✳️ Welcome to #TenTweetNephJC, where we catch you up on the week's #NephJC chat in 10 tweets ✳️
The topic at hand was diuretic resistance, specifically compensatory post-diuretic sodium reabsorption (CPDSR). Let’s walk you through how it all flowed 💧
The topic at hand was diuretic resistance, specifically compensatory post-diuretic sodium reabsorption (CPDSR). Let’s walk you through how it all flowed 💧
What did I miss?
We teach medical students that diuretic resistance occurs in large part due to CPDSR. While this has been validated in healthy individuals, does this hold true in patients w/ acute decomp heart failure (ADHF)?
Enter the study in question
pubmed.ncbi.nlm.nih.gov/34529781/
We teach medical students that diuretic resistance occurs in large part due to CPDSR. While this has been validated in healthy individuals, does this hold true in patients w/ acute decomp heart failure (ADHF)?
Enter the study in question
pubmed.ncbi.nlm.nih.gov/34529781/
1 tweet methods
✅Single center, prospective, observational study, with a randomized sub-cohort
✅Evaluating mechanisms of diuretic resistance in patients with ADHF on IV loops 💉
✅Supervised urine collection pre and post diuresis
✅Primary outcome = level of CPDSR
✅Single center, prospective, observational study, with a randomized sub-cohort
✅Evaluating mechanisms of diuretic resistance in patients with ADHF on IV loops 💉
✅Supervised urine collection pre and post diuresis
✅Primary outcome = level of CPDSR
1 tweet results
🔹43 pts identified w/ diuretic resistance i.e. 6 hour natriuresis of <100mmol
🔹18 received 2.5x previous diuretic dose, 25 got loop diuretic + thiazide
🔹Both had ⬆️ natriuresis at 6h but at 18h neither had the decrease in natriuresis seen in healthy volunteers
🔹43 pts identified w/ diuretic resistance i.e. 6 hour natriuresis of <100mmol
🔹18 received 2.5x previous diuretic dose, 25 got loop diuretic + thiazide
🔹Both had ⬆️ natriuresis at 6h but at 18h neither had the decrease in natriuresis seen in healthy volunteers
A figure is worth a thousand words
Give me something clever to say
“CPDSR is not a major mechanism contributing to diuretic resistance in those admitted with decompensated heart failure. Nonetheless, you can overcome the resistance either by saturating the loop or targeting the DCT”
“CPDSR is not a major mechanism contributing to diuretic resistance in those admitted with decompensated heart failure. Nonetheless, you can overcome the resistance either by saturating the loop or targeting the DCT”
Chat consensus?
1⃣ Diuretic resistance is common, and an important entity to be aware of
2⃣ CPDSR is not responsible for this in hospitalized patients with heart failure
3⃣ Decongest early & often by seeking complete OR sequential nephron blockade
1⃣ Diuretic resistance is common, and an important entity to be aware of
2⃣ CPDSR is not responsible for this in hospitalized patients with heart failure
3⃣ Decongest early & often by seeking complete OR sequential nephron blockade
Quote of the fortnight!
https://twitter.com/Jwaitz/status/1506446372135964684
I want more info
✅ Summary by @PriRenalAKI and @ZacCerra
nephjc.com/news/2022/3/21…
✅ Summary of mechanisms of diuretic resistance by @HusamJZ
✅ VA by @sophia_kidney
✅ Summary by @PriRenalAKI and @ZacCerra
nephjc.com/news/2022/3/21…
✅ Summary of mechanisms of diuretic resistance by @HusamJZ
✅ VA by @sophia_kidney
Final thoughts
✳️ It is important to challenge prior ‘knowledge’, even when it makes physiologic sense!
➡️ Up next - Revisiting PLEX in ANCA vasculitis from a meta analytic lens. See you on April 5th and 6th!
bmj.com/content/376/bm…
🧵 by @michaelturk6
✳️ It is important to challenge prior ‘knowledge’, even when it makes physiologic sense!
➡️ Up next - Revisiting PLEX in ANCA vasculitis from a meta analytic lens. See you on April 5th and 6th!
bmj.com/content/376/bm…
🧵 by @michaelturk6
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