Below is a quick summary of the key teaching points made by Dr. Kevin Finkel (University of Texas Medical School at Houston) during his special guest lecture on 8 November 2012 by Dr. Nirav Jasani (East Carolina University).

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1. Chloride rich fluid like NORMAL SALINE, high risk of AKI as compared to chloride poor fluids

2. High use of colloids- hexastarch, gelatin, albumin as oppose to crystalloids for resuscitation in sepsis in Europe as compared to USA

3. FACTT trial- NEJM 2006;354:2564-2575 (link)
liberal vs conservative fluid replacement— no difference in mortality, no difference in rates of renal failure—-> lesser ventilator days in conservative fluid replacement strategy in ICU

4. SOAP STUDY- Critical care medicine 2006; 34:344-353 (link)
every one liter in positive fluid balance (volume overload)— increased Odds of mortality (OR 1.1)

5. VASST trial- Critical care Medicine 2011;39:259 (link)
fluid overload yields increased mortality

6. Cannot define volume overload, cannot know which is better- colloids or crystalloid, or which colloid or crystalloid, cannot know how much to give, but one thing is known that fluid overload can lead to increased mortality

7. Earlier trials of ultrafiltration suggest that UF improves outcomes and reduces rate of re-admission

8. Possibility of restoration of diuretic sensitivity after “diuretic holiday” during Ultrafiltration–in diuretic resistant heart failure

9. UF—> isotonic fluid removal– more sodium removal— less chances of electrolyte imbalance

10. UNLOAD trial– JACC 2007 Feb 49; 675-83 (link)
– UF decreases rate of readmission

11. CARRESS- HF trial NEJM 2012, Part B (link)
Patient selected– cardiorenal syndrome type 1
compared UF 500 ml/min vs protocol diuretic use
no significant difference in mortality, rate of readmission

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Blogs from the 45th annual American Society of Nephrology ...