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
Fresenius bought NextStage for 2 billion dollars in 2019 #AspenKidney
Other options on the horizon:

Tablo by Outset Medical. Real time dialysate production
Quanta from the UK raised $245 million
CVS Kidney Care

The major investment in PD over the last 10 years is in connectivity allowing modification of prescription over the wire. Baxter in July 2019 announced major investment in PD. Can we get online PD fluid production? #AspenKidney
Online peritoneal dialysate production overturns the current business model. He does not see that change. #AspenKidney
Wearable kidney? Sorbents present problems as well as the portable nature of a wearable device. Wahlstrom is skeptical. Fresenius invested 100 million dollars in sorbent technology that did not go anywhere. #AspenKidney
WAK is hemodialysis, requires blood access
AWAK is based on PD technology, still dependent on sorbents to regenerate dialysate

He wants to make the case for PD. Better preservation of residual renal function. Better quality of life, cost-effective treatment. He thinks this is the best way to expand home therapy. #AspenKidney
It was difficult to grow PD despite major investments. Most effective was pre-ESRD education. But drop out was still a major problem. They improved starts but people stopped it. Fluid overload was a major reason for drop out. #AspenKidney
New technology to answer the problem of fluid overload in PD.

Steady Concentration Peritoneal Dialysis (SCPD)

Promises improved volume management
Limiting exposure of the peritoneum to high glucose concentrations

New device that supplement PD patients when they have fluid overload. They have a portable version for just fluid removal and small amount of solute removal. Working on a complete PD solution. #AspenKidney
The device works by continuously cycling the PD solution and adding glucose continuously to maintain osmotic gradient. #AspenKidney
May be an interesting device for CHF patients with fluid overload. #AspenKidney
The pitch #AspenKidney

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More from @kidney_boy

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

Read 8 tweets
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
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
19 Jul
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
Read 9 tweets
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:…
Follow-up publication focused on AKI:…
Here are some visual abstracts for Matrix
Read 7 tweets
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.…
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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