iiinova — where your digital self keeps evolving

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 09/04/2026

Happening tomorrow! @lonniepyne.bsky.social from McMaster will present on eGFR changes as outcomes of interest #NephGR #NephSky

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Reposted by @sbrimble.bsky.social

Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 13/02/2026

The 2.0 version of the Ontario Renal Network #KidneyWise toolkit is live now www.ontariorenalnetwork.ca/en/kidney-ca... From @sbrimble.bsky.social and team - referral forms - referral criteria - guidance on CKD mgt for PCPs #NephSky #MedSky

ontariorenalnetwork.ca

KidneyWise Toolkit

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sbrimble.bsky.social @sbrimble.bsky.social · 22/12/2025

How can you say twitter is dead? Where else will I learn from some random dude with a blue checkmark what the 10 most important things are to be successful before 5am while hitting the jackpot in crypto?

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sbrimble.bsky.social @sbrimble.bsky.social · 18/12/2025

I landed more or less in the same place reading the paper. Good thing we are not debating it!

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sbrimble.bsky.social @sbrimble.bsky.social · 01/12/2025

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.

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sbrimble.bsky.social @sbrimble.bsky.social · 01/12/2025

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.

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sbrimble.bsky.social @sbrimble.bsky.social · 01/12/2025

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

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sbrimble.bsky.social @sbrimble.bsky.social · 07/11/2025

Anecdotally every patient I see on these drugs gets AKI/pseudo-AKI. I’m sure it’s not ascertainment bias…😏

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sbrimble.bsky.social @sbrimble.bsky.social · 28/09/2025

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.

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ASN Publications @asnpublications.bsky.social · 11/09/2025

What are the most important risk factors for suboptimal dialysis initiation? In #ASNKidney360, this article investigates within a prospective cohort study. Read more: kidney.pub/KID0895 @hswapnil.medsky.social @sbrimble.bsky.social

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sbrimble.bsky.social @sbrimble.bsky.social · 30/07/2025

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?

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sbrimble.bsky.social @sbrimble.bsky.social · 02/07/2025

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.

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sbrimble.bsky.social @sbrimble.bsky.social · 18/06/2025

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?

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Reposted by @sbrimble.bsky.social

Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 16/04/2025

As an example Guidelines hijacked by industry for decades

Anemia guidelines flagrantly ignoring RCT evidence

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sbrimble.bsky.social @sbrimble.bsky.social · 16/04/2025

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.

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sbrimble.bsky.social @sbrimble.bsky.social · 16/04/2025

Maybe we should put together a consensus conference or controversies in guidelines meeting in Fiji to really hash this out.

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sbrimble.bsky.social @sbrimble.bsky.social · 16/04/2025

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.

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Dorothy Bishop @deevybee.bsky.social · 16/04/2025

some of the most striking tortured phrases i’ve seen in a while. Look here to discover what “moo warm steadiness” is pubpeer.com/publications...

pubpeer.com

PubPeer - Adsorption of heavy metals from wastewater by chitosan: A re...

There are comments on PubPeer for publication: Adsorption of heavy metals from wastewater by chitosan: A review (2024)

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sbrimble.bsky.social @sbrimble.bsky.social · 13/04/2025

I also wonder when chlorthalidone is back, how many patients will end up being on 2 thiazides for a time.

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sbrimble.bsky.social @sbrimble.bsky.social · 13/04/2025

Has to be the most heavily advertised movie in years. Makes me think they’re worried it’s going to be a flop.

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sbrimble.bsky.social @sbrimble.bsky.social · 09/04/2025

I finally got it. #NephMadness. Madness….its not supposed to make any sense.

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sbrimble.bsky.social @sbrimble.bsky.social · 09/04/2025

So basically you decide who would win and decided to put yourself second so as not to draw suspicion. Got it…

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derek guy @dieworkwear.bsky.social · 08/04/2025

a lot of people think you need a lot of money to buy clothes. now you're right. ok. my bad.

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sbrimble.bsky.social @sbrimble.bsky.social · 08/04/2025

Aww a little snow on April 7th doesn’t sound like fun?

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sbrimble.bsky.social @sbrimble.bsky.social · 06/04/2025

Presumably all-cause mortality. Trial could be stopped after the interim analysis by week 4.

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sbrimble.bsky.social @sbrimble.bsky.social · 06/04/2025

It’s the Police, man. And I’m old. Old enough to remember this movie…

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Rick @rickylongthread.bsky.social · 06/04/2025

THIS IS WHAT A TRADE WAR LOOKS LIKE -

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sbrimble.bsky.social @sbrimble.bsky.social · 06/04/2025

If you are a US size 12 I can sell you my old 2014 pair…

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sbrimble.bsky.social @sbrimble.bsky.social · 06/04/2025

I think it was Sting with Jean Roussel (I hear a drum kit and no guitar). Dusty Springfield also did the song the following year www.youtube.com/watch?v=Mksp...

youtube.com

Dusty Springfield - I Don't Think We Could Ever Be Friends 1982

YouTube video by francis bacon

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sbrimble.bsky.social @sbrimble.bsky.social · 05/04/2025

Little known fact, Christos is only 26 years old #kalopenia

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sbrimble.bsky.social @sbrimble.bsky.social · 03/04/2025

Yep, said as much. But ACHIEVE (clinicaltrials.gov/study/NCT030...) is recruiting 2500 dialysis patients; outcome is CV death or HF hospitalization. I seriously doubt any intervention short of transplant could be shown to reduce all-cause mortality in this pop’n with a sample size of 1K.

clinicaltrials.gov

ClinicalTrials.gov

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sbrimble.bsky.social @sbrimble.bsky.social · 02/04/2025

Fair enough. Any good info on environmental impact eg 💦?

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Lonnie Pyne @lonniepyne.bsky.social · 02/04/2025

First and only? Can’t be such a stickler as to ignore the PIVOTAL trial. PIVOTAL trial effect estimate on all-cause mortality HR 0.84 (95% CI 0.71 to 1) I do think expecting anything to improve all-cause mortality in ESRD is probably unwise. www.nejm.org/doi/full/10....

nejm.org

Intravenous Iron in Patients Undergoing Maintenance Hemodialysis | NEJM

Intravenous iron is a standard treatment for patients undergoing hemodialysis, but comparative data regarding clinically effective regimens are limited. In a multicenter, open-label trial with blin...

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sbrimble.bsky.social @sbrimble.bsky.social · 02/04/2025

But I still dislike iHD and agree it’s another #BlueRibbonFail. Probable that Oates character…

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sbrimble.bsky.social @sbrimble.bsky.social · 02/04/2025

A larger sample size does not mean the mortality benefit would have been even greater. I suspect the opposite to be true in fact.

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sbrimble.bsky.social @sbrimble.bsky.social · 02/04/2025

I get that the event (mortality) rate is high in this pop’n but the mechanisms leading to that unfortunate event are varied. I’m skeptical this modality reduces mortality 25% and would have greedily liked to see a larger sample size to have greater confidence in the estimate of benefit

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sbrimble.bsky.social @sbrimble.bsky.social · 02/04/2025

Just to be clear I’m not a fan of iHD. Just pointing out that I find the sample size a bit suspect. We are used to trials of 10K in non-dialysis population powered to detect a composite outcome. This trial is a 10th the size of those for a single outcome.

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sbrimble.bsky.social @sbrimble.bsky.social · 02/04/2025

Agreed though might quibble as to whether it was truly adequately powered.

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