Exploring Biomarkers and Furosemide Stress Testing in AKI

The Filtrate:

Joel Topf

Swapnil Hiremath

Nayan Arora

Sophie Ambruso

And special guests:

Jay L Koyner, Professor of Medicine, University of Chicago

Sarah Faubel, Professor of Medicine, University of Colorado

Editor

Nayan Arora

Show Notes:

It was Kidney 360, not Kidney Medicine. Here is the study I was thinking of: https://kidney360.asnjournals.org/content/2/1/33

SNL Five-Timers Club: https://www.youtube.com/watch?v=6bWGoWFMwKE

The Fluid and Electrolyte Companion. Download The Whole Enchilada

About the Authors from Topf and Faubel’s first book, The Microbiology Companion.

Ted Post: The Sarah Faubel of The Clinical Physiology of Acid Base and Electrolyte Disorders.

Meta analysis of early dialysis in AKI by Victor Seabra: https://pubmed.ncbi.nlm.nih.gov/18562058/

Meta analysis of early dialysis in AKI by Morgan Grimes: https://www.ajkd.org/article/S0272-6386(15)00530-2/abstract

H-index: https://en.wikipedia.org/wiki/H-index

Mortality in ARDS: ACURASYS study. The hazard ratio for death at 90 days in the cisatracurium group, as compared with the placebo group, was 0.68 https://www.nejm.org/doi/full/10.1056/nejmoa1005372

Has Mortality from Acute Respiratory Distress Syndrome Decreased over Time? A Systematic Review

It is commonly stated and assumed that mortality from acute respiratory distress syndrome (ARDS) is decreasing.

We found that mortality from ARDS has not decreased substantially since the publication of a consensus definition in 1994. Based on our findings, a baseline mortality risk from ARDS of 40 to 45% for observational studies and 35 to 40% for randomized control trials should be expected. These results highlight the need for future effective therapeutic interventions for this highly lethal syndrome.

https://www.atsjournals.org/doi/full/10.1164/rccm.200805-722oc

From Up To Date:

Numerous studies suggest that survival has improved over time [2,9,10,11]. As an example, an observational study of 2451 patients who had enrolled in ARDSNet randomized trials found a fall in mortality from 35 to 26 percent between 1996 and 2005 [10]. To the extent that mortality may be decreasing with time, several issues should be considered:

● It is not known if mortality has decreased among patients who received their care outside of a specialized center or a clinical trial.

● The improved mortality may be attributable to patients who have ARDS related to risk factors other than sepsis, such as trauma [9].

● To the extent that mortality has decreased, the reasons are uncertain. Likely causes include better supportive care and improved ventilatory strategies, such as low tidal volume ventilation [10,12,13]

Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock by Emanuel Rivers https://www.nejm.org/doi/full/10.1056/nejmoa010307

Early Goal Directed Therapy from NephMadness 2015 https://ajkdblog.org/2015/03/01/nephmadness-2015-critical-care-nephrology-region/#Early

Counter point by NSMC graduate Kamran Boka https://ajkdblog.org/2015/03/18/nephmadness-2015-process-arise-promise-and-the-promise-of-early-goal-directed-therapy/

Furosemide stress test https://jasn.asnjournals.org/content/26/8/2023

EM Crit looks at the furosemide stress test: https://emcrit.org/pulmcrit/furosemide-stress-test/

ASN Kidney Week Biomarker debate between Faubel and Koyner. https://www.asn-online.org/education/kidneyweek/2020/program-session-details.aspx?sessId=371699&sessPar=371678

NAD therapy Samir Parikh Don Seldin Young Investigator Award winner 2019.

Sarah Faubel’s Dream RCT https://ukidney.com/nephrology-resources/dream-rct-initiative/dream-rct-entries/item/nephrologist-driven-rrt-usual-late-or-early-start-for-acute-kidney-injury

Perry Wilson’s DreamRCT https://www.medpagetoday.com/Nephrology/DreamRCT/53876

Steve Coca on “Permissive AKI” with treatment of heart failure https://www.kidney-international.org/article/S0085-2538(19)30708-2/pdf

Edward Clark on HIRRT: Mechanisms for hemodynamic instability related to renal replacement therapy: a narrative review https://pubmed.ncbi.nlm.nih.gov/31407042/

Cytokine adsorption in patients with severe COVID-19 pneumonia requiring extracorporeal membrane oxygenation (CYCOV): a single centre, open-label, randomised, controlled trial https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00177-6/fulltext

The Handbook of Critical Care Nephrology Amazon | Target (actually not available 😩)

Sophia and Sarah Tweetorial on her Lung metabolomics in AKI study: https://twitter.com/sophia_kidney/status/1390394006366994432

AKIKI NephJC coverage | NEJM manuscript