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 Image
Dose of dialysis Ronco CRRT 20 ml/kg/hr vs 35 vs 45 from 2000 #AspenKidney ImageImage
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 ImageImage
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 ImageImageImageImage
She thinks that the KDIGO recommendations should be the ceiling and that it may be time to start to exploring lowering the floor. #AspenKidney Image
Onward to timing of dialysis. Points out that the N needs to be around 1000 to show a mortality benefit. #AspenKidney Image
Then AKIKI1 No mortality benefit from early start, but a lot of patients in the late start group never needed dialysis. #AspenKidney ImageImage
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:… #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 ImageImageImage
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!

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More from @kidney_boy

20 Jul
Next up Alkesh Jani to talk about literature review in transplant #AspenKidney Image
Wait list is stable and transplants are going up to more deceased donors. #AspenKidney ImageImage
Kidneys and Patients are doing better over time #AspenKidney ImageImageImage
Read 6 tweets
20 Jul
Next up is Joshua Thurman with a lot review of GN ImageImage
first study is BLISS-LN. Mentions that 2 years of infusions in 448 patients is a big lift. Points out they changed the outcome (probably listens to @NephJC_Podcast (…) #AspenKidney
Her is underwelmed with the magnitude of the effect size. He is not sure how to use it. #AspenKidney Image
Read 12 tweets
20 Jul
Her original title was “Beyond the ouch hypothesis, a new paradigm to explain the harm in AKI.” #AspenKidney
Mortality in ICU:
No AKI, No HD 5%
AKI no HD 23%
AKI with HD 58%

Standardized for APACHE 2 scores

Injured kidneys may be lashing out, releasing substances that cause systemic effects contributing to mortality. These substances are unique from substances that accumulate with zero GFR.

Read 15 tweets
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
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

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