Why we needed Kayexalate in the first place

In February I'm giving grand rounds on the Potassium Wars (what, you didn't realize we are in the opening stages of the potassium wars?). I was looking at the original research on Kayexalate from 1961 and came across this ad. Check out the doses of spironolactone they were slinging:

400 mg of spironolactone, daily and this is in a world without loop diuretics!

Purple Urine, now that's not something you see everyday

From the NEJM 2007.

Purple discoloration can occur in alkaline urine as a result of the degradation of indoxyl sulfate (indican), a metabolite of dietary tryptophan, into indigo (which is blue) and indirubin (which is red) by bacteria such as Providencia stuartii, Klebsiella pneumoniae, P. aeruginosa, Escherichia coli, and enterococcus species. The clinical course is benign, and the urine typically clears with resolution of the bacteriuria and acidification of the urine. 

H/T Life in the Fast Lane

The first Nephrology Social Media Internship

A few pioneers at the intersection of social media and nephrology have banded together to create an internship in social media. The founding members of the loosely coordinated Nephrology Social Media Collective (logo pending, but it should be pretty cool) are:

• Myself
• Swapnil Hiremath, co-founder and brain child of NephJC
• Matt Sparks, savior of Renal Fellow Network and co-creator of NephMadness
• Kenar Jhaveri, blogger at NephronPower and editor of AJKDblog
• Paul Phelan, contributor to NephJC, Renal Fellow Network and AJKDblog
• Jordan Weinstein, creator of UKidney
• Edgar Lerma, creator of #NephPearls hashtag and serial author

The idea behind the internship is to give guidance to doctors or students who want to become experts in social media. There are a number of different techniques and strategies in social media and we will provide the intern an opportunity to work with these techniques first hand. Projects that will be open to the interns include:

• NephMadness
• NephJC
• AJKDblog
• Renal Fellow Network
• Research
• UKidney
• DreamRCT

Technologies that the intern will be exposed to include:

• Podcasts
• Google hangouts
• Tweet chats
• Storify for curation
• Mail Chimp newsletters
• Twitter analytics
• Google analytics
• multiple blogging engines including:
• Blogger
• WordPress
• Medium
• SquareSpace

But more important than the technology, is that the interns will have access to our collective wisdom and have access to an instant personal learning network to allow them to pursue their personal social media goals. This is the first time we have done this and we are still working out the exact curricula, but if you are in nephrology, residency or medical school and want to learn how to leverage the power of social media consider applying for the position.

Link

Just another day at the PBFluids world headquarters

Waiting for me in my inbox today:

Hello Dr. Topf, 

My name is Julia XXXXX, and on behalf of Keryx Biopharmaceuticals, I’d like to introduce Keryx as a resource for you as you develop content for your blog, Precious Bodily Fluids, given your commitment to advancing understanding of renal diseases. I’d like to periodically share updates from the company to keep you informed regarding its lead therapeutic product and commitment to patients on dialysis.

In fact, Keryx just announced it has begun shipping AURYXIA™ (ferric citrate) tablets to wholesalers in the U.S. Auryxia is approved for the control of serum phosphorus levels in patients with chronic kidney disease (CKD) on dialysis. Auryxia is the first and only absorbable-iron-based phosphate binder that is clinically proven to effectively control phosphate levels within the KDOQI guidelines range of 3.5 mg/dL to 5.5 mg/dL. The U.S. Food and Drug Administration approved Auryxia in September 2014. In addition, Keryx has created the “Keryx Patient Plus” program to assist with patient accessibility to Auryxia. 

For more information, please visit http://www.auryxia.com/. The full press release is below and includes additional information. 

If you are amendable, we will continue to reach out to share updates from Keryx and AURYXIA in the coming year that we hope will be useful for your readers and followers. 

Please feel free to reach out with any questions. 

Best, 

Julia

My reply

Julia,

Thanks for reaching out. I’m glad there is a new phosphate binder available for dialysis patients. I was wondering if you have any data that shows Auryxia reduces any patient oriented outcomes (e.g. hospitalization, mortality, fractures, morbidity)? And if not, is Karyx planning on doing such a study? And if not, why not?

Joel

Fingers crossed but with a skeptic's scowl