Need more trials! Extra amino acids were 'good' for kidneys in the PROTECTION trial, but not really relevant in this population. I've heard nutritionists/intensivists cite the need for more protein to support wound healing, but not sure if there's any data. #NephJC

We are not as low-resource as before, but still, this rhythm of doing dialysis thrice weekly seems unsustainable, and very high cost for the health care system #nephjc

Agree, though I always wonder if there's some benefit to the high protein tube feeds, in which case we should just ignore the BUN and continue them. #NephJC

We think of it as 'playing it safe' but if it leads to less recovery, the effect on long-term mortality may be 'less safe,' though this is not addressed by this study. #NephJC

Point being that while the curves separate early, recovery was not apparent at randomization in either group (e.g., median urine output on day before randomization < 260 cc). #NephJC

I may have missed Table 1 being presented, but I want to highlight a few misunderstandings in the nephJC write-up: >80% of patients were in the ICU before randomization, >50% had been on mechanical ventilation prior to randomization, 14% had tracheostomies at randomization. Sick population. #NephJC

Most clinicians found them too risky/didn't wait for them - hence clinician judgement was the most common indication for RRT. #NephJC

Those who died were assigned 0 dialysis-free days, even if they came off dialysis before day 28. #NephJC

The 'clinician judgment' was a necessary safety valve for recruitment (much harder to get a primary team to agree if they have to give up control completely). With this we had inclusion of cardiac surgery and other teams with strong opinions on dialysis frequency. #NephJC

The trial took place at 4 centers over 5 years and only half randomized to intervention arm so it was rare to have more than 1 patient on protocol at a time = not a big effect on dialysis nursing/scheduling. #NephJC

Definitely an added workload for both the nephrologist and the HD RNs planning each day's dialysis schedule. #NephJC

Love the kidney chained to the machine! 😂 #NephJC

Hi! I'm a nephrologist and clinical researcher at UCSF.

COI: I was one of the LIBERATE-D investigators at the UCSF site.

I made a BlueSky account today to join this discussion. #NephJC