Go blue!

Birthday dip in Lake Michigan! Water temp down to 48 degrees. I need new neoprene booties for Christmas.

Dr Biff Palmer accepts the Narins award at #KidneyWk. I had the opportunity to serve on a hyperkalemia advisory board where Dr Palmer and I were the 2 nephrologists. We were tasked with giving a summary of K handling in the tubule. Biff emails me “Well Katie, how would you like to approach this?”

Thanks to everyone who stopped by the Barbie poster at #KidneyWk today. We have a great poster tomorrow: FR-PO0365. Come on by!

Poster 0370 is live at #KidneyWk and must be seen to be believed! #NoBoringPosters #NoComicSans

Hey #KidneyWk folks you can get the 500 bus direct from IAH to the convention center for $4.50. It leaves every 30 minutes and the stop is right by baggage claim. Public transportation FTW!

Heading out to #KidneyWeek and bringing some mandala rocks. If you come up and say “hello” I’ll give you one!

TSA agent this morning complimented my vintage Coach bag (which I bought new) and said it was a lot like her mom’s. 😐

Beautiful calm Lake Michigan. Water temp by the buoy was 58 but it felt colder going in!

After a long end to summer, fall has arrived in Michigan. The lake temperature dropped from 68 to 58 degrees inside of a week. This was a wonderful swim that helps us acclimate for winter dipping. I didn’t wear my gloves but I missed them! #coldwaterswimming

I am so excited for our ASN posters. I am on a mission to make beauty and great design a regular feature in the poster hall.

I am an incorrigible hobbyist - I get really into things in phases. With a near endless supply of beach rocks, painting mandalas was a natural choice. Maybe I’ll take some to #KidneyWk to spread some joy.

If you have patients with edema and #nephrotic syndrome, researchers at the University of Michigan would like to survey them about their symptoms. Patients are paid for their time.

Very pleased that the #Panoramic team have two posters accepted for #KidneyWeek! Looking forward to presenting our ongoing quality improvement projects including sex differences in SGLT2i prescriptions.

iSGLT2 effects on Acute Kidney Outcomes #ERA25 ✅ Clear protective effects for AKI ❌ No extra risk of AKI events during the acute eGFR dip

#CONFIDENCE results are in! Enjoying the posts from #era2025. Unlike the big SGLT2i trials primary endpoint here was reduction in ACR.

The first #ERA25 simultaneous pub CONFIDENCE trial of empagliflozin + finerenone in N = 579 Greater reduction in ACR and BP Note the impressive GFR dip www.nejm.org/doi/full/10....

"X is racist. The only thing up for debate is whether this is a feature or a bug for those in charge," writes Charlie Warzel.

At some point in early 2021 (IIRC) the number of 18-30-year-olds who died of covid exceeded the number killed in the Iraq and Afghanistan wars, in a much shorter period. The idea that it’s only dangerous to older people is a lethal myth. 🧪⚕️📈

Yes it’s a continual dumpster fire of news but I migrated my plants outside for the summer and it’s nice out here on my porch

New rule: if you do a TCM visit and your entire plan of care is “defer decision about restarting SGLT2i to nephrology” then let us do (and bill for) the TCM visit. Sheesh.

My #NephMadness bracket is in! Of course I picked #Hemodiafiltration to win it all. First significant change in US dialysis in decades? Potentially seeing units compete on the type of treatment they offer? And getting it done without changing the bundle? Yes, please!

Waiting in the car at the Amtrak station to see my son off to college when we see a car DRIVING DOWN THE TRACKS.

Holy moly are you all reading #CarelessPeople? I can’t believe this isn’t getting more media attention - wait I can after hearing how FB and other social media companies manipulate their algorithms. (I left Twitter when I noticed all the tradwife content popping up.)

Conditions have been amazing the past few days for #coldwater swimming in Lake Michigan. Air temp 70, water temp 37. Wonderful to stay on the beach afterwards with a thermos of milky sweet tea.

With @brianrifkin.bsky.social talking about how nephrology responds to the challenge of CKM syndrome - @asnkidney.bsky.social has put together a terrific group to discuss!

Still the most beautiful exterior of an airport terminal in the country IMO.

Free webinar via RPA: Immigration Issues in your practice. This Wednesday at 1 pm. Register at renalmd.org. Sign up for membership while you’re registering! We are stronger together.

Our office waiting room sign

Anyone else find themselves reclassifying stage 4 CKD to stage 3 after about 18 months in 4 drug GDMT for diabetic nephropathy? Happening too often for me to dismiss as a fluke any more. Confirmed with Cystatin as well.

#Coldwater swimming is stress relief for me. Today in Michigan it’s 75 degrees. There’s still big ice berms on the lake, but there’s about twenty feet of open water between the berms and the shore. It’s only 18 inches deep, I had to lie down to get in, but it’s great to be back in the water.

I practice in a red county and don’t talk politics in the exam room. The number of elderly patients spitting invective at GOP’s gutting of science and public health, unprompted, in clinic yesterday was remarkable. Outside of the MAGA cult people are PISSED.

Today I banned a drug rep from our office. They chose to use an aggressive, hectoring tone with my young associate doctor, pressuring him to prefer their drug (which is an excellent one) over another class for treating CKD-DM. Hard no.

My first time ever recording a podcast - thanks @kidneyboy.bsky.social @jordybc.bsky.social and @captainchloride.bsky.social for having me on and making it a great experience!

It is so, so important to tell your patients with GN - de novo or relapse - that they did not cause it by anything they did! Every single one of mine says they immediately blamed themselves - diet choices, alcohol, or something else. Make it explicit for them so they can get past self blame.

RPA runs the only nephrology specific PAC and is the most effective voice for reimbursement issues for our specialty. Come to our annual meeting in Las Vegas April 4-6 to learn more!

Did the task I’ve been avoiding for over a month. Took 10 minutes.

Ozempic now FDA approved for CKD!

I think I’m getting the hang of it, a little. #visiblemending

Second hole is fixed, this went much faster, maybe 40 minutes. #visiblemending

Got a vintage wool fisherman’s sweater off EBay, holes were undisclosed. My first attempt at #visiblemending. Not a “Five minute craft!” This took me two hours. Will flip warp and weft colors on the next one.

“It should be just as unthinkable for a nephrologist to defer treatment of heart failure with an SGLT2i… as it would be to pass on prescribing an ACEi for hypertension.” My editorial this month in Kidney News. www.kidneynews.org/downloadpdf/...

Over Christmas my parents asked us to go through their storage unit and take anything we wanted to save from the donation bin. Could not pass up this satin cadmium glass cruet set they got as a wedding gift 55 years ago (and never used!)

In further insurance nonsense chronicles, UHC needs full documentation including relevant CPT codes and a letter of necessity to authorize continued coverage of dialysis for my ESRD patient of two years.

The Panoramic experience, so to speak, in the CKCC payment model in 2022. cc: @katiekwonmd.bsky.social www.ajmc.com/view/a-stand...

Last #coldwater swim of the year as I’m on call tomorrow. So far I’ve only gone in when it’s calm but today I overcame a little mental block about that and got in despite the breakers. My hat got splashed but the water was still wonderful! I never swim alone - son was standing sentinel on the beach.

Let’s ask #NephSky How would you term the diuresis from #flozins leading to improvement in hyponatremia? Is it fair to call it a (free) water diuresis?

Wishing Bluesky a Merry Christmas and showing off my Moo Deng ornament created for me by my friend Nicole, who 3D printed it, sanded and painted it to perfection!

So glad Dr Manning is sharing these Grady stories on Bluesky.

Telehealth flexibilities extended to end of March 2025 (whoopee) but the 2.5% doc payment fix and the 3.53% APM bonus gone from the final compromise bill. That’s a little mire than a 6% haircut for some docs. Thank you for your service.