💥What is a PICC?
⚡️Peripherally Inserted Central Catheter
It is a Central Vein Catheter‼️
⚡️Inserted into the peripheral veins of the upper arm
⚡️It passes thru the central veins
⚡️Tip of the PICC resides at the SVC/atrial junction or in the Right Atrium 2/
💥PICC use has been growing for reasons stated below👇🏽
💥Why is it important to understand the impact of AVF on the heart?
⚡️Because AVF use has ⬆️ in 🇺🇸
⚡️Cardiac disease is highly prevalent among ESRD pts.
⚡️50% of all ESRD deaths are due to
a CV-related cause👇🏽 2/
💥What causes cardiac disease in ESRD patients?
⚡️Many factors contribute to it - as shown below👇🏽
⚡️In this tweetorial, the focus will be on how the AVF affects the heart 3/
💥 Dialysis Access Associated Venous Thoracic Outlet Syndrome (VTOS) is a rare but under-recognized cause of central vein stenosis in dialysis patients
⚡️Tweetorial on Dialysis Access Associated VTOS 👇🏽 1/ @ASDINNews @MedTweetorials #VascularAccessPearls
💥Venous Thoracic Outlet Syndrome
is due to:
⚡️Subclavian Vein stenosis caused by
it’s compression in the thoracic
⚡️Thoracic outlet is formed by the 1st
Rib, Clavicle & Subclavius
💥 Subclavian vein stenosis due to thoracic outlet compression can occur in healthy individuals & can present with:
⚡️Intermittent positional venous obstruction (McCleery Syndrome)
⚡️Venous thrombosis (Paget-Schroetter Syndrome)
💥Current American Diabetes Association guidelines recommend Metformin as the 1st line therapy for all T2DM patients👇🏽
⚡️But should Metformin be the 1st line therapy in T2DM patients with cardiovascular disease? 1/ #Metformin #endotwitter #cardiotwitter
💥Let’s review the following about
⚡️Mechanism of action
💥How does Metformin work?
⚡️It inhibits gluconeogenesis in the liver by mitochondrial inhibition & by ⬆️ activation of AMP-kinase👇🏽
⚡️It ⬆️ insulin sensitivity
⚡️It may have additional pleiotropic
💥Teaching point re: Rx of dialysis catheter related bacteremia
⚡️IV antibiotic alone is NEVER the correct Rx choice
Rx options are:
☄️IV antibiotic + CVC antibiotic
☄️IV antibiotic + CVC exchange @ASDINNews #VascularAccessPearls 1/
💥The reason IV antibiotic alone is not the correct choice is because it does not eradicate the bacteria in the CVC lumen biofilm
⚡️For effective clearance of bacteria from the biofilm you have to use CVC antibiotic lock solution or exchange the CVC
💥The choice of antibiotic for catheter related bacteremia is listed below👇🏽
⚡️How to prepare the CVC antibiotic lock solution?👇🏽 @RenalFellowNtwk 3/
💥 Hydroxychloroquine - is an
Anti-malarial drug that also has immunomodulatory properties
⚡️It is used to Rx auto-immune conditions
⚡️The origin and history of this drug is as fascinating as it’s benefits 1/ @RenalFellowNtwk #Lupus #medtwitter
💥 Quinine was 1st found in the bark of the ‘Cinchona’ tree by the Inca in Peru to Rx ‘shivering’
⚡️It is believed that the tree got its name ‘Cinchona’ after it was used to treat the ‘Countess of Chinchon’ for a febrile illness in the 1630s 2/
💥 In the early days, the Cinchona bark tree powder was called the ‘Jesuits Powder’ (and not Quinine)
⚡️However, this 👆🏽is why side effects from quinine - such as tinnitus, headaches and poor vision are referred to as ‘Cinchonism’ 3/
Q1: Why was the 100 mg dose of Canagliflozin used in #CREDENCE and not the 300 mg dose?
VP: We were anxious about the toxicity as seen in some previous trials, & we wanted to minimize that risk #NephJC
Q2: Why did centers from Germany have a lower HbA1C cut off for inclusion in the study compared to the centers from other parts of the world - 10.5% vs. 12%?
VP: That was a regulatory request from Germany 🇩🇪 #NephJC
💥How do SGLT2 Inhibitors work?
💥How does an anti-diabetic drug improve Renal & Cardiovascular outcomes?
💥To understand this let’s first review:
⚡️Renal handling of glucose 1/ @RenalFellowNtwk #NephJC #SGLT2 #CREDENCE
💥Renal handling of glucose:
⚡️180 g of glucose is filtered thru the glomeruli every day
(180 L x 100mg/dL)
⚡️But all the glucose is completely reabsorbed
⚡️Renal reabsorption of glucose occurs thru transporters in the proximal tubule called SGLT
💥Sodium-Glucose Co-transporters (SGLT)
⚡️There are many 👇🏽
⚡️Not all of them are located in the kidney👇🏽 3/
💥Tweetorial on ‘Are AVF’s the best dialysis vascular access?
⚡️Do AVFs have better long term patency than AVGs?
⚡️Impact of vascular access type on clinical outcomes?
⚡️Are AVFs cost effective in all pts? @RenalFellowNtwk #VascularAccessPearls
💥Do AVF’s have better long term patency than AVGs?
⚡️Observational studies have shown that AVFs have better cumulative access survival than AVGs but...👇🏽
💥Why is it important to look at the cumulative AV access survival from the ‘Time of AV access creation’ and NOT from the ‘Time of successful AV access use’?
⚡️Let’s take a look at this study which compared the cumulative survival of AVF vs. AVG 👇🏽
💥Tutorial on ‘Dialysis Adequacy’
⚡️Is Urea a good solute to assess Adequacy ?
⚡️Is Kt/V urea a good Adequacy test?
⚡️Should ‘time on dialysis’ be an independent measure of Adequacy?
⚡️Should ‘UF rate’ be a measure of Adequacy? @RenalFellowNtwk #NephPearls
Urea is not the perfect uremic solute to assess dialysis adequacy, in fact it is far from perfect👇🏽
Kt/V urea is a measure of the dialysis dose
‘K’ is the dialyzer clearance, ‘T’ is the time on dialysis and ‘V’ is the volume of distribution of urea (which = Total Body Water)
Familiarize yourself with spKt/V, eKt/V and stdKt/V 👇🏽