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kireports.bsky.social @kireports.bsky.social · 9d

21/ The answer is 5. We hope this #skeetorial has improved your knowledge on the effects of MCS on kidney outcomes. Please share this #skeetorial with your followers and friends! Thanks to @mchanmd.bsky.social D for authoring! @theisn.org @kireports.bsky.social

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kireports.bsky.social @kireports.bsky.social · 9d

20/ Now let’s see if you have learned something!

What were significant modifiers of needing dialysis?
1. Early slope
2. Late slope
3. Breakpoint time
4. Breakpoint eGFR
5. None

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kireports.bsky.social @kireports.bsky.social · 9d

19/ Limitations
👎Utilizing only creatinine for eGFR determination rather than cystatin-c
👎Older generation of MCS used
👎Missing data

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kireports.bsky.social @kireports.bsky.social · 9d

18/ Summary
🔑After MCS, patients had early rise in eGFR followed by decline
🔑This inflection point is around 1-2 weeks after placement
🔑Lower breakpoint eGFR and steeper eGFR decline in the late phase were risk factors of survival.
🔑Female sex and older age were modifiers of late trajectory slope

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kireports.bsky.social @kireports.bsky.social · 9d

17/ Modifiers of ⚰️ and Dialysis in Multicenter Registry
☝️Unadjusted Models for ⚰️: Early trajectory slope, breakpoint time, breakpoint eGFR, late trajectory slope
☝️Adjusted Models for ⚰️: Breakpoint eGFR, late trajectory slope
☝️No modifiers identified in unadjusted or adjusted models for dialysis

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kireports.bsky.social @kireports.bsky.social · 9d

16/ Modifiers of Late Trajectory Slope
☝️Single Center: HeartMate3, ischemic cardiomyopathy
☝️Multicenter: Female sex, older age, need for temporary MCS, mean arterial pressure

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kireports.bsky.social @kireports.bsky.social · 9d

15/ Modifiers of Breakpoint eGFR
☝️Both Cohorts: Baseline eGFR, pre-operative inotrope/vasopressor use, central venous pressures, older age, pulmonary artery systolic pressures

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kireports.bsky.social @kireports.bsky.social · 9d

14/ Modifiers of Breakpoint Time
☝️Single Center: Diabetes, female sex
☝️Multicenter: Need for temporary MCS, older age, and higher MAP

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kireports.bsky.social @kireports.bsky.social · 9d

13/ Modifiers of Early Trajectory Slope
☝️Single Center: Diabetes
☝️Multicenter: Older age, female sex, higher baseline eGFR, higher MAP, destination therapy, pre-operative inotrope/vasopressor use
☝️Both Cohorts: Need for temporary MCS and pulmonary arterial systolic pressures

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kireports.bsky.social @kireports.bsky.social · 9d

12/ Clinical Characteristics
📌Single center had 190 patients
📌Multicenter had 10794 patients
📌Similar cohorts except multi-center had more MCS placement due to acute decompensation and both used different device types

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kireports.bsky.social @kireports.bsky.social · 9d

11/ Statistics
📐Segmental regression as compared to logarithmic and linear models

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kireports.bsky.social @kireports.bsky.social · 9d

10/ Measurements
📏 Kidney Function: Using CKD-Epi 2021 based on creatinine. If on dialysis, eGFR presumed to be less than 10mL/min/1.73m2
📏 Early trajectory slope
📏 Late trajectory slope
📏 Breakpoint time (defined as when early positive slope transitions to late negative slope)
📏 Breakpoint eGFR

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kireports.bsky.social @kireports.bsky.social · 9d

9/ Methods
Inclusion
✅ Patients who survived past 90 days after MCS placement

Exclusion
❌ Transplant recipients
❌ Device Exchange/Explantation
❌ Those missing pre-operative; 1-week; 1-month; and 3-month post placement creatinine data

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kireports.bsky.social @kireports.bsky.social · 9d

8/ Methods
Cohort 🥇: Single-Center with MCS placement from 2019-2023, which provided more creatinine data

Cohort 🥈: Multicenter Registry (Interagency Registry for Mechanically Assisted Circulatory Support [INTERMACS]) with MCS placement from 2012-2017, which provided more participants

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kireports.bsky.social @kireports.bsky.social · 9d

7/ There is great need for ways to predict kidney trajectory in MCS patients as highlighted by a recent statement from @americanheart.bsky.social statement. We hope this manuscript sheds some 🔦!

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kireports.bsky.social @kireports.bsky.social · 9d

6/ Intro
💡 Most common kidney trajectory is an early improvement followed by sustained decline as seen in prior #NephMadness
💡 Identifying risk factors for poor renal outcomes have been challenging due to confounders

🔊https://ajkdblog.org/2023/03/01/nephmadness-2023-heart-failure-devices-region/

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kireports.bsky.social @kireports.bsky.social · 9d

5/ Intro
💡Increasing use of mechanical circulatory support (MCS) like, ie LVADs
💡Average time on MCS is 20 months
💡Mean survival has increased to 5 years

PMID: 30691593

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kireports.bsky.social @kireports.bsky.social · 9d

4/ Our #Skeetorial is based on a recent publication by Dr. Carl Waltherand VA by @husamjz.bsky.social :
Kidney Function Trajectories with Mechanical Circulatory Support
🗞️ www.kireports.org/article/S246...

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kireports.bsky.social @kireports.bsky.social · 9d

3/
There are no conflicts of interest. Please also check out #KIReportsCommunity educational #blogposts at www.kireportscommunity.org. FOLLOW US at @KIReports for more expert #MedEd in #kidneydisease. #FOAMed

Kidney Education | KI Reports Community

KI Reports Community is the blog page affiliated with KI Reports and the ISN, representing a less restricted space where a variety of content is presented, including expert commentaries, article summa...

www.kireportscommunity.org

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kireports.bsky.social @kireports.bsky.social · 9d

2/
Our author is Melvin @mchanmd.bsky.social (pediatric nephrologist)
Our topic: Kidney Function Trajectories with Mechanical Circulatory Support

#MedSky #nephsky @theisn.org

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kireports.bsky.social @kireports.bsky.social · 9d

🧵Tweetorial Alert 🧵

1/
Hey #NephSky!
Welcome to a 🆕 #skeetorial brought to you by @kireports.bsky.social

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Reposted

Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · Sep 8

somewhat related

www.sciencedirect.com/science/arti... in @kireports.bsky.social

see how less often do we think of TKD (4%) but how often it turns out to be (19%)

#NephSky

Figure 5. Reclassification rate for all solved participants (n = 103). (a) represents the participants’ diagnosis before genetic testing and (b) represents the diagnosis after genetic testing (their confirmed genetic diagnosis). Phenotypes include atypical hemolytic uremic syndrome (aHUS); Alport syndrome; congenital anomalies of the kidney and urinary tract (CAKUT); ciliopathies, including nephronophthisis; cystic kidney disease, including polycystic; glomerulopathy (GN), excluding Alport syndrome; hypertension (hypertensive kidney disease); and other kidney diseases (including amyloidosis), stones disease (nephrocalcinosis and nephrolithiasis), tubulointerstitial kidney disease (TKD), and tubulopathies. This figure was created using sankeymatic.com and biorender.com.

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Reposted

ISNkidneycare @theisn.org · 29d

𝗜𝗦𝗡 𝗩𝗜𝗗𝗘𝗢 𝗔𝗕𝗦𝗧𝗥𝗔𝗖𝗧 𝗦𝗘𝗥𝗜𝗘𝗦: Renal Outcomes Over the Course of 5 Years of Oral HIV Preexposure Prophylaxis Using Tenofovir Disoproxil/Emtricitabine. 2025 from @kireports.bsky.social www.kireports.org/article/S246...

#VideoAbstract by
@drsumanbehera.bsky.social

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Reposted

ISNkidneycare @theisn.org · 28d

📖 This weekend don't miss our @kireports.bsky.social #ISNFridaySelection: Kidney Transplant Outcomes in Recurrent Versus De Novo IgA Nephropathy www.kireports.org/ar...

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Reposted

ISNkidneycare @theisn.org · Aug 29

📖 This weekend don't miss our @kireports.bsky.social #ISNFridaySelection: Non-invasive diagnosis of anti-nephrin–associated podocytopathy www.kireports.org/ar...

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