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Wael Hussein

@waelhussein.bsky.social
890 followers 171 following 200 posts

Nephrologist. Informatics and data analysis enthusiast. #MedSky #NephSky

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Wael Hussein @waelhussein.bsky.social · 1h
Timely. On this week's NephSpace we asked whether bicarbonate at 2 a.m. treats the patient or the number, with SODa-BIC, the NEJM editorial and two ASN Kidney News viewpoints 🎧 nephspace.com/soda-bic-bicarbonate-icu-acidosis/
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Wael Hussein @waelhussein.bsky.social · 2h
You order net zero UF for CRRT. One assessment in the morning. ICU team orders a NS bolus to help with the BP. Nurse pulls it out the next hour. #AskRenal what do you do to avoid this? I’m trying to figure out a practical solution.
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Reposted by Wael Hussein
NephSpace @nephspace.bsky.social · 12/10/2026
New NephSpace weekly 🎧 Septic shock, pressure still low after a liter: more fluid, or start the pressor? ARISE FLUIDS (NEJM) put both paths to the test. Which group did better? Plus: bicarbonate at 2 a.m., and what's holding back PD. nephspace.com
NephSpace Weekly, October 12: Fluids or pressors, ICU bicarbonate and what's holding back PD.
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Wael Hussein @waelhussein.bsky.social · 12/10/2026
Love the Pollan line. On this week's NephSpace we took ARISE FLUIDS to the renal consult: after the first liter, does more fluid change who ends up on dialysis? 🎧 nephspace.com/arise-fluids-vasopressors-septic-shock/
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Wael Hussein @waelhussein.bsky.social · 12/10/2026
No, not a lab error
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Wael Hussein @waelhussein.bsky.social · 19/09/2026
Let’s be clear. The machine only rewards physicians for wRVUs. No meaningful recognition for self audit, quality improvement, teaching, or any deviation from the **see more bill more system**. Painful 😣
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Wael Hussein @waelhussein.bsky.social · 17/09/2026
Weighing scale app: need access to my full health info and now adding a monthly subscription. Vizio external speakers now has something with Walmart and requesting a subscription for god knows what. Stop the madness!
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Wael Hussein @waelhussein.bsky.social · 11/09/2026
Let me charge you more for the doctor visit you scheduled last minute. No other doctors available? Higher bill then. Oh, you want to sit? Extra fee. Let’s start with all those in the airlines business/ hotels/ apartment rentals. Who else wants this? #dynamic_pricing greed!
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Wael Hussein @waelhussein.bsky.social · 11/09/2026
Billing! Tell me your BP didn't go up! Some surveys estimate a physician spends more than 7 hrs/wk on billing. A 2018 JAMA article: 5 mins/ inpt visit. I'd rather spend that time on teaching, learning something new, or improving the service.
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Wael Hussein @waelhussein.bsky.social · 02/09/2026
I swear to God if EHR designers, healthcare admins, and policy makers were seeing patients, these systems would not be as crappy. Nothing is optimized for a streamlined physician experience. Can’t wait for new systems to shake their control.
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Wael Hussein @waelhussein.bsky.social · 30/08/2026
Patient with CKD, eGFR 7, declines dialysis. Let’s see what her kidney function has been doing… eGFR ranging between 5 and 8 since late 2023! Way to go, kidneys!
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Wael Hussein @waelhussein.bsky.social · 06/05/2026
40. Sickle. Lupus. ESKD on HD. Avascular necrosis, multiple joint replacements, recurrent infections. Many patients have it tough. Life can be brutal. Count your blessings.
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Wael Hussein @waelhussein.bsky.social · 23/04/2026
Help me out here. Why on earth do we have these two conditions when the second encapsulates the first? Can you have 3 events in 12 month without 2 of them being within a span of 6 months??!! #askrenal
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Wael Hussein @waelhussein.bsky.social · 03/04/2026
Why? Just why? When the main difference is the K, who decided this labeling?! #FreseniusPureFlow
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Wael Hussein @waelhussein.bsky.social · 26/03/2026
For a self-pay patient, this is followed by adjustments that brings the balance down to a couple of thousands. For patients with insurance, there are contractual adjustments. Well, if they are not real by any stretch (and they're very stretched!!), why have these prices?? Terrible system!
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Wael Hussein @waelhussein.bsky.social · 26/03/2026
A visit to the emergency room. Sit before you look at this:
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Wael Hussein @waelhussein.bsky.social · 01/03/2026
Did it fully reverse both times? I’m curious about these cases and I think we should discuss them more. However, when it’s not easy to check or it causes inertia, requiring that check is harmful. (I think)
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Wael Hussein @waelhussein.bsky.social · 01/03/2026
Requiring a test 2-3 weeks after starting an SGLT2i and then dealing with the (expected yet surprising!!) eGFR drop -> underprescription and unnecessary discontinuation. Checking should be limited (high risk eg vol issues or if symptoms). What guidance can we give our trainees? #askrenal
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Wael Hussein @waelhussein.bsky.social · 01/03/2026
Do you check labs after starting SGLT2i in CKD patients? What % of pts drop eGFR >30% after starting SGLT2i? What are the usual causes if that happens? Do you know of any studies that specifically looked at that? @askrenal.bsky.social #flozinators
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Wael Hussein @waelhussein.bsky.social · 22/01/2026
- y do u want to put me on januvia after my pcp stopped it? - It'll slow down ur dis.. (explaining and discussing) - yeah, but my pcp stopped it because of my kidney numbers. - Yes, and I'm ur kidney specialist (another round of explaining). - but my pcp said it was bad for my kidneys.. Me: 😭
media.tenor.com
a man is carrying a suitcase through a living room in a house .
ALT: a man is carrying a suitcase through a living room in a house .
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Wael Hussein @waelhussein.bsky.social · 15/01/2026
Patient was told to reduce his work hours so his lower income qualifies him for savings on health insurance. Ends up with more money if he works less. How ironic! Not a US-only problem. Seen it in Europe too.
media.tenor.com
a bald man wearing a plaid shirt and a black vest
ALT: a bald man wearing a plaid shirt and a black vest
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Wael Hussein @waelhussein.bsky.social · 12/01/2026
Gosh that will be painful! Only want the info available at the visit to assess the rate of decline of kidney fx. In this era, however, electronic systems should provide patients with far more individualized, meaningful info - not just numbers. I bet this wish is coming soon.
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Wael Hussein @waelhussein.bsky.social · 12/01/2026
I always struggle with how to judge GFR decline in individual patients. If I had a wish, it would be to have weekly measurements between clinic visits. Without needles. And without lab trips. Does that still count as one wish?! #NephroWishList
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Wael Hussein @waelhussein.bsky.social · 11/01/2026
Guidance: Be comfortable with short-term eGFR swings. Act only on *sustained* changes. Otherwise you are treating biological variability, not disease. *And always correlate with the clinical picture *
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Wael Hussein @waelhussein.bsky.social · 11/01/2026
At Cr = 2.0, a 5% CV = ±0.10 mg/dL noise. That normal scatter alone produces Cr 1.8–2.2, exactly the range creating our 42 - 33 eGFR swing. This small creatinine noise becomes a 7–9 mL/min eGFR illusion of progression or recovery.
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Wael Hussein @waelhussein.bsky.social · 11/01/2026
This study measured short-term variability in stable CKD. Most patients had within-person creatinine CV ~3–7% over <4 weeks. pmc.ncbi.nlm.nih.gov/articles/PMC...
pmc.ncbi.nlm.nih.gov
Biological Variability of Estimated GFR and Albuminuria in CKD
Determining whether a change in estimated glomerular filtration rate (eGFR) or albuminuria is clinically significant requires knowledge of short-term within-person variability of the measurements, which few studies have addressed in the setting of ...
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Wael Hussein @waelhussein.bsky.social · 11/01/2026
Using CKD-EPI 2021: Cr 1.8 → eGFR 42 Cr 2.0 → 37 Cr 2.2 → 33 So a trivial 0.2 mg/dL creatinine change shifts eGFR by ~5 mL/min.
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Wael Hussein @waelhussein.bsky.social · 11/01/2026
Noise or signal? eGFR fluctuating from 42 - 33 mL/min over a few weeks in a *stable* 57-yo man (Cr ~2.0): biological noise or reason to worry? 🧵⬇️
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Wael Hussein @waelhussein.bsky.social · 01/01/2026
Can’t get more surprising!
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Wael Hussein @waelhussein.bsky.social · 14/11/2025
Me leaving the clinic with all notes completed and signed- thanks to AI scribe:
media.tenor.com
a man in an orange suit is dancing in a room
ALT: a man in an orange suit is dancing in a room
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Reposted by Wael Hussein
Joel Topf @kidneyboy.bsky.social · 24/10/2025
Sing it brother!
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Wael Hussein @waelhussein.bsky.social · 02/10/2025
Humans: - Taking my job? ----- I hate AI!😡 - Helping me get rid of another human when doing something? ----- I love AI!🥰 We are doomed!! www.msn.com/en-us/health...
msn.com
MSN
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Wael Hussein @waelhussein.bsky.social · 28/09/2025
The recipe includes: trust, incentives, visible early adopters, and leadership. Innovation only starts at invention. Adoption is the next main component. How many clever solutions do you know that need a push towards adoption? Here is the JAMA article again: pubmed.ncbi.nlm.nih.gov/12697800/
pubmed.ncbi.nlm.nih.gov
Disseminating innovations in health care - PubMed
Health care is rich in evidence-based innovations, yet even when such innovations are implemented successfully in one location, they often disseminate slowly-if at all. Diffusion of innovations is a m...
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Wael Hussein @waelhussein.bsky.social · 28/09/2025
The lesson? Discovery is only half the battle. Without systems that support diffusion, life-saving interventions stay stuck in labs and journals instead of reaching patients.
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Wael Hussein @waelhussein.bsky.social · 28/09/2025
In healthcare today, effective interventions (drugs, vaccines, care models) take DECADES to become routine. Innovation diffuses slowly even when the benefits seem obvious.
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Wael Hussein @waelhussein.bsky.social · 28/09/2025
"To introduce any new article of food among seamen... requires both the EXAMPLES and the authority of a Commander." - Captain James Cook. LEADERSHIP DRIVES DIFFUSION!
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Wael Hussein @waelhussein.bsky.social · 28/09/2025
EVIDENCE ALONE IS NOT ENOUGH! Adoption required authority, leadership, and culture change. Cook saw this and he benefited from the immediate application for himself and his crews.
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Wael Hussein @waelhussein.bsky.social · 28/09/2025
However, it wasn't until 1865 - 264 yrs after Lancaster, that the British Board of Trade required merchant ships to follow suit. Two and a half centuries from proof to policy!!! So why so slow?? 😵‍💫
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Wael Hussein @waelhussein.bsky.social · 28/09/2025
It took 48 more years for the British Navy to officially issue citrus rations. Scurvy nearly disappeared from its fleets.
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Wael Hussein @waelhussein.bsky.social · 28/09/2025
Year: 1747 (146 years later!) James Lind repeated the test aboard HMS Salisbury. Again, citrus worked!! Now, there should be immediate adoption, right? Again, not even close!!😢
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Wael Hussein @waelhussein.bsky.social · 28/09/2025
Year: 1601. Nobody knows about vitamin C at that time. Captain James Lancaster tested lemon juice at sea. 👉 His sailors remained healthy. 🎉💪 👉 All while almost HALF the crews on other ships died of scurvy.💀 You'd expect immediate adoption? Not even close. The Navy ignored it.
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Wael Hussein @waelhussein.bsky.social · 28/09/2025
A fascinating story about prevention of scurvy shows how it can take CENTURIES between discovery and practice. Meanwhile, there will be winners and losers. Here is the story and some valuable lessons. A thread 🧵 below. doi.org/10.1001/jama...
doi.org
Disseminating Innovations in Health Care
Health care is rich in evidence-based innovations, yet even when such innovations are implemented successfully in one location, they often disseminate slowly—if at all. Diffusion of innovations is a m...
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Wael Hussein @waelhussein.bsky.social · 03/09/2025
15 L interdialytic wt gain. Record? Pt was trying to beat nausea with chips and water.
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Wael Hussein @waelhussein.bsky.social · 02/09/2025
How are our patients dealing with these tremendous costs? Do you have ppl in ur clinic to help pts obtain these medicines at an affordable cost? Source: Primer on Diabetes Management www.vumedi.com/video/primer...
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Reposted by Wael Hussein
American Journal of Kidney Diseases @ajkd.bsky.social · 03/08/2025
In case you missed it on the #AJKDBlog: AJKDBlog Interviews Editor Timothy Yau caught up with Dr. Subhash Chander to discuss if urea is effective for managing SIADH-induced hyponatremia. bit.ly/ChanderBlog25 (FREE)
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Wael Hussein @waelhussein.bsky.social · 25/07/2025
Do u have a local policy for picc- and mid-lines for pts with renal impairment? 🧭 Any simple algorithm that can be shared with other specialties? ⛔️ “Has to be discussed with nephrology” is a battle- we r the bad people who r inconsiderate of realities of the pt’s (immediate) care! #askrenal
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Wael Hussein @waelhussein.bsky.social · 23/07/2025
a good biomarker of what? 😊 Diet? Inflammation? Liver disease? Kidney disease? (Example etiologies) High risk patients for mortality or other poor outcomes? (outcomes) Not good as in non specific: yes. But good as gold as risk marker.
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Wael Hussein @waelhussein.bsky.social · 22/07/2025
⚠️ Calciphylaxis is a debilitating and painful condition that is hard to treat. ▶️ Do you use daily dialysis as part of treatment? If so, what criteria do you use? #askrenal pubmed.ncbi.nlm.nih.gov/21872378/ doi.org/10.1093/ndt/...
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Wael Hussein @waelhussein.bsky.social · 20/07/2025
*screaming
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Wael Hussein @waelhussein.bsky.social · 20/07/2025
I once witnessed a cardiothoracic surgeon (aka God) SCREENING in ICU: “I WANT DIALYSIS” for a patient after he was told nephrology suggested a different plan. 😬😟
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