Tejas Desai

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Background: A prior study using US electronic health records (EHR) directly compared the risk of heart failure- or edema-related hospitalizations, and edema-related emergency department (ED) visits for hyperkalemic patients using patiromer or sodium zirconium cyclosilicate. Incidence rates for all three clinical outcomes favored patiromer, but the prior study did not capture costs. Methods: The current investigation combines the patiromer and sodium zirconium cyclosilicate cohort heart failure hospitalization and edema event rates from the prior study with mean event and prescription costs from 2019-2021 Optum Clinformatics data. The resulting heart failure and edema-related event and medication costs were then compared between patiromer and sodium zirconium cyclosilicate cohorts. We inflation-adjusted those to 2024 US dollars. Results: For patiromer, costs for heart failure hospitalizations, edema hospitalizations, and edema ED visits were $30,269.05, $2,520.13, and $31.67 per person-year, respectively. For sodium zirconium cyclosilicate, costs for heart failure hospitalizations, edema hospitalizations, and edema ED visits were $39,478.29, $4,061.48, and $51.04, respectively. Medication costs per person-year were $11,423.68 and $8,561.71 for patiromer and sodium zirconium cyclosilicate, respectively. The aggregated cost savings with patiromer was $7,907.99 per person-year (95% CI $5,453.58 to $10,362.40) for all heart failure hospitalization and edema hospitalization and ED events, adjusted for both inflation and medication costs. Conclusions: Total event and medication costs were $44,245 in the patiromer cohort and $52,153 in the sodium zirconium cyclosilicate cohort. The $7,908 difference represents a 15% (95% CI 10% to 20%) cost savings associated with patiromer from all events, including medication costs and adjusted for inflation.

Background: Chronic kidney disease-associated pruritus (CKD-aP) is a common condition in dialysis patients, and is associated with lower quality of life, depression, and sleep problems. CKD-aP is under-recognized and undertreated. While question 20 of the KDQOL is used for CKD-aP assessment in the clinical setting, recent studies testing novel drugs for CKD-aP have used the WI-NRS. Therefore, evaluating the correlation between KDQOL-Q20 and the WI-NRS may enable the identification of patients who could potentially benefit from these treatments. Methods: This was an observational cohort study of patients receiving in-center hemodialysis from the Mount Sinai Kidney Center. Patients completed a baseline survey on CKD-aP (KDQOL-Q20 and WI-NRS), depression, and sleep quality. A repeat survey was conducted at 4 weeks, with the order of the CKD-aP surveys reversed. We defined moderate/severe CKD-aP as a KDQOL-Q20 score ≥2 and a WI-NRS score ≥ 4. Our outcomes of interest were the correlations of KDQOL-Q20 with the WI-NRS, missed HD treatments, depression, and sleep quality. Correlation analysis was performed with Spearman correlation analysis. Association testing between CKD-aP and outcomes was conducted by relative risk estimation with robust error variance. Results: A total of 112 patients completed the study. According to the WI-NRS, 42% of patients reported itching (score of ≥4) while according to KDQOL-Q20, 57% of patients reported itching (score of ≥2). KDQOL-Q20 and the WI-NRS were strongly correlated (r = 0.7; p < 0.001). Patients who had moderate/severe CKD-aP according to KDQOL-Q20 had a non-statistically significant trend towards a lower risk of missed HD treatments and a higher risk of depression, and a statistically significantly higher risk of sleep-related problems, compared to those with no or mild CKD-aP. Conclusions: CKD-aP is a common condition, and is associated with various clinical outcomes. We found a strong correlation between two CKD-aP measures. These results can help to identify patients for CKD-aP treatment.

Gender inequities negatively impact productivity and career advancement for women. Social media platforms like Twitter can be used to achieve greater parity and address underrepresentation by providing a medium for education, research and mentorship, however, it is unknown how it may contribute to gender inequity. Our aim was to examine gender interactions during a nephrology medical conference.

In Situation Report #3 and 39 days before declaring COVID-19 a pandemic, the WHO declared a -19 infodemic. The volume of coronavirus tweets was far too great for one to find accurate or reliable information. Healthcare workers were flooded with which drowned the of valuable COVID-19 information. To combat the infodemic, physicians created healthcare-specific micro-communities to share scientific information with other providers. We analyzed the content of eight physician-created communities and categorized each message in one of five domains. We coded 1) an application programming interface to download tweets and their metadata in JavaScript Object Notation and 2) a reading algorithm using visual basic application in Excel to categorize the content. We superimposed the publication date of each tweet into a timeline of key pandemic events. Finally, we created NephTwitterArchive.com to help healthcare workers find COVID-19-related signal tweets when treating patients. We collected 21071 tweets from the eight hashtags studied. Only 9051 tweets were considered signal: tweets categorized into both a domain and subdomain. There was a trend towards fewer signal tweets as the pandemic progressed, with a daily median of 22% (IQR 0-42%. The most popular subdomain in Prevention was PPE (2448 signal tweets). In Therapeutics, Hydroxychloroquine/chloroquine wwo Azithromycin and Mechanical Ventilation were the most popular subdomains. During the active Infodemic phase (Days 0 to 49), a total of 2021 searches were completed in NephTwitterArchive.com, which was a 26% increase from the same time period before the pandemic was declared (Days −50 to −1). The COVID-19 Infodemic indicates that future endeavors must be undertaken to eliminate noise and elevate signal in all aspects of scientific discourse on Twitter. In the absence of any algorithm-based strategy, healthcare providers will be left with the nearly impossible task of manually finding high-quality tweets from amongst a tidal wave of noise.

BACKGROUND In Situation Report #13 and 39 days before declaring COVID-19 a pandemic, the WHO declared a “COVID-19 infodemic”. The volume of coronavirus tweets was far too great for one to find accurate or reliable information. Healthcare workers were flooded with “noise” which drowned the “signal” of valuable COVID-19 information. To combat the infodemic, physicians created healthcare-specific micro-communities to share scientific information with other providers. OBJECTIVE Our objective was to eliminate noise and elevate signal tweets related to COVID-19 and provide easy access to the most educational tweets for medical professionals who were searching for information. METHODS We analyzed the content of eight physician-created communities and categorized each message in one of five domains. We coded 1) an application programming interface to download tweets and their metadata in JavaScript Object Notation and 2) a reading algorithm using visual basic application in Excel to categorize the content. We superimposed the publication date of each tweet into a timeline of key pandemic events. Finally, we created NephTwitterArchive.com to help healthcare workers find COVID-19-related signal tweets when treating patients. RESULTS We collected 21071 tweets from the eight hashtags studied. Only 9051 tweets were considered signal: tweets categorized into both a domain and subdomain. There was a trend towards fewer signal tweets as the pandemic progressed, with a daily median of 22% (IQR 0-42%). The most popular subdomain in Prevention was PPE (2448 signal tweets). In Therapeutics, Hydroxychloroquine/chloroquine wwo Azithromycin and Mechanical Ventilation were the most popular subdomains. During the active Infodemic phase (Days 0 to 49), a total of 2021 searches were completed in NephTwitterArchive.com, which was a 26% increase from the same time period before the pandemic was declared (Days -50 to -1). CONCLUSIONS The COVID-19 Infodemic indicates that future endeavors must be undertaken to eliminate noise and elevate signal in all aspects of scientific discourse on Twitter. In the absence of any algorithm-based strategy, healthcare providers will be left with the nearly impossible task of manually finding high-quality tweets from amongst a tidal wave of noise. CLINICALTRIAL not applicable

Twitter journal clubs are increasingly popular amongst healthcare providers. Most journal clubs rely on voluntary physician participation. Offering continuing medical education credit may incentivize and improve these journal clubs. In this investigation a series of 5 consecutive publication-sponsored Twitter journal clubs were analyzed in calendar year 2016, in which the latter 3 journal clubs offered CME credit. Various quality metrics were measured and analyzed to identify sustainable improvements in those journal clubs that offered CME credit. Overall, Twitter journal clubs that offered CME credit performed better in certain quality metrics, to wit activity, originality, and evidence-based tweeting, but fared poorly in number of and type of participant interactions. Twitter journal clubs are in their infancy and physician participation remains steady. Offering CME credit improves certain quality metrics within these journal clubs. This investigation should encourage more publications to sponsor CME-accredited Twitter journal clubs.

Social media is gaining popularity amongst both medical educators and life-long learners. One of the most popular social media platforms used by the medical community is Twitter, which is popular amongst physicians, students and patients, and particularly in medical societies. Major international and regional societies commonly use Twitter to amplify their reach beyond what their live annual meetings can achieve. There has been a unique and notable effort by Nephrology societies to craft a structured social media strategy that results in the broadest reach to the community of nephrology providers. We report on the first three such experiments performed by three separate nephrology organizations.