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NephMadness is not decided by popular vote (see Mommy where do winners come from), but we do have the data on the popular votes. If you go to the statistics page at Tourneytopia you can see the top vote-getters but not how the voting went round by round. We have crunched the numbers for you. Here is the popular vote from round two (the actual winners of each match-up are in bold):

Toxin Region:

1 Aristolochic Acid: 110
8 Hemoperfusion: 42
3 Toxic Metals: 42
6 Fomepizole: 66

5 Chelation Therapy: 60
4 Glycyrrhizic Acid: 48
7 Osmolar Gap: 109
2 DSHEA 1994: 43

The popular vote was right on aristocholic acid but wanted the osmolar gap, by a wide margin, in the bottom of the bracket.

Hypertension Region

1 ACEi ARBs combo: 93
8 Renal Artery Tx: 33
3 Systolic BP: 104
6 Diastolic BP: 30

5 Chlorthalidone: 93
4 HCTZ: 30
7 KDIGO BP in CKD: 53
2 JNC8: 84

Looks like the NephMadness cohort has received the message that chlorthalidone is the way to go (except for Pascale Lane) but we think JNC8 (right or wrong) is ultimately going to make a bigger difference in the future of cardiovascular and renal disease burden.

Renal Replacement Therapy Region

1 Convective Clearance: 74
8 Diffusive Clearance: 28
3 Buttonhole Technique: 20
6 Residual Renal Function: 138

5 Fistula First: 93
4 Urgent PD: 81
7 DreamRCT: AKI: 32
2 DreamRCT: ESRD: 54

The crowd was locked-in with us on residual renal function, but wanted Fistula First to rise over Urgent PD. This is understandable as 90+% of patients initiate with hemodialysis but we feel that Fistula First is yesterday’s news and so we went with the future.

Regeneration Region

1 Parietal Epithelial: 109
8 Renin Lineage: 56
3 Renal Pericytes: 60
6 EMT: 35

5 Tubules Self-Duplication: 23
4 Resident Stem Cells: 56
7 Hypertrophy: 40
2 Bioartificial Kidney: 141

Bioartificial kidney soaked up all the glory in this bracket.

Acute Kidney Injury Region

1 Contrast Nephropathy: 89
8 RIPC: 18
3 U/A and Indices: 61
6 AKI Biomarkers: 92

5 Balanced Solutions: 75
4 Normal Saline: 75
7 KDOQI AKI: 24
2 KDIGO AKI: 86

The people love AKI biomarkers. People want to keep chasing the dream. We think this is a case where there is a lot of smoke but no fire. KDIGO AKI guidelines trumped all comers in the bottom of the bracket and we liked KDIGO for publishing the first comprehensive, evidence-based guidelines on AKI but we felt that finally having data that changes the bedrock of crystalloid therapy was more important.

Electrolyte Region

1 Hypertonic Saline: 86
8 Vaptans: 68
3 Serum Anion Gap: 85
6 Urine Anion Gap: 21

5 ZS-9: 44
4 Kayexalate: 51
7 Bicarb in CKD: 129
2 Bicarb in Acute MA:36

Serum anion gap lost the popular vote to hypertonic saline. Considering the emerging data on hypertonic saline in heart failure, I can see that. Bicarbonate in CKD? We agree.

Kidney Stone Region

1 Surgical Acute Care: 75
8 Medical Acute Care: 90
3 CT Scan: 48
6 XO Inhibitors: 47

5 Dr. Charlie Pak: 40
4 Dr. Fred Coe: 53
7 Bariatric Surgery: 74
2 Oxalobacter: 93

A perfect match of crowd and Game Makers.

Biologics Region

1 Rituximab: 180
8 Bortezomib: 25
3 Belimumab: 15
6 Belatacept: 40

5 Eculizumab: 129
4 Soluble CR1: 21
7 ACTHAR Gel: 39
2 Abatacept: 71

The crowd loves Rituximab, which we feel is strange given that in study after study it is shown to be non-inferior. We were looking for clear wins, not glorified ties.

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