NephJC covered the most important manuscripts in nephrology for over ten years. With a decade of history, NephJC has covered a significant amount of the evidence used in day-to-day clinical care. Many of us find ourselves repeatedly sending links to old NephJC summaries. NephJC Rewind is an attempt to resurface some of these older yet still relevant summaries.
Last week I tweeted about this year old trial of dapa versus metolazone in diuretic resistant fluid overload.
Here is the “visual abstract” from the journal for the trial
The tweet triggered a lot of interesting commentary, but I was struck by this post in particular
We covered the ADVOR trial when it was published in 2022. I think a critical difference between ADVOR and the above trial of dapa v metolazone is that ADVOR added acetazolamide to furosemide and compared it to furosemide plus placebo. The title of the ten-tweet-NephJC got it right “More Diuretics = More Diuresis.” ADVOR pitted a diuretic against placebo and found that adding more diuretic got more diuresis (and natriuresis).
It is interesting that the decongestion score developed for ADVOR was used in this dapa v metolazone trial also. Listen to the Freely Filtered Episode for a breakdown of why The Filtrate found this score problematic.
How often are you able to clear pleural effusions and ascites in three days of diuresis?
Regardless of the concerns some had about the ADVOR trial, it is clear it has changed practice patterns and expanded peoples conception of sequential nephron blockade beyond the convoluted tubule.
