On 2015 Jun 18, NephJC - Nephrology Journal Club commented:

This study, along with another study in the same area, was discussed on May 27th and June 3rd 2015 in the open online nephrology journal club, #NephJC, on twitter.

Introductory comments are available at the NephJC website. The discussion was quite animated, with more than 50 participants, including nephrologists, fellows and residents.

A transcript and a curated (i.e. Storified) version of the tweetchat are available at the NephJC website.

The highlights of the tweetchat were:

• The participants thought true diuretic resistance requires higher doses and correct combinations of diuretics (e.g. furosemide, metolazone and spironolactone), and were hence not convinced with the data presented. Similar concerns were expressed about the severity of heart failure, and the low rate of device usage (e.g. defibrillators)

• Given the negative outcomes from a similar trial with ultrafiltration, CARESS-HF, the discussants were not impressed with the hypothetical increased sodium removal compared with diuresis.

• However, there was unanimity that peritoneal dialysis is a promising approach, and that this should be tested in a properly designed randomized trial. There was much discussion around possible inclusion criteria, comparators (standard care or left ventricular assist devices) and feasibility of arranging peritoneal dialysis. One such trial is already underway in UK and those results will be keenly followed.

Interested individuals can track and join in the conversation by following @NephJC or #NephJC, or visit the webpage at NephJC.com.

On 2015 Jun 18, NephJC - Nephrology Journal Club commented:

This study, along with another study in the same area, was discussed on May 27th and June 3rd 2015 in the open online nephrology journal club, #NephJC, on twitter.

Introductory comments are available at the NephJC website. The discussion was quite animated, with more than 50 participants, including nephrologists, fellows and residents.

A transcript and a curated (i.e. Storified) version of the tweetchat are available at the NephJC website.

The highlights of the tweetchat were:

• The participants thought true diuretic resistance requires higher doses and correct combinations of diuretics (e.g. furosemide, metolazone and spironolactone), and were hence not convinced with the data presented. Similar concerns were expressed about the severity of heart failure, and the low rate of device usage (e.g. defibrillators)

• Given the negative outcomes from a similar trial with ultrafiltration, CARESS-HF, the discussants were not impressed with the hypothetical increased sodium removal compared with diuresis.

• However, there was unanimity that peritoneal dialysis is a promising approach, and that this should be tested in a properly designed randomized trial. There was much discussion around possible inclusion criteria, comparators (standard care or left ventricular assist devices) and feasibility of arranging peritoneal dialysis. One such trial is already underway in UK and those results will be keenly followed.

Interested individuals can track and join in the conversation by following @NephJC or #NephJC, or visit the webpage at NephJC.com.