Debates in AKI

The meeting got off to a rousing start this morning with an epic matchup: Claudio Ronco took on challenger Steven Coca on the issue of whether a rise in serum creatinine is (Ronco) or is not (Coca) a bad thing in acute decompensated heart failure.  Dr. Ronco presented a convincing case that rising creatinine is not just ‘pre-renal’ azotemia any more, but is rather a conflagration of insults, hormonal perturbations, and inflammation that portends real damage rather than hemodynamic fluctuation.  Dr. Coca took the stage, armed with data and chutzpah, to show that perhaps the rise in creatinine we see in ADHF is in fact a mark of ‘acute renal success’ rather than of acute renal failure — that for many people in whom this occurs it is because of beneficial therapeutic manipuations (diuretics, ACE, decongestion) rather than an innate deterioriation of function.  People who are successfully decongested and have a rise in creatinine in that setting (and other evidence of volume removal) do better than those who are not decongested (and who, not coincidentally, do not have a rise in creatinine).

The audience was on the edge of its seat as the votes were taken — while 10% initially favored Dr. Coca’s point of view, more than 25% did at the end.  Statistically and clinically significant?  Did David conquer Goliath, and will patients benefit in the end?  You decide.

Check out more eAJKD coverage of the NKF’s 2014 Spring Clinical Meetings!