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Chong NJ, Yamamoto S, Wong RCC. Treatment for hyperkalaemia in heart failure: a network meta-analysis. Hippokratia 2021. [DOI: 10.1002/14651858.cd014770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Shuhei Yamamoto
- Department of Rehabilitation; Shinshu University Hospital; Matsumoto Japan
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Abstract
Hyperkalaemia has become an increasingly prevalent finding in patients with heart failure (HF), especially with renin–angiotensin–aldosterone system (RAAS) inhibitors and angiotensin–neprilysin inhibitors being the cornerstone of medical therapy. Patients living with HF often have other comorbidities, such as diabetes and chronic kidney disease, which predispose to hyperkalaemia. Until now, we have not had any reliable or tolerable therapies for the treatment of hyperkalaemia to facilitate implementation or achievement of target doses of RAAS inhibition. Patiromer sorbitex calcium and sodium zirconium cyclosilicate are two novel potassium-binding resins that have shown promise in the management of patients predisposed to developing recurrent hyperkalaemia, and their use may allow for further optimisation of guideline directed medical therapy.
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Affiliation(s)
- Umar Ismail
- Section of Cardiology, Max Rady College of Medicine, University of Manitoba Winnipeg, Manitoba, Canada
| | - Kiran Sidhu
- Section of Cardiology, Max Rady College of Medicine, University of Manitoba Winnipeg, Manitoba, Canada
| | - Shelley Zieroth
- Section of Cardiology, Max Rady College of Medicine, University of Manitoba Winnipeg, Manitoba, Canada
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Frenkel A, Hassan L, Segal A, Israeli A, Binyamin Y, Zlotnik A, Novack V, Klein M. Estimation of Potassium Changes Following Potassium Supplements in Hypokalemic Critically Ill Adult Patients-A Patient Personalized Practical Treatment Formula. J Clin Med 2021; 10:jcm10091986. [PMID: 34063164 PMCID: PMC8125284 DOI: 10.3390/jcm10091986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/16/2021] [Accepted: 04/29/2021] [Indexed: 10/29/2022] Open
Abstract
Hypokalemia is common among critically ill patients. Parenteral correction of hyperkalemia depends on dosages and patient characteristics. Our aims were to assess changes in potassium levels following parenteral administration, and to derive a formula for predicting rises in serum potassium based on patient characteristics. We conducted a population-based retrospective cohort study of adults hospitalized in a general intensive care unit for 24 h or more between December 2006 and December 2017, with hypokalemia. The primary exposures were absolute cumulative intravenous doses of 20, 40, 60 or 80 mEq potassium supplement. Adjusted linear mixed models were used to estimate changes in serum potassium. Of 683 patients, 422 had mild and 261 moderate hypokalemia (serum potassium 3.0-3.5 mEq/L and 2.5-2.99 mEq, respectively). Following doses of 20-80 mEq potassium, serum potassium levels rose by a mean 0.27 (±0.4) mEq/L and 0.45 (±0.54) mEq/L in patients with mild and moderate hypokalemia, respectively. Changes were associated with creatinine level, and the use of mechanical ventilation and vasopressors. Among critically ill patients with mild to moderate hypokalemia, increases in serum potassium after intravenous potassium supplement are influenced by several clinical parameters. We generated a formula to predict the expected rise in serum potassium based on clinical parameters.
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Affiliation(s)
- Amit Frenkel
- General Intensive Care Unit, Soroka University Medical Center, Beer-Sheva 8410101, Israel;
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel; (Y.B.); (A.Z.); (V.N.)
- Correspondence: ; Tel.: +972-8-640-0727; Fax: +972-8-640-3390
| | - Lior Hassan
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva 8410101, Israel; (L.H.); (A.S.); (A.I.)
- The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel
| | - Adi Segal
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva 8410101, Israel; (L.H.); (A.S.); (A.I.)
- The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel
| | - Adir Israeli
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva 8410101, Israel; (L.H.); (A.S.); (A.I.)
- The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel
| | - Yair Binyamin
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel; (Y.B.); (A.Z.); (V.N.)
- Department of Anesthesiology, Soroka University Medical Center, Beer-Sheva 8410101, Israel
| | - Alexander Zlotnik
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel; (Y.B.); (A.Z.); (V.N.)
- Department of Anesthesiology, Soroka University Medical Center, Beer-Sheva 8410101, Israel
| | - Victor Novack
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel; (Y.B.); (A.Z.); (V.N.)
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva 8410101, Israel; (L.H.); (A.S.); (A.I.)
- Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Moti Klein
- General Intensive Care Unit, Soroka University Medical Center, Beer-Sheva 8410101, Israel;
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel; (Y.B.); (A.Z.); (V.N.)
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Czogalla J, Tariparast PA, Huber TB, Janneck M, Grahammer F. Surprising Hyperkalemia of 10.2 mmol/L in a Patient with Hyperglycemia: A Case Report. Case Rep Nephrol Dial 2021; 11:69-77. [PMID: 33829044 PMCID: PMC7991282 DOI: 10.1159/000512590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 10/25/2020] [Indexed: 11/19/2022] Open
Abstract
Hyperkalemia is a life-threatening condition potentially leading to cardiac arrest. Here, we report a case of surprising severe hyperkalemia of 10.2 mmol/L in a diabetic patient with previously normal kidney function presenting without discernible clinical symptoms to our emergency department. The patient was admitted because of hyperglycemia of 32.8 mmol/L, which was detected during daily testing in her nursing home. The hyperkalemia was caused by prerenal failure due to hyperglycemic polyuria which led to volume depletion, and worsened by a combination of potassium-sparing drugs and potassium supplementation. The patient was treated conservatively. Eighteen hours later, the serum potassium concentration was 4.6 mmol/L. The patient could be released 6 days later. To our knowledge, this is the highest described hyperkalemia treated conservatively and survived without cardiopulmonary resuscitation.
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Affiliation(s)
- Jan Czogalla
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pischtaz Adel Tariparast
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias B Huber
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Janneck
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Grahammer
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Dahal K, Shrestha D, Hada R, Baral A, Sherpa K. Hyperkalemia mimicking brugada pattern in electrocardiogram: A rare case report from Nepal. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2021; 31:524-527. [PMID: 32394928 DOI: 10.4103/1319-2442.284030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Hyperkalemia is one of the dangerous complications of renal impairment (acute kidney injury or chronic kidney disease). Hyperkalemia may present with the electrocardiogram (ECG) changes as nonspecific repolarization abnormalities. Here, we report a case of AKI with hyperkalemia and the Brugada pattern of ECG, which reverted to normal after effective management of hyperkalemia. A 55-year-old male reported to the Emergency Department of National Academy of Medical Sciences (Bir Hospital) with injuries in his lower limbs and spine after he had met an accident two days back. He also had decreased urine output for the last one day. On physical examination, he had injuries in the spine and lower limbs. His laboratory investigations showed impaired renal function parameters with serum sodium 130 mEq/L and serum potassium of 7.3 mEq/L. His ECG was consistent with Brugada pattern. Patient was treated with 10% calcium gluconate, insulin and dextrose, salbutamol nebulization, and sodium polystyrene sulfonate till hemodialysis was initiated. Hyperkalemia and acidosis can manifest with the Brugada pattern in ECG. Thus, a careful evaluation of hyperkalemia and its treatment must be instituted in such an ECG pattern.
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Affiliation(s)
- Kashyap Dahal
- Department of Nephrology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Dineshowri Shrestha
- Department of Nephrology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Rajani Hada
- Department of Nephrology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Anil Baral
- Department of Nephrology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Kunjang Sherpa
- Department of Cardiology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
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Potasso L, Refardt J, Chifu I, Fassnacht M, Fenske WK, Christ-Crain M. Incidence of hyperkalemia during hypertonic saline test for the diagnosis of diabetes insipidus. Endocr Connect 2021; 10:401-409. [PMID: 33666570 PMCID: PMC8133371 DOI: 10.1530/ec-20-0531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/05/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Hyperkalemia has been reported upon different hypertonic saline infusion protocols. Since hypertonic saline test has recently been validated for the differential diagnosis of diabetes insipidus (DI), we aimed to investigate the course of plasma potassium during the test. DESIGN We analyzed data of 90 healthy volunteers and 141 patients with polyuria-polydipsia syndrome (PPS) from two prospective studies evaluating the hypertonic saline test. Our primary outcome was the incidence rate of hypertonic saline-induced hyperkalemia > 5 mmol/L. METHODS Participants received a 250 mL bolus of 3% NaCl solution, followed by 0.15 mL/min/kg body weight continuously infused targeting a plasma sodium level of 150 mmol/L. Blood samples and clinical data were collected every 30 min. RESULTS Of the 231 participants, 16% (n = 37/231) developed hyperkalemia. The incidence of hyperkalemia was higher in healthy volunteers and in patients with primary polydipsia (25.6% (n = 23/90) and 9.9% (n = 14/141), respectively), and only occurred in 3.4% (n = 2/59) of patients with diabetes insipidus. Hyperkalemia developed mostly at or after 90-min test duration (81.1%, n => 30/37). Predictors of hyperkalemia (OR (95% CI)) were male sex (2.9 (1.2-7.4), P => 0.02), a plasma potassium at baseline > 3.9 mmol/L (5.2 (1.8-17.3), P => 0.004), normonatremia at 30-min test duration (3.2 (1.2-9.5), P => 0.03), and an increase in potassium levels already at 30-min test duration as compared to baseline (4.5 (1.7-12.3), P => 0.003). Hyperkalemia was transient and resolved spontaneously in all cases. CONCLUSION The hypertonic saline test can lead to hyperkalemia, especially in patients with primary polydipsia who experience a longer test duration. Monitoring potassium levels in these patients is recommended.
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Affiliation(s)
- Laura Potasso
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Correspondence should be addressed to L Potasso:
| | - Julie Refardt
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Irina Chifu
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Wuerzburg, Wuerzburg Germany
| | - Martin Fassnacht
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Wuerzburg, Wuerzburg Germany
- Central Laboratory, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Wiebke Kristin Fenske
- Integrated Research and Treatment Center for Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany
- Leipzig University Medical Center, IFB Adiposity Diseases, Leipzig, Germany
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
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Cao M, Chen L, Sun C, Li G. Transient complete atrioventricular block and ST-segment elevation induced by coronary vasospasm due to iatrogenic hyperkalemia: a case report. J Med Case Rep 2021; 15:55. [PMID: 33568154 PMCID: PMC7877088 DOI: 10.1186/s13256-020-02644-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/21/2020] [Indexed: 12/02/2022] Open
Abstract
Background Hyperkalemia and acute coronary syndrome are not only all responsible for syncope related to complete atrioventricular block, but also share parts of electrocardiogram manifestations. Additionally, they influence each other. Case presentation A 32-year-old Chinese man presented with severe hypokalemia (1.63 mmol/l) at midnight in the emergency room. He developed unexpected rebound hyperkalemia (7.76 mmol/l) after 18 hours of oral and intravenous potassium chloride supplementation at a concentration of about 10 g/day and a rate of 10 mmol/hour. Subsequently, the patient complained of chest discomfort and dyspnea, followed by syncope for several minutes, approximately 2 hours after potassium reduction treatment had been started. The instant electrocardiogram showed complete atrioventricular block and elevated ST segment in the inferolateral leads, which resolved 15 minutes later, before hyperkalemia was corrected. Combined with mild coronary stenosis and negative myocardial injury markers, transient complete atrioventricular block induced by coronary vasospasm due to iatrogenic hyperkalemia was diagnosed. Normal urine potassium excretion, acid–base state, and other examinations made the diagnosis of hypokalemic periodic paralysis possible. Conclusions Hyperkalemia may provoke acute coronary syndrome, and early coronary angiography is an effective strategy for identifying the direct cause of acute complete atrioventricular block.
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Affiliation(s)
- Miaomiao Cao
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Li Chen
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Chaofeng Sun
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China.
| | - Guoliang Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
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Le Goff E, Jondeau K, Venon MD, Greffe S, Ronez E, Ngo S, Kahn JE, Hanslik T. [Pseudohyperkalemia and thrombocytosis]. Rev Med Interne 2021; 42:438-441. [PMID: 33531232 DOI: 10.1016/j.revmed.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/28/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Hyperkalemia is common in medicine and requires rapid management. Besides the easily evoked causes such as renal failure, adrenal insufficiency, cell lysis or iatrogenic causes, false or pseudo-hyperkalemia should not be forgotten. OBSERVATIONS Three patients (1 man, 2 women, aged 78, 84, 88) were managed for thrombocytosis (between 1306 and 2404 G/L) and non-symptomatic hyperkalemia (between 6.1 and 7.7mmol/L) are reported. Kalemia on blood collected in heparin tube was normal (4.4-4.6mmol/L). Therefore, no specific treatment for this pseudohyperkalemia was required. CONCLUSION The combination of thrombocytosis and non-symptomatic hyperkalemia should suggest the diagnosis of pseudohyperkalemia and should prompt for a control of kalemia on blood collected in heparin tube. The recognition of this diagnosis is important in order to avoid unnecessary and potentially deleterious treatment of hyperkalemia.
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Affiliation(s)
- E Le Goff
- Service de médecine interne, hôpital Ambroise-Paré, Assistance publique-Hôpitaux de Paris, 92100 Boulogne-Billancourt, France; UFR Simone Veil-Santé, université Versailles-Saint-Quentin, 78180 Montigny-le-Bretonneux, France.
| | - K Jondeau
- Service de médecine interne, hôpital Ambroise-Paré, Assistance publique-Hôpitaux de Paris, 92100 Boulogne-Billancourt, France; UFR Simone Veil-Santé, université Versailles-Saint-Quentin, 78180 Montigny-le-Bretonneux, France
| | - M-D Venon
- Service de médecine interne, hôpital Ambroise-Paré, Assistance publique-Hôpitaux de Paris, 92100 Boulogne-Billancourt, France; UFR Simone Veil-Santé, université Versailles-Saint-Quentin, 78180 Montigny-le-Bretonneux, France
| | - S Greffe
- Service de médecine interne, hôpital Ambroise-Paré, Assistance publique-Hôpitaux de Paris, 92100 Boulogne-Billancourt, France; UFR Simone Veil-Santé, université Versailles-Saint-Quentin, 78180 Montigny-le-Bretonneux, France
| | - E Ronez
- Service de médecine interne, hôpital Ambroise-Paré, Assistance publique-Hôpitaux de Paris, 92100 Boulogne-Billancourt, France; UFR Simone Veil-Santé, université Versailles-Saint-Quentin, 78180 Montigny-le-Bretonneux, France
| | - S Ngo
- Service de médecine interne, hôpital Ambroise-Paré, Assistance publique-Hôpitaux de Paris, 92100 Boulogne-Billancourt, France; UFR Simone Veil-Santé, université Versailles-Saint-Quentin, 78180 Montigny-le-Bretonneux, France
| | - J-E Kahn
- Service de médecine interne, hôpital Ambroise-Paré, Assistance publique-Hôpitaux de Paris, 92100 Boulogne-Billancourt, France; UFR Simone Veil-Santé, université Versailles-Saint-Quentin, 78180 Montigny-le-Bretonneux, France
| | - T Hanslik
- Service de médecine interne, hôpital Ambroise-Paré, Assistance publique-Hôpitaux de Paris, 92100 Boulogne-Billancourt, France; UFR Simone Veil-Santé, université Versailles-Saint-Quentin, 78180 Montigny-le-Bretonneux, France
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Lehtiranta S, Honkila M, Kallio M, Paalanne N, Peltoniemi O, Pokka T, Renko M, Tapiainen T. Risk of Electrolyte Disorders in Acutely Ill Children Receiving Commercially Available Plasmalike Isotonic Fluids: A Randomized Clinical Trial. JAMA Pediatr 2021; 175:28-35. [PMID: 33104176 PMCID: PMC7589076 DOI: 10.1001/jamapediatrics.2020.3383] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE The use of isotonic fluid therapy is currently recommended in children, but there is limited evidence of optimal fluid therapy in acutely ill children. OBJECTIVE To evaluate the risk for electrolyte disorders, including hyponatremia, hypernatremia, and hypokalemia, and the risk of fluid retention in acutely ill children receiving commercially available plasmalike isotonic fluid therapy. DESIGN, SETTING, AND PARTICIPANTS This unblinded, randomized clinical pragmatic trial was conducted at the pediatric emergency department of Oulu University Hospital, Finland, from October 3, 2016, through April 15, 2019. Eligible study subjects (N = 614) were between 6 months and 12 years of age, required hospitalization due to an acute illness, and needed intravenous fluid therapy. Exclusion criteria included a plasma sodium concentration of less than 130 mmol/L or greater than 150 mmol/L on admission; a plasma potassium concentration of less than 3.0 mmol/L on admission; clinical need of fluid therapy with 10% glucose solution; a history of diabetes, diabetic ketoacidosis, or diabetes insipidus; a need for renal replacement therapy; severe liver disease; pediatric cancer requiring protocol-determined chemotherapy hydration; and inborn errors of metabolism. All outcomes and samples size were prespecified except those clearly marked as exploratory post hoc analyses. All analyses were intention to treat. INTERVENTIONS Acutely ill children were randomized to receive commercially available plasmalike isotonic fluid therapy (140 mmol/L of sodium and 5 mmol/L potassium in 5% dextrose) or moderately hypotonic fluid therapy (80 mmol/L sodium and 20 mmol/L potassium in 5% dextrose). MAIN OUTCOMES AND MEASURES The primary outcome was the proportion of children with any clinically significant electrolyte disorder, defined as hypokalemia less than 3.5 mmol/L, hypernatremia greater than 148 mmol/L, or hyponatremia less than 132 mmol/L during hospitalization due to acute illness. The main secondary outcomes were the proportion of children with severe hypokalemia and weight change. RESULTS There were 614 total study subjects (mean [SD] age, 4.0 [3.1] years; 315 children were boys [51%] and all 614 were Finnish speaking [100%]). Clinically significant electrolyte disorder was more common in children receiving plasmalike isotonic fluid therapy (61 of 308 patients [20%]) compared with those receiving moderately hypotonic fluid therapy (9 of 306 patients [2.9%]; 95% CI of the difference, 12%-22%; P < .001). The risk of developing electrolyte disorder was 6.7-fold greater in children receiving isotonic fluid therapy. Hypokalemia developed in 57 patients (19%) and hypernatremia developed in 4 patients (1.3%) receiving plasmalike isotonic fluid therapy. Weight change was greater in children receiving isotonic, plasmalike fluid therapy compared with those receiving mildly hypotonic fluids (mean weight gain, 279 vs 195 g; 95% CI, 16-154 g; P = .02). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, commercially available plasmalike isotonic fluid therapy markedly increased the risk for clinically significant electrolyte disorders, mostly due to hypokalemia, in acutely ill children compared with previously widely used moderately hypotonic fluid therapy containing 20 mmol/L of potassium. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02926989.
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Affiliation(s)
- Saara Lehtiranta
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland,Research Unit of Pediatrics, Dermatology, Gynecology, and Obstetrics, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Minna Honkila
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland,Research Unit of Pediatrics, Dermatology, Gynecology, and Obstetrics, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Merja Kallio
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland,Research Unit of Pediatrics, Dermatology, Gynecology, and Obstetrics, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Niko Paalanne
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland,Research Unit of Pediatrics, Dermatology, Gynecology, and Obstetrics, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Outi Peltoniemi
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland,Research Unit of Pediatrics, Dermatology, Gynecology, and Obstetrics, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Tytti Pokka
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland,Research Unit of Pediatrics, Dermatology, Gynecology, and Obstetrics, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Marjo Renko
- Research Unit of Pediatrics, Dermatology, Gynecology, and Obstetrics, Medical Research Center Oulu, University of Oulu, Oulu, Finland,Department of Pediatrics, University of Eastern Finland, Kuopio University Hospital, Kuopio, Finland
| | - Terhi Tapiainen
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland,Research Unit of Pediatrics, Dermatology, Gynecology, and Obstetrics, Medical Research Center Oulu, University of Oulu, Oulu, Finland,Biocenter Oulu, University of Oulu, Oulu, Finland
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60
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Shahunja KM, Ahmed T, Hossain MI, Islam MM, Monjory MB, Shahid ASMSB, Faruque ASG, Chisti MJ. Clinical and laboratory characteristics of children under five hospitalized with diarrhea and bacteremia. PLoS One 2020; 15:e0243128. [PMID: 33264364 PMCID: PMC7710075 DOI: 10.1371/journal.pone.0243128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/16/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Diarrhea is one of the leading causes of mortality in children under five globally. When it is associated with bacteremia, mortality is even higher. However, bacteraemia in diarrheal children has gained little attention in spite of its deleterious impact in under-five mortality. So, we aimed to evaluate associated clinical and laboratory factors for death in under-five children hospitalized with both diarrhea and bacteremia. METHODS In this retrospective cross-sectional study, we used patients' electronic database of Dhaka Hospital of 'icddr,b', and enrolled all under-five children with diarrhea and bacterial growth in their blood samples on admission between June-2014 and May-2017. Clinical and laboratory characteristics were compared between those who died and who survived with a special attention to bacterial pathogens related to deaths and their sensitivity pattern. RESULTS In a total of 401 diarrheal children with bacteraemia, 45 (11%) died. Although Salmonella Typhi (34%) was the most predominant isolate followed by Staphylococcus species (16%) and Pseudomonas species (9%), children who died more often had E. coli (OR = 5.69, 95% CI = 2.42-13.39, p = <0.001) and Klebsiella bacteraemia (OR = 4.59, 95% CI = 1.84-11.46, p = 0.001) compared to those who survived. However, none of them was significantly associated with deaths in regression analysis when adjusted with other potential confounders. E. coli was 100% resistant to ampicillin, 41% to gentamicin, and 73% to ceftriaxone and Klebsiella species was 96% resistant to ampicillin, 42% to gentamicin, and 62% to ceftriaxone. Study children who died had significantly higher overall resistance pattern shown in World Health Organization (WHO) recommended one of the first line antibiotics in treating childhood sepsis such as ampicillin (80% vs. 50%, p = 0.001) and in second line antibiotic such as ceftriaxone (49% vs. 22%, p = 0.001) compared to the survivors. In logistic regression analysis, after adjusting for potential confounders, we found that clinical sepsis (aOR 3.79, 95% CI 1.60-8.96, p = 0.002), hypoxemia (aOR 4.20, 95% CI 1.74-10.12, p = 0.001), and hyperkalaemia (aOR 2.69, 95% CI 1.05-6.91, p = 0.039) were found to be independent predictors of deaths and receipt of sensitive antibiotic (aOR 0.42, 95% CI 0.18-0.99, p = 0.048) was revealed as the independent protective factor for deaths in this population. CONCLUSION AND SIGNIFICANCE The results of our data suggest that diarrheal children with bacteremia who died more often had gram negative bacteremia compared to those who survived and these pathogens are highly resistant to WHO recommended first line and second line antibiotics. The results further emphasize the critical importance of early identification of important clinical problems such as clinical sepsis, hypoxemia and hyperkalaemia in diarrheal children and treat them with potential sensitive antibiotic(s) in order to reduce bacteremia related mortality in children with diarrhea, especially in resource limited settings.
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Affiliation(s)
- K. M. Shahunja
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Md. Iqbal Hossain
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Md. Munirul Islam
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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Oliveira PE, Salvador GH, Marchi-Salvador DP. Malignant Hyperthermia in Bariatric Surgery: A Case Study With Clinical, Pathophysiological, Biochemical and Biophysical Correlations. J Med Cases 2020; 11:379-387. [PMID: 34434350 PMCID: PMC8383552 DOI: 10.14740/jmc3577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/19/2020] [Indexed: 12/23/2022] Open
Abstract
Malignant hyperthermia (MH) is an acute pharmacogenetic disorder, which while uncommon is potentially fatal. MH is a calcium channelopathy of skeletal muscle in which a constant increase of intracytoplasmic Ca2+ concentration occurs causing a change in cellular metabolism. A hypermetabolic state develops when susceptible patients are exposed to halogenated volatile inhalational anesthetic agents and depolarizing muscle relaxants and/or extreme physical activity in hot environments. MH presents variable clinical expression. During an episode of MH, the patient may present clinical signs and laboratory findings including masseter muscle spasm, tachycardia, rise in end-tidal CO2 (EtCO2), tachypnea, hyperthermia, cyanosis, metabolic acidosis, rhabdomyolysis, hyperkalemia, myoglobinuria, hyperlactacidemia, and acute renal failure. The aim of this case report is to describe an episode of MH associated with the use of halogenated anesthetic during bariatric surgery. A 29-year-old Brazilian man was admitted to the hospital to undergo a bariatric surgery. The patient's relevant medical history included morbid obesity grade III, allergy to sulfa-based drugs and severe obstructive sleep apnea. Preoperative evaluations with cardiopulmonary exercise testing, echocardiogram and electrocardiogram showed no anatomical and functional changes of the patient's heart. Surgical procedures lasted for 4 h, without complications, but the evolution of the patient's condition indicated oliguria and acute breathing insufficiency. Five hours after the patient was placed under mechanical ventilation in the intensive care unit, he started to present clinical signs of hypermetabolic state, with tremors, excessive sweating, and rapid body temperature increases. In the postoperative period, the patient had hyperglycemia, hypocalcemia, hypernatremia, hyperkalemia, changes in creatine phosphokinase (CPK), aspartate transaminase (AST), alanine aminotransferase (ALT), urea and creatine concentrations, and metabolic and respiratory acidosis. Urinalysis showed traces of proteinuria, presence of ketones, leukocytes, red blood cells, and urobilinogen. In our case report, MH crisis was diagnosed late; the dantrolene was not administrated because it was not available and the patient died. This detailed case report of MH episode triggered by isoflurane anesthetic during bariatric surgery allowed us to describe the severity and lethality of this hypermetabolic syndrome. Dantrolene should be mandatory in all operating rooms. Knowledge of the symptoms, an early diagnosis and an adequate treatment can prevent the death of patients in MH crisis.
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Elmoheen A, Mishreky LM, Albeiruti S, Elanani RH, Azad A. Severe Persistent Hyperkalemia with Electrocardiogram Changes in a Patient with Hyperaldosteronism. Cureus 2020; 12:e11358. [PMID: 33178543 PMCID: PMC7651772 DOI: 10.7759/cureus.11358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 62-year-old female presented to the emergency department (ED) with fatigue and generalized body weakness for the last three days. Upon arrival, initial ECG showed wide complex tachycardia with sine waves and a heart rate (HR) ranging between 100-170 bpm. She was otherwise vitally stable. The patient had a past medical history of hyperaldosteronism, type 2 diabetes mellitus (DM), chronic kidney disease (CKD) with microalbuminuria, and hypertension. She also had a history of cerebrovascular accident (CVA) and residual left-sided weakness more pronounced in the upper limb. Initial venous blood gas (VBG) analysis showed a potassium level of more than 10 mmol/L, chloride 114 mmol/L, bicarbonate 9 mmol/L, sodium 135 mmol/L, and pH of 7.1. Treatment for hyperkalemia was started immediately with calcium gluconate 1 gm that effectively narrowed her QRS complex and normalized her ECG. Salbutamol nebulization, glucose/insulin infusion, and calcium polystyrene syrup were given. Later, she was started on 100 mg sodium bicarbonate infusion, and Foley’s catheter was inserted to follow urine output (UOP) strictly. However, she did not show a decrease in serum potassium levels. Then the patient underwent hemodialysis for two hours. Her first potassium reading after hemodialysis was 5.2 mmol/L. The purpose of this case report is to emphasize the importance of hemodialysis in patients with persistent severe life-threatening hyperkalemia.
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Morris TG, Lamba S, Fitzgerald T, Roulston G, Johnstone H, Mirzazadeh M. The potential role of the eGFR in differentiating between true and pseudohyperkalaemia. Ann Clin Biochem 2020; 57:444-455. [PMID: 33016076 DOI: 10.1177/0004563220966858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Differentiating between true and pseudohyperkalaemia is essential for patient management. The common causes of pseudohyperkalaemia include haemolysis, blood cell dyscrasias and EDTA contamination. One approach to differentiate between them is by checking the renal function, as it is believed that true hyperkalaemia is rare with normal function. This is logical, but there is limited published evidence to support it. The aim of this study was to investigate the potential role of the estimated glomerular filtration rate in differentiating true from pseudohyperkalaemia. METHODS GP serum potassium results >6.0 mmol/L from 1 January 2017 to 31 December 2017, with a repeat within seven days, were included. Entries were retrospectively classified as true or pseudohyperkalaemia based on the potassium reference change value and reference interval. If the initial sample had a full blood count, it was classified as normal/abnormal to remove blood cell dyscrasias. Different estimated glomerular filtration rate cut-points were used to determine the potential in differentiating true from pseudohyperkalaemia. RESULTS A total of 272 patients were included with potassium results >6.0 mmol/L, with 145 classified as pseudohyperkalaemia. At an estimated glomerular filtration rate of 90 ml/min/1.73 m2, the negative predictive value was 81% (95% CI: 67-90%); this increased to 86% (95% CI: 66-95%) by removing patients with abnormal full blood counts. When only patients with an initial potassium ≥6.5 mmol/L were included (regardless of full blood count), at an estimated glomerular filtration rate of 90 ml/min/1.73 m2, the negative predictive value was 100%. Lower negative predictive values were seen with decreasing estimated glomerular filtration rate cut-points. CONCLUSION Normal renal function was not associated with true hyperkalaemia, making the estimated glomerular filtration rate a useful tool in predicting true from pseudohyperkalaemia, especially for potassium results ≥6.5 mmol/L.
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Affiliation(s)
- Thomas G Morris
- Blood Sciences, Epsom and St Helier University Hospitals NHS Trust, London, UK
| | - Sushmita Lamba
- Blood Sciences, Epsom and St Helier University Hospitals NHS Trust, London, UK
| | - Thomas Fitzgerald
- Nephrology, Epsom and St Helier University Hospitals NHS Trust, London, UK
| | - Gary Roulston
- Nephrology, Epsom and St Helier University Hospitals NHS Trust, London, UK
| | - Helen Johnstone
- Blood Sciences, Epsom and St Helier University Hospitals NHS Trust, London, UK
| | - Mehdi Mirzazadeh
- Blood Sciences, Epsom and St Helier University Hospitals NHS Trust, London, UK
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64
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Picard K, Barreto Silva MI, Mager D, Richard C. Dietary Potassium Intake and Risk of Chronic Kidney Disease Progression in Predialysis Patients with Chronic Kidney Disease: A Systematic Review. Adv Nutr 2020; 11:1002-1015. [PMID: 32191264 PMCID: PMC7360460 DOI: 10.1093/advances/nmaa027] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/23/2020] [Accepted: 02/24/2020] [Indexed: 12/13/2022] Open
Abstract
The prevalence of chronic kidney disease (CKD) is increasing and dietary interventions may be a strategy to reduce this burden. In the general population, higher potassium intake is considered protective for cardiovascular health. Due to the risk of hyperkalemia in CKD, limiting potassium intake is often recommended. However, given that poor cardiovascular function can cause kidney damage, following a low-potassium diet may be deleterious for patients with CKD. The aim of this systematic review was to summarize the evidence on dietary potassium intake and CKD progression. Multiple databases were searched on 7 June 2019 and data were managed with Covidence. No intervention trials met the inclusion criteria. Eleven observational studies met the inclusion criteria (10 post hoc analyses, 1 retrospective cohort), representing 49,573 stage 1-5 predialysis patients with CKD from 41 different countries. Of the 11 studies, 6 studies reported exclusively on early CKD (stage 1-2), 4 studies separately reported analyses on both early and late (stage 3-5) CKD, and 2 studies reported exclusively on late CKD. A total of 9 studies reported risk of disease progression in early CKD; in 4 studies high potassium intake was associated with lower risk, while in 2 studies the low intake showed a higher progression of risk, and 3 studies reported no relation. In late CKD, results are mixed: 2 studies suggested benefit of higher potassium intake and 1 suggested benefit of lower potassium intake, whereas 3 studies were neutral. These results should be interpreted with caution, as considerations preventing firm conclusions include 1) the overall low range of dietary potassium intake, with all studies reporting an average intake below the 2004 Kidney Disease Outcomes Quality Initiatives guidelines, and 2) the method used to assess potassium intake in most studies (i.e., urine) in late stages of CKD. Ideally, well-controlled intervention studies are needed to understand how dietary potassium intake is linked to CKD progression.
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Affiliation(s)
- Kelly Picard
- Department of Agricultural, Food, and Nutritional Sciences, Li Ka Shing Centre for Health Innovation, University of Alberta, Edmonton, Alberta, Canada
- Nutrition Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Maria Ines Barreto Silva
- Department of Agricultural, Food, and Nutritional Sciences, Li Ka Shing Centre for Health Innovation, University of Alberta, Edmonton, Alberta, Canada
| | - Diana Mager
- Department of Agricultural, Food, and Nutritional Sciences, Li Ka Shing Centre for Health Innovation, University of Alberta, Edmonton, Alberta, Canada
| | - Caroline Richard
- Department of Agricultural, Food, and Nutritional Sciences, Li Ka Shing Centre for Health Innovation, University of Alberta, Edmonton, Alberta, Canada
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Abe M, Akaishi T, Shoji M, Yamaguchi T, Miki T, Satoh F, Takayama S, Yamasaki S, Kawaguchi K, Sato H, Ishii T, Ito S. Reno-protective effects of oral alkalizing agents in chronic kidney disease with aciduria: protocol for a randomized cohort study. BMC Nephrol 2020; 21:144. [PMID: 32321450 PMCID: PMC7178750 DOI: 10.1186/s12882-020-01807-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 04/15/2020] [Indexed: 12/12/2022] Open
Abstract
Background Aciduria caused by urinary excretion of acidic metabolic wastes produced in daily life is known to be augmented in patients with chronic kidney disease (CKD). To evaluate the reno-protective effect of oral alkalizing agents for the improvement of metabolic acidosis and neutralization of intratubular pH in the patients with mild stages of CKD. Also, to identify reno-protective surrogate markers in the serum and urine that can closely associate the effect of urine alkalization. Methods In this single-centered, open-labeled, randomized cohort study, patients with CKD stages G2, G3a and G3b, who visited and were treated at Tohoku University Hospital during the enrollment period were registered. We administered sodium bicarbonate or sodium-potassium citrate as the oral alkalinizing agents. A total of 150 patients with CKD will be randomly allocated into the following three groups: sodium bicarbonate, sodium-potassium citrate and standard therapy group without any alkalinizing agents. The data of performance status, venous blood test, spot urine test, venous blood-gas test, electrocardiogram, renal arterial ultrasonography and chest X-ray will be collected at 0, 6, 12 and 24 weeks (short-term study) from starting the interventions. These data will be also collected at 1 and 2 years (long-term study). The samples of plasma and serum and early-morning urine at every visit will be acquired for the analysis of renal function and surrogate uremic biomarkers. The recruitment for this cohort study terminated in March, 2018, and the follow-up period for all the enrolled subjects will be terminated in December, 2020. The primary endpoint will be the development of originally-defined significant renal dysfunction or the occurrence of any cerebrovascular disease in the short-term study. The secondary endpoint will be the same endpoints as in the long-term study, or the patients with significant changes in the suggested the surrogate biomarkers. Discussion The findings of this study will address the importance of taking oral alkalizing agents in the patients with early stages of CKD, furthermore they could address any new surrogate biomarkers that can be useful from early stage CKD. Trial registration Registered Report Identifier: UMIN000010059 and jRCT021180043. The trial registration number; 150. Date of registration; 2013/02/26.
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Affiliation(s)
- Michiaki Abe
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan. .,Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - Tetsuya Akaishi
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Mutsumi Shoji
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Takuhiro Yamaguchi
- Clinical Research, Innovation and Education Center, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Takashi Miki
- Clinical Physiology Center, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Fumitoshi Satoh
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shin Takayama
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Satomi Yamasaki
- Medical Affairs Department, Nippon Chemiphar Co., Ltd., Tokyo, Japan
| | | | - Hiroshi Sato
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tadashi Ishii
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Sadayoshi Ito
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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O'Hara M, Wheatley EG, Kazmierczak SC. The Impact of Undetected In Vitro Hemolysis or Sample Contamination on Patient Care and Outcomes in Point-of-Care Testing: A Retrospective Study. J Appl Lab Med 2020; 5:332-341. [PMID: 32445387 DOI: 10.1093/jalm/jfz020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/19/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND Point-of-care (POC) testing is an integral diagnostic component in clinical settings like the emergency department (ED). However, most POC testing devices are unable to detect endogenous interferents such as hemolysis, which typically occurs during sample collection and handling and can falsely increase measured potassium (pseudohyperkalemia), a phenomenon we hypothesized may significantly impact patient care. METHODS In this retrospective study, we evaluated 100 unique admissions to the Oregon Health & Science University ED, presenting with elevated potassium measured at the POC. To evaluate whether in vitro hemolysis had occurred, POC test results were compared to repeat testing of the original specimen, or other specimens tested within 90 minutes in the Core laboratory. Review of associated Electronic Health Records determined whether elevated potassium initially measured using the POC analyzer was real, or due to in vitro hemolysis or contamination, and whether pseudohyperkalemia impacted patient management or care. RESULTS Of the 100 admissions with hyperkalemia measured using a POC analyzer, 40% were found to have pseudohyperkalemia due to hemolysis or contamination. Of these 40 patients, 6 experienced repeated testing, and an additional 5 were noted to have altered patient management, specifically due to pseudohyperkalemia. CONCLUSIONS This study demonstrates the incidence of in vitro hemolysis, which is unknown to the POC operator, is high in patients who show an elevated potassium as measured at the POC. Furthermore, in vitro hemolysis can significantly impact patient management, suggesting that minimizing the incidence of unrecognized hemolysis will benefit hospital efficiency, decrease waste, and improve patient care.
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Affiliation(s)
- Matthew O'Hara
- Trinity Life Sciences, Waltham, MA (formerly Boston Strategic Partners, Inc. Boston, MA)
| | - Elizabeth G Wheatley
- Trinity Life Sciences, Waltham, MA (formerly Boston Strategic Partners, Inc. Boston, MA)
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Lambert K, Bird L, Borst AC, Fuller A, Wang Y, Rogers GB, Stanford J, Sanderson-Smith ML, Williams JG, McWhinney BC, Neale EP, Probst Y, Lonergan M. Safety and Efficacy of Using Nuts to Improve Bowel Health in Hemodialysis Patients. J Ren Nutr 2020; 30:462-469. [PMID: 32001127 DOI: 10.1053/j.jrn.2019.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/23/2019] [Accepted: 10/04/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Constipation is common in patients with end-stage kidney disease. Nondrug strategies to manage constipation are challenging because of dietary potassium, phosphate, and fluid restrictions. Nuts are a high-fiber food but are excluded from the diet because of the high potassium and phosphate content. The aim of this study was to examine the safety and efficacy of using nuts to improve constipation in adults undertaking hemodialysis (HD). DESIGN AND METHODS Adult patients undertaking HD were recruited to this nonrandomized, 10-week repeated measures, within-subject, pragmatic clinical trial, conducted in two HD units. The intervention consisted of consumption of 40g of raw almonds daily for four weeks, followed by a two-week washout and four-week control period. The primary safety outcome measures were change in predialysis serum potassium and phosphate levels. The primary efficacy outcome was reduction in constipation, measured using the Bristol Stool Form Scale and Palliative Care Outcome Scale (POS-S) renal symptom score. Secondary outcomes included quality of life, selected uremic toxins, cognition, gut microbiota profile, and symptom burden. RESULTS Twenty patients completed the trial (median age: 67 [interquartile range: 57.5-77.8] years, 51% male). After controlling for dialysis adequacy, anuria, dietary intake, bicarbonate, and parathyroid hormone, there were no statistically significant changes in serum potassium (P = 0.21) or phosphate (P = 0.16) associated with daily consumption of almonds. However, statistically significant improvements in constipation were seen at weeks 2, 3, 4, and 10. There were statistically significant improvements in quality of life (P = 0.030), overall symptom burden (P = 0.002), vomiting (P = 0.020), itching (P = 0.006), and skin changes (P = 0.002). CONCLUSION Daily consumption of almonds for four weeks was safe, effective, and well tolerated. Improvements in quality of life and symptom burden warrant further research to elucidate potential mechanisms. The findings support the potential reinclusion of foods such as nuts into the diet of patients who underwent HD.
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Affiliation(s)
- Kelly Lambert
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia; Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia; Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia.
| | - Luke Bird
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Addison C Borst
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Andrew Fuller
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Yanan Wang
- Microbiome and Host Health Programme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Geraint B Rogers
- Microbiome and Host Health Programme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Jordan Stanford
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Martina L Sanderson-Smith
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia; School of Chemistry and Molecular Bioscience, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Jonathan G Williams
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia; School of Chemistry and Molecular Bioscience, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Brett C McWhinney
- Department of Chemical Pathology, Pathology Queensland, Brisbane, Queensland, Australia
| | - Elizabeth P Neale
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia; Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Yasmine Probst
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia; Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Maureen Lonergan
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia; Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia; Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
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Kambunga SN, Candeias C, Hasheela I, Mouri H. Review of the nature of some geophagic materials and their potential health effects on pregnant women: some examples from Africa. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2019; 41:2949-2975. [PMID: 30977022 DOI: 10.1007/s10653-019-00288-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/27/2019] [Indexed: 05/25/2023]
Abstract
The voluntary human consumption of soil known as geophagy is a global practice and deep-rooted in many African cultures. The nature of geophagic material varies widely from the types to the composition. Generally, clay and termite mound soils are the main materials consumed by geophagists. Several studies revealed that gestating women across the world consume more soil than other groups for numerous motives. These motivations are related to medicinal, cultural and nutrients supplementation. Although geophagy in pregnancy (GiP) is a universal dynamic habit, the highest prevalence has been reported in African countries such as Kenya, Ghana, Rwanda, Nigeria, Tanzania, and South Africa. Geophagy can be both beneficial and detrimental. Its health effects depend on the amount and composition of the ingested soils, which is subjective to the geology and soil formation processes. In most cases, the negative health effects concomitant with the practice of geophagy eclipse the positive effects. Therefore, knowledge about the nature of geophagic material and the health effects that might arise from their consumption is important.
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Affiliation(s)
- Selma N Kambunga
- Department of Geology, University of Johannesburg, Johannesburg, South Africa
| | - Carla Candeias
- GeoBioTec, Geosciences Department, University of Aveiro, Aveiro, Portugal
- EpiUnit, Public Health Institute, University of Porto, Porto, Portugal
| | - Israel Hasheela
- Environmental and Engineering Geology Division, Geological Survey of Namibia, Windhoek, Namibia
| | - Hassina Mouri
- Department of Geology, University of Johannesburg, Johannesburg, South Africa.
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Kavčič A, Avčin S, Grosek Š. Severe Hyperkalemia Immediately After Birth. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1471-1475. [PMID: 31587009 PMCID: PMC6792467 DOI: 10.12659/ajcr.916368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hyperkalemia is an important cause of arrhythmias and a medical emergency that requires urgent treatment. The etiology is usually multifactorial. It is most frequently caused by impaired potassium secretion, followed by transcellular potassium shifts and an increased potassium load. CASE REPORT A male newborn developed monomorphic ventricular tachycardia 2 hours after birth. He was born in the 35th week of gestation by urgent C-section following placental abruption. Laboratory results showed hemolytic anemia (Hb 99 g/L, Hct 0.31) with increased bilirubin levels and reticulocytosis, thrombocytopenia (39×10⁹/L), hypoglycemia (0.8 mmol/L), and severe hyperkalemia (9.8 mmol/L). Umbilical artery blood gas analysis showed hypoxemia with acidosis (pO₂ 3.8 kPa, pH 7.21, pCO₂ 7.84 kPa, HCO₃ 23.3 mmol/L, BE -5 mmol/L). Creatinine (102 µmol/L) and urea (9.8 mmol/L) were mildly elevated. Inflammatory markers were also increased (CRP 26 mg/L, blood leukocyte count 24×10⁹/L). Early-onset sepsis, caused by Candida albicans, was confirmed approximately 24 hours after birth. Non-invasive ventilation with 35-40% O₂ was necessary due to transient tachypnea. The neonate received a transfusion of packed red blood cells, a 10% glucose infusion, and empirical antibiotic therapy. Hyperkalemia accompanied by arrhythmias was treated with calcium gluconate, insulin, Sorbisterit enema, and, finally, by exchange transfusion. CONCLUSIONS We report a case of severe hyperkalemia in a newborn immediately after birth. Making a decision as early as possible regarding exchange transfusion is essential in patients with hyperkalemia with electrocardiogram changes and hemodynamic instability.
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Affiliation(s)
- Alja Kavčič
- University Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Simona Avčin
- Department of Pediatric Hematology and Oncology, University Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Štefan Grosek
- Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Pediatric Surgery and Intensive Care, University Medical Center Ljubljana, Ljubljana, Slovenia.,Neonatal Intensive Care Unit, Department of Perinatology, University Medical Center Ljubljana, Ljubljana, Slovenia
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70
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Kambunga SN, Candeias C, Hasheela I, Mouri H. The geochemistry of geophagic material consumed in Onangama Village, Northern Namibia: a potential health hazard for pregnant women in the area. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2019; 41:1987-2009. [PMID: 30778788 DOI: 10.1007/s10653-019-00253-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/27/2019] [Indexed: 06/09/2023]
Abstract
Ingestion of geophagic materials might affect human health and induce diseases by different ways. The purpose of this study is to determine the geochemical composition of geophagic material consumed especially by pregnant women in Onangama Village, Northern Namibia and to assess its possible health effects. X-ray fluorescence and inductively coupled plasma mass spectrometry were used in order to determine the major, and trace elements as well as anions concentrations of the consumed material. The geochemical analysis revealed high concentrations of aluminium (Al), calcium (Ca), iron (Fe), magnesium (Mg), manganese (Mn), potassium (K), sodium (Na), and silica (Si); and trace elements including arsenic (As), chromium (Cr), mercury (Hg), nickel (Ni) and vanadium (V) as well as sulphate (SO42-), nitrate (NO3-), and nitrite (NO2-) anions comparing to the recommended daily allowance for pregnant women. The pH for some of the studied samples is alkaline, which might increase the gastrointestinal tract pH (pH < 2) and cause a decrease in the bioavailability of elements. The calculated health risk index (HRI > 1) revealed that Al and Mn might be a potential risk for human consumption. Based on the results obtained from the geochemical analysis, the consumption of the studied material might present a potential health risk to pregnant women including concomitant detrimental maternal and foetal effects.
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Affiliation(s)
- Selma N Kambunga
- Department of Geology, University of Johannesburg, Johannesburg, South Africa
| | - Carla Candeias
- GeoBioTec, Geosciences Department, University of Aveiro, Aveiro, Portugal
- EpiUnit, Public Health Institute, University of Porto, Porto, Portugal
| | - Israel Hasheela
- Environmental and Engineering Geology Division, Geological Survey of Namibia, Windhoek, Namibia
| | - Hassina Mouri
- Department of Geology, University of Johannesburg, Johannesburg, South Africa.
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Thomsen RW, Nicolaisen SK, Hasvold P, Sanchez RG, Pedersen L, Adelborg K, Egstrup K, Egfjord M, Sørensen HT. Elevated potassium levels in patients with chronic kidney disease: occurrence, risk factors and clinical outcomes-a Danish population-based cohort study. Nephrol Dial Transplant 2019; 33:1610-1620. [PMID: 29177463 DOI: 10.1093/ndt/gfx312] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 10/04/2017] [Indexed: 11/14/2022] Open
Abstract
Background Data on the true burden of hyperkalemia (HK) in patients with chronic kidney disease (CKD) in a real-world setting are scarce. Methods The incidence rate of HK [first blood test with an elevated blood potassium level level >5.0 mmol/L] in primary or hospital care was assessed in a population-based cohort of all newly diagnosed CKD patients [second estimated glomerular filtration rate (eGFR) measurement <60 mL/min/1.73 m2 or hospital diagnosis] in northern Denmark. Risk factors and clinical outcomes were compared for CKD patients with HK and matched CKD patients without HK. Results Of 157 766 patients with CKD, 28% experienced HK, for an overall HK incidence rate of 70/1000 person-years. Among patients with Stage 3A, 3B, 4 or 5 CKD, 9, 18, 31 and 42%, respectively, experienced HK within the first year. Important HK risk factors included diabetes {prevalence ratio [PR] 1.74 [95% confidence interval (CI) 1.69-1.79]}, heart failure [PR 2.31 (95% CI 2.23-2.40)] and use of angiotensin-converting enzyme inhibitors [PR 1.45 (95% CI 1.42-1.48)], potassium supplements [PR 1.59 (95% CI 1.55-1.62)] or spironolactone [PR 2.53 (95% CI 2.44-2.63)]. In CKD patients who developed HK, 34% had any acute hospitalization 6 months before the HK event, increasing to 57% 6 months after HK [before-after risk ratio 1.72 (95% CI 1.69-1.74)]. The 6-month mortality following HK was 26%, versus 6% in matched non-HK patients. Compared with non-HK patients, 6-month hazard ratios for any acute hospitalization in HK patients were 2.11-fold higher, including hazard ratios of 2.07 for cardiac diagnoses, 2.29 for ventricular arrhythmias, 3.26 for cardiac arrest, 4.77 for intensive care and 4.85 for death. Conclusions More than one in four CKD patients develops HK. Patients with severe CKD, diabetes, heart failure or use of spironolactone are at high risk. HK is associated with severe clinical outcomes.
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Affiliation(s)
- Reimar W Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Sia K Nicolaisen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Pål Hasvold
- AstraZeneca Nordic Medical Department, Etterstad, Oslo, Norway
| | | | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kasper Adelborg
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kenneth Egstrup
- Department of Cardiology, Svendborg Hospital, Svendborg, Denmark
| | - Martin Egfjord
- Department of Nephrology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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72
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Opiyo RO, Nyasulu PS, Olenja J, Zunza M, Nguyen KA, Bukania Z, Nabakwe E, Mbogo A, Were AO. Factors associated with adherence to dietary prescription among adult patients with chronic kidney disease on hemodialysis in national referral hospitals in Kenya: a mixed-methods survey. RENAL REPLACEMENT THERAPY 2019. [DOI: 10.1186/s41100-019-0237-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Adherence to dietary prescriptions among patients with chronic kidney disease is known to prevent deterioration of kidney functions and slow down the risk for morbidity and mortality. This study determined factors associated with adherence to dietary prescription among adult patients with chronic kidney disease on hemodialysis.
Methods
A mixed-methods study, using parallel mixed design, was conducted at the renal clinics and dialysis units at the national teaching and referral hospitals in Kenya from September 2018 to January 2019. The study followed a QUAN + qual paradigm, with quantitative survey as the primary method. Adult patients with chronic kidney disease on hemodialysis without kidney transplant were purposively sampled for the quantitative survey. A sub-sample of adult patients and their caregivers were purposively sampled for the qualitative survey. Numeric data were collected using a structured, self-reported questionnaire using Open Data Kit “Collect software” while qualitative data were collected using in-depth interview guides and voice recording. Analysis on STATA software for quantitative and NVIV0 12 for qualitative data was conducted. The dependent variable, “adherence to diet prescription” was analyzed as a binary variable. P values < 0.1 and < 0.05 were considered as statistically significant in univariate and multivariate logistic regression models respectively. Qualitative data were thematically analyzed.
Results
Only 36.3% of the study population adhered to their dietary prescriptions. Factors that were independently associated with adherence to diet prescriptions were “flexibility in the diets” (AOR 2.65, 95% CI 1.11–6.30, P 0.028), “difficulties in following diet recommendations” (AOR 0.24, 95% CI 0.13–0.46, P < 001), and “adherence to limiting fluid intake” (AOR 9.74, 95% CI 4.90–19.38, P < 0.001).
Conclusions
For patients with chronic kidney disease on hemodialysis, diet prescriptions with less restrictions and requiring minimal extra efforts and resources are more likely to be adhered to than the restrictive ones. Patients who adhere to their fluid intake restrictions easily follow their diet prescriptions. Prescribed diets should be based on the individual patient’s usual dietary habits and assessed levels of challenges in using such diets. Additionally, diet adherence messages should be integrated with fluid limitation messages. Further research on understanding patients’ adherence to fluid restriction is also suggested.
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73
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Bischof H, Burgstaller S, Vujic N, Madl T, Kratky D, Graier WF, Malli R. Purification and Application of Genetically Encoded Potassium Ion Indicators for Quantification of Potassium Ion Concentrations within Biological Samples. CURRENT PROTOCOLS IN CHEMICAL BIOLOGY 2019; 11:e71. [PMID: 31483097 PMCID: PMC6927797 DOI: 10.1002/cpch.71] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Vital cells maintain a steep potassium ion (K+ ) gradient across the plasma membrane. Intracellular potassium ion concentrations ([K+ ]) and especially the [K+ ] within the extracellular matrix are strictly regulated, the latter within a narrow range of ∼3.5 to 5.0 mM. Alterations of the extracellular K+ homeostasis are associated with severe pathological alterations and systemic diseases including hypo- or hypertension, heart rate alterations, heart failure, neuronal damage or abnormal skeleton muscle function. In higher eukaryotic organisms, the maintenance of the extracellular [K+ ] is mainly achieved by the kidney, responsible for K+ excretion and reabsorption. Thus, renal dysfunctions are typically associated with alterations in serum- or plasma [K+ ]. Generally, [K+ ] quantifications within bodily fluids are performed using ion selective electrodes. However, tracking such alterations in experimental models such as mice features several difficulties, mainly due to the small blood volume of these animals, hampering the repetitive collection of sample volumes required for measurements using ion selective electrodes. We have recently developed highly sensitive, genetically encoded potassium ion indicators, the GEPIIs, applicable for in vitro determinations of [K+ ]. In addition to the determination of [K+ ] within bodily fluids, GEPIIs proved suitable for the real-time visualization of cell viability over time and the exact determination of the number of dead cells. © 2019 The Authors.
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Affiliation(s)
- H Bischof
- Gottfried Schatz Research Center, Molecular Biology and Biochemistry, Medical University of Graz, Graz, Austria
| | - S Burgstaller
- Gottfried Schatz Research Center, Molecular Biology and Biochemistry, Medical University of Graz, Graz, Austria
| | - N Vujic
- Gottfried Schatz Research Center, Molecular Biology and Biochemistry, Medical University of Graz, Graz, Austria
| | - T Madl
- Gottfried Schatz Research Center, Molecular Biology and Biochemistry, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - D Kratky
- Gottfried Schatz Research Center, Molecular Biology and Biochemistry, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - W F Graier
- Gottfried Schatz Research Center, Molecular Biology and Biochemistry, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - R Malli
- Gottfried Schatz Research Center, Molecular Biology and Biochemistry, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
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74
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Liang P, Mast J, Chen W. Synchronization Modulation of Na/K Pumps Induced Membrane Potential Hyperpolarization in Both Physiological and Hyperkalemic Conditions. J Membr Biol 2019; 252:577-586. [PMID: 31410502 DOI: 10.1007/s00232-019-00080-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/08/2019] [Indexed: 11/29/2022]
Abstract
The capability of the synchronization modulation (SM) technique in enhancing the function of Na/K pumps has been demonstrated in various cells and tissues, including cardiomyocytes, a monolayer of cultured MDCK kidney cells, peripheral blood vessels, and frog skeletal muscles. This study characterized the membrane potential hyperpolarization induced by SM in both physiological and high [K+]o conditions on single skeletal muscle fibers. The results showed that SM could consistently induce membrane potential hyperpolarization by a few millivolts, and this hyperpolarization was not possible in the presence of ouabain. In contrast, the same electrical pulses but with random frequencies, constant frequencies, or synchronization with backward-modulation could not hyperpolarize the membrane potential. Prolonged field application and higher field intensity enhanced the effects of SM-induced hyperpolarization. Finally, the effect of SM was tested on skeletal muscle fibers incubated in a solution with high external potassium. Results showed that the SM electric field could hyperpolarize the membrane potential even if the external K+ concentration was higher than the normal, which implied the therapeutic effects of the SM electric field on the hyperkalemic situation.
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Affiliation(s)
- Pengfei Liang
- Department of Physics, Cellular and Molecular Biophysics Lab, University of South Florida, Tampa, FL, 33620, USA
| | - Jason Mast
- Department of Physics, Cellular and Molecular Biophysics Lab, University of South Florida, Tampa, FL, 33620, USA
| | - Wei Chen
- Department of Physics, Cellular and Molecular Biophysics Lab, University of South Florida, Tampa, FL, 33620, USA.
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75
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Llubani R, Vukadinović D, Werner C, Marx N, Zewinger S, Böhm M. Hyperkalaemia in Heart Failure-Pathophysiology, Implications and Therapeutic Perspectives. Curr Heart Fail Rep 2019; 15:390-397. [PMID: 30421355 DOI: 10.1007/s11897-018-0413-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Hyperkalaemia is a frequent and sometimes life-threatening condition that may be associated with arrhythmia and cardiac dysfunction. Evaluating the prevalence of hyperkalaemia in patients with heart failure (HF) and potential treatments of this condition is essential for patients using renin-angiotensin-aldosterone system inhibitors or angiotensin receptor-neprilysin inhibitor and mineralocorticoid receptor antagonists, which represent the cornerstone and highly proven life-saving therapy. RECENT FINDINGS Novel findings from the past few years include data regarding the epidemiology, pathomechanisms, implications and novel therapeutic approaches to counteract hyperkalaemia in patients with HF. Whilst older potassium-binding agents are associated with serious adverse events, novel potassium-binding drugs are effective in lowering potassium levels and are generally well tolerated. Hyperkalaemia represents both a direct risk of cardiovascular complication and an indirect biomarker of the severity of the underlying disease such as neurohormonal activation and renal dysfunction. Novel potassium-binding drugs such as patiromer and sodium zirconium cyclosilicate may help to optimize therapy in HF and achieve guideline-recommended doses.
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Affiliation(s)
- Redi Llubani
- Department for Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Medical Center, Kirrberger Strasse, 66421, Homburg, Saarland, Germany.
| | - Davor Vukadinović
- Department for Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Medical Center, Kirrberger Strasse, 66421, Homburg, Saarland, Germany
| | - Christian Werner
- Department for Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Medical Center, Kirrberger Strasse, 66421, Homburg, Saarland, Germany
| | - Nikolaus Marx
- Department of Internal Medicine I, RWTH Aachen University, Aachen, Germany
| | - Stephen Zewinger
- Department for Internal Medicine IV, Nephrology, Saarland University Medical Center, Homburg, Germany
| | - Michael Böhm
- Department for Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Medical Center, Kirrberger Strasse, 66421, Homburg, Saarland, Germany
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76
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Vanholder R, Van Biesen W, Nagler EV. Treating potassium disturbances: kill the killers but avoid overkill. Acta Clin Belg 2019; 74:215-228. [PMID: 30353786 DOI: 10.1080/17843286.2018.1531206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES In this publication, we review the definitions, symptoms, causes, differential diagnoses and therapies of hypokalemia and hyperkalemia. METHODS Comprehensive tables and diagnostic algorithms are provided when appropriate. RESULTS AND CONCLUSIONS Although both hypokalemia and hyperkalemia may be life-threatening, this is essentially the case with severe changes (serum potassium < 2.5 or > 6.5 mmol/L), the presence of symptoms or electrocardiographic deviations, the association with aggravating factors (e.g. digitalis intake) and/or rapid acute changes. Only these truly need an emergency therapeutic approach. In all other cases, a careful consideration of the causes and their correction should prevail over additional approaches to modify serum potassium concentration. Although most therapeutic approaches to both hypokalemia and hyperkalemia have been well established since many years, recently two new intestinal potassium binders have been introduced on the market. It remains to be elucidated whether these drugs truly have an additional role on top of the existing treatments.
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Affiliation(s)
- R. Vanholder
- Nephrology Section, Department of Internal Medicine, University Hospital Ghent, Belgium
| | - W. Van Biesen
- Nephrology Section, Department of Internal Medicine, University Hospital Ghent, Belgium
| | - E. V. Nagler
- Nephrology Section, Department of Internal Medicine, University Hospital Ghent, Belgium
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77
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Lin MC, Tsai MH, Leu JG, Fang YW. Hyperkalemia in a patient with myasthenia gravis: case presentation. BMC Endocr Disord 2019; 19:80. [PMID: 31349821 PMCID: PMC6660675 DOI: 10.1186/s12902-019-0406-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 07/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Myasthenia gravis (MG) is the most common disorder of neuromuscular transmission, and it is typified by fluctuating degrees and variable combinations of weakness in the ocular, bulbar, limb, and respiratory muscles. Under rare circumstances, MG can be accompanied by Addison's disease. CASE PRESENTATION Here, we reported the case of a 57-year-old Chinese woman with MG. She experienced progressive muscle weakness for 1 week. MG with acute exacerbation was initially suspected. However, further biochemistry tests found mild hyperkalemia (5.6 mEq/L) and a lower renal potassium excretion rate. Consequently, low aldosterone action was highly suspected. Further findings included a suppressed cortisol level, a higher adrenocorticotropic hormone concentration, and 21-hydroxylase antibody positivity, supporting a diagnosis of primary adrenal insufficiency due to autoimmune adrenalitis. CONCLUSION We successfully demonstrated that adrenal insufficiency could be diagnosed, due to the presence of hyperkalemia. This case suggested a need for clinicians to consider the possible coincidence of adrenal insufficiency in a patient with MG and hyperkalemia. Early hormone supplementation should be begun.
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Affiliation(s)
- Mi-Chu Lin
- Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, Republic of China
| | - Ming-Hsien Tsai
- Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, Republic of China
- Fu-Jen Catholic University School of Medicine, Taipei, Taiwan, Republic of China
| | - Jyh-Gang Leu
- Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, Republic of China
- Fu-Jen Catholic University School of Medicine, Taipei, Taiwan, Republic of China
| | - Yu-Wei Fang
- Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, Republic of China
- Fu-Jen Catholic University School of Medicine, Taipei, Taiwan, Republic of China
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78
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Co I, Gunnerson K. Emergency Department Management of Acute Kidney Injury, Electrolyte Abnormalities, and Renal Replacement Therapy in the Critically Ill. Emerg Med Clin North Am 2019; 37:459-471. [PMID: 31262415 DOI: 10.1016/j.emc.2019.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Acute kidney injury (AKI) is a common sequela of critical illness. Clinical manifestation of AKI varies and can include electrolyte abnormalities, anion gap, or non-anion-gap metabolic acidosis. Treatment strategies require careful identification of the cause of the AKI, relying on both clinical history and laboratory data. Once the cause has been identified, treatment can then target the underlying cause and avoid further insults. Conservative management should first be attempted for patients with AKI. If conservative management fails, renal replacement therapy or hemodialysis can be used.
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Affiliation(s)
- Ivan Co
- Department of Emergency Medicine, University of Michigan Health System, 1500 East Medical Center Drive SPC 5301, Ann Arbor, MI 48109, USA; Department of Internal Medicine, Division of Pulmonary Critical Care, University of Michigan Health System, 1500 East Medical Center Drive SPC 5301, Ann Arbor, MI 48109, USA.
| | - Kyle Gunnerson
- Department of Emergency Medicine, Division of Emergency Critical Care, Massey Family Foundation Emergency Critical Center (EC3), University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5303, USA; Department of Anesthesiology, Division of Emergency Critical Care, Massey Family Foundation Emergency Critical Center (EC3), University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5303, USA; Department of Internal Medicine, Division of Emergency Critical Care, Massey Family Foundation Emergency Critical Center (EC3), University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5303, USA
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79
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Zhang X, Cheng Q, Li L, Shangguan L, Li C, Li S, Huang F, Zhang J, Wang R. Supramolecular therapeutics to treat the side effects induced by a depolarizing neuromuscular blocking agent. Theranostics 2019; 9:3107-3121. [PMID: 31244944 PMCID: PMC6567959 DOI: 10.7150/thno.34947] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 03/27/2019] [Indexed: 12/19/2022] Open
Abstract
Succinylcholine (Sch) is the only depolarizing neuromuscular blocking agent widely used for rapid sequence induction in emergency rooms. Unfortunately, a variety of (sometimes lethal) adverse effects, such as hyperkalemia and cardiac arrest, are associated with its use, and currently there are no specific antidotes to reverse Sch or to treat these side-effects. Methods: The binding behaviors of Sch and several synthetic receptors, including cucurbit[7]uril, sulfo-calix[4]arene and water-soluble carboxylatopillar[6]arene (WP[6]), were first investigated. With a mouse model, a leathal dose of Sch was selected for evaluation of the antidotal effects of these synthetic receptors on Sch induced mortality. The antidotal effects of a selected synthetic receptor, WP[6], on Sch induced cardiac arrhythmias, hyperkalemia, rhabdomyolysis and paralysis were subsequently evaluated with rat and mouse models. The reversal mechanism was also investigated at a cellular level. Results: All of these macrocyclic molecules exhibited relatively high binding affinities with Sch in vitro. In a Sch-overdosed mouse model, immediate injection of these synthetic receptors right after Sch administration increased the overall survival rate, with WP[6] standing out with the most effective antidotal effects. In addition, administration of WP[6] also reversed the paralysis induced by Sch in a mouse model. Moreover, infusion of WP[6] to Sch-overdosed rats reduced the incidence of cardiac arrhythmia, inhibited the otherwise abnormally high serum potassium levels, and relieved the muscular damage. At the cellular level, WP[6] reversed the Sch induced depolarization and reduced the efflux of intracellular potassium. Conclusion: Synthetic receptors, particularly WP[6], exhibited high binding affinities towards Sch, and presented a significant potential as supramolecular therapeutics to treat the various side effects of Sch by specifically sequestering Sch in vivo.
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Affiliation(s)
- Xiangjun Zhang
- State Key Laboratory of Quality Research in Chinese Medicine, and Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau, China
| | - Qian Cheng
- State Key Laboratory of Quality Research in Chinese Medicine, and Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau, China
| | - Lanlan Li
- Department of Pharmaceutics, College of Pharmacy, Third Military Medical University, Chongqing 400038, China
| | - Liqing Shangguan
- State Key Laboratory of Chemical Engineering, Center for Chemistry of High-Performance & Novel Materials, Department of Chemistry, Zhejiang University, Hangzhou 310027, P. R. China
| | - Chenwen Li
- Department of Pharmaceutics, College of Pharmacy, Third Military Medical University, Chongqing 400038, China
| | - Shengke Li
- State Key Laboratory of Quality Research in Chinese Medicine, and Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau, China
- School of Materials Science and Engineering, Nanjing University of Science and Technology, Nanjing 210094, China
| | - Feihe Huang
- State Key Laboratory of Chemical Engineering, Center for Chemistry of High-Performance & Novel Materials, Department of Chemistry, Zhejiang University, Hangzhou 310027, P. R. China
| | - Jianxiang Zhang
- Department of Pharmaceutics, College of Pharmacy, Third Military Medical University, Chongqing 400038, China
| | - Ruibing Wang
- State Key Laboratory of Quality Research in Chinese Medicine, and Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau, China
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80
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Moshinsky JA, Tutungi E. Malignant Hyperthermia During Sleeve Lobectomy for Resection of a Proximal Endobronchial Tumor. J Cardiothorac Vasc Anesth 2019; 33:3095-3100. [PMID: 31076299 DOI: 10.1053/j.jvca.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 04/05/2019] [Accepted: 04/08/2019] [Indexed: 11/11/2022]
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81
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Wooten JM, Kupferman FE, Kupferman JC. A Brief Review of the Pharmacology of Hyperkalemia: Causes and Treatment. South Med J 2019; 112:228-233. [DOI: 10.14423/smj.0000000000000957] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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82
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Vijayakumar S, Butler J, Bakris GL. Barriers to guideline mandated renin-angiotensin inhibitor use: focus on hyperkalaemia. Eur Heart J Suppl 2019; 21:A20-A27. [PMID: 30837801 PMCID: PMC6392419 DOI: 10.1093/eurheartj/suy030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Hyperkalaemia in patients with chronic disease states can be caused by both abnormalities of potassium homeostasis as well as extrinsic factors such as medication use and potassium intake. In patients with heart failure (HF), chronic kidney disease (CKD), diabetes mellitus (DM), and in those who use renin-angiotensin-aldosterone system inhibitors (RAASi), there is particularly increased risk of chronic or recurrent hyperkalaemia. Hyperkalaemia is often a reason for the suboptimal dosing or complete discontinuation of RAASi. This review presents current options for the management of hyperkalaemia in patients with chronic disease states. It also explores barriers to guideline-mediated RAASi prescribing patterns in these high-risk patients and highlights the unmet need for agents that adequately manage hyperkalaemia in patients with chronic diseases on concomitant RAASi therapy.
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Affiliation(s)
- Shilpa Vijayakumar
- Department of Medicine, Stony Brook University, 101 Nicolls Road, Stony Brook, NY, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi, 2500 North State Street, Jackson, MS, USA
| | - George L Bakris
- Department of Medicine, Comprehensive Hypertension Center, The University of Chicago Medicine, 5481 S. Maryland Avenue MC 1027, Chicago, IL, USA
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83
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Rafique Z, Chouihed T, Mebazaa A, Frank Peacock W. Current treatment and unmet needs of hyperkalaemia in the emergency department. Eur Heart J Suppl 2019; 21:A12-A19. [PMID: 30837800 PMCID: PMC6392420 DOI: 10.1093/eurheartj/suy029] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hyperkalaemia is a common electrolyte abnormality and can cause life-threatening cardiac arrhythmia. Even though it is common in patients with diabetes, heart failure, and kidney disease, there is poor consensus over its definition and wide variability in its treatment. Medications used to treat hyperkalaemia in the emergent setting do not have robust efficacy and safety data to guide treatment leading to mismanagement due to poor choice of some agents or inappropriate dosing of others. Moreover, the medications used in the emergent setting are at best temporizing measures, with dialysis being the definitive treatment. New and old k binder therapies provide means to excrete potassium, but their roles are unclear in the emergent setting. Electrocardiograms are the corner stones of hyperkalaemia management; however, recent studies show that they might manifest abnormalities infrequently, even in severe hyperkalaemia, thus questioning their role. With an aging population and a rise in rates of heart and kidney failure, hyperkalaemia is on the rise, and there is a need, now more than ever, to understand the efficacy and safety of the current medications and to develop newer ones.
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Affiliation(s)
- Zubaid Rafique
- Baylor College of Medicine, Ben Taub General Hospital, Houston, TX, USA
| | - Tahar Chouihed
- Emergency Department, University Hospital of Nancy, France; Clinical Investigation Center-Unit 1433; INSERM U1116, University of Lorraine, Nancy, France
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care, APHP - Saint Louis Lariboisière University Hospitals, University Paris Diderot and INSERM UMR-S 942, Paris, France
| | - W Frank Peacock
- Baylor College of Medicine, Ben Taub General Hospital, Houston, TX, USA
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84
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Chlíbková D, Nikolaidis PT, Rosemann T, Knechtle B, Bednář J. Maintained Hydration Status After a 24-h Winter Mountain Running Race Under Extremely Cold Conditions. Front Physiol 2019; 9:1959. [PMID: 30687135 PMCID: PMC6336898 DOI: 10.3389/fphys.2018.01959] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 12/28/2018] [Indexed: 12/21/2022] Open
Abstract
Background: To date, no study has examined the hydration status of runners competing in a 24-h winter race under extremely cold environmental conditions. Therefore, the aim was to examine the effect of a 24-h race under an average temperature of -14.3°C on hydration status. Methods: Blood and urine parameters and body mass (BM) were assessed in 20 finishers (women, n = 6; men, n = 14) pre- and post-race. Results: Five (25%) ultra-runners had lower pre-race plasma sodium [Na+] and 11 (52%) had higher pre-race plasma potassium [K+] values than the reference ranges. Post-race plasma [Na+], plasma osmolality, urine osmolality and urine specific gravity remained stable (p > 0.05). The estimated fluid intake did not differ (p > 0.05) between women (0.30 ± 0.06 L/h) and men (0.46 ± 0.21 L/h). Runners with a higher number of completed ultra-marathons (r = -0.50, p = 0.024) and higher number of training kilometers (r = -0.68, p = 0.001) drank less than those with lower running experience. Pre-race and post-race plasma [Na+] were related to plasma osmolality (r = 0.65, p = 0.002, r = 0.69, p < 0.001, respectively) post-race, but not to fluid intake (p > 0.05). BM significantly decreased post-race (p = 0.002) and was not related to plasma [Na+] or fluid intake (p > 0.05). Post-race hematocrit and plasma [K+] decreased (p < 0.001) and transtubular potassium gradient increased (p = 0.008). Higher pre-race plasma [K+] was related to higher plasma [K+] loss post-race (p = -0.85, p < 0.001). Conclusion: Hydration status remained stable despite the extremely cold winter weather conditions. Overall fluid intake was probably sufficient to replenish the hydration needs of 24-h runners. Current recommendations may be too high for athletes competing in extremely cold conditions.
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Affiliation(s)
- Daniela Chlíbková
- Centre of Sports Activities, Brno University of Technology, Brno, Czechia
| | | | | | - Beat Knechtle
- Exercise Physiology Laboratory, Nikaia, Greece.,Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland
| | - Josef Bednář
- Faculty of Mechanical Engineering, Brno University of Technology, Brno, Czechia
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85
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Association of Abnormal Serum Potassium Levels with Arrhythmias and Cardiovascular Mortality: a Systematic Review and Meta-Analysis of Observational Studies. Cardiovasc Drugs Ther 2019; 32:197-212. [PMID: 29679302 DOI: 10.1007/s10557-018-6783-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To provide the first systematic review and meta-analysis of observational studies on the association of abnormal serum potassium and cardiovascular outcomes. METHODS Medline and ISI Web of Knowledge were systematically searched from inception until November 24, 2017. Data synthesis of relevant studies was performed using random effects model meta-analyses. RESULTS Meta-analyses included 310,825 participants from 24 studies. In the older general population, low serum potassium was associated with a 1.6-fold increased risk of supraventricular arrhythmias (risk ratio [95% confidence interval] 1.62 [1.02-2.55]). Contrarily, high serum potassium was associated with increased cardiovascular mortality (CVM) (1.38 [1.14-1.66]). In patients with acute myocardial infarction, the risk of ventricular arrhythmias was increased for high serum potassium (2.33 [1.60-3.38]). A U-shaped association was observed with a composite cardiovascular outcome in hypertensive patients (2.6-fold increased risk with hypokalemia and 1.7-fold increased risk with hyperkalemia), with CVM in dialysis patients (1.1-fold increased risk with hypokalemia and 1.4-fold increased risk with hyperkalemia) and with CVM in heart failure patients (albeit not statistically significant). Further, only hyperkalemia was associated with an increased risk of a composite cardiovascular outcome in both dialysis (1.12 [1.03-1.23]) and chronic kidney disease (1.34 [1.06-1.71]) patients. CONCLUSIONS Controlled clinical trials are needed to determine which populations may profit from more frequent potassium-monitoring and subsequent interventions, e.g., change or withdrawal of potassium-influencing drugs, in order to restore normal values and prevent cardiovascular outcomes. REGISTRATION DETAILS Registration in PROSPERO (Centre for Reviews and Dissemination University of York, York, UK): CRD42016048897 ( https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=48897 ).
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86
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Castro MCM. Conservative management for patients with chronic kidney disease refusing dialysis. J Bras Nefrol 2019; 41:95-102. [PMID: 30048562 PMCID: PMC6534024 DOI: 10.1590/2175-8239-jbn-2018-0028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/14/2018] [Indexed: 12/24/2022] Open
Abstract
Estimates suggest that 20-30% of the deaths of patients with chronic kidney disease with indication to undergo dialysis occur after refusal to continue dialysis, discontinuation of dialysis or inability to offer dialysis on account of local conditions. Contributing factors include aging, increased comorbidity associated with chronic kidney disease, and socioeconomic status. In several occasions nephrologists will intervene, but at times general practitioners or family physicians are on their own. Knowledge of the main etiologies of chronic kidney disease and the metabolic alterations and symptoms associated to end-stage renal disease is an important element in providing patients with good palliative care. This review aimed to familiarize members of multidisciplinary care teams with the metabolic alterations and symptoms arising from chronic kidney disease treated clinically without the aid of dialysis.
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87
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Saw HP, Chiu CD, Chiu YP, Ji HR, Chen JY. Nebulized salbutamol diminish the blood glucose fluctuation in the treatment of non-oliguric hyperkalemia of premature infants. J Chin Med Assoc 2019; 82:55-59. [PMID: 30839405 DOI: 10.1016/j.jcma.2018.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hyperkalemia is a risky and potentially life-threatening condition in pre-term infants. Glucose-insulin infusion has been considered a major therapeutic way for non-oligouric hyperkalemia but affects the stability of blood sugar level. We aimed to evaluate the effectiveness of salbutamol nebulization compared to glucose-insulin infusion for the treatment of non-oliguric hyperkalemia in premature infants. METHODS Forty premature infants (gestation age ≤36 weeks) with non-oliguric hyperkalemia (central serum potassium level greater than 6.0 mmol/L) within 72 h of birth were enrolled in this study. These infants were randomly assigned into two groups. One group received a regular insulin bolus with glucose infusion (Group A; n = 20), and the other received salbutamol (Ventolin) by nebulization (Group B; n = 20). Potassium level, blood sugar, heart rate, and blood pressure were recorded for each group before treatment and at 3, 12, 24, 48, and 72 h post-treatment. RESULTS The serum potassium levels were reduced after treatment in both groups. No significant changes in heart rate or blood pressure were observed in either group. The fluctuation in glucose levels was gentler in the salbutamol-treated group than in the glucose-insulin infusion group. CONCLUSION Salbutamol nebulization is not only as effective as glucose-insulin infusion for treating non-oliguric hyperkalemia in premature infants but can avoid potential side effects such as vigorous blood glucose fluctuations.
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Affiliation(s)
- Hean-Pat Saw
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
- Chung Kang Branch, Cheng Ching General Hospital, Taichung, Taiwan, ROC
| | - Cheng-Di Chiu
- School of Medicine, China Medical University, Taichung, Taiwan, ROC
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan, ROC
- Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan, ROC
- Stroke Center, China Medical University Hospital, Taichung, Taiwan, ROC
| | - You-Pen Chiu
- School of Medicine, China Medical University, Taichung, Taiwan, ROC
- Stroke Center, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Hui-Ru Ji
- School of Medicine, China Medical University, Taichung, Taiwan, ROC
- Stroke Center, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Jia-Yuh Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC
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88
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Abbasi P, Mojalli M, Kianmehr M, Zamani S. Effect of acupressure on constipation in patients undergoing hemodialysis: A randomized double-blind controlled clinical trial. AVICENNA JOURNAL OF PHYTOMEDICINE 2019; 9:84-91. [PMID: 30788281 PMCID: PMC6369316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 07/17/2018] [Accepted: 08/08/2018] [Indexed: 10/29/2022]
Abstract
OBJECTIVE Constipation is one of the most common digestive problems in patients undergoing hemodialysis. It has a negative effect on quality of life in these patients. As routine treatments are not effective in this regard, complementary therapies may help to overcome this condition. This study aimed to investigate the effect of acupressure on constipation in patients undergoing hemodialysis. MATERIALS AND METHODS This was a randomized double- blind placebo- controlled clinical trial conducted in 2014. A convenience sample of 70 patients undergoing hemodialysis was selected from hemodialysis units of three hospitals affiliated to Mazandaran University of Medical Sciences, Mazandaran, Iran. Patients were randomly assigned to intervention or control group. Intervention group received acupressure in acupressure points three times a week for four weeks during hemodialysis. In control group, acupressure was delivered in false points. We assessed the frequency of defecation in the two groups before and after the study. The study instruments consisted of a demographic questionnaire, and a data sheet for documenting constipation frequency. RESULTS The results indicated a significant difference between intervention group (13.73±3.63) and control group (10.06±3.77) in frequency of defecation during the fourth week of intervention (p<0.001). Regarding quality of stool, there was a meaningful difference between the groups in the fourth week in a way that the stool in the intervention group was more natural and in the control group, it was thicker and more adhesive. CONCLUSION Acupressure seems to be an effective complementary treatment for constipation in patients undergoing hemodialysis.
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Affiliation(s)
- Parivash Abbasi
- Student Research Committee,Gonabad University of Medical Sciences, Gonabad, Iran
| | - Mohammad Mojalli
- Social Development and Health Promotion Research Center & Department of Nursing, Faculty of Nursing and Midwifery, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Mojtaba Kianmehr
- Department of Medical Physics, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Somayeh Zamani
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Abstract
Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are available online to subscribers. Monographs can be customized to meet the needs of a facility. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, contact Wolters Kluwer customer service at 866-397-3433.
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90
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Bakhai A, Palaka E, Linde C, Bennett H, Furuland H, Qin L, McEwan P, Evans M. Development of a health economic model to evaluate the potential benefits of optimal serum potassium management in patients with heart failure. J Med Econ 2018; 21:1172-1182. [PMID: 30160541 DOI: 10.1080/13696998.2018.1518239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AIMS Patients with heart failure are at increased risk of hyperkalemia, particularly when treated with renin-angiotensin-aldosterone system inhibitor (RAASi) agents. This study developed a model to quantify the potential health and economic value associated with sustained potassium management and optimal RAASi therapy in heart failure patients. MATERIALS AND METHODS A patient-level, fixed-time increment stochastic simulation model was designed to characterize the progression of heart failure through New York Heart Association functional classes, and predict associations between serum potassium levels, RAASi use, and consequent long-term outcomes. Following internal and external validation exercises, model analyses sought to quantify the health and economic benefits of optimizing both serum potassium levels and RAASi therapy in heart failure patients. Analyses were conducted using a UK payer perspective, independent of costs and utilities related to pharmacological potassium management. RESULTS Validation against multiple datasets demonstrated the predictive capability of the model. Compared to those who discontinued RAASi to manage serum potassium, patients with normokalemia and ongoing RAASi therapy benefited from longer life expectancy (+1.38 years), per-patient quality-adjusted life year gains (+0.53 QALYs), cost savings (£110), and associated net monetary benefit (£10,679 at £20,000 per QALY gained) over a lifetime horizon. The predicted value of sustained potassium management and ongoing RAASi treatment was largely driven by reduced mortality and hospitalization risks associated with optimal RAASi therapy. LIMITATIONS Several modeling assumptions were made to account for a current paucity of published literature; however, ongoing refinement and validation of the model will ensure its continued accuracy as the clinical landscape of hyperkalemia evolves. CONCLUSIONS Predictions generated by this novel modeling approach highlight the value of sustained potassium management to avoid hyperkalemia, enable RAASi therapy, and improve long-term health economic outcomes in patients with heart failure.
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Affiliation(s)
- Ameet Bakhai
- a Department of Cardiology , Royal Free Hospital , London , UK
| | - Eirini Palaka
- b Global Health Economics, AstraZeneca , Cambridge , UK
| | - Cecilia Linde
- c Heart and Vascular Theme , Karolinska University Hospital and Karolinska Institutet , Stockholm , Sweden
| | - Hayley Bennett
- d Health Economics and Outcomes Research Ltd , Cardiff , UK
| | - Hans Furuland
- e Department of Nephrology , Uppsala University Hospital , Uppsala , Sweden
| | - Lei Qin
- f Global Health Economics, AstraZeneca , Gaithersburg , MD , USA
| | - Phil McEwan
- d Health Economics and Outcomes Research Ltd , Cardiff , UK
- g School of Human and Health Sciences , Swansea University , Swansea , UK
| | - Marc Evans
- h Diabetes Resource Centre , Llandough Hospital , Cardiff , UK
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91
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Munyenyembe AU, Gausi K, Nyirenda TS, Hiestand J, Mallewa J, Mandala WL. HIV infection has a profound effect on hematological factors but not on electrolyte profile of Malawian adults presenting with uncomplicated malaria and severe malaria. J Blood Med 2018; 9:153-162. [PMID: 30323699 PMCID: PMC6178338 DOI: 10.2147/jbm.s172869] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim Although malaria and HIV infections independently affect the electrolyte and hematologic profiles, little is known of how these profiles are affected in individuals coinfected with malaria and HIV. We therefore conducted this study to investigate the electrolyte and hematologic profiles of Malawian adults presenting with either uncomplicated malaria (UM), severe malaria (SM), and those presenting with HIV and UM or HIV and SM. Methods Study participants were recruited at Queen Elizabeth Central Hospital, and malaria infection was confirmed by rapid diagnostic test and malaria slides, and full blood count, HIV, and wet chemistries were analyzed. Results Sodium, potassium, calcium, and chloride levels of all 4 study groups were similar to those of healthy controls. Both HIV-infected groups (UM and SM) had lower red blood cell counts and lower hemoglobin concentration than the reference range. Platelet counts were lower in both HIV-uninfected SM cases (64×109/L) and in the HIV-infected SM cases (66×109/L) compared to the reference range (115–290×109/L). HIV− UM cases had higher proportion and absolute counts of neutrophils and white blood cell counts compared to the HIV+ UM cases. Conclusion HIV infection did not affect the electrolyte profile of Malawian adults presenting with UM or SM but had an effect on red blood cells, Hb concentration, neutrophils, and platelet counts.
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Affiliation(s)
| | - Kamunkhwala Gausi
- Malawi-Liverpool Wellcome Trust, Malaria Immunology Department, Blantyre, Malawi, ,
| | | | | | - Jane Mallewa
- Medicine Department, College of Medicine, Blantyre, Malawi
| | - Wilson L Mandala
- Malawi-Liverpool Wellcome Trust, Malaria Immunology Department, Blantyre, Malawi, , .,Academy of Medical Sciences, Biological Sciences Department, Malawi University of Science & Technology, Thyolo, Malawi,
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92
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An adolescent presenting with acquired acute renal damage: Answers. Pediatr Nephrol 2018; 33:1687-1688. [PMID: 29335770 DOI: 10.1007/s00467-017-3879-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022]
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93
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Pitt B, Zann V, Roe C, Jacobs JW, Davidson JP, Dowd C, Kumaraswamy P, Lin F, Korner P, Blanks RC, Rosenbaum DP. An Evaluation of the Pharmacodynamics, Safety, and Tolerability of the Potassium Binder RDX7675. J Clin Pharmacol 2018; 58:1035-1043. [DOI: 10.1002/jcph.1102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 01/18/2018] [Indexed: 01/14/2023]
Affiliation(s)
- Bertram Pitt
- Department of Medicine; University of Michigan School of Medicine; Ann Arbor MI USA
| | | | - Chris Roe
- Quotient Clinical; Ruddington Nottingham UK
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94
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Effect of Serum Potassium on Residual-specific Mortality: Interaction Evaluation by Physical Activity. Am J Ther 2018; 25:e489-e490. [PMID: 29990312 DOI: 10.1097/mjt.0000000000000564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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95
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Ribeiro HS, Oliveira MC, Anastácio LR, Generoso SV, Lima AS, Correia MI. PREVALENCE AND RISK FACTORS OF HYPERKALEMIA AFTER LIVER TRANSPLANTATION. ACTA ACUST UNITED AC 2018; 31:e1357. [PMID: 29947691 PMCID: PMC6050000 DOI: 10.1590/0102-672020180001e1357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 02/08/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND There is a lack of data regarding hyperkalemia after liver transplantation. AIM To evaluate the prevalence of hyperkalemia after liver transplantation and its associated factors. METHODS This retrospective cohort study evaluated 147 consecutive post-transplant patients who had at least one year of outpatient medical follow up. The data collection included gender, age, potassium values, urea, creatinine, sodium and medication use at 1, 6 and 12 months after. Hyperkalemia was defined as serum potassium concentrations higher than 5.5 mEq/l. RESULTS Hiperkalemia was observed in 18.4%, 17.0% and 6.1% of patients 1, 6 and 12 months after tranplantation, respectively. Older age (p=0.021), low creatinine clearance (p=0.007), increased urea (p=0.010) and hypernatremia (p=0.014) were factors associated with hyperkalemia, as well as the dose of prednisone at six months (p=0.014). CONCLUSION Hyperkalemia was prevalent in less than 20% of patients in the 1st month after liver transplantation and decreased over time. Considering that hyperkalemia does not affect all patients, attention should be paid to the routine potassium intake recommendations, and treatment should be individualized.
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Affiliation(s)
- Helem Sena Ribeiro
- Postgraduate Program in Applied Sciences for Surgery, Faculty of Medicine
| | | | | | | | - Agnaldo Soares Lima
- Hospital das Clínicas, Alpha Institute of Gastroenterology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Maria Isabel Correia
- Hospital das Clínicas, Alpha Institute of Gastroenterology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
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96
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Abstract
OBJECTIVE The retrospective study aimed to estimate prevalence of hyperkalemia using a large US commercial claims database. METHODS Adults with serum potassium lab data (2010 to 2014) and ≥1 calendar year of data were included from a large US commercial claims database. Hyperkalemia was defined as ≥2 serum potassium measurements >5.0 mEq/L or one hyperkalemia diagnosis code (ICD-9-CM, 276.7) or one sodium polystyrene sulfonate fill. Hyperkalemia prevalence was estimated for the overall population and subgroups with hyperkalemia-related comorbidities by calendar year. Hyperkalemia prevalence was also standardized to the US population to estimate the number of US adults with hyperkalemia. RESULTS The analysis included 2,270,635 patients (2010-2014). The annual prevalence of hyperkalemia in the overall population was 1.57% in 2014, with higher rates observed in patients with chronic kidney disease (CKD), heart failure, diabetes and hypertension. Among patients with CKD and/or heart failure, the 2014 annual prevalence was 6.35%. Among patients with hyperkalemia, 48.43% had CKD and/or heart failure in 2014. The prevalence of hyperkalemia was higher in patients with more severe CKD, as well as older patients and men. Extrapolating those results to the US population supports that 1.55% or 3.7 million US adults had hyperkalemia in 2014. CONCLUSIONS An estimated 3.7 million US adults had hyperkalemia in 2014, and this prevalence rate has increased since 2010. In patients with CKD and/or heart failure, the annual prevalence of hyperkalemia was 6.35% in 2014, and about half of all patients with hyperkalemia have either CKD and/or heart failure.
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Affiliation(s)
| | - J Michael Woolley
- b ZS Pharma, a member of the AstraZeneca Group , San Mateo , CA , USA
| | - Fan Mu
- a Analysis Group Inc. , Boston , MA , USA
| | | | - Wenxi Tang
- a Analysis Group Inc. , Boston , MA , USA
| | - Eric Q Wu
- a Analysis Group Inc. , Boston , MA , USA
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Campbell CA, Lam Q, Horvath AR. An evidence- and risk-based approach to a harmonized laboratory alert list in Australia and New Zealand. ACTA ACUST UNITED AC 2018; 57:89-94. [DOI: 10.1515/cclm-2017-1114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/15/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Individual laboratories are required to compose an alert list for identifying critical and significant risk results. The high-risk result working party of the Royal College of Pathologists of Australasia (RCPA) and the Australasian Association of Clinical Biochemists (AACB) has developed a risk-based approach for a harmonized alert list for laboratories throughout Australia and New Zealand. The six-step process for alert threshold identification and assessment involves reviewing the literature, rating the available evidence, performing a risk analysis, assessing method transferability, considering workload implications and seeking endorsement from stakeholders. To demonstrate this approach, a worked example for deciding the upper alert threshold for potassium is described. The findings of the worked example are for infants aged 0–6 months, a recommended upper potassium alert threshold of >7.0 mmol/L in serum and >6.5 mmol/L in plasma, and for individuals older than 6 months, a threshold of >6.2 mmol/L in both serum and plasma. Limitations in defining alert thresholds include the lack of well-designed studies that measure the relationship between high-risk results and patient outcomes or the benefits of treatment to prevent harm, and the existence of a wide range of clinical practice guidelines with conflicting decision points at which treatment is required. The risk-based approach described presents a transparent, evidence- and consensus-based methodology that can be used by any laboratory when designing an alert list for local use. The RCPA-AACB harmonized alert list serves as a starter set for further local adaptation or adoption after consultation with clinical users.
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Affiliation(s)
- Craig A. Campbell
- NSW Health Pathology, Department of Clinical Chemistry and Endocrinology , Prince of Wales Hospital , Sydney, NSW 2031 , Australia , Phone: +612 93829082, Fax: +612 93829099
- Australian Institute of Health Innovation , Macquarie University , Sydney, NSW , Australia
| | - Que Lam
- Department of Pathology , Austin Health , Heidelberg, Victoria , Australia
| | - Andrea R. Horvath
- NSW Health Pathology, Department of Clinical Chemistry and Endocrinology , Prince of Wales Hospital , Sydney, NSW , Australia
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Te Dorsthorst RPM, Hendrikse J, Vervoorn MT, van Weperen VYH, van der Heyden MAG. Review of case reports on hyperkalemia induced by dietary intake: not restricted to chronic kidney disease patients. Eur J Clin Nutr 2018; 73:38-45. [PMID: 29588531 DOI: 10.1038/s41430-018-0154-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 02/19/2018] [Accepted: 02/28/2018] [Indexed: 12/31/2022]
Abstract
Hyperkalemia is a metabolic disturbance of the potassium balance that can cause potentially fatal cardiac arrhythmias. Kidney dysfunction and renin-angiotensin-aldosterone system inhibiting drugs are notorious for their tendency to induce hyperkalemia by decreasing the excretion of potassium. The role of dietary potassium intake in inducing hyperkalemia is less clear. We review and analyze the common presentation, laboratory, and electrocardiogram (ECG) findings and therapeutic options associated with dietary-induced hyperkalemia, and find evidence for hyperkalemia development in non-renal impaired patients. Thirty-five case reports including 44 incidences of oral intake-induced hyperkalemia were assessed, 17 patients did not suffer from kidney dysfunction. Mean age was 49 ± 20 years. Mean potassium concentration was 8.2 ± 1.4 mEq/l, most frequently caused by abundant intake of fruit and vegetables (n = 17) or salt substitutes (n = 12). In patients with normal kidney function, intake of salt substitutes or supplements was the main cause of hyperkalemia. Main symptoms encompassed muscle weakness (29.5%), vomiting (20.4%), and dyspnea (15.9%). When ECGs were performed (n = 30), abnormalities were present in 86.7% of cases. Treatment involved administration of insulin (n = 22), sodium/calcium polystyrene sulfonate (n = 14), and/or calcium gluconate (n = 14). Forty patients fully recovered. Three, non-renal impaired, patients passed away. These results offer insight into the clinical aspects of dietary-induced hyperkalemia and suggest that the common assumption that dietary-induced hyperkalemia is a condition of renal impaired patients might be incorrect.
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Affiliation(s)
- Rogier P M Te Dorsthorst
- Participant in the Honours Program CRU2006 Bachelor, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jytte Hendrikse
- Participant in the Honours Program CRU2006 Bachelor, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Mats T Vervoorn
- Participant in the Honours Program CRU2006 Bachelor, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Valerie Y H van Weperen
- Participant in the Honours Program CRU2006 Bachelor, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Marcel A G van der Heyden
- Department of Medical Physiology, Division of Heart & Lungs, University Medical Center Utrecht, Yalelaan 50, 3584 CM, Utrecht, The Netherlands.
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99
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Palaka E, Leonard S, Buchanan-Hughes A, Bobrowska A, Langford B, Grandy S. Evidence in support of hyperkalaemia management strategies: A systematic literature review. Int J Clin Pract 2018; 72. [PMID: 29381246 DOI: 10.1111/ijcp.13052] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/06/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Hyperkalaemia is a potentially life-threatening condition that can be managed with pharmacological and non-pharmacological approaches. With the recent development of new hyperkalaemia treatments, new information on safe and effective management of hyperkalaemia has emerged. OBJECTIVES This systematic literature review (SLR) aimed to identify all relevant comparative and non-comparative clinical data on management of hyperkalaemia in adults. Our secondary aim was to assess the feasibility of quantitatively comparing randomised controlled trial (RCT) data on the novel treatment sodium zirconium cyclosilicate (ZS) and established pharmacological treatments for the non-emergency management of hyperkalaemia, such as the cation-exchangers sodium/calcium polystyrene sulphonate (SPS/CPS). METHODS MEDLINE, Embase and the Cochrane Library were searched on 3rd April 2017, with additional hand-searches of key congresses and previous SLRs. Articles were screened by two independent reviewers. Eligible records reported interventional or observational studies of pharmacological or non-pharmacological management of hyperkalaemia in adults. RESULTS Database searches identified 2,073 unique records. Two hundred and one publications were included, reporting 30 RCTs, 29 interventional non-RCTs and 43 observational studies. Interventions investigated in RCTs included ZS (3), SPS/CPS (3), patiromer (4) and combinations of temporising agents (6 RCTs). A robust and meaningful indirect treatment comparison between ZS and long-established cation-binding agents (SPS/CPS) was infeasible because of heterogeneity between studies (including time points and dosing) and small sample size in SPS/CPS studies. CONCLUSIONS Despite hyperkalaemia being associated with several chronic diseases, there is a paucity of high-quality randomised evidence on long-established treatment options (SPS and CPS) and a limited evidence base for hyperkalaemia management with these agents.
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Betts KA, Woolley JM, Mu F, Xiang C, Tang W, Wu EQ. The Cost of Hyperkalemia in the United States. Kidney Int Rep 2017; 3:385-393. [PMID: 29725642 PMCID: PMC5932129 DOI: 10.1016/j.ekir.2017.11.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 10/04/2017] [Accepted: 11/06/2017] [Indexed: 11/16/2022] Open
Abstract
Introduction There are limited data on the cost of hyperkalemia. Methods This retrospective analysis of the Truven MarketScan claims database assessed the economic burden of hyperkalemia among selected adult patients with hyperkalemia and matched controls. Results A total of 39,626 cases (patients with hyperkalemia) were matched to 39,626 controls (patients without hyperkalemia) based on age, dialysis, chronic kidney disease (CKD) stage, heart failure, and renin-angiotensin aldosterone system inhibitor use. Compared with controls, cases incurred $4128 (95% confidence interval [CI] $3893-$4363) higher 30-day total health care costs ($5994 vs. $1865) and $15,983 (95% CI $15,026-$16,940) higher 1-year costs ($31,844 vs. $15,861). Among 11,221 matched pairs of patients with CKD and/or heart failure, cases incurred $5553 (95% CI $5059-$6047) higher 30-day total health care costs ($8165 vs. $2612) and $24,133 (95% CI $21,748-$26,518) higher 1-year costs ($48,994 vs. $24,861) than controls. The multivariable adjusted 1-year total health care cost difference was $15,606 (95% CI $14,648-$16,576) among all patients and $25,156 (95% CI $23,529-$26,757) among patients with CKD and/or heart failure. Cases had higher resource utilization rates including inpatient admissions (30-day: 0.14 vs. 0.03; 1-year: 0.44 vs. 0.19), outpatient visits (30-day: 3.33 vs. 2.28; 1-year: 26.58 vs. 18.53), and emergency department visits (30-day: 0.16 vs. 0.06; 1-year: 0.86 vs. 0.50) (all P < 0.001). When hospitalized, cases stayed 1.51 days (95% CI 1.22-1.80) longer and were 40% more likely to be readmitted. Conclusion These data indicate that hyperkalemia is associated with a significant economic burden on afflicted patients and the health care system.
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Affiliation(s)
| | - J Michael Woolley
- ZS Pharma, a member of the AstraZeneca Group, San Mateo, California, USA
| | - Fan Mu
- Analysis Group, Inc., Boston, Massachusetts, USA
| | - Cheryl Xiang
- Analysis Group, Inc., Boston, Massachusetts, USA
| | - Wenxi Tang
- Analysis Group, Inc., Boston, Massachusetts, USA
| | - Eric Q Wu
- Analysis Group, Inc., Boston, Massachusetts, USA
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