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Joel M. Topf, MD FACP Profile picture
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19 Jul, 9 tweets, 5 min read
Kicking off the 47th Annual Course on Renal Disease and Electrolyte Disorders (I am declaring the hashtag to be #AspenKidney) is @kamkalantar with a talk on incremental dialysis.
Recognizing that we are 2 years away from 50 year mark from @dick_nixon expanding chronic dialysis to all Americans. 50 Years! Wow. #AspenKidney
Starting dialysis is marked by high mortality, high cost. #AspenKidney
Are we extending life when we initiate dialysis in the elderly? #AspenKidney
@kamkalantar explaining the thrice weekly dialysis was an accident of legislation. It was an opening ask in hopes that congress would actually fund twice a week dialysis. People were surprised when congress funded the full ask. #AspenKidney
Better preserved kidney function with twice weekly rather than thrice weekly dialysis. #AspenKidney
He does not do longer dialysis, his target is still the same spKt/v per treatment. #AspenKidney
What does the dialysis schedule look like with twice weekly dialysis? #AspenKidney
@kamkalantar summarizes that RCTs are coming but for now he is prescribing incremental dialysis (twice weekly dialysis) based on Hope and Choice. #AspenKidney

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More from @kidney_boy

Joel M. Topf, MD FACP Profile picture
19 Jul
Next up Mats Wahlstrom on The Next Generation of Dialysis. Former CEO of Fresenius and Gambro. #AspenKidney
We are seeing a major investment in home therapies. Credits government initiatives. We are currently at 2% home hemo and 10% PD. #AspenKidney
He credits NextStage as putting home hemo back on the map. Small. Portable. Easy to use. Online dialysat4e production. Major driver of success: Capturing commercial payers! #AspenKidney
Read 16 tweets
Joel M. Topf, MD FACP Profile picture
19 Jul
Next up is @kamkalantar again, this time on nutritional management of CKD. #AspenKidney
#AspenKidney Preservative management of CKD: life sustaining conservative management, delay dialysis by pharmacological and modifying diet and lifestyle.
He says even though we closed the book (MDRD study) on low protein diet 30 years ago we are reopening the book.

low protein 0.6 to 0.8 g/kg
Very low protein diet 0.3 g/kg

#AspenKidney
Read 8 tweets
Joel M. Topf, MD FACP Profile picture
19 Jul
Next up Isaac Teitelbaum on Delivering High Quality Peritoneal Dialysis: What Really Matters? #AspenKidney
Teitelbaum measures Kt/V and then ignores it. He starts by focusing on the poor quality of V in the equation. 95% CI will range Kt/V from 1.44 to 1.94 (and that is using bioimpedence) #AspenKidney
If you use anthropomorphic formulas (which we all do) will be off ±20% Think Kt/V ranging from 1.44 to 2.06 #AspenKidney
Read 5 tweets
Joel M. Topf, MD FACP Profile picture
19 Jul
Next up at #AspenKidney is Jessica Kendrick fellowship PD to talk about CKD and Acid-Base Disorders
Metabolic acidosis, defined as HCO3 < 22, is found in 20% of stage 4 CKD. #AspenKidney
Ammonia is responsible for most of the renal adaption to metabolic acidosis. Requires proximal tubule function. Becomes problematic as GFR falls below 45. #AspenKidney
Read 6 tweets
Joel M. Topf, MD FACP Profile picture
27 Jun
There is more AKI after arterial contrast but I wonder if it is the contrast or something else. A thread
In Matrix randomizing patients to femoral or radial caths resulted less CIN/CAN with radial approach. No difference in contrast.
Primary publication: thelancet.com/journals/lance…
Follow-up publication focused on AKI: sciencedirect.com/science/articl…
Here are some visual abstracts for Matrix
Read 7 tweets
Joel M. Topf, MD FACP Profile picture
16 Mar
So this is the first push back I have seen on the movement to standardize and simplify the language we use in nephrology
As a blogger, I always want more words for everything. I want to luxuriate in as many ways to say kidney as possible. If Eskimos have 50 ways to say snow (and it's over 50), nephrologists should have at least a dozen ways to say kidney.

readable.com/blog/do-inuits…
But what I want is separate from the question of what should we do.

For a long time nephrology projected an aura of mastery. We understood the chemistry of the body better than any other doctor. We jelously hoarded that knowledge behind walls of complexity.
Read 7 tweets

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