Rolando Claure
@runningkidneys.bsky.social
#KidneyDoctor #Researcher
Member Executive Committee @kdigo.org Member #SLANH #AKI committee
Views do not represent those of my employer
#KidneyRunner 🏃🏻♂️ #StopAKI
Member Executive Committee @kdigo.org Member #SLANH #AKI committee
Views do not represent those of my employer
#KidneyRunner 🏃🏻♂️ #StopAKI
Just received my complimentary copy of Tropical Nephrology (2nd Ed.) 📘🌿
Recently discussed my chapter on kidney disease from herbal medicine with our fellows—2 days later we saw an AKI case linked to these products.
We must ask about herbal meds/supplements routinely. #AKI #CKD
Recently discussed my chapter on kidney disease from herbal medicine with our fellows—2 days later we saw an AKI case linked to these products.
We must ask about herbal meds/supplements routinely. #AKI #CKD
November 25, 2025 at 4:57 PM
Subclinical #AKI in the wards: in 103 at-risk adults, a simple urine microscopy score (UMS≥2) within ARA-F4 identified AKI-1S; 90% developed clinical AKI with higher KRT use & ☠️. UMS (AUC 0.84) is a low-cost trigger for earlier intervention in LMICs. journals.lww.com/kidney360/fu...
November 22, 2025 at 4:43 PM
Subclinical #AKI in the wards: in 103 at-risk adults, a simple urine microscopy score (UMS≥2) within ARA-F4 identified AKI-1S; 90% developed clinical AKI with higher KRT use & ☠️. UMS (AUC 0.84) is a low-cost trigger for earlier intervention in LMICs. journals.lww.com/kidney360/fu...
November 9, 2025 at 2:09 PM
Starting HD? Don’t rush to 🛑loop diuretics. Medicare cohort (n=11,297): continuing loops ↓ hospitalizations (IRR 0.93), ↓ intradialytic hypotension (IRR 0.95) &↓ interdialytic weight gain; no mortality difference at 1 yr. If still making urine, consider continuing. #KidneyWk
November 8, 2025 at 11:29 PM
Starting HD? Don’t rush to 🛑loop diuretics. Medicare cohort (n=11,297): continuing loops ↓ hospitalizations (IRR 0.93), ↓ intradialytic hypotension (IRR 0.95) &↓ interdialytic weight gain; no mortality difference at 1 yr. If still making urine, consider continuing. #KidneyWk
AKI-D pearls:
•Gentle UF & individualized Rx-minimize dialytrauma
•⬇️frequency/intensity as recovery starts
•Prevent IDH: 🆒 dialysate + slower UF
•Consider tolerating pre-HD SBP 🆙 to 180 mmHg before starting antihypertensives to avoid recurrent AKI & aid ❤️🩹#KidneyWk
•Gentle UF & individualized Rx-minimize dialytrauma
•⬇️frequency/intensity as recovery starts
•Prevent IDH: 🆒 dialysate + slower UF
•Consider tolerating pre-HD SBP 🆙 to 180 mmHg before starting antihypertensives to avoid recurrent AKI & aid ❤️🩹#KidneyWk
November 8, 2025 at 11:21 PM
AKI-D pearls:
•Gentle UF & individualized Rx-minimize dialytrauma
•⬇️frequency/intensity as recovery starts
•Prevent IDH: 🆒 dialysate + slower UF
•Consider tolerating pre-HD SBP 🆙 to 180 mmHg before starting antihypertensives to avoid recurrent AKI & aid ❤️🩹#KidneyWk
•Gentle UF & individualized Rx-minimize dialytrauma
•⬇️frequency/intensity as recovery starts
•Prevent IDH: 🆒 dialysate + slower UF
•Consider tolerating pre-HD SBP 🆙 to 180 mmHg before starting antihypertensives to avoid recurrent AKI & aid ❤️🩹#KidneyWk
AKI-D isn’t “ESRD lite.” Patients face ↑ disability, ↓HRQoL, CKD after “recovery,” and high CV events (Lee 2018). Outpatient HD still lacks ID flags, order sets, recovery monitoring, and dedicated teams. Time for AKI-D–specific pathways. #KidneyWk
November 8, 2025 at 7:09 PM
AKI-D isn’t “ESRD lite.” Patients face ↑ disability, ↓HRQoL, CKD after “recovery,” and high CV events (Lee 2018). Outpatient HD still lacks ID flags, order sets, recovery monitoring, and dedicated teams. Time for AKI-D–specific pathways. #KidneyWk
AKI-D recovery is shaped by layers beyond the kidney:
• Patient—older age, female, minority status, CKD/proteinuria, HF/CVD
• Meds—nephrotoxins
• Dialysis—↑UF/UFR, longer sessions, IDH
• SDOH—neighborhood poverty, dual-eligibility
(Babroudi et al., JASN 2024) #KidneyWk
• Patient—older age, female, minority status, CKD/proteinuria, HF/CVD
• Meds—nephrotoxins
• Dialysis—↑UF/UFR, longer sessions, IDH
• SDOH—neighborhood poverty, dual-eligibility
(Babroudi et al., JASN 2024) #KidneyWk
November 8, 2025 at 6:08 PM
AKI-D recovery is shaped by layers beyond the kidney:
• Patient—older age, female, minority status, CKD/proteinuria, HF/CVD
• Meds—nephrotoxins
• Dialysis—↑UF/UFR, longer sessions, IDH
• SDOH—neighborhood poverty, dual-eligibility
(Babroudi et al., JASN 2024) #KidneyWk
• Patient—older age, female, minority status, CKD/proteinuria, HF/CVD
• Meds—nephrotoxins
• Dialysis—↑UF/UFR, longer sessions, IDH
• SDOH—neighborhood poverty, dual-eligibility
(Babroudi et al., JASN 2024) #KidneyWk
LIBERATE-D RCT in AKI-D (n=218) — conservative dialysis (only when metabolic/clinical triggers) vs conventional 3x/wk. Kidney recovery at discharge: 64% vs 50% (ARR 13.8%). Adjusted OR NS → needs larger trial. #KidneyWk
November 8, 2025 at 6:01 PM
LIBERATE-D RCT in AKI-D (n=218) — conservative dialysis (only when metabolic/clinical triggers) vs conventional 3x/wk. Kidney recovery at discharge: 64% vs 50% (ARR 13.8%). Adjusted OR NS → needs larger trial. #KidneyWk
Take-home from #KidneyWk💡
💧 Balanced crystalloids: modest survival benefit.
💉 IV bicarbonate: no survival advantage in severe acidosis overall.
⚠️ But in KDIGO stage 2–3 AKI + acidosis, may delay or reduce KRT need.
The story of bicarb continues… #AKI #CriticalCare
💧 Balanced crystalloids: modest survival benefit.
💉 IV bicarbonate: no survival advantage in severe acidosis overall.
⚠️ But in KDIGO stage 2–3 AKI + acidosis, may delay or reduce KRT need.
The story of bicarb continues… #AKI #CriticalCare
November 8, 2025 at 3:42 PM
Take-home from #KidneyWk💡
💧 Balanced crystalloids: modest survival benefit.
💉 IV bicarbonate: no survival advantage in severe acidosis overall.
⚠️ But in KDIGO stage 2–3 AKI + acidosis, may delay or reduce KRT need.
The story of bicarb continues… #AKI #CriticalCare
💧 Balanced crystalloids: modest survival benefit.
💉 IV bicarbonate: no survival advantage in severe acidosis overall.
⚠️ But in KDIGO stage 2–3 AKI + acidosis, may delay or reduce KRT need.
The story of bicarb continues… #AKI #CriticalCare
BICARICU-2 insights 🔍
Event rates lower than expected, 15% crossover (controls got bicarb, 50% KRT).
KRT reduction remains provocative—true renal protection or just buying time?
Still not powered for MAKE-90.
More data coming from MOSAICC & SODa-BIC!
#KidneyWk
Event rates lower than expected, 15% crossover (controls got bicarb, 50% KRT).
KRT reduction remains provocative—true renal protection or just buying time?
Still not powered for MAKE-90.
More data coming from MOSAICC & SODa-BIC!
#KidneyWk
November 8, 2025 at 3:41 PM
BICARICU-2 insights 🔍
Event rates lower than expected, 15% crossover (controls got bicarb, 50% KRT).
KRT reduction remains provocative—true renal protection or just buying time?
Still not powered for MAKE-90.
More data coming from MOSAICC & SODa-BIC!
#KidneyWk
Event rates lower than expected, 15% crossover (controls got bicarb, 50% KRT).
KRT reduction remains provocative—true renal protection or just buying time?
Still not powered for MAKE-90.
More data coming from MOSAICC & SODa-BIC!
#KidneyWk
BICARICU-2: 627 adults with KDIGO stage 2–3 AKI + metabolic acidosis (pH≤7.2, HCO3≤20, SOFA≥4) in 43 French ICUs randomized to 4.2% NaHCO₃ (target pH≥7.30) vs usual care. Primary: 90-day mortality; key secondary: KRT, MAKE-90, organ failure. #KidneyWk
November 8, 2025 at 3:40 PM
BICARICU-2: 627 adults with KDIGO stage 2–3 AKI + metabolic acidosis (pH≤7.2, HCO3≤20, SOFA≥4) in 43 French ICUs randomized to 4.2% NaHCO₃ (target pH≥7.30) vs usual care. Primary: 90-day mortality; key secondary: KRT, MAKE-90, organ failure. #KidneyWk
BICAR-ICU
389 adults with severe acidemia randomized to 4.2% IV bicarb vs usual care. Overall primary outcome neutral, but in AKI stage 2–3 bicarb ↓ composite events, mortality, organ failure & KRT use (52%→35%). More alkalosis, hyperNa, hypoCa. #KidneyWk
389 adults with severe acidemia randomized to 4.2% IV bicarb vs usual care. Overall primary outcome neutral, but in AKI stage 2–3 bicarb ↓ composite events, mortality, organ failure & KRT use (52%→35%). More alkalosis, hyperNa, hypoCa. #KidneyWk
November 8, 2025 at 3:37 PM
BICAR-ICU
389 adults with severe acidemia randomized to 4.2% IV bicarb vs usual care. Overall primary outcome neutral, but in AKI stage 2–3 bicarb ↓ composite events, mortality, organ failure & KRT use (52%→35%). More alkalosis, hyperNa, hypoCa. #KidneyWk
389 adults with severe acidemia randomized to 4.2% IV bicarb vs usual care. Overall primary outcome neutral, but in AKI stage 2–3 bicarb ↓ composite events, mortality, organ failure & KRT use (52%→35%). More alkalosis, hyperNa, hypoCa. #KidneyWk
Treat acute metabolic acidosis? Bicarb may improve hemodynamics, arrhythmias, cellular energetics & immune function…but at the cost of intracellular acidosis, hypoK/hypoCa/alkalosis and Na⁺/volume load. Love this balanced view from Kraut & Madias at #KidneyWk
November 8, 2025 at 3:32 PM
Treat acute metabolic acidosis? Bicarb may improve hemodynamics, arrhythmias, cellular energetics & immune function…but at the cost of intracellular acidosis, hypoK/hypoCa/alkalosis and Na⁺/volume load. Love this balanced view from Kraut & Madias at #KidneyWk
Amazing #KidneyWk 🏃🏻♀️ 🏃🏻♂️ Thank you, @kidneyboy.bsky.social and @nephjc.bsky.social for organizing it. @kdigo.org runners #Run4Kidneys 🫘 #850Challenge. Now we’re ready for day three of #KidneyWk !
November 8, 2025 at 2:50 PM
Amazing #KidneyWk 🏃🏻♀️ 🏃🏻♂️ Thank you, @kidneyboy.bsky.social and @nephjc.bsky.social for organizing it. @kdigo.org runners #Run4Kidneys 🫘 #850Challenge. Now we’re ready for day three of #KidneyWk !
Mixed or modest? Across SPLIT, SMART, BaSICS, PLUS & FLUID the signal is consistent: balanced crystalloids have ≈90% probability of a survival benefit in the critically ill. Effect modest, costs small. Prefer balanced (esp. sepsis/DKA); consider saline in TBI. #KidneyWk
November 7, 2025 at 11:44 PM
Mixed or modest? Across SPLIT, SMART, BaSICS, PLUS & FLUID the signal is consistent: balanced crystalloids have ≈90% probability of a survival benefit in the critically ill. Effect modest, costs small. Prefer balanced (esp. sepsis/DKA); consider saline in TBI. #KidneyWk
PLUS RCT (NEJM 2022) 🇦🇺🇳🇿—53 ICUs, n=5,037: Plasma-Lyte 148 vs 0.9% saline for ICU resuscitation.
90-day mortality 21.8% vs 22.0% (OR 0.99); new RRT 12.7% vs 12.9%; max ↑SCr 0.41 vs 0.41 mg/dL.
Bottom line: no difference. #KidneyWk
90-day mortality 21.8% vs 22.0% (OR 0.99); new RRT 12.7% vs 12.9%; max ↑SCr 0.41 vs 0.41 mg/dL.
Bottom line: no difference. #KidneyWk
November 7, 2025 at 11:34 PM
PLUS RCT (NEJM 2022) 🇦🇺🇳🇿—53 ICUs, n=5,037: Plasma-Lyte 148 vs 0.9% saline for ICU resuscitation.
90-day mortality 21.8% vs 22.0% (OR 0.99); new RRT 12.7% vs 12.9%; max ↑SCr 0.41 vs 0.41 mg/dL.
Bottom line: no difference. #KidneyWk
90-day mortality 21.8% vs 22.0% (OR 0.99); new RRT 12.7% vs 12.9%; max ↑SCr 0.41 vs 0.41 mg/dL.
Bottom line: no difference. #KidneyWk
BaSICS 🇧🇷 75 ICUs(n=11,052).
Plasma-Lyte 🆚 0.9% saline (fast vs slow).
90-day mortality 26.4% vs 27.2% (HR 0.97) → no overall difference; AKI/RRT/SOFA 🟰.
Post-hoc: if pre-enrollment💧were balanced, mortality likely ↓ (92% overall; 96% sepsis). TBI signal harm. #KidneyWk
Plasma-Lyte 🆚 0.9% saline (fast vs slow).
90-day mortality 26.4% vs 27.2% (HR 0.97) → no overall difference; AKI/RRT/SOFA 🟰.
Post-hoc: if pre-enrollment💧were balanced, mortality likely ↓ (92% overall; 96% sepsis). TBI signal harm. #KidneyWk
November 7, 2025 at 11:30 PM
BaSICS 🇧🇷 75 ICUs(n=11,052).
Plasma-Lyte 🆚 0.9% saline (fast vs slow).
90-day mortality 26.4% vs 27.2% (HR 0.97) → no overall difference; AKI/RRT/SOFA 🟰.
Post-hoc: if pre-enrollment💧were balanced, mortality likely ↓ (92% overall; 96% sepsis). TBI signal harm. #KidneyWk
Plasma-Lyte 🆚 0.9% saline (fast vs slow).
90-day mortality 26.4% vs 27.2% (HR 0.97) → no overall difference; AKI/RRT/SOFA 🟰.
Post-hoc: if pre-enrollment💧were balanced, mortality likely ↓ (92% overall; 96% sepsis). TBI signal harm. #KidneyWk
Normal saline isn’t “normal.” It reproducibly raises chloride and worsens acidemia vs balanced crystalloids. Observational/early studies link saline to ↑AKI, ↑RRT, ↑LOS, transfusions, ↑mortality. Choose balanced fluids first. (Young 2014; Shaw 2012; Yunos JAMA 2012) #KidneyWk
November 7, 2025 at 11:22 PM
Normal saline isn’t “normal.” It reproducibly raises chloride and worsens acidemia vs balanced crystalloids. Observational/early studies link saline to ↑AKI, ↑RRT, ↑LOS, transfusions, ↑mortality. Choose balanced fluids first. (Young 2014; Shaw 2012; Yunos JAMA 2012) #KidneyWk
Dialysis in AKI = stability vs speed. In septic shock/poor EF/brain swelling—and if CRRT isn’t available—consider PD or PIRRT/SLED for better hemodynamic/ICP stability. IHD gives the fastest solute/fluids correction but ↑ osmolar shifts. (Ostermann, Blood Purif 2016) #KidneyWk
November 7, 2025 at 11:12 PM
Dialysis in AKI = stability vs speed. In septic shock/poor EF/brain swelling—and if CRRT isn’t available—consider PD or PIRRT/SLED for better hemodynamic/ICP stability. IHD gives the fastest solute/fluids correction but ↑ osmolar shifts. (Ostermann, Blood Purif 2016) #KidneyWk
Invasive:
CVP: simple trends, poor for fluid responsiveness. PAC: full hemodynamics but invasive; static pressures not predictive. TPTD: CO/GEDV/EVLW—useful but invasive. PWCA: continuous dynamic indices; limits with arrhythmias/vaso-tone. #KidneyWk
CVP: simple trends, poor for fluid responsiveness. PAC: full hemodynamics but invasive; static pressures not predictive. TPTD: CO/GEDV/EVLW—useful but invasive. PWCA: continuous dynamic indices; limits with arrhythmias/vaso-tone. #KidneyWk
November 7, 2025 at 9:12 PM
Invasive:
CVP: simple trends, poor for fluid responsiveness. PAC: full hemodynamics but invasive; static pressures not predictive. TPTD: CO/GEDV/EVLW—useful but invasive. PWCA: continuous dynamic indices; limits with arrhythmias/vaso-tone. #KidneyWk
CVP: simple trends, poor for fluid responsiveness. PAC: full hemodynamics but invasive; static pressures not predictive. TPTD: CO/GEDV/EVLW—useful but invasive. PWCA: continuous dynamic indices; limits with arrhythmias/vaso-tone. #KidneyWk
Non-invasive:
Exam/CXR/BNP → poor for venous congestion. Lung+IVC US better; VExUS best—predicts AKI/HF events & guides decongestion. BIA/BIVA trend TBW/edema but can’t split intravascular vs interstitial; ↓accuracy in obesity. #KidneyWk
Exam/CXR/BNP → poor for venous congestion. Lung+IVC US better; VExUS best—predicts AKI/HF events & guides decongestion. BIA/BIVA trend TBW/edema but can’t split intravascular vs interstitial; ↓accuracy in obesity. #KidneyWk
November 7, 2025 at 9:11 PM
Non-invasive:
Exam/CXR/BNP → poor for venous congestion. Lung+IVC US better; VExUS best—predicts AKI/HF events & guides decongestion. BIA/BIVA trend TBW/edema but can’t split intravascular vs interstitial; ↓accuracy in obesity. #KidneyWk
Exam/CXR/BNP → poor for venous congestion. Lung+IVC US better; VExUS best—predicts AKI/HF events & guides decongestion. BIA/BIVA trend TBW/edema but can’t split intravascular vs interstitial; ↓accuracy in obesity. #KidneyWk