#NephJC Transcript
Healthcare social media transcript of the #NephJC hashtag.
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See #NephJC Influencers/Analytics.
| Profile | Tweet |
|---|---|
 | Nephrology Journal Club @NephJC Please introduce yourself & declare any conflicts of interest (COIs), also we all do it, but don’t forget the hashtag #NephJC |
 | Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: Welcome to tonight’s discussion on the recently released Restrictive versus liberal fluid therapy in major abdominal surgery (RELIEF) trial involving fluid management after major abdominal surgery #NephJC https://t.co/lTLTbfz4JU |
 | Soy Argel @SoyArgel RT @edgarvlermamd: Join us on tonight’s #NephJC #Nephpearls RELIEF 👉🏼 https://t.co/VCcJvWs0YI https://t.co/lyPqQmyqdA |
| Nephrology Journal Club @NephJC Don’t forget tomorrow’s NephJC has been moved to 7/18/18 at 8 PM BST due to an some soccer (the real futbol) match #NephJC https://t.co/Q03c90o16B |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil Swapnil Hiremath @ottawarenal nephrologist #NephJC co-creator No disclosures https://t.co/yyV74A41FG |
 | Samira Farouk, MD, MSCR @ssfarouk Samira Farouk, transplant nephrologist @ISMMSKidney, NSMC intern, and big fan of @bejethomas215. No COI. #NephJC |
 | Khaled Shawwa @khaledshawwa Khaled Shawwa, Nephrology Fellow, Rochester MN, No COI. #NephJC |
| Nephrology Journal Club @NephJC Hey Tulun, Swap, and Ankit welcome! #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: Don’t forget tomorrow’s NephJC has been moved to 7/18/18 at 8 PM BST due to an some soccer (the real futbol) match #NephJC https://t.co/Q03c90o16B |
 | Michelle Rheault @rheault_m RT @NephJC: Welcome to tonight’s discussion on the recently released Restrictive versus liberal fluid therapy in major abdominal surgery (RELIEF) trial involving fluid management after major abdominal surgery #NephJC https://t.co/lTLTbfz4JU |
 | Gary Singer @GarySingerMD@med-mastodon.com @GarySingerMD Gary Singer generalist nephrologist interested but lurking tonight #NephJC |
 | James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph James Novak, TPD of @HFNephrology and #NSMC intern 2018, no COI. #NephJC |
 | Edgar V. Lerma 🇵🇭 @edgarvlermamd Edgar Lerma, Chicago-based Nephrologist #NephJC https://t.co/vW3xPgDGCG |
 | Hector Madariaga, MD FASN 🇲🇽 @HecmagsMD Hector Madariaga. No COI. From #Patriotsnation. I’ll be lurking tonight. #NephJC https://t.co/L5OTSuCOwe |
| Nephrology Journal Club @NephJC Word NephSim co-creator Samira in the house what's up NSMC co-intern! #NephJC |
 | Mario Funes, MD @MarioFunesMD Mario Funes. PGY-2 Internal Medicine. New Brunswick, NJ. No COI. #NephJC |
 | Martín Vargas 🇲🇽 @MartinVargas89 Martín Vargas, Nephrology Fellow in México, No COI #nephjc |
| Michelle Rheault @rheault_m @NephJC Michelle Rheault here, Ped Neph UMN #NephJC |
 | William Beaubien-Souligny @WBeaubien William Beaubien-Souligny, Research Fellow in Toronto, No COI #nephjc |
 | Gates Colbert, MD @DoctorGates Dallas #Nephrologist #NSMC . No COI #nephjc |
 | Mohamed E. Elrggal @M_Elraggal @NephJC @MedStarGUHNeph Hey @bthomas215 , I am here also, Mohamed Elrggal, nephrologist from Egypt. #NSMC co-intern. It's almost Dawn here, not evening at all 😂. #nephjc |
| Nephrology Journal Club @NephJC Welcome Gary, Hames, and Edgar! #NephJC |
| Nephrology Journal Club @NephJC Great to see you Hector, Mario, Martin, and Michelle, we're rockin it tonight #NephJC |
 | Jonathan J Suarez @ICUnephroSuarez Jonathan Suarez, nephrologist and intensivist @EmoryDeptofMed. No COI #NephJC |
| Gary Singer @GarySingerMD@med-mastodon.com @GarySingerMD Forgot no COI #NephJC |
| Samira Farouk, MD, MSCR @ssfarouk @NephJC Woo @Neph_Sim! #NephJC |
| Hector Madariaga, MD FASN 🇲🇽 @HecmagsMD @NephJC @MedStarGUHNeph Hi Beje. How are you? You rock! #NephJC |
| Nephrology Journal Club @NephJC Hey there William, Gates, and Mohamed, thanks for joining in! #NephJC |
| Nephrology Journal Club @NephJC Yes it is Swapnil! #NephJC |
 | Manasi Bapat MD, FASN, FNKF🇮🇳🇺🇸 @manasib33 Hello heloow! Manasi Bapat, NSMC intern, Cali nephrologist. #NephJC |
 | Skeptical Scalpel @Skepticscalpel @Skepticscalpel no COIs #nephjc |
| Nephrology Journal Club @NephJC Welcome Dr. Suarez thanks for checking in #NephJC |
 | Silvi Shah, MD, MS @silvishah Hi this is Silvi Shah, Transplant nephrologist from U Cincy no Coi #nephJC |
| Nephrology Journal Club @NephJC Wow more NSMC co-interns coming by, welcome Manasi! #NephJC |
| Samira Farouk, MD, MSCR @ssfarouk @manasib33 Long time no see...do you miss the best coast? #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @WBeaubien Hi William - sounds cool, research in what field? Also a masters, perhaps? #nephjc |
| Nephrology Journal Club @NephJC Hey Skeptical can't wait to hear your viewpoints, welcome! Hi Silvi thanks for retweeting us earlier today! #NephJC |
 | Angel Cesar Ortiz @AngelCesarOrtiz Angel Ortiz Nephrology fellow from Mexico City 🇲🇽 Lurking & learning today #NSMC intern No COI #NephJC |
| William Beaubien-Souligny @WBeaubien @hswapnil @WBeaubien POCUS aaaannnddd venous congestion.... this might be a COI.... and a PhD in the works #nephjc |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd RELIEF Trial: Restrictive vs. Liberal Fluid Therapy for Major Abdominal Surgery from @NEJM #Nephpearls #NephJC 👉🏼 https://t.co/VCcJvWs0YI https://t.co/tvSPTiJ4og |
 | Nalin Yadav @DrNalinYadav RT @NephJC: Next #NephJC July 10/18: Next #NephJC July 10/18: How much fluid is too much fluid. - https://t.co/vv3T36MQ3g https://t.co/2s7h9OqW6I |
| Nephrology Journal Club @NephJC Welcome Angel! #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil Woohoo! The Skep is in the house - thanks for joining in #NephJC https://t.co/NKzfePQEqL |
 | Alex Meraz @NephroGuy Alex from Mexico; general nephrologist, soon to be onconephrologist. No COI. Only lurking #NephJC |
 | Sayna Norouzi, MD, FASN @SaynaNorouzi Hi. Sayna Norouzi; nephrology fellow @BCMKidneyHealth. #NSMC intern, no CoI. #nephjc |
| Nephrology Journal Club @NephJC Might hear about POCUS later #NephJC |
| Mario Funes, MD @MarioFunesMD RT @edgarvlermamd: RELIEF Trial: RELIEF Trial: Restrictive vs. Liberal Fluid Therapy for Major Abdominal Surgery from @NEJM #Nephpearls #NephJC 👉🏼 https://t.co/VCcJvWs0YI https://t.co/tvSPTiJ4og |
 | ~~~ @DrNamkeen Nephrologist out of dallas w @DallasRenal , #nsmc intern, salty that the surgeons may have been right all along re LR (kidding) here to learn moar! no coi #nephjc |
 | Franklin Loachamin @FranLoachamin #nephjc franklin Loachamin no COI |
| Nephrology Journal Club @NephJC Welcome Nimra, Sayna, and Alex, great to see you guys #NephJC |
 | Natalie McCall @_NatalieMcCall Natalie McCall. Nephrologist at Vanderbilt. Excited! No COI. #NephJC |
| Silvi Shah, MD, MS @silvishah @manasib33 Hi Manasi! How is Cali? You well settled #nephJC |
| Nephrology Journal Club @NephJC Franklin welcome to NephJC #NephJC |
 | Matthew Sparks, MD @Nephro_Sparks I'm here. I know it is a #Relief #nephjc |
 | Dr. Divya Bajpai 🇮🇳 @divyaa24 Hi Divya from Mumbai #NSMC intern #NephJC no Coi |
| Silvi Shah, MD, MS @silvishah @SaynaNorouzi @BCMKidneyHealth Hi Sayna! How is fellowship going #nephjC |
| Nephrology Journal Club @NephJC Ah now I'm relieved that @Nephro_Sparks is in the house :) #NephJC |
 | Raj Mehta @raj_mehta #NephJC Raj Mehta, family doc. No COI. From sunny Florida! |
| Nephrology Journal Club @NephJC Divya and Raj welcome #NephJC |
| Nephrology Journal Club @NephJC Welcome all! And let’s get those gloves on and scrub into another NephJC episode #NephJC |
| Matthew Sparks, MD @Nephro_Sparks @SaynaNorouzi @BCMKidneyHealth Hi @SaynaNorouzi full fledged fellow now #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @_NatalieMcCall Welcome to #NephJC - where is Ed Siew? |
 | devika nair md msci @devimol Devika Nair, 3rd year nephrology fellow, no COIs. Lots of qs - excited to be here! @VUMCKidney #NephJC |
| Nephrology Journal Club @NephJC Hey Sri welcome #nephjc |
| Nephrology Journal Club @NephJC Tonight, we are discussing Restrictive versus liberal fluid therapy in major abdominal surgery (RELIEF) trial published in the June edition of NEJM earlier this year #NephJC |
| Matthew Sparks, MD @Nephro_Sparks Is @JamiePrivratsky in the house yet #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @divyaa24 Hey Divya! Using a boat 🚣♀️ to get to work in Mumbai? #NephJC #Monsoon |
| Nephrology Journal Club @NephJC Hi Devika and Susan #NephJC |
| Nephrology Journal Club @NephJC Abbreviations: RELIEF: Restrictive versus Liberal Fluid therapy in major abdominal surgery #NephJC |
| Silvi Shah, MD, MS @silvishah @ansakhuja I am good. You moved already to WV? We are neighbors now #nephjc |
 | Tulane Kidney Beans @TulaneRedBeans Adrian Baudy here from Tulane (@TheMansCloset ) #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @devimol @VUMCKidney Hey Devika - @VUMCKidney well represented tonight! #NephJC |
| Matthew Sparks, MD @Nephro_Sparks @devimol @VUMCKidney Hi Devika 3rd year... whoa #nephjc |
| Nephrology Journal Club @NephJC Welcome Adrian! #NephJC |
 | Anna Burgner MD MEHP @anna_burgner Hi everyone! Anna Burgner nephrologist @VUMCKidney no COI. Mostly lurking tonight. #NephJC |
| Tulane Kidney Beans @TulaneRedBeans No COI here #NephJC |
| Nephrology Journal Club @NephJC Check out the great summary and VA from @Slatts_1 at https://t.co/VDNhk0OpjS #NephJC https://t.co/tmYwxGcBwr |
| Matthew Sparks, MD @Nephro_Sparks @TulaneRedBeans @TheMansCloset Adrian!!!! yes!!! and Red Beans account is the best #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @TulaneRedBeans @TheMansCloset Welcome to #NephJC Adrian! |
| Samira Farouk, MD, MSCR @ssfarouk @NephJC A+ for the trial name #NephJC |
| Matthew Sparks, MD @Nephro_Sparks @ansakhuja Hi Ankit #nephjc |
| Nephrology Journal Club @NephJC Hi Ankit and Anna welcome thanks for joining #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: Check out the great summary and VA from @Slatts_1 at https://t.co/VDNhk0OpjS #NephJC https://t.co/tmYwxGcBwr |
| Mario Funes, MD @MarioFunesMD @NephJC @Slatts_1 Great one! @Slatts_1 #NephJC |
| Nephrology Journal Club @NephJC Here we go! #NephJC |
| Matthew Sparks, MD @Nephro_Sparks @divyaa24 Hi Divya #nephjc |
| Nephrology Journal Club @NephJC T0a: What do surgeons and anesthesiologists follow at your centre? A restrictive or liberal strategy? #NephJC |
| Mario Funes, MD @MarioFunesMD @Nephro_Sparks Hello Matt! #NephJC |
| Matthew Sparks, MD @Nephro_Sparks @MarioFunesMD Hi Mario #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: T0a: T0a: What do surgeons and anesthesiologists follow at your centre? A restrictive or liberal strategy? #NephJC |
| ~~~ @DrNamkeen @NephJC curious re this answer tbh, whever I've worked its a task to find out what was given/how much in OR #NephJC |
 | Mya Htwe Nge @mhtwenge Hi, everyone. Mya from mm, no COI #NephJC |
| Dr. Divya Bajpai 🇮🇳 @divyaa24 @hswapnil Boats dont work in Mumbai #Monsoon #NephJC https://t.co/DjKrDy54Sf |
| Silvi Shah, MD, MS @silvishah @devimol @VUMCKidney Hi Devika! Hope things good. Yay #nephJC |
| Matthew Sparks, MD @Nephro_Sparks shameless plug... clear your calendar for #KIDNEYcon 2019 April 12-14 https://t.co/2nws5uvuG9 #nephjc |
| Nephrology Journal Club @NephJC RT @Nephro_Sparks: shameless plug... clear your calendar for #KIDNEYcon 2019 April 12-14 https://t.co/2nws5uvuG9 #nephjc |
| William Beaubien-Souligny @WBeaubien @NephJC A personalized approach based on dynamic markers of fluid responsiveness.... most of the time.... #nephjc |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @NephJC @Slatts_1 I think the "liberal" and "restrictive" labels in the visual abstract have been switched. #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil T0: embarrassed to say I don’t know if we are restrictive (I think so) or liberal with fluids @OttawaHospital Perhaps @colinjmccartney might know? #nephjc |
| Matthew Sparks, MD @Nephro_Sparks @mhtwenge Mya!! #nephjc |
 | Rajesh rajan @rajeshrajan79 Hi every. Rajesh. No COI #nephjc |
| Nephrology Journal Club @NephJC T0b: This meta-analysis lays the foundation this trial https://t.co/4gwtXX6zV9, it found that goal directed therapy had lower hospital stay and less complications than non-goal directed therapy, thoughts? #NephJC |
 | Ankit Sakhuja 🇺🇸 @ansakhuja @Nephro_Sparks Hello Matt #NephJC |
| Silvi Shah, MD, MS @silvishah @NephJC T0: liberal for now #nephJC |
| Nephrology Journal Club @NephJC James your right my bad on the oversight #nephjc |
| Tulane Kidney Beans @TulaneRedBeans Hey @Nephro_Sparks and @hswapnil #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @JamesNovakNeph @NephJC @Slatts_1 Right! We will fix - just checking to make sure everyone reads the fine print, eh @kidney_boy ? #NephJC |
| Jonathan J Suarez @ICUnephroSuarez in my fellowship they used a more GDT approach, more "liberal" i guess. Used fluids instead of pressors. #NephJC |
| Nephrology Journal Club @NephJC Hi Brendon and Rajesh welcome #NephJC |
| Khaled Shawwa @khaledshawwa @NephJC some use "urine replacement" protocol, depending on urine output. #NephJC |
| Gates Colbert, MD @DoctorGates I think the liberal happens by default/accident. The fluids add up! Abx BID, IV sedation, IV Levo/Vaso/Neo. Blood. Sepsis "Bundle". Paralytics. Have I counted up them all yet? no #nephjc |
| Nephrology Journal Club @NephJC Welcome Khaled #NephJC |
| Manasi Bapat MD, FASN, FNKF🇮🇳🇺🇸 @manasib33 RT @DoctorGates: I think the liberal happens by default/accident. The fluids add up! Abx BID, IV sedation, IV Levo/Vaso/Neo. Blood. Sepsis "Bundle". Paralytics. Have I counted up them all yet? no #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @DoctorGates: I think the liberal happens by default/accident. The fluids add up! Abx BID, IV sedation, IV Levo/Vaso/Neo. Blood. Sepsis "Bundle". Paralytics. Have I counted up them all yet? no #nephjc |
| Tulane Kidney Beans @TulaneRedBeans At our university hospital the LSU guys are very much restrictive #NephJC |
| Nephrology Journal Club @NephJC Remember all fluid is not just IVF #NephJC |
| Martín Vargas 🇲🇽 @MartinVargas89 #NephJC I think that on our hospital surgeons prefer liberal. |
| Nephrology Journal Club @NephJC T0c: Are you using non-invasive methods such as point of care ultrasound to assess volume status? (POCUS see told you it's coming) #NephJC |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph We usually hold ACEi/ARB the day before, of, and after contrast administration, as we have some data to suggest that may be a good idea, but there's no consensus on what to do peri-operatively. #NephJC https://t.co/CiMQeBEK6F |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd RELIEF Trial: Restrictive vs. Liberal Fluid Therapy for Major Abdominal Surgery from @NEJM #Nephpearls #NephJC 👉🏼 https://t.co/VCcJvWs0YI https://t.co/HI6p1hdYLC |
| Angel Cesar Ortiz @AngelCesarOrtiz RT @NephJC: Check out the great summary and VA from @Slatts_1 at https://t.co/VDNhk0OpjS #NephJC https://t.co/tmYwxGcBwr |
 | Jamie Privratsky MD/PhD @JamiePrivratsky Increased #AKI in restrictive arm does not surprise me. Too much fluid is not good, but somehow goal-directed fluid therapy has morphed into more and more restrictive fluid therapy. #everythinginmoderation #nephjc |
| Nephrology Journal Club @NephJC T1d: No mention of any specific intervention for oliguria? Could this confound or bias the results given this was open label? #NephJC |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @rheault_m @NephJC However, these would be average-risk adult nephrology consult patients. After a while, you get used to seeing "HTN, DM, CAD, CKD, CHF" in the first line of most HPIs. #NephJC |
| Mario Funes, MD @MarioFunesMD @NephJC How come hypotension was treated with IVF, but was not the case for oliguria? This might have changed the rates of AKI? #NephJC https://t.co/s6vMvHwuqf |
| Silvi Shah, MD, MS @silvishah @NephJC Depends on overall volume status and Kidney function #nephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @JamiePrivratsky Interesting - tell us more about this! #NephJC |
 | Fitsum Asnakech Tilahun MD @fitse_t @Nephro_Sparks I will be quietly following, been waiting to attend #NephJC as a fellow. |
| Gary Singer @GarySingerMD@med-mastodon.com @GarySingerMD @NephJC Treatment of hypotension based on assessment of volume status. Usually give IVF before starting pressers #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @MarioFunesMD: @NephJC How come hypotension was treated with IVF, but was not the case for oliguria? This might have changed the rates of AKI? #NephJC https://t.co/s6vMvHwuqf |
| Nephrology Journal Club @NephJC Fitsum excited to have you #NephJC |
| Jonathan J Suarez @ICUnephroSuarez what do anesthesia folks think of "restrictive" arm? That seems very "restrictive" from what I have normally seen. #NephJC |
| ~~~ @DrNamkeen @NephJC if volume overloaded then pressors, not responding to fluids, pressors #nephjc |
| Manasi Bapat MD, FASN, FNKF🇮🇳🇺🇸 @manasib33 @NephJC Yeah these are the ones with most difficult fluid balances- the time critical surgeries and they were excluded- perhaps a reason for less than 10% patients with severe HF or severe kidney disease ? #NephJC |
| Khaled Shawwa @khaledshawwa @NephJC maybe, but mind you that they only went with the creatinine criteria for defining AKI (without urine output). #nephjc |
| Nephrology Journal Club @NephJC T1e: The liberal group gained 1.6 kg as opposed to 0.3 kg in the restrictive group thought due to better surgical technique and using more balanced IVF, are there other reasons that the weight gain was not more in the liberal group #NephJC |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @LTummalapalli Thanks for the reference. To their point of >24 h effect of ACEi/ARB, effects of these drugs can actually last up to 4 weeks. #NephJC |
| William Beaubien-Souligny @WBeaubien @GarySingerMD @NephJC Some people agree that in distributive shock, pressors would be first: mobilize the unstressed volume #nephjc |
| Matthew Sparks, MD @Nephro_Sparks here is @JamiePrivratsky comment... anesth crit care ... restrictive is too restrictive now #nephjc https://t.co/I6ZtqgKOaP |
| Nephrology Journal Club @NephJC Authors mention there was difficulty weighing patients days 1-3 #NephJC |
| Angel Cesar Ortiz @AngelCesarOrtiz @MartinVargas89 @NephJC Por supuesto que se asigna en las recomendaciones de las interconsultas. Pero aún sin infraestructura suficiente ni personal capacitado. Esperemos pronto! #NephJC |
| Nephrology Journal Club @NephJC RT @JamesNovakNeph: @LTummalapalli Thanks for the reference. To their point of >24 h effect of ACEi/ARB, effects of these drugs can actually last up to 4 weeks. #NephJC |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd Comparison of Rivers, ProMISe, ProCESS, ARISE studies #Nephpearls #NephJC https://t.co/Fw33HEv78C |
| devika nair md msci @devimol @khaledshawwa @NephJC i think this is a very important point #NephJC |
| Nephrology Journal Club @NephJC RT @edgarvlermamd: Comparison of Rivers, ProMISe, ProCESS, ARISE studies #Nephpearls #NephJC https://t.co/Fw33HEv78C |
| Nephrology Journal Club @NephJC Let’s dive into the results #NephJC |
| Matthew Sparks, MD @Nephro_Sparks @MikeManningMD anes cardiac throwing in ACEi hold and ARB continue #nephJC https://t.co/WrGoariYaM |
| Dr. Divya Bajpai 🇮🇳 @divyaa24 Can it be Hawthorne effect? Our pts usually gain more than 2- 3 kgs #NephJC https://t.co/6K3IpumjE4 |
 | Brian Stotter, MD @StotterMD Sorry I’m late folks, just lurking while on call #NephJC |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph Difficult to tell without an assessment of output. If the liberal group gained (5.4-3=) 2.4 L but only 1.3 kg, presumably they had higher urine output. #NephJC https://t.co/PkCzqH6Et9 |
| Nephrology Journal Club @NephJC Brian never late your always welcome! #NephJC |
| Matthew Sparks, MD @Nephro_Sparks i thought Hawthorne was always a middle author #nephjc |
| Nephrology Journal Club @NephJC T2a: Primary endpoint of disability free survival at one year was not different between the two groups, was this a fair endpoint or would you have chosen another endpoint? #NephJC |
| Samira Farouk, MD, MSCR @ssfarouk @divyaa24 Hawthorne effect might be difficult with an objective endpoint like weight? #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @MikeManningMD @Nephro_Sparks Interesting - why do you say that? #NephJC |
| Jamie Privratsky MD/PhD @JamiePrivratsky The thinking is shifting. Was always held due to potential for profound hypotension on induction. Data still not definitive but maybe starting to head more toward continuing. @MikeManningMD what study shows to continue ARBs? #nephjc https://t.co/ySFowA38DI |
| Nephrology Journal Club @NephJC Let’s dig in on the AKI aspect of the trial with some tables from the supplementary appendix (Yea we went there) #NephJC |
| Nephrology Journal Club @NephJC T2b: AKI and use of RRT was higher in the restrictive group, how might you explain this keeping in mind the earlier use of pressors? Thoughts on no specific intervention in the protocol for oliguria? #NephJC https://t.co/GPgoOvwRIO |
| Michelle Rheault @rheault_m @NephJC Probably the most important endpoint. #NephJC |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd POSEIDON Trial: Sliding scale hydration based on LVEDP to prevent Contrast Nephropathy #Nephpearls #NephJC 👉🏼 https://t.co/2ocMkzmJAe https://t.co/K4AtrpgvUQ |
| Hector Madariaga, MD FASN 🇲🇽 @HecmagsMD RT @JamiePrivratsky: Increased #AKI in restrictive arm does not surprise me. Too much fluid is not good, but somehow goal-directed fluid therapy has morphed into more and more restrictive fluid therapy. #everythinginmoderation #nephjc |
 | brocalcitonin @brocalcitonin RT @edgarvlermamd: Comparison of Rivers, ProMISe, ProCESS, ARISE studies #Nephpearls #NephJC https://t.co/Fw33HEv78C |
| Nephrology Journal Club @NephJC RT @edgarvlermamd: POSEIDON Trial: POSEIDON Trial: Sliding scale hydration based on LVEDP to prevent Contrast Nephropathy #Nephpearls #NephJC 👉🏼 https://t.co/2ocMkzmJAe https://t.co/K4AtrpgvUQ |
| Nephrology Journal Club @NephJC T2c: They also adjusted creatinine measurements on day 1 & 3 according to the patient’s fluid balance at 1 day & 3 days after surgery, where adj creat = serum creat*(1 + cumulative fluid balance/total body water) Thoughts? #NephJC https://t.co/5bu0uhkeuc |
| Khaled Shawwa @khaledshawwa @NephJC It is intriguing that they used "calculated adjusted creatinine" for the fluid balance, I am not aware that it was used in major trials, any thoughts? #NephJC |
| Hector Madariaga, MD FASN 🇲🇽 @HecmagsMD #NephJC https://t.co/OjPoVvB251 |
| ~~~ @DrNamkeen @rheault_m @NephJC Patient reported outcomes! #nephjc #nephmadness |
| Nephrology Journal Club @NephJC Khaled reading the NephJC mind #NephJC |
| devika nair md msci @devimol what percentage of patients had documented sepsis? is this information known? etiology of AKI influences whether IVFs would cause more benefit than harm #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: T2b: T2b: AKI and use of RRT was higher in the restrictive group, how might you explain this keeping in mind the earlier use of pressors? Thoughts on no specific intervention in the protocol for oliguria? #NephJC https://t.co/GPgoOvwRIO |
| Michelle Rheault @rheault_m @khaledshawwa @NephJC What is that? Calculated adjusted creatinine?? Never heard of it. #NephJC |
| Nephrology Journal Club @NephJC RT @NephJC: T2c: T2c: They also adjusted creatinine measurements on day 1 & 3 according to the patient’s fluid balance at 1 day & 3 days after surgery, where adj creat = serum creat*(1 + cumulative fluid balance/total body water) Thoughts? #NephJC https://t.co/5bu0uhkeuc |
 | John Pickering, Skrymaster, 43.6S 172.6E @kiwiskiNZ Sorry late & a fly on the wall #NephJC disclosure - was part of study with different results https://t.co/IgBlD54HlU |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd The SPLIT Trial: Saline vs Plasma-Lyte from @srrezaie #Nephpearls #NephJC 👉🏼 https://t.co/2ywZW2eZMP https://t.co/vy7CZP3Z2R |
| Nephrology Journal Club @NephJC John welcome #NephJC |
| Nephrology Journal Club @NephJC T2d:The goal of the restricted group was zero fluid balance, how could insensible losses come into play here? Would these patients potentially be in negative balance then? #NephJC |
| Angel Cesar Ortiz @AngelCesarOrtiz RT @khaledshawwa: @NephJC It is intriguing that they used "calculated adjusted creatinine" for the fluid balance, I am not aware that it was used in major trials, any thoughts? #NephJC |
| Nephrology Journal Club @NephJC T2e: Interesting note that the fluid liberal group had less overall surgical site infections, and anastomotic leaks thought not statistically significant, thoughts? #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @kiwiskiNZ: Sorry late & a fly on the wall #NephJC disclosure - was part of study with different results https://t.co/IgBlD54HlU |
 | Mayuri Trivedi @MayuriTrivedi80 @NephJC Hi sorry for being late Mayuri Trivedi nephrologist India no COI,#nephJC |
| Nephrology Journal Club @NephJC RT @edgarvlermamd: The SPLIT Trial: The SPLIT Trial: Saline vs Plasma-Lyte from @srrezaie #Nephpearls #NephJC 👉🏼 https://t.co/2ywZW2eZMP https://t.co/vy7CZP3Z2R |
| William Beaubien-Souligny @WBeaubien @rheault_m @NephJC adjusted creatinine = serum creatinine × (1 + cumulative fluid balance/total body water) #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @kiwiskiNZ Very cool, and also from NZ - what’s your impression of RELIEF John? #NephJC |
| Jonathan J Suarez @ICUnephroSuarez @NephJC Yes. I think this group was "very restrictive" #NephJC |
| Samira Farouk, MD, MSCR @ssfarouk @NephJC Seems odd that there was even a trend this way, would have expected restrictive group to have less subcutaneous, bowel wall edema, etc. #NephJC |
| William Beaubien-Souligny @WBeaubien @WBeaubien @rheault_m @NephJC I am more of a believer in Dr Prowle vision of "creatinine dilution"DOI: 10.1007/s00134-014-3538-7 #nephjc |
| Nephrology Journal Club @NephJC Thanks for dropping in Mayuri #NephJC |
| Jamie Privratsky MD/PhD @JamiePrivratsky Might get booted out of the chat but anyone heard of #ELAIN :) #nephjc https://t.co/ICh3nBBx1A |
| Mayuri Trivedi @MayuriTrivedi80 RT @edgarvlermamd: Comparison of Rivers, ProMISe, ProCESS, ARISE studies #Nephpearls #NephJC https://t.co/Fw33HEv78C |
| Mayuri Trivedi @MayuriTrivedi80 @NephJC Yes for sure...#nephJC |
| Jamie Privratsky MD/PhD @JamiePrivratsky In the OR almost always continuous cardiac output monitor like Lidco or PPV/SVV on monitor. #nephjc https://t.co/Xe0jHSF2Vu |
 | Dr. A. Muñoz Ramos @amr_1971 RT @edgarvlermamd: Comparison of Rivers, ProMISe, ProCESS, ARISE studies #Nephpearls #NephJC https://t.co/Fw33HEv78C |
 | Timothy Yau @Maximal_Change Sorry i’m late. Lurking while on vacation #nephjc |
 | John P Erwin III MD FACC @HeartOTXHeartMD RT @edgarvlermamd: POSEIDON Trial: POSEIDON Trial: Sliding scale hydration based on LVEDP to prevent Contrast Nephropathy #Nephpearls #NephJC 👉🏼 https://t.co/2ocMkzmJAe https://t.co/K4AtrpgvUQ |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph Fairly unconventional, but also fairly insignificant. Volumes of 3-5.4 L would usually be <10% of TBW so would dilute creatinine only minimally. #NephJC https://t.co/z59hCgw78N |
 | Arvind Canchi (Conjeevaram)🇮🇳 @arvindcanchi RT @edgarvlermamd: The SPLIT Trial: The SPLIT Trial: Saline vs Plasma-Lyte from @srrezaie #Nephpearls #NephJC 👉🏼 https://t.co/2ywZW2eZMP https://t.co/vy7CZP3Z2R |
| Mayuri Trivedi @MayuriTrivedi80 @NephJC No...#nephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @ssfarouk @NephJC Yeah - pulm edema did trend higher with liberal, but not significant #NephJC https://t.co/BkxTCoJIe1 |
| Nephrology Journal Club @NephJC Ok Ok so where do we go from here? #NephJC |
| Dr. Divya Bajpai 🇮🇳 @divyaa24 we tried calculating this sometimes. But in real world its so difficult to calculate cumulative fluid load #NephJC https://t.co/NeBnZnfmHJ |
| Matthew Sparks, MD @Nephro_Sparks @ChrisPrabhakar now with new Ang II data... hold both and give Ang II if hypotensive #NephJC |
| ~~~ @DrNamkeen RT @JamesNovakNeph: Fairly unconventional, but also fairly insignificant. Volumes of 3-5.4 L would usually be <10% of TBW so would dilute creatinine only minimally. #NephJC https://t.co/z59hCgw78N |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd Balanced crystalloids vs. Saline in critically ill & non-critically ill adult patients from @NEJM #Nephpearls #NephJC #VisualAbstract by @aakashshingada SALT-ED 👉🏼 https://t.co/EAMrcyDcNE SMART 👉🏼 https://t.co/md8IEEjASB https://t.co/WPf0PtR4Nh |
| Nephrology Journal Club @NephJC T3a: The overall conclusion for the authors seems to be that a modestly liberal fluid regiment that is guided by hemodynamics is optimal and from my bthomas215 bias we should carefully intervene for hypotension and oliguria #NephJC |
| Jamie Privratsky MD/PhD @JamiePrivratsky In typical care it is. In this trial it apparently wasn't. Probably appropriate as post-major surgery patients often oliguric due to increased ADH release. #nephjc https://t.co/BCJX899dGP |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @JamiePrivratsky Yup - we love AKIKI & @StephaneG05 more on #NephJC https://t.co/pe2mITkO2k While waiting for @STARRTAKI |
| Matthew Sparks, MD @Nephro_Sparks when creat is in AKI equation (bigly) and trial is fluids (liberal v. restrictive) isn't this a problem. need a none creat based #nephjc |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @JamiePrivratsky Yes, we reviewed ELAIN and AKIKI last year @HFNephrology. Different conclusions, but also different perspectives on whether they should be compared. These trials had more to do with RRT timing, not fluid/blood administration in liver transplant surgery. #NephJC |
| Dr. Divya Bajpai 🇮🇳 @divyaa24 @JamesNovakNeph this becomes significant in pts who are in icu for long time. They have huge positive water balance (accumulated with time) #NephJC |
 | Chris Prabhakar @ChrisPrabhakar #NephJC https://t.co/pgGqtbXkPN |
| Nephrology Journal Club @NephJC Remember they also started pressors earlier and if too restrictive does that mean there was ischemia induced from early use of pressors #NephJC |
| Matthew Sparks, MD @Nephro_Sparks also, urine output another... and doh. 2x fluids in one group. #handonheademoji #nephjc |
| Samira Farouk, MD, MSCR @ssfarouk @JamesNovakNeph @JamiePrivratsky @HFNephrology Also significantly different indications for "early" and "late" RRT #NephJC #AKIKI #ELAIN |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @Nephro_Sparks @ChrisPrabhakar Trolling Matt? Et tu #Giapreza #NephJC https://t.co/yoWql1U5wJ |
| Skeptical Scalpel @Skepticscalpel @JamiePrivratsky Who doesn’t give oliguric patients a fluid challenge? #NephJC |
| Samira Farouk, MD, MSCR @ssfarouk @Nephro_Sparks Your emojis are broken??? #NephJC |
| Samira Farouk, MD, MSCR @ssfarouk RT @Skepticscalpel: @JamiePrivratsky Who doesn’t give oliguric patients a fluid challenge? #NephJC |
| Gates Colbert, MD @DoctorGates Anyone else notice night shift sneaking in fluid when you chart round in the AM? #GiveABolus #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @Skepticscalpel: @JamiePrivratsky Who doesn’t give oliguric patients a fluid challenge? #NephJC |
| Mario Funes, MD @MarioFunesMD @JamiePrivratsky Up to what point you would consider oliguria to be post surgery ADH release vs prerenal oliguric AKI? #NephJC |
| Dr. Divya Bajpai 🇮🇳 @divyaa24 It looks little too restrictive but still the cumulative fluid given was 3671 ml which is not actually bad... Dont know about losses though #NephJC https://t.co/ykYKGCB9XS |
| Jamie Privratsky MD/PhD @JamiePrivratsky @Skepticscalpel: Agree, almost always done. Just don't think it is always appropriate after surgery without other evidence such as POCUS or hemodynamic monitor to indicate patient needs fluid. #nephjc https://t.co/HckVPpOYEW |
| Mario Funes, MD @MarioFunesMD @NephJC Hard to generalize same amount of fluids for all regardless of type of surgery or its complications. Sepsis patients might have required more fluids vs non sepsis. #NephJC |
| Nephrology Journal Club @NephJC Welcome Amir #NephJC |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @divyaa24 How long were these patients administered fluid? We seem to be looking at fluid gains of 3-5 L and weight gains of 0.5-2 kg, but that may only be a 24-h period. Even so, to dilute a creatinine from 1.2 to 0.8, you'd have to give 21 L to the 70-kg man. #NephJC |
| John Pickering, Skrymaster, 43.6S 172.6E @kiwiskiNZ Did some calcs on fluid dilution once - 1L/h for 6h “increases” Cr by ~15% over 6h, but all resolved by 12h. #NephJC |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd @JamiePrivratsky Optimal timing of RRT in the ICU: AKIKI vs ELAIN Infographic by @lucey_mark #Nephpearls #NephJC 👉🏼 https://t.co/if8WtxjuQ8 https://t.co/sKPmRv7USn |
| Samira Farouk, MD, MSCR @ssfarouk @JamesNovakNeph @divyaa24 During and up to 24 hours after surgery #NephJC |
| Jamie Privratsky MD/PhD @JamiePrivratsky @DoctorGates Always! #nephjc |
| Nephrology Journal Club @NephJC Any use of urine chemistries? #NephJC |
| Matthew Sparks, MD @Nephro_Sparks I always come back to CORONARY https://t.co/C6bQdGYcCD #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @kiwiskiNZ: Did some calcs on fluid dilution once - 1L/h for 6h “increases” Cr by ~15% over 6h, but all resolved by 12h. #NephJC |
| John Pickering, Skrymaster, 43.6S 172.6E @kiwiskiNZ oops “decreases” #NephJC https://t.co/hCO1o9Bt6H |
| Nephrology Journal Club @NephJC RT @edgarvlermamd: @JamiePrivratsky Optimal timing of RRT in the ICU: @JamiePrivratsky Optimal timing of RRT in the ICU: AKIKI vs ELAIN Infographic by @lucey_mark #Nephpearls #NephJC 👉🏼 https://t.co/if8WtxjuQ8 https://t.co/sKPmRv7USn |
| Matthew Sparks, MD @Nephro_Sparks In CORONARY more AKI in on pump vs. off pump... but long term CKD dev same #nephjc |
| Nephrology Journal Club @NephJC RT @Nephro_Sparks: I always come back to CORONARY https://t.co/C6bQdGYcCD #nephjc |
| William Beaubien-Souligny @WBeaubien @NephJC Urinary sodium does not predicts well renal fluid responsiveness in the ICU DOI: 10.1186/s13054-016-1343-0. #nephjc |
| Jonathan J Suarez @ICUnephroSuarez @NephJC Spin the urine!! #NephJC |
| Jamie Privratsky MD/PhD @JamiePrivratsky @MarioFunesMD Depends. Needs to be other evidence besides urine output. #nephjc |
| ~~~ @DrNamkeen @NephJC ohhh #ngal etc? #nephjc |
| Angel Cesar Ortiz @AngelCesarOrtiz RT @Nephro_Sparks: I always come back to CORONARY https://t.co/C6bQdGYcCD #nephjc |
| Jamie Privratsky MD/PhD @JamiePrivratsky @ansakhuja @NephJC True! Just not in the OR! #nephjc |
| Nephrology Journal Club @NephJC Wow this is great lots of great papers and viewpoints mentioned really what NephJC is about with various viewpoints, stimulating us to go further in our search for "the Truth" #NephJC |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph This is a good reference, and illustrates the complexity that IV fluid may take a while to equilibrate from the vascular compartment. Also, D5W will distribute into total body water, whereas 0.9% NS will distribute into the ECF space only. #NephJC https://t.co/JMaPFVyyFJ |
| Gary Singer @GarySingerMD@med-mastodon.com @GarySingerMD @NephJC FENa or FEUrea? #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @ansakhuja @NephJC Yup - out last discussion (sparked by @MayuriTrivedi80 ) https://t.co/lqHth2LRoy #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: Wow this is great lots of great papers and viewpoints mentioned really what NephJC is about with various viewpoints, stimulating us to go further in our search for "the Truth" #NephJC |
| Nephrology Journal Club @NephJC Awesome discussion! #nephjc |
| Jamie Privratsky MD/PhD @JamiePrivratsky @JamesNovakNeph @HFNephrology Agree. My point was more that I can see ELAIN results being true in surgical patients. #nephjc |
| Matthew Sparks, MD @Nephro_Sparks what is the take home then #nephjc |
| Nephrology Journal Club @NephJC RT @JamesNovakNeph: This is a good reference, and illustrates the complexity that IV fluid may take a while to equilibrate from the vascular compartment. Also, D5W will distribute into total body water, whereas 0.9% NS will distribute into the ECF space only. #NephJC https://t.co/JMaPFVyyFJ |
| Nephrology Journal Club @NephJC Thanks for joining us today and for contributing to this rich discussion, and a special thank you to my co-interns @@Slatts_1 and @Stones_ and our NSMC faculty especially @hswapnil and @@kidney_boy #nephjc |
| Jonathan J Suarez @ICUnephroSuarez @ansakhuja @NephJC If many casts then I might slow down with fluids. Still will take my hemodynamics into account as well. #NephJC |
| Nephrology Journal Club @NephJC Shout out to my co-interns thanks for coming by! #nephjc |
| Nephrology Journal Club @NephJC Don’t forget to join NephMadness superstar @Stones_ for the next NephJC chat on RELIEF on 7/18/18 - ie next week - at 8 pm BST and 12 noon pacific time #NephJC |
| Nephrology Journal Club @NephJC If you haven’t, please sign up for our weekly newsletter https://t.co/5aumn8ImwF #NephJC |
| Mario Funes, MD @MarioFunesMD Thank you! Great discussion! @bthomas215 #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @JamiePrivratsky @JamesNovakNeph @HFNephrology Dunno - hard to believe those results (yes I said it) #nephjc Anyone know what happened to IDEAL-ICU? https://t.co/vgwRxL6Y58 |
| Nephrology Journal Club @NephJC Until next time...goodnight! Feel free to linger #NephJC https://t.co/EtJlQfFW3l |
| Jamie Privratsky MD/PhD @JamiePrivratsky Everything in moderation! #nephjc https://t.co/wxces5hAIx |
| Gary Singer @GarySingerMD@med-mastodon.com @GarySingerMD Or @Stones__ #nephJC https://t.co/iSt57CEGwG |
| Samira Farouk, MD, MSCR @ssfarouk Life lessons from #NephJC https://t.co/xxvWpqlccW |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil Take home? Discuss this with your surgeons and anesthesia folks Not sure how robust? Wait for longer term AKI to CKD outcome results #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @JamiePrivratsky: Everything in moderation! #nephjc https://t.co/wxces5hAIx |
| Jamie Privratsky MD/PhD @JamiePrivratsky RT @hswapnil: Take home? Discuss this with your surgeons and anesthesia folks Not sure how robust? Wait for longer term AKI to CKD outcome results #nephjc |
| Jamie Privratsky MD/PhD @JamiePrivratsky RT @ssfarouk: Life lessons from #NephJC https://t.co/xxvWpqlccW |
| Gates Colbert, MD @DoctorGates Take home: Give fluid when evidence of crisis begins, then hold, then tell nurse to tell other providers to hold. Easier said than done. Use your non invasive strategies to guesstimate response probability. #nephjc |
 | Amir Mian @NaimRima #NephJC Preop/intraop another advantage of fluid loading is hemodilution: so surgical bleeding has less of an effect on the absolute hematocrit |
| Jamie Privratsky MD/PhD @JamiePrivratsky RT @DoctorGates: Take home: Take home: Give fluid when evidence of crisis begins, then hold, then tell nurse to tell other providers to hold. Easier said than done. Use your non invasive strategies to guesstimate response probability. #nephjc |
| Nephrology Journal Club @NephJC One additional point is that surgical technique today is less invasive and better in many ways then 5-10 years ago, this is important to remember as well #NephJC |
 | Juguin Padawan @huguinhopa RT @edgarvlermamd: @JamiePrivratsky Optimal timing of RRT in the ICU: @JamiePrivratsky Optimal timing of RRT in the ICU: AKIKI vs ELAIN Infographic by @lucey_mark #Nephpearls #NephJC 👉🏼 https://t.co/if8WtxjuQ8 https://t.co/sKPmRv7USn |
| Jamie Privratsky MD/PhD @JamiePrivratsky Great discussion! Thanks @NephJC #nephjc |
| Nephrology Journal Club @NephJC And remember it's key that this patient population is different than our ICU/Trauma patients #NephJC |
| Manasi Bapat MD, FASN, FNKF🇮🇳🇺🇸 @manasib33 @JamiePrivratsky @hswapnil Also important to watch inadvertant fluid administration with antibiotics etc... need to keep a very close tab of those as they add up a lot of fluids in the background #nephjc |
| Alex Meraz @NephroGuy RT @NephJC: Check out the great summary and VA from @Slatts_1 at https://t.co/VDNhk0OpjS #NephJC https://t.co/tmYwxGcBwr |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd Mis-applications of commonly used KIDNEY EQUATIONS - MDRD, GFR, FENa #Nephpearls #NephJC 👉🏼 https://t.co/QUM2seshQT https://t.co/Q9QeqbscVi |
| Khaled Shawwa @khaledshawwa @NephJC Important point #NephJC |
| Jamie Privratsky MD/PhD @JamiePrivratsky @NephJC: Enjoyed hearing perspectives from surgery, anesthesia, and medicine colleagues! #nephjc |
| Jamie Privratsky MD/PhD @JamiePrivratsky Very true. #nephjc https://t.co/NH29iuPBbo |
| Natalie McCall @_NatalieMcCall RT @edgarvlermamd: Comparison of Rivers, ProMISe, ProCESS, ARISE studies #Nephpearls #NephJC https://t.co/Fw33HEv78C |
| Jamie Privratsky MD/PhD @JamiePrivratsky RT @NephJC: And remember it's key that this patient population is different than our ICU/Trauma patients #NephJC |
| Alex Meraz @NephroGuy RT @JonJSuarez: @NephJC Spin the urine!! #NephJC |
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