@askrenal @NephJC @CharlesHallMD Much of that fear comes from this 1983 paper on #CKD https://t.co/TPb4Qfm4O4, but let’s not forget that #acidosis decreases the CNS threshold to the toxic effects of local anesthetics —#Bupivacaine—as stated here https://t.co/I3GDh4RBid hence the reason to limit dosing https://t.co/vUjdYS4v9B