Episodes

Weekly · Oct 12: Fluids or Pressors, ICU Bicarbonate and What's Holding Back PD

Your weekly digest: fluids or pressors for septic shock, bicarbonate at 2 a.m., and what's really holding back PD.

Dr Wael Hussein

— 2 min read
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Three reflexes worth rethinking. In septic shock in the emergency department, stopping the fluid and starting the vasopressor early showed no difference in days alive and out of the hospital compared with the classic fluids-first approach, with about half the extra fluid. In a blinded ICU trial, sodium bicarbonate for metabolic acidosis in shock fixed the blood gas but did not significantly lower death, dialysis or lasting kidney damage. And a review of 13 interview studies asks why so few patients start peritoneal dialysis. Each with what's new, the caveats and what it means on Monday.

Disclosure: Dr. Hussein serves on the Fresenius Medical Care US Home Medical Advisory Board; Fresenius sells peritoneal dialysis equipment. The PD segment includes our take on US payment for staff-assisted home dialysis and a bill in Congress. One author of an ASN Kidney News viewpoint discussed in the bicarbonate segment, Dr. Lenar Yessayan, reports a seat on a Fresenius Medical Care medical advisory board (the authors' own disclosure).

Chapters

Papers in this episode

  • The ARISE FLUIDS Investigators and the ANZICS Clinical Trials Group and ACEM Clinical Trials Network. Vasopressors or Fluids in Early Septic Shock. N Engl J Med 2026;395:1387-1398. Link
  • The SODa-BIC Investigators and the ANZICS Clinical Trials Group. Sodium Bicarbonate for Critically Ill Adults with Metabolic Acidosis and Shock. N Engl J Med 2026;395:1062-1074. Link
  • Ostermann M, Cook DJ. Sodium Bicarbonate in Critical Illness — A New Chapter for the Book. N Engl J Med 2026;395 (editorial). Link
  • Sette L. A Better Blood Gas but Not a Better Outcome: Rethinking Bicarbonate in the ICU. Kidney News 2026;18(10/11):59. Link
  • Teixeira JP, Yessayan L, Tolwani A. Intravenous Bicarbonate for Metabolic Acidosis in the ICU: Improving Outcomes or Just Fixing Numbers? Kidney News 2026;18(10/11):60-61. Link
  • Shankar R, et al. Barriers to and Facilitators of the Adoption of Peritoneal Dialysis: A Systematic Review of Qualitative Studies. Am J Kidney Dis 2026 (articles in press). Link

Also mentioned: H.R. 8875, Improving Home Dialysis Act of 2026 (119th Congress), mentioned in the PD segment. Link

Listen anywhere: Apple Podcasts · Spotify · other apps. Discuss: NephSpace on LinkedIn.

Physician-led, AI-assisted. Dr. Wael Hussein chooses the papers, reviews and edits every script, and approves every episode. AI (Claude, by Anthropic) writes the first draft from the full text of each paper, and a separate AI check compares every number with the papers; Dr. Hussein then reviews and edits the draft before the AI hosts (ElevenLabs) voice it. Everything is summarized in our own words. For education and information only, not medical advice. Please talk to your own physician or care team about your health. Clinicians: read the original before changing practice. See our disclaimer. Views are the creator's own and not those of his employer. No sponsors.

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