Protein restriction in Chronic Kidney Disease
Last Month in Nephrology
by lastmonthinnephrology
4d ago
Wines get better with time-they say-but the same can’t be said with old hypotheses unsupported by good evidence. Hypothesis in question is that of dietary protein restriction in management of CKD. With the expanding armamentarium of CKD, when nephrologists were almost saying goodbye, the protein restriction debate was sparked by the latest KDOQI (2020) guidelines, by recommending Very Low Protein Diet (VLPD) (0.3-0.5gm/kg/day) with ketoanalogues in patients with pre dialysis CKD (1A recommendation). Debate was colored further by the NEJM review article as many doctors believe that the letters ..read more
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March 2024
Last Month in Nephrology
by lastmonthinnephrology
1w ago
Are you CONVINCED? It is believed that conventional diffusion-based dialysis is not effective to remove larger-molecular-weight toxins. In contrast, hemodiafiltration (HDF) uses convection to remove broad range of uremic toxins and may improve patient outcomes. CONVINCE trial was a multinational, randomized, controlled trial that compared the benefits of high-dose hemodiafiltration (HDF) with standard hemodialysis (HD) in adult patients with end-stage renal disease (ESRD). A total of 1360 patients were randomized to receive either high-dose HDF or high-flux HD. The intervention group received ..read more
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Hypertension in CKD: what we know, what we don’t and what’s wrong with KDIGO 2021 BP goal of <120mmHg?
Last Month in Nephrology
by lastmonthinnephrology
10M ago
Management of hypertension is one of the most important tasks of nephrologists, which if done well can be highly rewarding. More often than not, blood pressure is either left uncontrolled or is lowered too much, putting patients at risk of the attendant complications. Realising the fallacy and dangers of ‘one size fits all’ approach which has been the part of preexisting guidelines, ACC/AHA  2019 guidelines, were a much needed departure from the ‘target based’ to the ‘risk based’ approach of BP treatment. This is a sensible approach, when one views BP elevation as a risk factor for organ ..read more
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May 2023
Last Month in Nephrology
by lastmonthinnephrology
11M ago
Hydrochlorthiazide: the turtle of the race? “Adalphane Acedrex (a Novartis made combo of Reserpine+Dihydralazine+Hydrochlorothiazide)- was available in the hospital formulary and ‘uncontrolled hypertension’ was a rare condition”, Prof Hase would get nostalgic and remark on his grand rounds discussing evolution of pharmacotherapy for hypertension. One of the earliest classes of antihypertensives, thiazide diuretics are also one of the most effective drugs, with latest trial evaluating chlorthalidone showing a BP decline of almost 10mmHg. However, whether chlortalidone should altogether replace ..read more
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June 2022
Last Month in Nephrology
by lastmonthinnephrology
1y ago
Fluid restriction in critically ill Indiscriminate intravenous fluid administration is extremely common, and nephrologists’ advice on fluid restriction often lands on deaf ears. Fluid management often becomes the battlefield involving intensivists, surgeons, and nephrologists. ‘Patient appears cool’ (when actually its the freezing air conditioner), ‘Skin turgor is poor’ (80-year-old lady, with dry and wrinkled skin for years, won’t glow up to pose for fairness cream ad), ‘BP isn’t picking up, give a bolus’ and so on! So many excuses! Most intriguing of all was this: I once asked a surgical f ..read more
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April 2022
Last Month in Nephrology
by lastmonthinnephrology
2y ago
PLEX for ANCA vasculitis Moderate certainty evidence gathered from this updated systematic review and meta-analysis in BMJ says: a) PLEX has no important effects on all-cause mortality, b) PLEX reduced the risk of ESKD at 12 months, and c) PLEX increased the risk of serious infections at 12 months. These conclusions are just as definitive and helpful for clinicians as the monsoon predictions of our meteorologic department to farmers, and wise farmers take them just as seriously as the monsoon predictions based on the height of the crow’s nest on the tree. This paper demands a major correction ..read more
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Making sense of numbers, Interpreting statistics for clinicians
Last Month in Nephrology
by lastmonthinnephrology
2y ago
The department of nephrology, Seth GSMC and KEM Hospital, Mumbai invites you to a unique virtual CME on Interpreting published Statistics for Clinicians Let’s learn how to make sense of those numbers published in the results & apply them to your clinical practice. We have a grand ensemble of speakers & chairpersons from India and abroad. Click here to register:  https://swarnimtouch.com/Statistics-for-Clinicians/ All those who register will also get the recording of the program. Registrations involving foreign transactions should be made to Mr Kishore Vardham, Name of Bank – Saras ..read more
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December 2021
Last Month in Nephrology
by lastmonthinnephrology
2y ago
KDIGO 2021 guidelines on Glomerular diseases KDIGO glomerulonephritis guidelines for 2021 are here. Recently they were reviewed and summarised here and here. Summary provides the quick evidence based guide for the management of glomerulonephritis for practicing nephrologists. Unlike the past version, rituximab(RTX) comes out as almost the ‘blue-eyed boy’ of the 2021 guidelines. Instead of finding indications for RTX use in GN, it may be easier to point out some of the disease categories where it is not mentioned as an option for treatment. Not only in conditions where RTX is a potential trea ..read more
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October 2021
Last Month in Nephrology
by lastmonthinnephrology
2y ago
Racing further away from truth: story of eGFR equations Blacks have a higher serum creatinine; nobody know for sure, why. Decreased tubular secretion, increased muscle mass, and increased generation are the speculations, but given the higher incidence and poor outcomes of kidney diseases in blacks, further research on this is urgently needed. mGFR (measured GFR by exogenous markers like inulin, iohexol- Gold standard) in blacks therefore is about 15-16% higher than whites at comparable age, sex and creatinine levels. This is the the reason for ‘race coefficient’ in eGFR equations. A recent a ..read more
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May 2021
Last Month in Nephrology
by lastmonthinnephrology
3y ago
Steroid for Acute Pyelonephritis in children Acute pyelonephritis in children can lead to renal scarring, hypertension, proteinuria and ESRD, although its causal relationship with renal damage is increasingly questioned after RIVUR trial which showed that antibiotic prophylaxis in children with reflux prevents UTI, but not renal scarring. In these patients inflammation is thought to mediate renal scarring and its consequences. So far, trials mainly focussed on preventing UTIs (with antibiotic prophylaxis), however, role of corticosteroids to prevent renal scarring by addressing renal inflam ..read more
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