Very interesting! We seldom use vasopressin. However, we use dobutamine quite a lot. I guess this could be due to the cardiologist running the ICU. I still believe we could be more familiar with other vasopressors. Next time I consider using vasopressin, I will have your tips in mind 🙏

I totally agree that RCTs are at the top of the pyramid and that we do not have evidence that vaso is better than NE/NA! But maybe the study indicates that we should use two vasopressors earlier? At which doses of NA do you start vaso? Btw, you are really inspiring!

RESOLVE design: www.georgeinstitute.org/projects/ran...

Thank you! I agree the DOPPS study has some bias. The small RCT by Paula et al (KI 2004) is interesting, showing decreased IDWG and fewer symptoms during HD. I wasn't aware of the RESOLVE study. Hope it provides answers! Meanwhile, we should individualize, but I will keep Na lower rather than higher

Check out the recent Cochrane review (behind a paywall…) if interested in dialysate sodium levels. They conclude that there is reduced interdialytic weight gain (IDWG) but more intradialytic hypotension. www.cochranelibrary.com/cdsr/doi/10....

Interesting! There are other studies reporting really good effect, such as this with 81 Chinese patients: karger.com/ajn/article-...
And this meta-analysis with 221 patients with MCD/FSGS: pubmed.ncbi.nlm.nih.gov/32293308/
However, I haven't found any studies assessing when to ✋ RTX

Gleder meg forresten til samarbeid i FuN! 😎

It was about a year ago, but there were few/no side effects/complications of RTX, and the patient has been pleased with it. Anyway, I think I will reach the same conclusion as you. I will see if the attendees agree!

Our group does research on the technique, and we were pleasantly surprised to find out it holds up in TR patients (paper coming soon!). Still big ? about cirrhosis, positive pressure ventilation, CKD/ESRD. And then there’s the issue that it was only really built to predict cardio renal aki.

Very interesting! I will definitely check it out and follow your work closely. My conclusion is that we need several assessment tools to determine when the patient is in fluid balance.

That's a valid point! I use vexus to supplement clinical examination, other types of pocus and medical history. So, I do not believe it is the “only and right answer.” What do you think? Which patients should we be more careful about assessing fluid status using Vexus?

Thank you! I guess there is a way to go, but it's nice to know that studies are ongoing. I hope and believe that complement inhibitors will be imported into LN in the future!

➡️ Up next on #NephJC #NephSky 🦋

Join us for some high pressure discussion on Dec 3,4 as we discuss #BPROAD from #NEJM

nejm.org/doi/abs/10.1...

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