽️
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9/10
I want more info: Check out #NephJC summary by @nephroseeker.medsky.social @dramiliflores.bsky.social @husamjz.bsky.social
✅ www.nephjc.com/news/nudge-ckd
Visual abstract by Dr. Divya Bajpai
✅ www.nephjc.com/news/2025/6/24/the-nudge-ckd-visual-abstract
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8/10
#NephJC Quote of the fortnight
Clearly @hswapnil.medsky.social is not a fan of the nudge, poke, push or prod 🐄
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7/10
Chat consensus?
💌Interesting pragmatic study, that would be hard to reproduce in other countries.
💌More individualized 📨is better? Would significantly ⬆️ cost & manpower.
💌Denmark is already doing very well with uptake of SGLT2i/RASi compared with other countries, hard to move needle.
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6/10
Give me something clever to say 🤓
@brianrifkin.bsky.social thought that if direct to patient advertising (about every 3rd TV commercial in the US is now a pharma advertisement which accounts for >15% of all ad revenue), then a single nudge was very unlikely to be effective.
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5/10
A figure paints🖼️ a 1000 words!
A nudge is as good as a wink, if you know what I mean! -Monty Python
Unfortunately, no matter how you sliced it this single, pragmatic, low-cost intervention did not change behaviors of patients or GPs.
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4/10
One post results
6-month f/u:
65% of pts receiving a nudge e-mail filled a script for RASi or SGLT2i vs 66% in usual care group.
The provider-level intervention was also not significant. 64% of GPs assigned to the provider-facing letter met the endpoint vs 64% in the usual care group.
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3/10 One post methods
NUDGE-CKD was a pragmatic, registry-based, 2x2 factorial randomized trial in Denmark. Patients & GPs were independently randomized to receive either a nudge letter or usual care. Goal: to ⬆️ use of RASi or SGLT2i.
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2/10
What'd I miss?
Treatment of diabetic CKD has evolved over the last decade.
Uptake of the 4 pillars (ACEi/ARB, nsMRA, GLP1, SGLT2i) to slow progression of CKD has been sluggish. Are there simple strategies that could increase the request (by patients) & prescribing (by GPs) of these meds?
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➡️Up next: Just give it a little NUDGE! E-nudges to try to get better adoption of GDMT in diabetic kidney disease. A pragmatic study from Denmark.
👋 #NephJC #Skytorial by @brianrifkin.bsky.social
Join us @nephjc.bsky.social
See you soon! www.nephjc.com
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10/10
Final #Nephjc thoughts:
We love our peds colleagues! There are many challenges to treating GN without biopsies and ongoing uncertainty about the pathophysiology differences of relapsing or steroid dependent disease 😮💨
@shinamenon.bsky.social @rheaultm.bsky.social
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9/10
I want more info: Check out #NephJC summary by @brianrifkin.bsky.social
✅ www.nephjc.com/news/stamp
Visual abstracts by @krithicism.bsky.social and @dramiliflores.bsky.social
✅www.nephjc.com/news/2025/6/tac-or-mmf-in-peds-nephrotic-syndrome
✅www.nephjc.com/news/2025/6/8/the-stamp-trial-va1
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8/10
#NephJC Quotes of the fortnight
Side effects remain a significant concern for any medication regimen used in children and teens. @jostflynnmd.bsky.social worries about long-term steroids and TAC exposure while @rheaultm.bsky.social opines about the side effects of cyclosporin 🪒
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7/10
Chat consensus?
💊There are many second line treatments for SSNS
💊Choice of med may be based upon availability/cost/side effects
💊Additional head-to-head studies would be helpful for updating guidance
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6/10
Give me something clever to say 🤓
One of the potential advantages of MMF over TAC was the ⬇️ need for blood draws to monitor drug levels. If we don’t monitor MMF (MMA) levels in kids, are we at risk of underdosing? @hswapnil.medsky.social referenced this write up 👇
www.nephjc.com/news/mmf
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5/10
A figure paints🖼️ a 1000 words!
In the full analysis set, the 1-year relapse-free survival rate in the TAC group was 1.86 fold higher.
The 1-year relapse-free survival rate in the per-protocol set- TAC group had significantly lower relapse rates (18%) compared to the MMF group (42%)
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4/10
One post results
✅Unadjusted & adjusted Cox analyses consistently demonstrated HRs of 0.35 for TAC vs MMF
✅43 relapses occurred in the TAC group vs 105 events in MMF patients
✅The mean time to first relapse: TAC 324 days > MMF 263 days
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3/10
One post methods
The STAMP trial was a prospective, multicenter, open-label, parallel-arm randomized clinical trial from China.
Compared TAC vs MMF in pediatric pts with SSNS & FRNS or SDNS.
Eligible children were randomized 1:1 (TAC or MMF) along with prednisolone taper over 12-months.
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2/10
What'd I miss?
85–90% of peds nephrotic pts attain remission of proteinuria within 4–6 weeks of treatment with glucocorticoids (SSNS).
The choice of second line therapy remains individualized.
There’s limited data on the superiority of one med over others in inducing remission with relapses.
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You think so?
The rates are already not very low at baseline - we need to understand why the remainder are not prescribed RASi or Flozins. Maybe it’s not just MD inertia/laziness/ignorance?
#NephJC
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For decades, we complained about our studies being too small. Smaller sample size, would overselect the patients. I don't see how u can pick a more representative population for one country and region, besides including up to 80% of the country's people #nephjc
Agree with @hswapnil.medsky.social
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you had a lot of AI-generated stuff last year... maybe #NephSKy needs them #nephjc 😉
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Welcome, @drpallaviprasad.bsky.social
Glad you made it #nephjc