#NephMadness 2019: The Effluent Eight

How are you doing after the Saturated 16 results were released? This round, the regional champions are named. Did the Blue RIbbon Panel keep you alive or break your heart and your bracket? Check out the Current Standings and tweet your reaction and score with the hashtag: #Effluent8

We proudly present:

Current Standings  | NephMadness 2019 | #NephMadness #Effluent8

Hypertension Region

While not exactly a close game, it was hard fought with US HTN Guidelines beating Hyperaldo Diagnosis.

US Guidelines wins 6-3.

Comments from the BRP:

130/80 vs 140/90 big yawn. I can’t vote these guidelines down fast enough, as important as this topic may be from an epidemiological or public standpoint. I didn’t go into Nephrology to nitpick mm of Hg, I went into it because I found electrolyte to be challenging and fun. I strongly doubt I am on the majority Blue Ribbon Panel (BRP) side on this one. BRP usually picks the side that has more impact on greater # of patients. HyperAldo Dx 8 to 2 over US HTN Guidelines.”

“I’m sticking with this one – keeping it simple (or simples, as the advert says). Everyone needs to know and care about this, patients and doctors.”

“The new hypertension guidelines require revolutionary changes in clinical practice, a paradigm shift in care.”

“HTN is such an important public health issue.”


Exercise Region

Not surprisingly, the athletes had an easy win after all their hard practice. Athletes on Dialysis handily beats Substance-Associated Nephrotoxicity.

Athletes on Dialysis wins 7-2.

Comments from the BRP:

“While I just don’t see patients on dialysis exercising much more, because dialysis works so poorly to return health (even though it is infinitely better than the alternative and is associated with amazing technology), it is a cool idea requiring a shift in mindset. Substance nephrotoxicity relies on a few case reports. Not enough there. I am very surprised it won over Exercise Nephrotoxicity in Round 1. Athletes in Dialysis 6 to 4 over Substance Nephrology.”

“This is a fabulous topic. It’s subject to myths and there are both staff and patients who will gains lots from deeper knowledge and being able to offer better advice on the ‘dos and don’ts’ of exercise on dialysis.”

“Substance abuse is a public health crisis that overlaps with kidney disease.”

“So many people use supplements.”


Hospitalist Nephrology Region

The crowd favorite, Lactated Ringers, lost big to  Perioperative ACE-i with their tough defense and inability to miss a 3-point shot.

Perioperative ACE-Inhibitors wins 7-2.

Comments from the BRP:

“Having been at the ground floor of RAAS inhibition (captopril), I am obsessed with any thing RAAS (“REE-nin, not RENN-in”). The balanced fluid argument is important (p value strong and the change is so easy to do) but the effects are really minor, the risk reduction is very little. I doubt the BRP will agree with me on this one, everybody got all excited about balanced fluids, and I think it will go very far the more I think about it. Perioperative ACE-i 6 to 4 over Lactated Ringers.”

“Notwithstanding SMART or SALT-ed trials, I am plumping for ACE-i. This will bring out the balance of gain vs harm for patients undergoing surgery and inform some joint treatment decisions.”

“Tomato tomahto – I’m going with perioperative ACE-i. Was always an intriguing question to ask Joe Bonventre.”

“Hot topic. Chloride: defender of volume or toxin?”


Pain Region

Opioids against GABAnergics:

Opioids wins 7-2.

Comments from the BRP:

“In some respects Opioids v NSAIDs was the same side – be careful with opioids and don’t overlook NSAIDs as an alternative. Opioids won. Both Opioids and GABA drugs can be disastrous in the ESRD patient, even when dosed properly. I see a lot of both, obtundation, morbidity, probably mortality from them. I think Opioids are the slightly more important one here because they are not appreciated as such even when you look them up in the PDR. Opioids 6 to 4 over GABA.”

“Pain is often felt by patients to be ill-managed, with a range of treatments with difficult side effects. Recent contradictory commentary and regular patient questions lead me to vote for Opioids and more concentration on individualizing prevalent and distressing pain in kidney patients.”

“Who knew pain control was ultimately going to be so painful?”

“Lots of promise. Delivery?”


Volume Assessment Region

New School versus Dry on Dialysis:

New School wins 7-2.

Comments from the BRP:

“These are the same. We need our patients dry on dialysis (‘Volume is the new uremia’) and we need new school ways to do it. Lung US, IVC US – I think this team has legs. New School 5.2 to 4.8 over Dry on Dialysis.”

“Wet or dry on dialysis, patients deserve the best tools there are to support their quality of life, which is profoudly affected by poor dialysis and being under- or overhydrated. So new tech deserves an outing and detailed examination.”

“If the research is funded by wrestling matches, then you have to pay attention to those Canadians doing dialysis with an MRI machine.”

“We need new tools.”


Hepatorenal Region

With crowd favorite, Terlipressin, falling in the first round, Norepinephrine easily beats 4th seed Bile Casts:Incidental.

Norepinephrine wins 7-2.

Comments from the BRP:

“Because I believe that biles casts ARE Incidental, they gotta lose this round – it only advanced bc it was up against Bile Casts Pathologic. Norepi for HRS, that may really matter. Norepi 8 to 2 over Bile Casts.”

“Big fan of keeping the glass half-full.”

“Let’s look at the obvious. Patients with cirrhosis are jaundiced.”


Plasma Exchange Region

This hard-fought battle between ANCA Vasculitis and Pre-Transplant went into overtime before team Pre-Transplant was able to pull away with team ANCA Vasculitis top scorer fouling out.

Pre-Transplant wins 5-4.

Comments from the BRP:

“PLEX is pretty much dead in the water for ANCA vasculitis (surprised it beat light chains, which doesn’t look good but isn’t dead just yet IMO…‘but I’m not dead yet’ – Monty Python). But there is a real use of PLEX pre-transplant for recurrent FSGS and for positive cross match transplants. PreTx 7 to 3 over ANCA.”

“It’s all about getting more folks transplanted.”

“Still so many questions.”


Complement Region

The Complement Region has been one close game after another and this matchup was no different. C3-i and Beyond was able to win at a buzzer beater in regular time over Acquired C3GN.

C3-i and Beyond wins 5-4.

Comments from the BRP:

“Having met and worked with some of the C3GN families and seen the effect of these conditions, while treatments may be expensive, understanding how and where to target them is a noble and patient-centered goal.”

“Waiting for that drug that cures all.”

“The most exciting development in glomerular disease. Period…”


Current bracket:

Current Standings  | NephMadness 2019 | #NephMadness #Effluent8

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