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# Weekly · Oct 20: Intermittent or Continuous Dialysis in the ICU, Fluid Creep, Deprescribing and the Dialysis Bike
- URL: https://nephspace.com/weekly-oct-20/
- Published: 2026-10-20T15:14:47.000Z
- Updated: 2026-10-20T15:14:47.000Z
- Description: Your weekly digest: the ICU dialysis trial that stopped early, where ICU fluid really comes from, and a bike in the dialysis chair.
- Author: Dr Wael Hussein
- Tags: Episodes, AKI and critical care, Dialysis, #weekly, #has-audio, #tr-5b949230

For years, most of us thought it didn't matter whether critically ill patients started on intermittent hemodialysis or continuous therapy. In the ICRAKI trial, starting on intermittent hemodialysis was linked to more deaths, and the trial stopped early. We explain why the size of that gap is uncertain, but its direction is harm, and why the trial couldn't show that intermittent was no worse. A JAMA study follows last week's fluids-or-pressors thread: resuscitation was only about one liter in six of ICU fluid, with maintenance and the fluid that comes in with drugs making up most of the rest. Then the dialysis unit: how hard it is to deprescribe gabapentin and other risky medications, pedaling on the dialysis bike, and what a new fistula asks of the heart.

**Disclosure:** Dr. Hussein serves on the Fresenius Medical Care US Home Medical Advisory Board. The exercise segment discusses a study of an exercise program implemented in Portuguese dialysis units with support from NephroCare, the clinic network of Fresenius Medical Care; two authors are affiliated with NephroCare, and outcome data came from Fresenius's clinical database. The segment also mentions hemodiafiltration, which Fresenius sells. Dr. Hussein also wrote the Healio Perspective on the deprescribing study discussed in this episode.

## Chapters

- **01:27** Intermittent or continuous dialysis in the ICU · [Read the story](https://nephspace.com/icraki-intermittent-continuous-dialysis-icu/)
- **08:00** Where ICU fluid comes from · [Read the story](https://nephspace.com/profluid-icu-fluid-creep-maintenance/)
- **10:38** Deprescribing on dialysis · [Read the story](https://nephspace.com/deprescribing-hemodialysis-improved-feasibility/)
- **14:59** Exercise on the dialysis bike · [Read the story](https://nephspace.com/intradialytic-exercise-dose-mortality/)
- **19:24** The fistula and the heart · [Read the story](https://nephspace.com/fistula-cardiac-output-ntprobnp/)

## Papers in this episode

- Gaudry S, Boubaya M, Louis G, et al., for the ICRAKI Trial Group. Intermittent or Continuous Renal-Replacement Therapy in Acute Kidney Injury. N Engl J Med. Published online October 14, 2026\. [Link](https://doi.org/10.1056/NEJMoa2608397?ref=nephspace.com)
- Palevsky PM. Continuous or Intermittent Renal-Replacement Therapy — What Is the Question? N Engl J Med. Published online October 14, 2026 (editorial). [Link](https://doi.org/10.1056/NEJMe2612910?ref=nephspace.com)
- Blok SG, de Grooth HJ, Pisani L, et al., for the PRoFLUID Investigators. Fluid Therapy in Mechanically Ventilated Critically Ill Adult Patients. JAMA. Published online October 14, 2026\. [Link](https://doi.org/10.1001/jama.2026.21291?ref=nephspace.com)
- Hall R, Rutledge J, Alvarado H, et al. Intervention to Manage and Prevent Overuse of Potentially Inappropriate Medications in Dialysis (IMPROVED): A Feasibility Study. Kidney360\. Published ahead of print 2026\. [Link](https://doi.org/10.34067/KID.0000001285?ref=nephspace.com)
- Manley HJ, Li NC, Born S, et al. Medication Burden and Regimen Complexity among Dialysis Patients from 2003 to 2024\. Clin J Am Soc Nephrol. 2026;21(9):1575-1583\. [Link](https://doi.org/10.2215/CJN.0000001114?ref=nephspace.com)
- Martins PM, Leal DV, Ferreira AA, Wilund KR, Viana JL. Association of Intradialytic Exercise With Mortality and Hospitalization: A Cohort Study. Kidney Med. Published online October 9, 2026 (article in press). [Link](https://doi.org/10.1016/j.xkme.2026.101570?ref=nephspace.com)
- Shah NA, Thomas R, Thomas SD, et al. The Proof is in the Peptide: Baseline NT-proBNP and Cardiac Output Responses at AVF Maturation in Hemodialysis Patients. Kidney Med. Published online October 13, 2026 (article in press). [Link](https://doi.org/10.1016/j.xkme.2026.101580?ref=nephspace.com)

**Also mentioned:** Healio, October 14, 2026: Deprescribing for older adults on hemodialysis feasible; but challenges remain, with a Perspective by Dr. Wael Hussein. [Link](https://www.healio.com/news/nephrology/20261014/deprescribing-for-older-adults-on-hemodialysis-feasible-but-challenges-remain?ref=nephspace.com)

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*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](https://nephspace.com/disclaimer/). Views are the creator's own and not those of his employer. No sponsors.*