The Curious Clinicians
85 - NephMadness 2024
Mar 5, 2024
Dr. Jeff Kott, a nephrology specialist, discusses phosphate binders in acute kidney injury and the usefulness of urine anion gap in non-gap metabolic acidosis. The podcast explores NephMadness 2024 and the impact of TWDFNR practices on patient care. It delves into the debate on nephrology selections, patient-centered AKI treatment options, and emphasizes informed decision-making in nephrology.
28:59
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Quick takeaways
- Debates on using phosphate binders in AKI due to inconsistent evidence and potential harm like pill burden and side effects.
- Limitations of urine anion gap as a surrogate for urinary ammonium levels in metabolic acidosis despite theoretical advantages.
Deep dives
Phosphate Binders in Acute Kidney Injury
In the podcast, the use of phosphate binders in acute kidney injury is discussed. The episode explains how hyperphosphatemia develops, primarily sourced from Western high-phosphate diets, leading to hormonal cascades like FGF23. While in chronic kidney disease, it's crucial to lower elevated phosphorus, the role of phosphate binders in AKI is debated. Phosphate binders may not be effective in AKI due to differences in patient oral intake, leading to potential harm like pill burden and GI side effects, despite inconclusive evidence on improved outcomes.
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