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Nephrology With Joel Topf, MD

Nephrology

Dr. Topf is an assistant clinical professor of medicine at Oakland University William Beaumont School of Medicine, creator and host of the Freely Filtered and Channel Your Enthusiasm podcasts, creator of the Precious Bodily Fluids blog, and co-creator of NephMadness and NephJC.

From Too Much Fluid With Hurricane Helene to Not Enough

Hello readers,

A couple of topics for today. First off is the IV fluid shortage. Helene crushed a Baxter IV fluid factory and now there is a nationwide shortage of IV fluids. Terrible. Every time the supply chain is revealed, it is shocking how fragile everything is. Included in the shortage are peritoneal fluids. As part of the conservation strategy, dialysis units are putting a moratorium on starting new patients. This affected one of my patients recently. Terrible. If you are short on resuscitation fluids, consider the soy sauce packet. Josh Farkas outlines how to make isotonic salt solutions using soy sauce.

Secondly, one of the most anticipated trial results will be announced on Saturday at Kidney Week. Get excited for the Hyponatremia Intervention Trial. It should be interesting.

See you at kidney week and the NephJC party!

Thanks,

Joel Topf, MD

Articles
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    As IV shortage continues after hurricane, U.S. invokes wartime power to speed recovery - 3 month(s) ago

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      kidney_boy

      Hurricane Helene damaged a Baxter intravenous fluid factory in North Carolina resulting in a nationwide shortage. Baxter will not be able to deliver any 0.9% normnal saline for three and a half weeks. Surgeries are being delayed and other conservation measures are being implemented around the US. The federal government is helping Baxter get back up and running as soon as possible. They are also making it easier for Baxter to import fluids from international sources. 

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      kidney_boy

      Last week I wanted to get a patient with failing kidneys started on home therapy, but Hurricane Helene had something to say about that.

      New plan vein mapping and an AV access. https://t.co/xuCrJobu7M

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      kidney_boy

      The North Carolina Baxter factory also produced peritoneal dialysate, so there is now also a nationwide shortage of PD solutions and patients are having to modify prescriptions inorder to conserve fluids. 

      Additionally, there is hold on initiating new patients on peritoneal dialysis. This effected one of my patients last week. Unfortunately, their kidneys are deteriorating faster than expected and we need to move forward with renal replacemeent therapy. This patient really wanted peritoneal dialysis but we need to go with hemodialysis, at least for now. Heart breaking.

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      bryan_johnson

      Completed my first total plasma exchange (TPE). Removing all the plasma in my body and replacing with Albumin.

      This is different from what I did last year: removing 1 L of plasma from my body and then replacing it with 1 L of plasma from my blood boy @talmagejohnson_ . I gave… https://t.co/lsbIGztPeP https://t.co/mrKsKt3zrg

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    Hyponatremia Intervention Trial (HIT): Study Protocol of a Randomized, Controlled, Parallel-Group Trial With Blinded Outcome Assessment - 3 month(s) ago

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      kidney_boy

      We have a handful of randomized controlled trials on the treatment of hyponatremia, but those have only been concerned with improving the sodium level. The larger question is does fixing the sodium matter? A meta analysis showed that improvements in sodium concentration were associated with improved mortality but a randomized trial is needed to show causality. The Hyponatremia Intervention Trial (HIT) is designed to see if rigorous targeted improvements in sodioum concentration reuces mortaltiy or readmission rates. 

      On October 26th we will get the results of this trial.

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      NephroMD

      Looking forward to seeing the results of the HIT trial at ASN, the largest randomized controlled trial of hyponatremia ever (enrollment goal=2,278 patients) @ChristCrain @Julie_Celine @ASNKidney #KidneyWk https://t.co/MyWvHXFwpH

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