Kevin Fay

Dad/Husband | Critical care nephrologist @PennKidney | @HFHIntMedRes | @JeffHealthNE | @UMich. | Bridge player | Myriad other interests.

[M Velia Antonini @FOAMecmo]

(Circuit) integration or separation approach in #ECMO patients requiring #CRRT? E-CRRT RCT
🔎 80 pts allocated to CRRT/ECMO circuits integration vs separation
⚖️ no significant difference in filter lifespan between integration/separation configurations
🪦 comparable mortality
🫧 no significant differences in serious adverse events, including air embolism
🚨 transmembrane pressure + CRRT machine alarm frequencies similar
#FOAMcc
🔓 https://t.co/SZ0y6Yx0Me

[JAMA @JAMA_current]

Among patients with early #SepticShock, a personalized hemodynamic resuscitation protocol targeting capillary refill time was superior to usual care for the primary composite outcome, primarily driven by a lower duration of vital support.

#LIVES2025 @ESICM

https://t.co/UQH5mSw8Ty

[Kevin Fay @TheKFay]

@ThinkingCC @NephroP Here's the IVC of my brother, an avid hurler, from just the other day.

[Kevin Fay @TheKFay]

@IM_Crit_ It actually is pseudohyperbocarbonatemia. Other possibility is hyperlipid/hypertriglyceridemia. Doubt monoclonal gammopathy -- no protein gap and hypocalcemic anyways.

I'd have to lit search to find alt. Reason. (Rhabdo or very high LDH can also cause this -- different mech.).

[Kevin Fay @TheKFay]

@IM_Crit_ Can you post a blood gas, LDH, and CPK?

[Kevin Fay @TheKFay]

@cgaibor102 @PoojaJagadishMD @drjohnm The avg. pt on HD has 19 pills/day. there is evidence of increased rates of adverse effects from statins. Don't force pills when (good) evidence says not to. Uremia in general lowers LDL. They have more calcific dz and hyperTG. They are different from pts with functioning kidneys

[Kevin Fay @TheKFay]

@cgaibor102 @PoojaJagadishMD @drjohnm I agree with you about transplant but that's just opinion. There is observational data that patients who were on a statin prior to transplant have fewer CV events, and they will be prescribed a statin regardless after transplant.

[Kevin Fay @TheKFay]

@NephroSeeker @giovannilandoni @NephJC This is my point. If 2 groups, and 1 got a drug that lowers Cr, I'd expect at least some mathematical analysis of how the lower Cr after surgery compares to expectation from drug effect. Without that the trial seems of low value to me, and even with -- not a "randomized trial."

[Kevin Fay @TheKFay]

His serum sodium is 149 mmol/L. You prescribe iHD with a predicted Kt/V of 1.0 against a dialysate sodium of 138 mmol/L.

Ignoring Gibbs-Donnan, what would be the predicted loss of plasma volume l, if any. Would you proceed or adjust your prescription?
#nephrotwitter @PennKidney

[Kevin Fay @TheKFay]

Dialysis problem: 64M cirrhosis with high cardiac output state, HRS now on KRT awaiting SLK. Recently resuscitated for UGIB with hemorrhagic shock now 1+d without bleeding. VStable vitals on room air A+Ox3. Diarrhea from lactose. You decide not to remove fluid and to trial iHD.

[Kevin Fay @TheKFay]

@kidney_boy Tenet:

AI men. A level anemia.

[AC Gomez @MedPEEdsKidneys]

Recommending a lasix stress test be like
#nephrology #nephtwitter #fellowshiplife

[Kevin Fay @TheKFay]

@UVoverP @Aha @KidneyInCVD Congrats, Arun!

[Kevin Fay @TheKFay]

@acweyand Nephrologist. We routinely get iron studies. Earlier this year I set up a patient for IV iron and, no joke, when our office visit was over and we were about to say goodbye she says, "Oh yeah I was meaning to ask you... Lately I can't stop eating baking soda right out of the box."

[Kevin Fay @TheKFay]

@WilliamAird4 As the proud husband of a veterinarian I am peppered every day with amazing things that non-human animals (and their spleens) can do that we cannot.

[Kevin Fay @TheKFay]

@MichaelToal6 @dochill82 @DamianFog Standard.

[Kevin Fay @TheKFay]

@kidney_boy Is this in response to this? https://t.co/fy00kG1oV7

[Critical Care @Crit_Care]

#CritCare #OpenAccess

Identification of an optimal threshold to define oliguria in critically ill patients

Read the full article: https://t.co/4msRdcWZYY

@jlvincen @ISICEM #FOAMed #FOAMcc

[Kevin Fay @TheKFay]

@captainchloride @thecurbsiders Is the HF observation a dosing issue? The starting dose is 12.5 mg for that indication (even in the pediatric literature it's 1 mg/kg starting dose. I don't have many 12.5 kg patients these days). And in general, at most HF wind up on half the doses seen in cirrhosis at most.