"Tweet storm" on the topic of albuminuria lowering as a surrogate endpoint and why it's a bad idea. As requested by @S_brimble Fair warning this isn't going to be short.

RT @turbo_dc: Check out our latest publication in @NDTsocial on the meta-epidemiology of heart failure events in RCTs for adults receiving…

@DrPallaviPrasad @NephJC We also did a varieyt of other analyses with varying degrees of adjustment for baseline variables that give very similar answers around the 0.23 to 0.27 ml/min per year range. #NephJC

@nefron1310 Daily for an average of around 3 years for randomization. #NephJC

@thisis_drgsp @NephJC @NSMCInternship @RowanZyada @hswapnil I don't think the VA says it is statistically significant. It just gives the effect estimate and 95% CI. #NephJC

@DrPallaviPrasad @NephJC on average 3.3 years between randomization and open label extension enrollment #NephJC

@thisis_drgsp @NephJC @NSMCInternship @RowanZyada @hswapnil It wasn't statistically significant #NephJC

Hi. Lonnie Pyne. Nephrologist from Hamilton, Ontario, Canada at McMaster University COI - one of the authors #NephJC

@ThachLonnie

@AnnaGaddy @NephJC Sounds like a good post #NephJC activity. Don't mind if I do.

@hswapnil @NephJC @jmteakell @DrPallaviPrasad @SayaliBThakare @NephroSeeker @brian_rifkin @dra_miliflores @DrPSVali @divyaa24 @anandthedoc @lastwalsh Thanks to #NephJC for discussing our paper!

@Jwaitz @brian_rifkin @lastwalsh @NephJC Gotta be careful with the stopping PPI at the same time as starting something else. Particularly in those patients inclined to blame the meds. Do I have some patients who are convinced the SGLT2i caused their heartburn? Yes, yes I do. #NephJC

@VijayanMD @kidney_boy @brian_rifkin @NephJC Gotta leave them wanting more 😀 #NephJC

@VijayanMD @kidney_boy @brian_rifkin @NephJC Not possible using the COMPASS trial data given no info on magnesium levels. Currently working on response to very interesting letter to the editor looking at mechanism.....first look seems very interesting, more to come. #NephJC

@Jwaitz Discontinuation trial in health volunteers. Lots of rebound dyspepsia and symptoms seem to correlate to gastrin levels. #NephJC

@VijayanMD @kidney_boy @brian_rifkin @NephJC Seems reasonable that gradual taper would be more successful. I have suggested prn usage in some cases as well. If they were on it for episodic rather than chronic acid reflux arguably should have always been prn. #NephJC

@kidney_boy @brian_rifkin @NephJC The extra tricky part is PPIs are kind of habit forming in a way. Even if they didn't have an indication for PPI initially the compensatory increased gastrin you get after being on PPI chronically means they may get rebound GI symptoms when stopping. #NephJC

@Jwaitz @hswapnil @NephJC @lastwalsh @brendonneuen But impossible to know if this putative PPI effect is absolute (everyone's eGFR decline accelerates by ~0.27 ml/min per year) or relative (everyone's decline accelerates by 20%) as we mention in the discussion. #NephJC