Thread by @kidney_boy

Next up is @doc_faubel again for a lit review in AKI. She starts out saying that she will not be able to go over all 68,000 articles in pubmed on the topic. Also nice shout out to #NephJC

#AspenKidney

Dose of dialysis Ronco CRRT 20 ml/kg/hr vs 35 vs 45 from 2000 #AspenKidney

ATN 20 ml/kg/hr vs 35 CRRT or 3 day/week or 6 d/wk with IHD
She says this is one of the greatest RCT ever done in nephrology.

The study was negative with a bunch of negative outcomes with intensive dialysis #AspenKidney

Sorry I forgot the pics

She points out recent data showing that more intensive dialysis is harmful to ventilated patients. The authors suspect it is the phos that is problematic. Faubel is skeptical of the phos hypoth. #AspenKidney

She thinks that the KDIGO recommendations should be the ceiling and that it may be time to start to exploring lowering the floor. #AspenKidney

Onward to timing of dialysis. Points out that the N needs to be around 1000 to show a mortality benefit. #AspenKidney

Then AKIKI1 No mortality benefit from early start, but a lot of patients in the late start group never needed dialysis. #AspenKidney

Talked about IDEAL and then on to START-AKI

Faubel likes the study design of START-AKI especially the points in the protocol where they defer to the opinion of the treating nephrologist. #AspenKidney

AKIKI2 is next. Faubel was on Freely Filtered to talk about this study: nephjc.com/freelyfiltered… #AspenKidney

She concludes with this article from 1960 and she feels the conclusion from this study holds up pretty well (KRT at a BUN of 120). Also note how similar the mortality rates (33%) are to contemporary studies. #AspenKidney

She adds a shout out to @BookBurton with the statement, "There are only normal values for blood because there are no normal values for urine." As part of her plea that the kidney is more than an ultrafiltration organ and that KRT is in no way a replacement for the kidney!