Maurice Khayat
@peeingredagain.bsky.social
Nephrologist and academic hospitalist at Dallas VA Medical Center. Assistant Professor of Medicine, UT Southwestern.
This encapsulates my feelings on FeNa reasonably well. It still has some good use-cases, but we need to stop using it indiscriminately for every AKI!
(Ref below, VA markup/emphasis mine)
pmc.ncbi.nlm.nih.gov/articles/PMC...
(Ref below, VA markup/emphasis mine)
pmc.ncbi.nlm.nih.gov/articles/PMC...
October 7, 2025 at 1:56 PM
This encapsulates my feelings on FeNa reasonably well. It still has some good use-cases, but we need to stop using it indiscriminately for every AKI!
(Ref below, VA markup/emphasis mine)
pmc.ncbi.nlm.nih.gov/articles/PMC...
(Ref below, VA markup/emphasis mine)
pmc.ncbi.nlm.nih.gov/articles/PMC...
In a lot of ways medicine is like troubleshooting a computer, but not all the parts are replaceable and in most cases "have you tried turning it off and back on again?" isn't useful advice.
August 31, 2025 at 12:33 PM
In a lot of ways medicine is like troubleshooting a computer, but not all the parts are replaceable and in most cases "have you tried turning it off and back on again?" isn't useful advice.
I wonder if this will result in any changes?
US House Panel Launches Antitrust Probe of Medical Residency System: www.doximity.com/newsfeed/17e...: www.doximity.com/newsfeed/17e...
US House Panel Launches Antitrust Probe of Medical Residency System: www.doximity.com/newsfeed/17e...: www.doximity.com/newsfeed/17e...
US House panel launches antitrust probe of medical residency system
A U.S. congressional committee is investigating how medical students are placed in residency training programs, seeking documents from major university hospitals, the American Medical Association and other organizations as part of an antitrust probe.
www.doximity.com
March 29, 2025 at 3:12 PM
I wonder if this will result in any changes?
US House Panel Launches Antitrust Probe of Medical Residency System: www.doximity.com/newsfeed/17e...: www.doximity.com/newsfeed/17e...
US House Panel Launches Antitrust Probe of Medical Residency System: www.doximity.com/newsfeed/17e...: www.doximity.com/newsfeed/17e...
Reposted by Maurice Khayat
Standard metformin practice is:
GFR 45+. No changes
GfR 30-45. Decrease dose
(but don’t initiate new therapy)
GFR <30. Discontinue
But maybe some low risk patients with CKD IV are losing a benefit by discontinuing their metformin?
GFR 45+. No changes
GfR 30-45. Decrease dose
(but don’t initiate new therapy)
GFR <30. Discontinue
But maybe some low risk patients with CKD IV are losing a benefit by discontinuing their metformin?
We often stop metformin when eGFR < 30 (CKD stage 4). In this observational study of 4,278 patients with type 2 diabetes and CKD stage 4, stopping metformin (40.1% of patients) was associated with lower 3-year survival (63.7% vs 70.5%). Time for an RCT? #MedSky #NephSky www.ajkd.org/article/S027...
Stopping Versus Continuing Metformin in Patients With Advanced CKD: A Nationwide Scottish Target Trial Emulation Study
Despite a lack of supporting evidence, current guidance recommends against the use
of metformin in people with advanced kidney impairment. This observational study compared
the outcomes of patients wi...
www.ajkd.org
February 21, 2025 at 6:14 PM
Standard metformin practice is:
GFR 45+. No changes
GfR 30-45. Decrease dose
(but don’t initiate new therapy)
GFR <30. Discontinue
But maybe some low risk patients with CKD IV are losing a benefit by discontinuing their metformin?
GFR 45+. No changes
GfR 30-45. Decrease dose
(but don’t initiate new therapy)
GFR <30. Discontinue
But maybe some low risk patients with CKD IV are losing a benefit by discontinuing their metformin?
Getting caught up on my HoP episodes!
On the subjevt of poisonings: I wanted to share this diagram to estimate the best method to use to enhance elimination from the body.
I also can't overstate how helpful poison control is in these situations. Make sure to call them!!
On the subjevt of poisonings: I wanted to share this diagram to estimate the best method to use to enhance elimination from the body.
I also can't overstate how helpful poison control is in these situations. Make sure to call them!!
February 18, 2025 at 3:28 PM
Getting caught up on my HoP episodes!
On the subjevt of poisonings: I wanted to share this diagram to estimate the best method to use to enhance elimination from the body.
I also can't overstate how helpful poison control is in these situations. Make sure to call them!!
On the subjevt of poisonings: I wanted to share this diagram to estimate the best method to use to enhance elimination from the body.
I also can't overstate how helpful poison control is in these situations. Make sure to call them!!
When I was younger I just to have cool dreams. Now my dreams are "we need to treat this RPGN patient but no one can find the biopsy results."
February 6, 2025 at 5:32 PM
When I was younger I just to have cool dreams. Now my dreams are "we need to treat this RPGN patient but no one can find the biopsy results."
@raghumnephdoc.bsky.social please forgive my delayed response. You sent a great article, so I wanted to scrutinize it properly! Here's what I learned:
(1) ↑↑triglycerides interfere w/any indirect ISE measured HCO₃⁻ (same as in pseudo-↓Na!)
(2) Most automated chem panels use indirect ISE
(3) →
(1) ↑↑triglycerides interfere w/any indirect ISE measured HCO₃⁻ (same as in pseudo-↓Na!)
(2) Most automated chem panels use indirect ISE
(3) →
www.ajkd.org/article/S027...
This article in AJKD seems to suggest that POC ABG derived HCo3 is free from interference due to lipids and stuff.
This article in AJKD seems to suggest that POC ABG derived HCo3 is free from interference due to lipids and stuff.
January 26, 2025 at 1:32 AM
@raghumnephdoc.bsky.social please forgive my delayed response. You sent a great article, so I wanted to scrutinize it properly! Here's what I learned:
(1) ↑↑triglycerides interfere w/any indirect ISE measured HCO₃⁻ (same as in pseudo-↓Na!)
(2) Most automated chem panels use indirect ISE
(3) →
(1) ↑↑triglycerides interfere w/any indirect ISE measured HCO₃⁻ (same as in pseudo-↓Na!)
(2) Most automated chem panels use indirect ISE
(3) →
The key is to establish dominance. #WhatCouldGoWrong
December 27, 2024 at 8:06 PM
The key is to establish dominance. #WhatCouldGoWrong
I love this! Fatigue is so non-specific, and IDA is often overlooked. Also, for anemic pts with CKD, the inflammation drives up the ferritin. KDIGO guidelines rec Fe for these pts for Fe sat<30% and ferritin<500! Unsure if its the same for peds CKD. Can you weigh in @rhodeshambrick.bsky.social
I’ve been checking ferritin whenever I can (it’s often expensive!) in young adults who menstruate and usually half of them have ferritin <30ng/ml and feel so much better with a few months iron supplementation.
Our study found that nearly 40% (!) of 12-21 yo females are iron deficient.
tinyurl.com/FeJAMA
But did you know that in addition to many physical symptoms, iron deficiency is associated with multiple mental health issues?
A #medsky #bluetorial 🧵1/
tinyurl.com/FeJAMA
But did you know that in addition to many physical symptoms, iron deficiency is associated with multiple mental health issues?
A #medsky #bluetorial 🧵1/
November 25, 2024 at 5:08 PM
I love this! Fatigue is so non-specific, and IDA is often overlooked. Also, for anemic pts with CKD, the inflammation drives up the ferritin. KDIGO guidelines rec Fe for these pts for Fe sat<30% and ferritin<500! Unsure if its the same for peds CKD. Can you weigh in @rhodeshambrick.bsky.social
Optimist: The cup is half full
Pessimist: the cup is half empty
Internist: Both are in the differential, but I have ordered more imaging to ensure this is not actually a bowl. Will consider pottery consult.
Pessimist: the cup is half empty
Internist: Both are in the differential, but I have ordered more imaging to ensure this is not actually a bowl. Will consider pottery consult.
Optimist: The cup is half full
Pessimist: the cup is half empty
The nephrologist: It's only half a cup? We can dialyze that off, no problem.
Pessimist: the cup is half empty
The nephrologist: It's only half a cup? We can dialyze that off, no problem.
Optimist: The cup is half full
Pessimist: The cup is half empty
@traumasoapboxes.bsky.social: The cup is completely empty and needs blood, not saline
Pessimist: The cup is half empty
@traumasoapboxes.bsky.social: The cup is completely empty and needs blood, not saline
November 23, 2024 at 4:05 PM
Optimist: The cup is half full
Pessimist: the cup is half empty
Internist: Both are in the differential, but I have ordered more imaging to ensure this is not actually a bowl. Will consider pottery consult.
Pessimist: the cup is half empty
Internist: Both are in the differential, but I have ordered more imaging to ensure this is not actually a bowl. Will consider pottery consult.
Reposted by Maurice Khayat
Is adding SZC + 3K bath the solution to sudden death in dialysis?
Join us this on #NephJC to discuss
www.nephjc.com/news/potassi...
#NephSky
Join us this on #NephJC to discuss
www.nephjc.com/news/potassi...
#NephSky
Potassium Rollercoaster Heartbreak — NephJC
This week, we will discuss the use of 3K dialysis bath with sodium zirconium cyclosilicate versus 2K bath and no potassium lowering medications in dialysis patients and the associated risk of arrhythm...
www.nephjc.com
November 19, 2024 at 3:44 AM
Is adding SZC + 3K bath the solution to sudden death in dialysis?
Join us this on #NephJC to discuss
www.nephjc.com/news/potassi...
#NephSky
Join us this on #NephJC to discuss
www.nephjc.com/news/potassi...
#NephSky
This conversion is so vital to life that our bodies evolved an enzyme to make an essentially spontaneous reaction occur roughly 10000000 times more quickly!
1 mol of CO2 occupies 22.4 L at STP. Using the ideal gas law we calculate it’s 23.3 L at 37 C.
That means an amp of bicarb has
0.05 mol * 23.3 L/mol = 1.16 L of CO2!
1.16 liters of CO2!?
That’s more than I expected & kinda a LOT. At rest a person exhales ~200 ml of CO2/min!
5/
That means an amp of bicarb has
0.05 mol * 23.3 L/mol = 1.16 L of CO2!
1.16 liters of CO2!?
That’s more than I expected & kinda a LOT. At rest a person exhales ~200 ml of CO2/min!
5/
November 20, 2024 at 1:47 AM
This conversion is so vital to life that our bodies evolved an enzyme to make an essentially spontaneous reaction occur roughly 10000000 times more quickly!
Reposted by Maurice Khayat
Python = Kale
interesting point, python, the programming language equivalent of a kale salad 😂
November 15, 2024 at 12:53 PM
Python = Kale
Reposted by Maurice Khayat
in real life clinical practice you mean? wonder why NGAL fell by the wayside despite data like pubmed.ncbi.nlm.nih.gov/29352071/. i don;’t think NephroCheck is as useful in this setting - or is it?
(we don’t have anything like that up here…urea, creatinine, and now cystatin C)
(we don’t have anything like that up here…urea, creatinine, and now cystatin C)
Worsening Renal Function in Patients With Acute Heart Failure Undergoing Aggressive Diuresis Is Not Associated With Tubular Injury - PubMed
Kidney tubular injury does not appear to have an association with WRF in the context of aggressive diuresis of patients with acute heart failure. These findings reinforce the notion that the small to ...
pubmed.ncbi.nlm.nih.gov
November 12, 2024 at 11:30 PM
in real life clinical practice you mean? wonder why NGAL fell by the wayside despite data like pubmed.ncbi.nlm.nih.gov/29352071/. i don;’t think NephroCheck is as useful in this setting - or is it?
(we don’t have anything like that up here…urea, creatinine, and now cystatin C)
(we don’t have anything like that up here…urea, creatinine, and now cystatin C)
I was giving the residents the acid-base lecture and was reminded of this important point:
"When there is a discrepancy between your model and reality, it's not typically reality that is inaccurate."
"When there is a discrepancy between your model and reality, it's not typically reality that is inaccurate."
November 11, 2024 at 7:43 PM
I was giving the residents the acid-base lecture and was reminded of this important point:
"When there is a discrepancy between your model and reality, it's not typically reality that is inaccurate."
"When there is a discrepancy between your model and reality, it's not typically reality that is inaccurate."
Really need to get into a rhythm w/r/t posting on BlueSky vs Twitter. Most of the academic discussion is on the latter for now, but not being bombarded by angry tweets and ads is a blessing.
December 15, 2023 at 5:30 PM
Really need to get into a rhythm w/r/t posting on BlueSky vs Twitter. Most of the academic discussion is on the latter for now, but not being bombarded by angry tweets and ads is a blessing.