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@Muppet_Father @DGlaucomflecken That's a salt.
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Atul Bali, MD, CHS, FASN, FNKF
1.2K posts
Atul Bali, MD, CHS, FASN, FNKF
@AtulBaliMD
Nephrologist, Certified Hypertension Specialist, Rural Healthcare Advocate. All views expressed are my own.
Virginia, USA Katılım Nisan 2020
443 Takip Edilen526 Takipçiler
@realarainmd @jbspadoni @SripalBangalore @evandrofilhobr @aspergian1 @ziadalinyc @rajivxgulati @jedicath @ESHLOF @Laserrman @MauroCarlino3 @DrBIqbal @tadano98 @MichaelMegalyMD @Hragy @stefan_harb @SarahFairley7 @TWilsonMD @jl35wilsonMD @MarekRadomski71 @KovacicMihajlo @DrIHHashmi1 @ABaliMD I think it's the former. This is why the risk of contrast nephropathy is very low in outpatient procedures in clinically stable patients. But I'm not ready to abandon the idea of risk in acutely ill, volume depleted patients, and those with CKD in the inpatient setting.
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Thank you Atul. I (like many colleagues) went through an ultra low contrast phase - but that didn’t keep me/us from doing angios! 😅
Recently we had an ‘enthusiastic’ discussion about the true etiology of contrast induced nephrology.
👉🏼 Some colleagues felt it occurs largely bec. of the patient’s comorbidities with some (minor) contrast effect
👉🏼 Others felt that contrast truly is the culprit. 🤔
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Something Wickedly Calcified This Way Comes!
Here is a case referred by a former fellow. He tried to wire this ‘tortuous’ RCA with a TurnPike LP and a Runthrough followed by a Fielder XT. Neither was successful! 😳
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@realarainmd @jbspadoni @SripalBangalore @evandrofilhobr @aspergian1 @ziadalinyc @rajivxgulati @jedicath @ESHLOF @Laserrman @MauroCarlino3 @DrBIqbal @tadano98 @MichaelMegalyMD @Hragy @stefan_harb @SarahFairley7 @TWilsonMD @jl35wilsonMD @MarekRadomski71 @KovacicMihajlo @DrIHHashmi1 @ABaliMD Don't fear the contrast my friend!
pubmed.ncbi.nlm.nih.gov/15339996/
#SayNoToRenalism
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@AtulBaliMD @jbspadoni @SripalBangalore @evandrofilhobr @aspergian1 @ziadalinyc @rajivxgulati @jedicath @ESHLOF @Laserrman @MauroCarlino3 @DrBIqbal @tadano98 @MichaelMegalyMD @Hragy @stefan_harb @SarahFairley7 @TWilsonMD @jl35wilsonMD @MarekRadomski71 @KovacicMihajlo @DrIHHashmi1 @ABaliMD Haha! I was looking for your doppelgänger @ABaliMD! Now I will have to make up by posting a no contrast or ultra low contrast #CTOPCI. 😀
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@realarainmd @jbspadoni @SripalBangalore @evandrofilhobr @aspergian1 @ziadalinyc @rajivxgulati @jedicath @ESHLOF @Laserrman @MauroCarlino3 @DrBIqbal @tadano98 @MichaelMegalyMD @Hragy @stefan_harb @SarahFairley7 @TWilsonMD @jl35wilsonMD @MarekRadomski71 @KovacicMihajlo @DrIHHashmi1 Did you tag me to see if I cringe at the sight of contrast?
Or were you looking for my doppelganger, @ABaliMD?
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@jbspadoni @SripalBangalore @evandrofilhobr @aspergian1 @ziadalinyc @rajivxgulati @jedicath @ESHLOF @Laserrman @MauroCarlino3 @DrBIqbal @tadano98 @MichaelMegalyMD @Hragy @stefan_harb @SarahFairley7 @TWilsonMD @jl35wilsonMD @MarekRadomski71 @KovacicMihajlo @DrIHHashmi1 Yes! 1:1 torque is almost essential here. This is truly a labyrinth but with jagged corners and switchbacks!
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@kidney_boy That seems purposely dismissive. Would it be fair to make a similar graph for mortality from COVID-19, as a percentage of total infections?
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In case anyone was interested in the rates of osmotic demyelinating syndrome sorted by rate of sodium correction, I made a graph for you
jamanetwork.com/journals/jamai…
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Honey, stop what you're doing, new hyponatremia research just dropped!
What's it say?
It looks like slow correction is associated with worse outcomes, like death and length of stay!
Was it just a small study?
No, it was a meta-analysis of almost 12,000 patients!
jamanetwork.com/journals/jamai…
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@MobiusDick @kidney_boy I'm primarily referencing etiology.
A serum sodium of 120 mEq/L has very different clinical implications in beer potomania vs SIADH vs advanced liver cirrhosis.
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@AtulBaliMD @kidney_boy Which part ? The etiology or the low sodium levels? 🥸
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@kidney_boy I would hate to have someone misinterpret these results as "let's correct hyponatremia faster because slow correction leads to death, and rapid correction rarely leads to ODS".
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@kidney_boy All hyponatremia is not the same, of course.
Slow correction often occurs when the factor(s) causing hyponatremia are advanced, irreversible, or difficult to reverse. Think malignancy or liver cirrhosis.
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@kidney_boy It only took me 10 minutes to get to Supplement 3.
I don't see the problem here.
Probably because of all the tears welling up in my eyes, obscuring my vision.
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Journals need to wake up to digital distribution and not be trapped in a paper publish paradigm. The supplement has important information about the study, and is regularly referenced in manuscript. Why is it a separate download? There should be one PDF with all the methods and results.
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@kidney_boy As the nephrologist, you're the only qualified to put "p" where there isn't any.
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"It was only after the @nytimes correction was issued, that the protesting members of the @ASNKidney called off the hunger strike."
Kam Kalantar-Zadeh, MD, MPH, PhD@kamkalantar
In Extreme Heat, Do You Need More Electrolytes? "A @nytimes correction: An earlier version of this story .... also incorrectly described having too little sodium in the blood due to lost electrolytes as hyponatremia. it occurs when the sodium in the blood is diluted by too much water, regardless of the amount of sodium in the body." nytimes.com/2024/07/17/wel… @weddellite
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Atul Bali, MD, CHS, FASN, FNKF retweetledi
In Extreme Heat, Do You Need More Electrolytes?
"A @nytimes correction:
An earlier version of this story .... also incorrectly described having too little sodium in the blood due to lost electrolytes as hyponatremia. it occurs when the sodium in the blood is diluted by too much water, regardless of the amount of sodium in the body."
nytimes.com/2024/07/17/wel…
@weddellite
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If you buy your favorite cake for your husband’s birthday and he isn’t a big dessert person then the onus is on you to have cake at every meal until it’s gone.
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HFpEF is where good drugs go to die.
ACEi failed
ARBs failed
Spiro failed*
Sacubitril failed*
Good luck.
Muthu Vaduganathan@mvaduganathan
Finerenone has a cleaner pharmacological profile (selective, short half-life, balanced heart/kidney, & no active metabolites) & ⬇️ hyperK vs spiro Will finerenone safely improve outcomes in HF #FINEARTSHF? 🔗 Design🆓 onlinelibrary.wiley.com/doi/full/10.10… 🔗Baseline🆓 onlinelibrary.wiley.com/doi/10.1002/ej…
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@alexchangmd Watching the debate with your little one?
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@NephRodby I heard you speak on acid base balance on BRCU in 2014, and I still enjoy calling the lungs "dumb little dialyzers" much to the chagrin of the ICU staff. Thank you for that memorable lecture!
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The pass rate for first time takers for ABIM Nephrology Board certification exam was 80% in 2023. Increase your chances by attending the INTERACTIVE BRCU in Chicago in late July: As BRCU Co-director 2017-23 I am a bit biased, but this is THE course. asn-online.org/education/brcu/
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@kidney_boy My critique of the KFRE was from the perspective of patients trying to understand its implications to their health and perhaps getting a kidney-centric understanding without realizing the implications to their cardiac health.
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@kidney_boy I'm also glad that albuminuria is only a biomarker for kidney disease and has no implications whatsoever on cardiovascular outcomes.
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I think putting the KFRE 5-year of ESRD on routine lab results will right many of the wrongs unleashed by posting the eGFR on routine labs.
I think the eGFR is useful and important but I know I (and many other practitioners) misunderstood the significance of some of the results.
Allan Grill@allan_k_grillMD
Glad to see the reporting of the 5-year KFRE (Kidney Failure Risk Equation - kidneyfailurerisk.com) & promotion of the @renalnetwork_on KidneyWise toolkit (KidneyWise.ca) on Ontario outpatient lab results. I’ll be presenting my CKD talk at Pri-Med this Thursday.
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@Beandoc2 @kidney_boy I have often wondered that!
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@kidney_boy Yes it is. Would love to offer PD to our AKI-D patients. I suspect they would potentially have a higher chance to recover.
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I had a dialysis patient with AKI from VFib arrest. He was dialysis dependent for 3 months. Recovered renal function. 5 days after his last HD his Cr was 3.7. A week later it was down to 3.1.
Stopping dialysis for renal recovery is the best part of the job.
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@KatieKwonMD @GlassockJ @kidney_boy I can't take credit for it! It's been in use for a few years now.
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Nearly a billion people with kidney disease on this pale blue dot. Nephrologists, roll up those sleeves, set your alarm 30 minutes earlier, we have a lot of work to do.
#NephJC
Nephrology Journal Club@NephJC
18/ #NephJC after all the rush, are you ready to zoom out of the US? 🌐 >850 million people are estimated to live with kidney disease, aka >10% of the world's population.... TWICE the global diabetes count and >20 times ⬆️ than AIDS/HIV cases twitter.com/FerArceAmare/s…
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