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Joel M. Topf, MD FACP Profile picture
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20 Jul, 6 tweets, 5 min read
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
Sars COV2 and kidney transplant. Not good. #AspenKidney ImageImageImage
Tranplant patients are able to mount an antibody response to natural infection #AspenKidney Image
Vaccine response in kidney transplant #AspenKidney ImageImageImage

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More from @kidney_boy

Joel M. Topf, MD FACP Profile picture
20 Jul
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
Read 12 tweets
Joel M. Topf, MD FACP Profile picture
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 (nephjc.com/freelyfiltered…) #AspenKidney
Her is underwelmed with the magnitude of the effect size. He is not sure how to use it. #AspenKidney Image
Read 12 tweets
Joel M. Topf, MD FACP Profile picture
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%
ESRD HD 11%
AKI no HD 23%
AKI with HD 58%

Standardized for APACHE 2 scores

#AspenKidney
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.

#AspenKidney
Read 15 tweets
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

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