Welcome to #TenTweetNephJC tweetorial
✳️ 10 tweets to catch-up with #NephJC ✳️
Have you ever prescribed piperacillin-tazobactam? Or avoided it due to fear of causing AKI?
Read on to learn more about the ‘nephrotoxin’ versus ‘pseudonephrotoxin’ debate
✳️ 10 tweets to catch-up with #NephJC ✳️
Have you ever prescribed piperacillin-tazobactam? Or avoided it due to fear of causing AKI?
Read on to learn more about the ‘nephrotoxin’ versus ‘pseudonephrotoxin’ debate
2/10
What did I miss?
50+ observational studies have linked the vancomycin/pip-taz combo with AKI. However, most only used creatinine as their injury biomarker, & evidence for ⬆️dialysis is limited
This study included cystatin-C & BUN measurements
pubmed.ncbi.nlm.nih.gov
What did I miss?
50+ observational studies have linked the vancomycin/pip-taz combo with AKI. However, most only used creatinine as their injury biomarker, & evidence for ⬆️dialysis is limited
This study included cystatin-C & BUN measurements
pubmed.ncbi.nlm.nih.gov
3/10
1 tweet methods
✅ Identified patients in MESSI, a prospective cohort gathering biomarker data
✅ Adults, on ICU with severe sepsis/shock
✅ Compared biomarkers in patients who got >48 hours vanc & pip-taz to those who received vanc & cefipime instead
1 tweet methods
✅ Identified patients in MESSI, a prospective cohort gathering biomarker data
✅ Adults, on ICU with severe sepsis/shock
✅ Compared biomarkers in patients who got >48 hours vanc & pip-taz to those who received vanc & cefipime instead
4/10
1 tweet results
🔹297 patients in vanc/pip-taz arm 🆚 442 vanc/cef (but only 192 with cystatin-C done)
🔹 Pip-taz again associated with increased ‘serum creatinine-defined’ AKI
🔹 No difference in cystatin-C or BUN at day 2-3
🔹 No difference in dialysis need at day 14
1 tweet results
🔹297 patients in vanc/pip-taz arm 🆚 442 vanc/cef (but only 192 with cystatin-C done)
🔹 Pip-taz again associated with increased ‘serum creatinine-defined’ AKI
🔹 No difference in cystatin-C or BUN at day 2-3
🔹 No difference in dialysis need at day 14
5/10
A figure paints 1000 words
Rapid separation in serum creatinine - does this pattern fit best with pseudotoxicity?
A figure paints 1000 words
Rapid separation in serum creatinine - does this pattern fit best with pseudotoxicity?
6/10
Give me something clever to say
Nah not this time… this week you get a meme from @kidney_boy instead…
Give me something clever to say
Nah not this time… this week you get a meme from @kidney_boy instead…
7/10
Chat consensus?
1️⃣ Observational studies of AKI are overly reliant on serum creatinine, use of cystatin-C was welcomed here
2️⃣ This study dents the narrative that pip-taz is nephrotoxic - next we eagerly await the ACORN RCT results
clinicaltrials.gov
Chat consensus?
1️⃣ Observational studies of AKI are overly reliant on serum creatinine, use of cystatin-C was welcomed here
2️⃣ This study dents the narrative that pip-taz is nephrotoxic - next we eagerly await the ACORN RCT results
clinicaltrials.gov
9/10
I want more info
✅ Follow @miano81
✅ NephJC summary from @nephrokavitha & @SayaliBThakare
nephjc.com
✅ Nice blogpost from @pulmcrit
emcrit.org
✅ 1st author on @pharmso_hard podcast
pharm-so-hard.com
✅ VAs by @Ade_Nephro & @DrPSVali
I want more info
✅ Follow @miano81
✅ NephJC summary from @nephrokavitha & @SayaliBThakare
nephjc.com
✅ Nice blogpost from @pulmcrit
emcrit.org
✅ 1st author on @pharmso_hard podcast
pharm-so-hard.com
✅ VAs by @Ade_Nephro & @DrPSVali
10/10
Final thoughts
✳️ Don’t be the 50th study showing the same association; change up the methodology
➡️ Up next is a fun one - ADVOR & addition of acetazolamide for diuresis in patients with CCF. See you on 20/21 Sept!
nejm.org
Tweetorial by @jamiekwillows
Final thoughts
✳️ Don’t be the 50th study showing the same association; change up the methodology
➡️ Up next is a fun one - ADVOR & addition of acetazolamide for diuresis in patients with CCF. See you on 20/21 Sept!
nejm.org
Tweetorial by @jamiekwillows
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