Kevin Fay

(Circuit) integration or separation approach in #ECMO patients requiring #CRRT? E-CRRT RCT 🔎 80 pts allocated to CRRT/ECMO circuits integration vs separation ⚖️ no significant difference in filter lifespan between integration/separation configurations 🪦 comparable mortality 🫧 no significant differences in serious adverse events, including air embolism 🚨 transmembrane pressure + CRRT machine alarm frequencies similar #FOAMcc 🔓 rdcu.be/e2FyX

Among patients with early #SepticShock, a personalized hemodynamic resuscitation protocol targeting capillary refill time was superior to usual care for the primary composite outcome, primarily driven by a lower duration of vital support. #LIVES2025 @ESICM ja.ma/4hv22Vc

@ThinkingCC @NephroP Here's the IVC of my brother, an avid hurler, from just the other day.

@NephroP and athletes. never, ever equate IVC alone to volume. ask it the right question and it never lies, ask it the wrong question and, well, that's on you.

#Nephpearls #POCUS #VExUS The IVC may be dilated at baseline in individuals with larger body surface area, and caution is warranted against inferring congestive nephropathy or the so-called 'volume' status solely on this finding. 👇Normal IJV waveform (vessel was collapsed ta neck base) but a dilated IVC close to 3 cm in a morbidly obese patient.

@IM_Crit_ It actually is pseudohyperbocarbonatemia. Other possibility is hyperlipid/hypertriglyceridemia. Doubt monoclonal gammopathy -- no protein gap and hypocalcemic anyways. I'd have to lit search to find alt. Reason. (Rhabdo or very high LDH can also cause this -- different mech.).

@IM_Crit_ Can you post a blood gas, LDH, and CPK?

ICU Snapshots: Another nightshift and while checking the chart of a patient admitted during the am shift, I notice this 👇 1. Can anion gap (AGAP) be negative? To complicate things more: 2. Can anion gap be negative -instead of "very" positive- with a lactate of 14 mmol/l?

@cgaibor102 @PoojaJagadishMD @drjohnm The avg. pt on HD has 19 pills/day. there is evidence of increased rates of adverse effects from statins. Don't force pills when (good) evidence says not to. Uremia in general lowers LDL. They have more calcific dz and hyperTG. They are different from pts with functioning kidneys

@cgaibor102 @PoojaJagadishMD @drjohnm I agree with you about transplant but that's just opinion. There is observational data that patients who were on a statin prior to transplant have fewer CV events, and they will be prescribed a statin regardless after transplant.

Patients with advanced CKD on Dialysis should NOT be started on a statin (Class III: No Benefit). This is odd since CKD is a major risk-enhancer for ASCVD, and those on dialysis have the highest risk of events. Older RCTs showed a lack of benefit of statins. #CVBoardPearl #MedX

@NephroSeeker @giovannilandoni @NephJC This is my point. If 2 groups, and 1 got a drug that lowers Cr, I'd expect at least some mathematical analysis of how the lower Cr after surgery compares to expectation from drug effect. Without that the trial seems of low value to me, and even with -- not a "randomized trial."

@giovannilandoni @TheKFay @NephJC Here is the evidence why- no truly positive trials in terms of hard endpoints in AKI 👇#NephJC One question, from nephro pov : why didn't you look for tubular injury biomarkers? (this would've make us trust the results more) x.com/hswapnil/statu…

What about the supposed mechanism?#NephJC We usually associate high dietary protein intake with intraglomerular hypertension, kidney hyperfiltration, glomerular injury, and proteinuria Authors invoke renal functional reserve as main explanation Infographic by @NephroSeeker

His serum sodium is 149 mmol/L. You prescribe iHD with a predicted Kt/V of 1.0 against a dialysate sodium of 138 mmol/L. Ignoring Gibbs-Donnan, what would be the predicted loss of plasma volume l, if any. Would you proceed or adjust your prescription? #nephrotwitter @PennKidney

Dialysis problem: 64M cirrhosis with high cardiac output state, HRS now on KRT awaiting SLK. Recently resuscitated for UGIB with hemorrhagic shock now 1+d without bleeding. VStable vitals on room air A+Ox3. Diarrhea from lactose. You decide not to remove fluid and to trial iHD.

@kidney_boy Tenet: AI men. A level anemia.

Anemia managers, you had a good run…there will be a retirement party with sheet cake and tokens of our appreciation next Wednesday. journals.lww.com/cjasn/abstract…

Recommending a lasix stress test be like #nephrology #nephtwitter #fellowshiplife

@UVoverP @Aha @KidneyInCVD Congrats, Arun!

@acweyand Nephrologist. We routinely get iron studies. Earlier this year I set up a patient for IV iron and, no joke, when our office visit was over and we were about to say goodbye she says, "Oh yeah I was meaning to ask you... Lately I can't stop eating baking soda right out of the box."

@WilliamAird4 As the proud husband of a veterinarian I am peppered every day with amazing things that non-human animals (and their spleens) can do that we cannot.

Greyhound Dog - Ferrari of Dogs Check out the data and answer: 1. How can the Hct increase so quickly during a race? 2. Why does MCV increase and MCHC drop? 3. What is the RBC count at rest and immediately post-race? 4. How many RBCs are released into blood during a race?

@MichaelToal6 @dochill82 @DamianFog Standard.

Calling all (adult) Nephrologists! See how your renal biopsy practice compares with colleagues and contribute to an international study to explore access inequities. Please take this 5 minute anonymous questionnaire. @dochill82 @DamianFog qubkidneybiopsy.qualtrics.com/jfe/form/SV_6A…

@kidney_boy Is this in response to this? twitter.com/Crit_Care/stat…

In fellowship I learned to use the term oligo-anuria to describe a patient with a tiny bit of urine, but not enough to be meaningful and to essentially consider the patient anuric. Is this a thing? Is there a volume of urine which qualifies? #AskRenal

@captainchloride @thecurbsiders Is the HF observation a dosing issue? The starting dose is 12.5 mg for that indication (even in the pediatric literature it's 1 mg/kg starting dose. I don't have many 12.5 kg patients these days). And in general, at most HF wind up on half the doses seen in cirrhosis at most.

The conventional diuretic treatment of ascites in patients with cirrhosis is high doses of spironolactone w/furosemide (classic 100/40 ratio). This was also mentioned recently on @thecurbsiders. Where does this come from and is it true? A quick🧵. #MedTwitter #nephtwitter