Author: admin

The ASN has long had a Twitter account but it was infamous among the nephrologists of Twitter as being a oneway mode of communication. A fact that was lampooned on the ASN Bingo board. Getting a reply from @ASNKidney was a badge of honor.

While complaining about how the leadership at the ASN just doesn’t get it was a great parlor game among the renal bloggers, things began to change. In the Fall of 2013, Sarah Faubel called me to ask if I thought we could do a social media symposium at Kidney Week 2014. This materialized as the Tweets, Likes, and Blogs: How to Use Social Media for Your Patients and Your Benefit session. See recaps here and here.

Even before the session other things were changing. In early November, the ASN sent out it’s first Work Force Task Force Report. In the e-mail that announced it, they asked people to discuss the report on Twitter with the hashtag #NephWorkForce.

It was the first time I had seen a hashtag come from ASN. The community was ready to talk and we had a great discussion about some of the issues, but strangely there was no participation by the ASN leadership. MGKatz said it best:

@kidney_boy @ASNKidney haha it’s like Coffee Talk With Linda Richman… Here’s a topic. Discuss amongst yourselves.
— Michael Katz (@MGKatz036) November 6, 2014

But ASN was not foolish, just cautious. They were testing the waters. When the second Work Force Report was published they had Mark Parker available for a formal tweet chat and he was gracious enough to answer questions from me to knock together a table setting blog post. Again there was spirited discussion, and ASN was actively participating.

In mid February-Dr. Faubel drove one of the NephJC on NephroCheck. She suggested the article, wrote up the introduction and was one of the primary tweeters during the chat. Dr. Faubel is the chair of the ASN AKI Advisory Group. Jay Koyner, another member of that group also joined the chat.

ASN then organized a pre-World Kidney Day chat with leaders from the NKF and ISN. Deidra Crews was the representative from ASN for that chat. This chat was amazing with incredible participation from industry, government and all three major real professional organizations. The ASN no longer looked like a reluctant partner but was driving the conversation:

This year’s WKD theme is of paramount importance given the stark disparities in CKD outcomes #WorldKidneyDay
— Dr. Deidra Crews (@DrDeidraCrews) February 25, 2015

Kidney Health For All. #worldkidneyday #WKD2015 #glassofwater pic.twitter.com/EAadUGhyHx
— Tom M.D. (@tomas_md) February 25, 2015

Hello all. Andy Narva, nephrologist & National Kidney Disease Education Program director. #WorldKidneyDay
— Dr. Andrew Narva (@NarvaNKDEP) February 25, 2015

Happy to join! #worldkidneyday
— IFKF (@IFKF_) February 25, 2015

Hello to the group! Happy to participate in the #worldkidneyday chat tonight.
— DaVita Kidney Care (@DaVita) February 25, 2015

Hi everyone, Allen Nissenson here, CMO for DaVita, nephrologist based in LA #worldkidneyday
— Allen Nissenson, MD (@DrNissenson) February 25, 2015

Ernesto Lopez-Almaraz, Nephrologist, Mexico City. Thank you #worldkidneyday
— Ernesto LopezAlmaraz (@kidney_doctor) February 25, 2015

Leslie Spry representing National Kidney Foundation Thank you #worldkidneyday
— NKF CLINICALS (@NKFCLINICALS) February 25, 2015

Joining in late from up north Great initiative – the tweet chat and #WorldKidneyDay Fantastic discussion
— CSN (@CSNSCN) February 25, 2015

15 minutos más para el chat sobre #WorldKidneyDay. Te invitamos a seguirlo a través de nuestro hashtag. pic.twitter.com/dCVFWB0FkF
— Día Mundial de Riñón (@DiaDelRinon) February 25, 2015

Deidra Crews here. Representing the ASN. I am a nephrologist at Johns Hopkins #WorldKidneyDay
— Dr. Deidra Crews (@DrDeidraCrews) February 25, 2015

Tomorrow the ASN will continue this trend by hosting a chat about the upcoming ASN Hill Day, where ASN goes to the nation’s capitol to talk to our elected leaders about how the government can help kidney patients. The ASN is sending three representatives to chat about the event:

1. Crystal Gadegbeku @Crystal4Kidneys Section Chief, Temple Health Nephrology, kidney researcher, ASN public policy board member.
2. Michelle Josephson @Michelle53598125 Transplant Nephrologist and chair of the ASN Transplant Advisory Group
3. Richard Knight @knightra Transplant patient, vice president of the Association of American Kidney Patients

This should be an interesting chat about something that I have only thin knowledge. Please join the chat at 9PM EDT, hashtag #ACT4Kidneys

We have been calling for ASN to join the social media revolution, now that they’ve awoken we need to do our part to make this partnership meaningful and productive.

Feel free to join us for a Twitter chat to learn about this year’s Kidney Health Advocacy Day on 4/21 @ 9:00 pm EDT #Act4Kidneys
— Am Soc Nephrology (@ASNKidney) April 20, 2015

So Pi Day is just about over but during the day we did a three stooges around the Topf household. After taking the pie to the kisser I wrote a check to the National Kidney Foundation of Michigan for $31.41.

I’d like to challenge Matt Sparks, Kenar Jhaveri and Edgar Lerma to take pie and write a check.

Pi Day Kidney Challenge from joel topf on Vimeo.

I did a quick 10 minute presentation at morning report for the residents to get them excited for NephMadness.

You can download the presentation here:

Keynote file

Video:

NephMadness: What’s up with that? from joel topf on Vimeo.

Only eight more days. Get those entries in!

Last Sunday we launched NephMadness

for the third time. This began as a last minute Hail Mary by the crew at AJKDblog to commemorate World Kidney Day in 2013. The response was so overwhelming that despite initially thinking this would be a one-and-done we decided to come back and improve the idea.

We have steadily improved the execution of NephMadness.

Last year we introduced a system to allow online bracket submissions. We found a company that provides white labelled online tournament brackets. This gave us streamlined registration and allowed for automatic scoring. Participation sky rocketed. Last year we also brought in content experts to act as our selection committee to make sure we had the best field possible.

This year, we have a number of further improvements. The primary complaint last year was seemingly arbitrary way the winners of each match up were determined, basically it was a system we called “Matt and Joel decide.” Not surprisingly people were not enamored with this system and this year we have deputized a blue ribbon panel of nephrology experts to make the decisions.

We are also getting better at producing the brackets themselves and filling out the field. We now have written on 192 concepts since we started NephMadness. We have seen that the best match-ups pit related concepts up against each other and we have really increased the use of that technique in this year’s brackets. In addition we have themed the entire tournament as nephrology’s interaction with other specialties.

Download a PDF of the brackets

We have also changed the schedule. The first two years we tried to track the schedule of March Madness as closely as possible. This meant we opened the brackets on Selection Sunday and closed them a week later. This year we opened the brackets on March 1 and accept submissions for 3 weeks, until March 22. This will, hopefully, increase participation.

Another area of improvement is in the Tourneytopia rollover descriptions. Last year we just copied the scouting reports from AJKDblog and pasted them in to the roll overs. They had a bunch of links and were really long. This resulted in really long descriptions that were difficult to read in the rollovers. This year we have a short 2-3 sentence description for the rollovers written solely for that purpose. Oh and a picture.

Go to Tourneytopia to submit your brackets for NephMadness

Last year we had a confusing collection of three sites, Tourneytopia, NephMadness.com and AJKDblog. This year we jettisoned NephMadness.com and completely redesigned AJKDblog to be a much more effective container for NephMadness. The editorial staff at AJKD really did an outstanding job with the redesign.

This year the journal, AJKD, is really behind the contest. The Feb and March issues of AJKD had pack ins to promote the contest.

This months AJKD! #NephMadness

A photo posted by @jtopf on Feb 6, 2015 at 6:38pm PST

And the journal website has two high profile ads for NephMadness.

The last change is we are partnering with MedScape, a long time partner with the NKF and AJKD to promote NephMadness. Medscape is republishing all the content from the scouting reports and e-mailing their audience.

At St John Hospital and Medical Center we are having all of our fellows and faculty complete their own brackets and then we will have a consensus conference and build a collective entry to see if we can do better as a pit crew or as lone cowboys (and cowgirls).

I have been involved in Nephrology social media for years now, and it has been rewarding seeing the global community of nephrologists connect and develop a voice over that time.

While social media in general and Twitter in particular was once thought of as a time waster, it is now recognized as critical communication channel that allows back and forth communication as well as side to side communication.

First order communication: traditional top down

Second order communication: back and forth

Third order communication: back and forth and side to side

The side to side communication is what builds the community and is what twitter excels at. Imagine how boring the NephJC chats wold be if the only communication you saw was from the NephJC host? The whole point of the chat is to leverage the diversity of expertise in the crowd. 

Improving albumin levels among hemodialysis patients

1. Albumin is made in hepatocytes at a rate of 200 mg/kg/day 
1. or 14 g in 70 kg person
2. Total body albumin is 4-5 g/kg
3. 40-45% of albumin is in the intravascular space
4. Normal albumin concentration in the interstitial space is 
1. 0.7 in fat and 
2. 1.3 in skeletal muscle
5. Albumin has a half life of 2 to 3 weeks
6. The drop in albumin with inflammation is due to: 
1. reduced synthesis and 
2. increased fractional catabolic rate (FCR)
7. Intradialytic weight gain of 2.8 liters (4% in a 70 kg man) will dilute the albumin down 0.8 g/dL 

Last week I delivered my grand rounds to both St John Hospital and Providence Hospital. This grand rounds on Kayexalate and the new therapies to increase colonic potassium clearance. Take a look. I hope you enjoy. I have more to say about this talk, and hopefully I will do a directors commentary of the presentation. I have 99 problems but have no for that time now.

Potassium Wars, The Native Keynote file (431 mb) Alternative link.zip (307 mb)
Potassium Wars, The PDF of the Keynote (184 mb)
Potassium Wars, The Movie, It’s almost like being there (1.05 gb)

Or stream it:

K wars, The Movie from joel topf on Vimeo.

Mark Parker, the chair of the ASN Workforce Committee, will be on Twitter next Tuesday to discuss the latest report. This report is the second done by Ed Salsberg and his colleagues at GWU. This report is all about the fellow experience in getting a job.

The report is available here.

Dr. Parker answered some questions to stoke the fires of discussion, that interview can be seen on Medium.

ASN Nephrology Workforce Report

The first workforce report stimulated some discussion on Twitter, that discussion is saved here:

A summary of the discussion about the second report so far is available here:

My summary of the report:

• The survey was distributed to 1,530 ASN Nephrology fellow and trainee members in June and July of 2014.
• 441 responded. Response rate of 28.8%.
• There are 930 fellows in ACGME accredited programs and they received 333 responses from this sub-group. 
• What is up with the 600 trainees not in ACGME spots? DO programs?

Interesting gender differences:

How about this eye opening stat:

USMGs had a median debt of $100,000 to $149,999. IMGs were significantly different with a median debt of $0 and 65% having no debt.

Career plans

Nephrology breaking barriers, has higher starting salaries for women compared to men:

Female respondents had a slightly higher median anticipated base income than male respondents, who had a median anticipated base income of $150,000 to $174,999.

Job hunting troubles were much more common among IMGs with only 22% finding a satisfactory job compared to 56% of USMGs. Visa problems and unappealing locations were leading problems in job hunting. 71% reported no or very few jobs within 50 miles of their training location.

Happily 72% of respondents indicated they would recommend nephrology to medical students and internal medicine residents.

It’s an interesting report, take a look and…

Please join Dr. Parker to talk about #NephWorkForce Tuesday, January 13 at 9pm