2017 #Nephmadness Tournament Selection Report

The
@ISNKidneyCare Social Media Task Force 2017 #Nephmadness Tournament Selec8on Report
The @ISNKidneyCare Social Media Task Force

2017
#Nephmadness Tournament
Selec8on Report

The @ISNKidneyCare Social Media Task Force 2017 #Nephmadness Tournament Selec8on Report 2
The @ISNKidneyCare Social Media Task Force 2017 #Nephmadness Report is authored by:
Credits

1. @sayitmywaya !
2. @arvindcanchia "
h*ps:// aThe Interna8onal Society of Nephrology
youtu.be/ 3. @HecmagsMDa # Social Media Task Force

xj2LAQD7Cys 4. @krishnadoctor1a $ bNOD Analy8cs

5. @pauldlawtona %
6. @LangoteAmita " Cite this report as:

7. @xaviervela & Sridharan S, Conjeevaram A, Madariaga H,
8. @Rclaure_nefroa ' Penmatsa K, Lawton P, Langote A, Vela-Parada
XF, Claure R, Iannuzzella F, Buchkremer F, Paunic
9. @caioqualunquea ( Z, Gopal B, Desai T. The @ISNKidneyCare Social
10. @swissnephroa ) Media Task Force 2017 #Nephmadness
Tournament SelecLon Report. NOD AnalyDcs. 20
11. @unicipaa * March 2017. goo.gl/iQyRgo
12. @BasuNephroa %
13. @nephondemanda,b #
Follow us at the 2017 World Congress of Nephrology (20-25 April 2017) in Mexico City, MX + | @WCN2017 | #WCN2017
SPONSORED
The @ISNKidneyCare Social Media Task Force 2017 #Nephmadness Tournament CONTENT 3
Selec8on Report
The #Nephmadness Tournament is a single-elimina8on compe88on. Thirty-two nephrology-

related topics are divided into 8 regions and compete against one another in both intra-region and inter-
Background region pairwise matchups. The more inuen8al/important topic is labeled the winner of that matchup
and progresses forward in the compe88on. Because topics are organized into a single-elimina8on

bracket, the next compe8ng topic that a winning topic must face is already pre-determined. The
h*ps://
youtu.be/ individual matchups occur over 5 rounds (round 1: 32 topics, 16 intra-region matchups | round 2: 16
Cgc13mAPhZ0 topics, 8 intra-region matchups | round 3: 8 topics, 4 inter-region matchups | round 4: 4 topics, 2 inter-
region matchups | nal round: 2 topics, 1 ul8mate winner).
This report details the manner in which the ISN Social Media Task Force (SMTF) made its selec8ons
for the 2017 Tournament. Each of the 32 topics was given a seed (rank) using crowd-sourced data from
#nephmadness 2017 social media campaign. This data was quan8ed into a pre-tournament rank using
the PageRank algorithm. Using polling data, 2 regions (8 teams total) were given a one-8me increase in
their ini8al PageRank to account for home-court advantage (see page 5). Next, topics within each
matchup were given a probability of winning that matchup based on their current PageRank seed and a
modied Arpad Elo ranking algorithm. Members of the ISN SMTF then debated whether the topic with
the greater mathema8cal probability of winning should actually win based on their (SMTF) clinical
experience and gut ins8nct. The declared winner of each matchup would progress forward to its next
match (as dened by the bracket) with a new PageRank that reected the ease/diculty in its most
recent victory and the round (higher rounds diculty) . This itera8on con8nued un8l the nal round
when a proposed champion was named.
In most head-to-head matchups there is usually one team is favored to win. Typically this
team (or topic) is the one that is more familiar to the spectator (you). In #Nephmadness, your
Home Court
familiarity with a topic increases its likelihood of being chosen as a winner (by you) in any given head-
Advantage
to-head match. This familiarity confers a home court advantage and needs to be reected in the
tournament.
To account for home court advantage, the Social Media Task Force deployed 2 polls (shown
below) targe8ng #Nephmadness par8cipants. Two regions were chosen as the most likely to win and
each topic within those regions (8 topics in total) was given an added increase in their Round of 32
ranking (PageRank). The higher PageRank subsequently portends a greater probability of winning
through the Arpad Elo ranking system.
Map Round of 32 Home Court

Topic Legend PageRank Advantage
We analyzed 3164 tweets from 456 Protocol Bx in Lupus 1A 2.253 2.4783
Steroids for IgA
IniLal par8cipants in the 2017 #Nephmadness social AnD-PLA2r in Membranous
1B 3.13 3.443
1C 6.372 7.0092
Ranks media campaign to rank the crowd favorites. Of Rituximab for Minimal Change 1D 4.563 5.0193
History of DipsDck U/A 2A 4.624 4.624
the 32 topics in the tournament, there was not History of Kidney Biopsy 2B 15.948 15.948
History of Hemodialysis 2C 1.151 1.151
enough crowd support to rank 5 topics in 2 History of Kidney Transplant 2D 1.783 1.783
Kt/V Urea 3A 1.371 1.371
regions: Depression in Dialysis 3B 2.933 2.933
NeurocogniDve Decline in HD 3C 0.566 0.566
Society in ESKD | Pa8ent Factors in Transplant | PaDent Reported Outcomes 3D 8.467 8.467
Gene Microarray 4A 0.345 0.345
System Factors in Transplant | Protein Restric8on Two Photon Microscopy 4B 0.762 0.762
CRISPR-Cas9 4C 1.401 1.401
in CKD | Omega 3 Faoy Acids Single Cell RNA Sequencing 4D 1.947 1.947
Genes in ESKD 5A 0.261 0.261
The ini8al PageRanks for the remaining 27 Society in ESKD 5B 0 0
PaDent Factors in Transplant 5C 0 0
topics are shown. Home court advantage (+ 10%) System Factors in Transplant 5D 0 0
Podocytopathies 6A 2.022 2.022
was given to the appropriate topics in the
Ciliopathies 6B 0.98 0.98
Glomerulonephri8s and Diabetes regions (see page Drosophila 6C 1.3 1.3
Danio (zebrash) 6D 1.174 1.174
5). The Map Legend refers to the Ranking Map on ACEi & ARB 7A 1.79 1.969
Glycemic Control 7B 0.336 0.3696
page 7. SGLT2 Inhibitors 7C 1.511 1.6621
GLP1 Agonists 7D 0.273 0.3003
Protein RestricDon in CKD 8A 0 0
Feeding during Dialysis 8B 0.5 0.5
Microbiome & the Kidney 8C 0.658 0.658
Omega 3 Facy Acids 8D 0 0
IniLal
Ranking
Map

Legend on
page 6

Smaller gray
spheres
represent
parLcipants

Gray lines
represent
parLcipant-
parLcipant
interacLons
This is the opening round of the Tournament. Close matches to watch in this round include:
Pa8ent Factors in Transplant (0.000 | 50.0%) v System Factors in Transplant (0.000 | 50.0%)
Round of 32
Genes in ESKD (0.261 | 52.8%) v Society in ESKD (0.000 | 47.2%)
(PageRank |
Likelihood of Drosophila (1.300 | 51.3%) v Zebrash (1.174 | 48.7%)
winning match) Blowout matches include:

h*ps:// Pa8ent Reported Outcomes (8.467 | 96.6%) v Neurocogni8ve Decline in HD (0.566 | 3.4%)
twi*er.com/
WCN2017/status/ History of Kidney Biopsy (15.948 | 99.2%) v History of Dips8ck U/A (4.624 | 0.8%)
844281553891020
801/photo/1
In a stunning upset, the Task Force unanimously voted for History of Dips8ck U/A (4.624 | 0.8%) to defeat History of
Kidney Biopsy (15.948 | 99.2%). Despite having a predicted < 1% chance of winning, the Task Force felt that the simplicity
Round of 32 and longevity of the dips8ck U/A was more valuable than that of the biopsy. Specic comments include: the dipsLck,
which is an essenLal part of our daily pracLce, is largely unknown and oden underesLmated. Urinalyses are always the rst
Social Media step. Perhaps there will be a future in which the kidney biopsy will be considered obsolete, but a non-invasive study of urine
Task Force (with novel biomarkers) will always be essenLal to our work
Comments Other upset victories include: History of Hemodialysis (1.151 | 43.3%) defea8ng History of Kidney Transplant
(1.783 | 56.7%), Ciliopathies (0.98 | 39.1%) over Podocytopathies (2.022 | 60.9%), and Danio (zebrash) (1.174 | 48.7%)
overcoming Drosophila (1.300 | 51.3%). As one Task Force member put it, that Kolf [sic] started developing the machine
and using it on paLents while hiding from the Nazis in the Netherlands makes for the drama. Despite the fact that theres
so much room to improve outcomes [in transplantaLon], the stagna8on of transplanta8on in the last two decades plus the
drama of dialysis gave History of Hemodialysis the upset victory. In a rst, an en8re region was deemed an upset with
Ciliopathies and Zebrash pulling ahead. Task Force members were keen on their use in polycys8c kidney disease
inves8ga8ons even though these 2 concepts are, arguably, less popular than podocytes and Drosophila.
In a closely predicted match, CRISPR-Cas9 (1.401 | 44.2%) narrowly edged Single Cell RNA Sequencing (1.947 |
55.8%). Sta8s8cally this wasnt a blow-out match and indeed the Task Force was tepid about endorsing CRISPR-Cas9. In the
end, the victory boiled down to the poten8al that CRISPR-Cas9 c/would cure gene8c condi8ons like polycys8c kidney
disease.
Finally there was a toss up between Pa8ent Factors in Transplant and System Factors in Transplant as neither
registered enough of a signal for a PageRank to be calculated. With a toss of a coin, System Factors in Transplant was
declared victorious.
Auer numerous upsets predicted by the Task Force, the Round of 16 begins with 4 matches of
evenly-paired topics. These matches are:
Round of 16 Genes in ESKD v System Factors in Transplant

(Updated Integral Ciliopathies v Zebrash
PageRank | ACEi & ARB v SGLT2 Inhibitors
Likelihood of
winning match) Feeding during Dialysis v Microbiome & the Kidney
On the other side of the bracket we nd Pa8ent Reported Outcomes (9 | 92.7%) with the greatest
probability of winning its match. Interes8ngly, An8-PLA2r in Membranous (7 | 78.1%) begins this round
with a higher PageRank but lower probability of winning than History of Dips8ck U/A (6 | 84.5%) because
of a tougher compe8tor in Steroids for IgA (4 | 21.9%).
If one word could describe the Round of 16 for the Task Force, it would be
Round of 16 novelty. Task Force members were convinced that the freshness of Microbiome & the

Kidney and SGLT2 Inhibitors would propel these topics onto the Round of 8. Quo8ng the
Social Media
Task Force Task Force, these topics are new players in the eld and their compeLtors, like ACEi &
Comments ARB, are topics in which the path of research is well treaded. System Factors in
Transplant and Ciliopathies round out the victors amongst the evenly-paired matches.
Turning its aoen8on to the non-evenly paired matches, the Task Force universally
agreed with the modeled predic8ons. Auer overturning the model 6 8mes in the Round of
32, the Task Force was happy with the predic8ons made in this round.
Round of 8 In the Round of 8 we see that Pa8ent Reported Outcomes (9 | 92.7%) maintains its

(Updated Integral high ranking. This is the third round in which this topic has been predicted to win by over
PageRank |
Likelihood of 90%. On the other side of the bracket we nd Ciliopathies (4 | 60.5%) and SGTL2 Inhibitors
winning match) (4 | 60.5%) maintaining an edge over their respec8ve opponents.

Despite a blowout predic8on by our model, the Task Force vigorously debated the match between Pa8ent
Related Outcomes (9 | 92.7%) and CRISPR-Cas9 (3 | 7.3%). Those in support of the front-runner felt that the
Round of 8 poli8cal and emo8onal support it has are enough to propel it to the Final Four. On the contrary, strong support
was voiced for CRISPR-Cas9 (3 | 7.3%) because of the fascinaLng science it represents. Moreover, considering
Social Media
that the 2016 #Nephmadness Tournament winner was a clinical topic (Conserva8ve Care), it was unlikely that
Task Force
another clinical topic (Pa8ent Related Outcomes ) would move onwards. This match was the most debated thus
Comments
far, but in the end Pa8ent Related Outcomes (9 | 92.7%) won as most Task Force members believed it currently
has greater global implica8ons than the up-and-coming CRISPR-Cas9 (3 | 7.3%.

Take a look at our proposed Final Four topics and a quick summary of how they got
there.
Pa8ent Reported Outcomes (9 | 50%) v An8-PLA2r in Membranous (9 | 50%)
Ciliopathies (6 | 50%) v SGLT2 Inhibitors (6 | 50%)
Once again, the Task Force was placed in an exci8ng posi8on of having to determine the winners of two
sets of evenly paired matches. Pa8ent Reported Outcomes, the powerhouse of the Tournament, now faces an
The Final Four
equally worthy opponent in An8-PLA2r in Membranous auer it defeated stronger opponents in the rst 3

rounds.
Social Media
Task Force Similarly, Ciliopathies baoled and won against tougher opponents to pull even with SGLT2 Inhibitors.
Comments Interes8ngly, the winner of this matchup will automa8cally be the underdog regardless of the winner of Pa8ent
Reported Outcomes v An8-PLA2r in Membranous: having only a 21.9% of being Champion.
The Task Force was vocal about the con8nued success of Pa8ent Reported Outcomes. On the other side
of the bracket, Ciliopathies, which had a great run because of its promise in polycys8c kidney disease, ran out of
steam and succumbed to SGLT2 Inhibitors.
Pa8ent Reported Outcomes (13 | 78.1%) v SGLT2 Inhibitors (10 | 21.9%)

Championship

Throughout the Tournament the underdog status hasnt deterred the Task Force
Social Media
Task Force from selec8ng those topics as winners. So it comes as liole surprise that the proposed
Comments 2017 #Nephmadness Tournament winner by the @ISNKidneyCare Social Media Task Force
is
Our eorts to use both clinical experience and mathema8cal modeling are novel in developing a
#Nephmadness Tournament bracket. It is, however, an eort that requires special considera8ons, as detailed
Special below.
ConsideraLons Our eorts aoempt to predict what the judges would select as important topics in Nephrology. The method(s) by
which they made their selec8ons is/are subjec8ve and opaque. These two characteris8cs add an unpredictable and
unquan8able element of diculty to our modeling
Most models use data from a small sample and extrapolate those ndings to the larger popula8on from which the
sample is derived. Our eorts operate in reverse. We analyzed data from 456 #Nephmadness par8cipants from
over 25 na8ons to determine how the 9 tournament judges (exclusively based in the US) would behave.

Our team (see page 2) is comprised of 12 nephrologists (excluding @nephondemand) that added their clinical
exper8se to our predic8on model. They hail from 10 na8ons (! " # $ % & ' ( ) * ) and, as a group,
may not be an accurate representa8on of the 9 exclusively #--based tournament judges.
The Social Media Task

Many Thanks Force is thankful to all the
par8cipants in the
#Nephmadness campaign.
Whether you were a casual or
prolic tweeter, your tweets
resulted in a rich data set that
helped create our bracket.

Grazie

Gracias

Asante
Je vous remercie

Thank you
Comments
Comments
(conLnued)
Overall the Task Force is pleased with the results in the Round of 32. Its very hard and
Round of 32 extremely unlikely for anyone to have a perfect bracket, especially the way in which
Results & #Nephmadness topics are chosen as winners (see page 18). The key to evalua8ng a single-
Assessment elimina8on bracket is not by coun8ng the number of winners correctly selected or losers picked.

Rather, astute bracketologists measure the success of a bracket by iden8fying the eect of the
h*ps://
twi*er.com/ losses. Mi8ga8ng losses means that a loss in the Round of 32 does not extend into future
WCN2017/status/
845995986052886 rounds. Our bracket is a representa8ve example of both a mi8gated and catastrophic loss.
5281 Of the 16 matches in the Round of 32, we suered a total of 4 losses. Two are fully
mi8gated losses (Depression in Dialysis and Two Photon Microarray) because the losses are
restricted to the the Round of 16. The third loss, History of Dips8ck U/A, is par8ally mi8gated
because the loss extends into the Round of 8. The last, Ciliopathies, would be considered a
par8ally catastrophic loss, because the repercussions are felt deep into the Tournament (up to
the Final 4).
High resolu8on
bracket (with
results) @:

hops://twioer.com/
WCN2017/status/
8459959860528865
281

Auer the release of the Round of 32 results, the #Nephmadness crowd had much to say. Here are select comments.
History of DipsDck U/A (4.624 | 0.8%) v History of Kidney Biopsy (15.948 | 99.2%)
Round of 32 @ChrisRabbat: Today, nephrology stopped revolving around the #urinanalysis. It revolves around the #BlueRibbonpanel.
Crowd hop://twioer.com/ChrisRabbat/statuses/846150212410376192
Comments @sayitmyway: How many 8mes have we done biopsy w/o urine dips8ck? A BIG FAT ZERO! Bread & Buoer knocked out by
pancakes! hop://twioer.com/sayitmyway/statuses/846114682469564416

@alamiri_k: The Blue Ribbon's creden8als need to be posted. hop://twioer.com/alamiri_k/statuses/846039567723458560
@Nair_Sanj: Plus dips8ck is the way forward for preven8ve nephrology which should be our focus. hop://twioer.com/
Nair_Sanj/statuses/846241521833668608
Depression in Dialysis (2.933 | 66.0%) v Kt/V Urea (1.371 | 34.0%)
@silvishah: Flabbergasted that's Depression looses [sic] to Kt/v. I was taught- pa8ents always rst. hop://twioer.com/
silvishah/statuses/846050217149550593
Podocytopathies (2.022 | 60.9%) v Ciliopathies (0.98 | 39.1%)
@KidneyCathy: "Podocytopathies must be more far-reaching though recogni8on of the cilium and its role in PKD is a fantas8c
breakthrough. hop://twioer.com/KidneyCathy/statuses/845987240060764162
Genes in ESKD (0.261 | 52.8%) v Society in ESKD (0.000 | 47.2%)
@gag_aggarwal: society in eskd is the biggest problem here- genes in eskd really!? hop://twioer.com/gag_aggarwal/
statuses/846012510188679168
In General
@dannymcg: Spot on. This decision alone has made me think #NephMadness isnt what I hoped it would be. hops://
twioer.com/dannymcg/status/846129027618365440
@arvindcanchi: since the blue ribbon panel consists of members from the USA, you shouldnt expect a global approach.
hops://twioer.com/arvindcanchi/status/846276001667567616
All-in-all, this was a good round for the Task Force. Entering into the Round of 16 our fates regarding
History of Hemodialysis v History of Dips8ck U/A and Danio (zebrash) v Ciliopathies were already sealed;
Round of 16
Results & we incorrectly selected the laoer in each pair during the Round of 32. Thus, of the remaining 6 matches in
Assessment the Round of 16 we correctly iden8ed 5 winners (83% correct): An8-PLA2r in Membranous (8 | 70.0%),

Pa8ent Reported Outcomes (9 | 92.7%), CRISPR-Cas9 (3 | 7.3%), SGLT2 Inhibitors (4 | 60.5%), and
17 of 24 matches
correctly predicted Microbiome & the Kidney (3 | 39.5%). The remaining match, Genes in ESKD v System Factors in Tx , was
(71%)
both a new and fully mi8gated loss: wreaking liole havoc in our bracket. Thats because we had already
incorrectly selected Ciliopathies to remain in the Final 4. As a par8ally catastrophic loss (see page 22),
Ciliopathies eec8vely negated any other losses in its sec8on of the bracket. And perhaps most
importantly: our Final 4 didnt suer new losses (3 of 4 s8ll viable).

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The

The @ISNKidneyCare Social Media Task Force

youtu.be/ 3. @HecmagsMDa # Social Media Task Force

The #Nephmadness Tournament is a single-elimina8on compe88on. Thirty-two nephrology-

Map Round of 32 Home Court

Pa8ent Reported Outcomes (13 | 78.1%) v SGLT2 Inhibitors (10 | 21.9%)

The Social Media Task

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