In Gemini's defense, it was OpenEvidence that was misquoting things! But maybe that's even more scary because of the perceived, "This is associated with NEJM/JAMA/etc and cites sources and therefore is more trusted"..

Meanwhile, it's misquoting the guidelines and evidence and apologizing to me when I call it out.. I'm more worried how it will impact learners who just regurgitate the factually incorrect responses..

Our dark horse - fish oil! Too good to be true? But also pretty low risk.. I smell a (fishy) craze on the horizon similar to vitamin C in sepsis (remember when we all just started prescribing vitC+hydrocortisone+thiamine in the ICU without any questions?)

I'd like to believe that the AI will kill us all before it tanks the planet. It seems like the logical, AI-generated thing to do!

Follow the beans! (And not the kidney beans..)

I totally forgot to join #nephjc yesterday - I wanted to join just to say I detest phos binders and their sole purpose is to torture the patient so a lab number can improve. Plus major under recognized and under reported side effect like colonic ulcers and GI bleeding

Could fund a year or two of college with that bag 😩

I fear there is a lot of brow beating and shame projected at patients for something the majority of us would struggle with..

But to your point - I agree that a modest and realistic use of a binder to lower phos is doable, and should be about aligning to a “best case scenario” for the patient. Shoving more at them in setting of non adherence just sets up a worse failure when they do decide to take it (ouch tummy!!)

That’s the thing, though, there’s a lot of 14 Renvelas/day out there. Many are just treating a number. It says a lot when patients tell me post-txp meds are far easier than their dialysis med regimen, and it always tracks back to the binders.. I’m so jaded by this drug class now 🤣

They are, but there’s a two year TDAPA period that gives additional payment to the dialysis provider during the transition. After that 2 year window and ASP erosion, reimbursement may decrease significantly.

It will be interesting to see what happens with phos management when TDAPA ends for the phos binders. Once the real financial impact hits, I wonder how the LDOs will react and “liberalize” phos control. Follow the 💸 #NephJC

It’s refreshing to see something like this published vs the 10,000th retrospective study of a single center or region. Kudos to the team for bringing it to publication! #NephJC

If you can tolerate the diarrhea then it’s a higher potency (less pill burden) option. PI states 6 tabs/day max but of course if the phos isn’t at goal, the answer is always more 😏 (also more profit for someone somewhere) #NephJC

As a PharmD who works with CKD, ESKD and KTx pts, I’m fascinated by how much complexity this class brings into the med regimen. More complex regimen=more non adherence. Are we worsening pts more than just QoL? Who knows! Take a $5000 binder with all meals and snacks and say thank you #NephJC

This is honestly the saddest part because we love to sling information like it’s 100% vetted truth. It’s ok to explain to patients what we know for certain and what we aren’t fully sure about - patients deserve to know that nuance, especially with something as challenging as diet and binders.

I can’t wait!

Would also love to see someone look at increasing binder regimen complexity and adherence to entire med regimen. We know in other populations the more complex a regimen gets, the less adherent pts are to ALL meds. Seems crazy we would write TID w meals and BID with snacks for a phos of 5.8…

I’d love to see a timeline of how practice patterns and recommendations have changed over time in regards to drug approvals and reps pushing beyond “reasonable”. The wildly high doses, snack doses, it all seems madness for me for some really shoddy data supporting use.