How are you doing after the first round of NephMadness 2020? This round, the regional champions are named. Did the Blue Ribbon Panel keep your bracket alive or break your heart? Check out the Current Standings and tweet your reaction and score with the hashtag: #Effluent8

We present:

Current Standings | Match Results | Saturated 16 | #NephMadness

Hyperkalemia Region

Interestingly, Exercise Prevents HyperK just didn’t have the stamina to keep up with K Binders in CKD, leading to an easy win for K Binders in CKD .

K Binders in CKD wins 6-3.

Comments from the BRP:

“Interesting and potentially paradigm-shifting concept that higher K is associated with better outcomes in CKD.”

“Exercise and K is much more interesting, but K binders have a much bigger impact. Not even close.”

“A new era with K Binders in CKD.”

“Any insight that can get our patients to exercise is most welcome.”

“While binders are nice, especially ones that make spironolactone an antihypertensive option in CKD, it’s impossible to resist the vision of Peloton bikes in Dialysis Centers. I can see it now…”

“I believe K binders are changing practice and may have more impact than exercise and K.”

HD Access Region

There was no competition in this matchup. Team American Guidelines played like a 16-seed (not the bracket-busting Cinderella kind) against a number one seed. This was an easy win for Percutaneous AVF Creation.

Percutaneous AVF Creation wins 8-1.

Comments from the BRP:

“I picked Surgical AVF and European Guidelines… 0-2 here. Oh, well. Big yawn still for Guidelines. I’m not surprised the BRP picked pAVF, all the rage. It has to win over Guidelines.

“Guidelines are great but new fistulas without a surgeon are greater.”

“Though not suitable for every patient, percutaneous AVF creation is a game-changer, both procedurally (and also summer fashion-wise).”

Vaccines Region

Flu Vaccine came out hard and fast, playing like they were out to prove they belong, and took a strong early lead over No Live Vaccines in Transplant that they coasted through the final buzzer.

Flu Vaccine wins 6-3.

Comments from the BRP:

“With Coronavirus monopolizing the news, vaccines for all (not just transplant recipients) are more important than ever.”

“The most cost-effective intervention to reduce mortality in ESKD.”

“Pound for pound, the flu deserves props as a prize fighter. That said, giving live vaccines to transplant patients is risky business, especially now. No Live Vaccines for the win on this one.”

Ethics Region

Patient-Driven Choice for Dialysis is out to prove they belong in this tournament and played a solid game, leading to victory over End-of-Life Care for Patients on Dialysis.

Patient-Driven Choice for Dialysis wins 6-3.

Comments from the BRP:

“Patients should drive choice.”

Green Nephrology Region

This proved to be a good matchup and a tight game. Consumable Waste in HD took the overtime victory over Climate Change and CKD on a last-minute three-point shot that hit nothing but net.

Consumable Waste in HD wins 5-4.

Comments from the BRP:

“Again, I just cannot accept that a few degrees of heat is causing CKD. Dialysate = Water = Consumable Waste: this is how climate is going to impact the future of nephrology in many countries.”

“Climate change is real and so is CKD.”

“I may be biased as this is my area of research interest but I believe heat stress is one of the potential causes of CKDu, an epidemic that is causing thousands of deaths around the world.”

“Even if you don’t compost, there’s no denying the impact of a game plan to deal with the waste of dialysis. Infection protection is a thought for sure, but those in power need to think about conserving power–and water, too.”

Transplantation Region

After taking an early lead, Marijuana is OK in Transplant seemed to fall asleep on the court in the last two minutes of the game leading to a win for Biomarkers in Rejection.

Biomarkers in Rejection wins 5-4.

Comments from the BRP:

“I couldn’t accept biomarkers over biopsy. #BlueRibbonFail or #MyFail? But I’ll accept it now over the non-issue of weed and transplant concerns (which I suspect is ethics more than medicine).”

“Leaving an 18-gauge needle in the dust would be great for all of us.”

“I’ve never been convinced about these biomarkers in rejection.”

Genetics Region

There were several lead changes in this tightly fought matchup but a last second buzzer beater by Women with X-Linked Alport led to their victory over Genetic Counseling for Cystic Diseases.

Women with X-Linked Alport wins 5-4.

Comments from the BRP:

“Wow, is this tough. I really like Women with X-Linked Alport but most of these patients do fine. On the other hand, autosomal dominant interstitial diseases are probably missed more than not. I have a family with this, and seeing the mother with a transplant and two daughters that had high uric acids, and genetic testing confirmed their diagnosis, this is real renal genetics.”

“X-linked Alport disease is probably woefully under recognized.”

“Genetic Counseling for Cystic Diseases is probably more important given the PKD and other cystic disease prevalence around the world.”

SGLT2i Region

TG Feedback came into this tournament being highly touted but they seem to have forgotten to leave the locker room and thus went down in flames to SGLT2i Without DM.

SGLT2i Without DM wins 7-2.

Comments from the BRP:

“SGLT2i in patients without diabetes? I love thinking outside the box. Remember ACEi were initially proven to be renoprotective in diabetics, later also in most proteinuric renal diseases. This may be the same?”

“TG Feedback – cool mechanism for renal protection.”

“The answer to obesity? My vote is for SGLT2i Without DM in this round.”

“SGLT2i Without DM is more relevant for nephrology practice.”

“The benefits of SGLT2i beyond just glucose control are just too sweet to resist. Let the patients without diabetes in on the action–and in on the studies.”

NephMadness 2020 | #NephMadness | @NephMadness

How to Claim CME and MOC
US-based physicians can earn 1.0 CME credit and 1.0 MOC point for reading this region.

1. Register/log in to the NKF’s Professional Education Resource Center (PERC). If you select “Physician” in the drop-down menu during registration, the ABIM ID will pop up – make sure to complete this during registration to receive MOC points after course completion.
2. Review the activity, disclosure, and accreditation information.
3. Click “Continue” and review Course Instructions.
4. Complete Post-Test. Please note: By selecting “Yes” to the participation questions for each region, the corresponding Post-Test questions will appear. Click “Save Draft” to save your responses and finish later. When you are ready to submit your answers, click “Preview” to review all responses, then click “Submit.”
5. Click “Next” to complete the Evaluation form, then click“Submit.”
6. Claim 1.0 CME credit and 1.0 MOC point per region (up to 8.0 total for 8 regions of NephMadness).
7. Save/print your certificate.

The CME and MOC activity will expire on June 13th, 2020.