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Maybe Scrolly?
Joel M. Topf, MD FACP Profile picture
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Jun 19 • 5 tweets • 4 min read
He seems nice
And Doc Hudson showed up! #eyesondesign
Porsche has won many races but this aluminum 356 was the first car to win. One of sixteen.
Why would you want a race car with an automatic transmission?

So the driver can operate the aerodynamics with their left foot.

Wait…what?
Differential between the legs. Wow.

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More from @kidney_boy

Joel M. Topf, MD FACP Profile picture
Jun 14
I was on call last night and the ER called with a case hyperkalemia. The ER was crazy (literally there was an active shooter in the ambulance bay moments before I received the call clickondetroit.com/news/local/202…)

So you need to be quick and precise with your questions.
How high is the potassium and is it confirmed on the EKG? It is always helpful to quickly establish that this is not pseudohyperkalemia. It was not.
Does the patient have a foley and are they making urine? Quickly correct urinary obstruction which can cause hyperkalemia and determine if you can use the kidneys to clear the potassium.

Yes on foley, no on urine.
Read 10 tweets
Joel M. Topf, MD FACP Profile picture
May 22
Every person who ever had a high potassium on labs was told to adopt a low potassium diet. Recently, a meta-analysis and systematic review looked into the data to support this. jrnjournal.org/article/S1051-…
Regarding the question of dietary restriction of potassium to lower serum K, there were 2 studies. TWO. And take a look at the weight of the two studies, Cockram has 90%. So in essence this meta -nalysis can just be replaced by looking at Cockram alone.
And Cockram is a weird study. It is all dialysis patients that were placed on liquid feeds and nothing but liquid feeds for two weeks. 🤮

And this is the "science" that ubiquitous recommendation of "low potassium diet" rests on. sciencedirect.com/science/articl…
Read 4 tweets
Joel M. Topf, MD FACP Profile picture
Apr 9
Tim @Maximal_Change Yau talking about Bridging the Generation Gap:Undertanding the Millennial and GenZ mind to optimize Med Ed. #NKFClinicals
Boomer 1946 to 1964. They have a landline. They read a newspaper. #NKFClinicals
Gen X 1965-1980 Saw the transition from traditional to digital media #NKFClinicals
Read 18 tweets
Joel M. Topf, MD FACP Profile picture
Apr 9
Nayan @captainchloride Aurora calls his own number to speak on stopping RASi. #NKFClinicals
The debate comes from worrying about EGFR decline, hyperkalemia vs CV health, mortality benefit, kidney benefit #NKFClinicals
In CRIC in propensity matched evaluation of RASi users vs no RASI in CKD 4/5. No difference in outcomes, Kidney Medicine 2020 Aurora. #NKFClinicals
Read 8 tweets
Joel M. Topf, MD FACP Profile picture
Apr 9
Next up Implications of lower BP thresholds in patients with advanced CKD by Paul Drawz. Starts with a question
Effects of intensive BP lowering in patients with advanced CKD likely include:
A) Prevention of ESRD
B) Increased risk of AKI
C) Increased fall risk
D) Increased risk of infection
Low BP targets and renal outcomes #NKFClinicals
Read 8 tweets
Joel M. Topf, MD FACP Profile picture
Apr 9
Slipped into the Optimizing antihypertensives medications selection in hemodialysis patients with Jennifer Flythe. #NKFClinicals
Audience response question.

The people chose fosinopril. #NKFClinicals
Treating blood pressure in HD reduces outcomes (just barely) #NKFClinicals
Read 16 tweets

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