Tuesday, May 14, 2013

NKF posts total dreck on alcohol and the kidney

So bad you need to read it to believe it. The NKF has this ask the doctor article by
Look at all those paper charts! How 2007 of you.
Dr Spry on the effects of alcohol on the kidney.

His first point is that drinking alcohol suppresses ADH. You know what other beverage suppresses ADH? All of them. Because that's what drinking does. Alcohol may have some aditional ADH suppressing property but it is not clinically relevent because being drunk doesn't cause hypernatremia.

Here is what UpToDate has to say about the electrolyte abnormalities of alcohol:

So beyond some increase in thirst from the suppression of ADH, this is a side show.

Then Spry confuses that point by saying that drinking beer to excess can cause hyponatremia as part of beer drinkers potomania (BTW: Best name for a disease ever). To say that beer-drinkers potomania is a consequence of alcohol misses the point, the disease comes from a bizarre diet that is void of protein and salt. These people exist on carbohydrates alone.

Then he mentions that excessive drinking can cause high blood pressure, but fails to mention that not drinking is associated with increased mortality, in fact being a teetotaler has the same relative risk of death as drinking a sixer every night. Seems like an important omission.

For some more on this crazy phenomenon see this post or this one

Regarding his next point, I'm speechless:
Alcohol can also cause significant drug interactions with medication that you are taking for chronic kidney disease (CKD) and lead to complications with the drugs that you are taking.

What CKD drug interacts with alcohol? Am I an idiot (likely) or is he just making shit up?

How can some one spend almost two thirds of a short essay talking about irrelevent (suppression of ADH) or seldom seen (beer drinkers potomania) sodium abnormalities but fail to even mention what any internal medicine intern knows are are the most common electrolyte abnormalities of alcoholism:
  • hypokalemia
  • hypomagnesemia
  • hypophosphatemia
These are common and have real patient consequences.

Thank-god his final sentence has some wisdom, god knows the rest of the post is crap.

Drinking alcohol to excess can also lead to liver disease which could cause serious complications with underlying CKD.

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