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Frederik H. Verbrugge Profile picture
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Sep 7 • 5 tweets • 4 min read
Don't miss our monthly educational review #EHJACVC @ESC_Journals!

This month by the great @ArgaizR: fluids in #AKI
Co-starring: @ThinkingCC @khaycock2

Extremely proud that our journal offers a platform to 3 great clinicians & Twitter educators. I always learn from them... Image
A strong argument is made to switch mainstream thinking in #AKI away from the fallacious concept of fluid responsiveness in all to a primary assessment of fluid tolerance.

Probably the most important thing I have learned on Twitter: #VExUS Image
Why do I like #VExUS so much? Because it really changed my everyday practice... Portal vein became part of my standard #echocardiography assessment.

And that's what we want to achieve with this review, offer something directly applicable at your bedside! Image
Join the #diuresisjedi and go after these people who think fluids (& especially electrolytes they contain) are harmless...

People @HeartBrussels know that I am obsessed with trying to avoid a positive sodium and/or chloride balance in hospitalised patients: #killer
Never forget: fluids never help the kidneys when they don't come out!

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More from @FH_Verbrugge

Frederik H. Verbrugge Profile picture
Aug 27
For those who can't get enough from #ADVOR, below the promised Tweetorial!

Acetazolamide in acute #HeartFailure w volume overload on background high-dose loop diuretics:
👍Increases diuresis & natriuresis
👍More euvolemia after 3 days & discharge
👍⬇️LOS
#ESCCongress #Cardiology
First, the unsung hero's of this trial, done with a little bit over 2 million €, bargain for largest diuretic #RCT ever!
@KatrienTartagl2 & her team, with only 3FTE, they ran the most successful trial in #AHF
@PieterMartensMD & @JeroenDauw who did most fieldwork
👏
How did we come up with the idea? Actually, cause we all love #physiology. Credits go to Prof. Em. Paul Steels who teached us all how kidneys work.
@GLW_UHasselt

65% of sodium is reabsorbed in the proximal tubules, can be up to 85% in #HeartFailure
Read 12 tweets
Frederik H. Verbrugge Profile picture
Nov 26, 2021
Do You keep slamming Your face because You missed the 1st #HFA @escardio Clinical Practice Update Course on #HeartFailure, orchestrated masterfully by MC Mullens?

Are You particularly disappointed to have missed the clinical pearls of #HFA giants @kevin_damman & @FinnGustafsson?
Catch up for 2 months on the platform on demand: escardio.org/Education/Cour…

I'll release just a teaser under the form of a clinical case below. You might call on my partners in crime @Ph_Bertrand & @petranijst to do the same...

Have fun & see you live without #COVID next year!
@Ph_Bertrand @petranijst 61 y/o woman
PMH: Chronic HCV, hypertension, poorly controlled diabetes (HbA1c 9.6%), obesity (BMI 32 kg/m²)
Currently no meds

Found in apartment with motoric aphasia & right hemiplegia due to ischemic stroke (middle cerebral artery)
R/No thrombolysis (subacute), thrombectomy!
Read 27 tweets
Frederik H. Verbrugge Profile picture
Oct 31, 2020
How is diuretic efficiency changing with severity of #CKD? What is its prognostic relevance?
Read our new paper in CardioRenal Medicine!

@WilsonTangMD @BammensBert
Also thanks to Jeff Testani, Pieter Martens & Dirk Kuypers for their help with the paper...
We used 3 metrics of diuretic efficiency, based on urine output, natriuresis & chloruresis.

Irrespectively of metric, loop diuretic efficiency decreased significantly from KDIGO class IV, while remaining relatively preserved in less advanced CKD.
Patterns were similar for furosemide versus bumetanide (very little patients were on torsemide, which is hardly used in Belgium). Yet, baseline characteristics were strikingly different with bumetanide users older with higher cardiovascular risk.
Read 6 tweets
Frederik H. Verbrugge Profile picture
Aug 19, 2020
Always nice to write an editorial together with partner-in-crime @kevin_damman! We dig into the question: "Is spironolactone a disease-modifying drug or diuretic in #HFpEF?" @ESC_Journals
onlinelibrary.wiley.com/doi/epdf/10.10…

Comment on:
onlinelibrary.wiley.com/doi/abs/10.100…
Key points:
1. Spironolactone = most cost-effective drug in #HFrEF
2. Considering modest diuretic effects with 25-50mg, likely due to pleiotropic effects (Figure)
3. Natriuretic effects increase with dosing up to 600 mg (cirrhosis)
4. Average TOPCAT ~ RALES dose
5. Current study shows marginal (<1%) & short-term (first 8 months) effect on weight loss in TOPCAT Americas.
Spiro patients gradually had lower diuretic need and RAS blockers more frequently withdrawn.
6. Beneficial effects of spironolactone independent of these trends
Read 4 tweets
Frederik H. Verbrugge Profile picture
Jun 27, 2020
Why #kidney function does not equal #GFR (and certainly not Cr), making it an elusive target in clinical practice & the latter a poor surrogate outcome, despite its robust correlation with prognosis. Caring for kidneys versus improving Cr/GFR. A thread below:
The kidneys in essence have 3 functions:
1. Glomerular function = Clearance
2. Tubular function = Homeostasis
3. Neurohumoral function

GFR mainly reflects 1. So why do we take GFR (or its estimate Cr) as a surrogate for renal function?
Look at GFR determinants (=N x snGFR).

In stable circumstances, GFR mainly reflects the number of functional nephrons.

Starting from 1 million per kidney at birth, one loses 5,000-10,000 per year with aging: age-related GFR decline <1 mL/min/1.73m²/y

ncbi.nlm.nih.gov/pmc/articles/P…
Read 9 tweets
Frederik H. Verbrugge Profile picture
Apr 27, 2020
Question to all #VExUS experts: "Do you ever diurese VExUS 0 ?" Thread below.
I admit not being a #VExUS user, but learned much from your tweets and have been practicing many #DiuresisJedi concepts.
@ArgaizR @msiuba @ThinkingCC @NephroP @load_dependent @khaycock2 @Thind888
Ever since I read this great paper, tend to consider volume status and cardiac filling pressures as 2 separate and equally important concepts that both deserve optimisation in #ICU and #HeartFailure.
Basically, V-p correlation is all over the place! (1/6)
journal.chestnet.org/article/S0012-… Image
What I learned from you all is that #VExUS & especially portal vein flow is a great tool to assess the impact of ⬆️(right-sided) pressure on organ function. This gives you more confidence to diurese patients, even when hypotensive or still hemodynamic unstable. (2/6)
Read 7 tweets

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