We did 2 consecutive urine collections: 1. Randomization => First morning (<24 h) 2. First morning => Second morning (=24 h)
If in those 2 collections, cumulative urine output <3.5 L ➡️ Failed decongestion!
Mar 16 • 9 tweets • 9 min read
Teaming up again with the great @VerwerftJan to share our experience with #echoCPET in #HFpEF. This hot-of-the-press paper @ESC_Journals demonstrates myriad of opportunities for diagnosis & treatment, far beyond #SGLT2i only. Tweetorial below!
- UNa [mmol/L] ~ diuretic efficiency
- Total natriuresis [mmol] ~ ECV & interstitial Na buffer removed
Oct 9, 2022 • 14 tweets • 8 min read
What is your take on #vasodilators in acute #HeartFailure? The upcoming November issue of #EHJACVC will bring you a PRO/CON "Vasodilator therapy in acute heart failure revisited"
As our PRO paper was published in advanced access, a sneak preview Tweetorial below...
First some background...
Current @escardio guidelines state (IIb, B): "In patients with AHF and a systolic blood pressure (SBP) >110 mmHg, intravenous vasodilators may be considered as an initial therapy to improve symptoms and reduce congestion."
Only 1 flowchart has them in...
Extremely proud that our journal offers a platform to 3 great clinicians & Twitter educators. I always learn from them...
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
Aug 27, 2022 • 12 tweets • 8 min read
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
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
Nov 26, 2021 • 27 tweets • 10 min read
Do You keep slamming Your face because You missed the 1st #HFA@escardio Clinical Practice Update Course on #HeartFailure, orchestrated masterfully by MC Mullens?
How is diuretic efficiency changing with severity of #CKD? What is its prognostic relevance?
Read our new paper in CardioRenal Medicine!
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.
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
Jun 27, 2020 • 9 tweets • 4 min read
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?