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Shen N, Zhang L, Yang J, Lin Y, Liu X, Cai X, Cao J, Zhu Q, Luo X, Wan X, Wu H, Ye J, Shan C, Xie H, Wu Y, Cao Y, Wang J, Yu X, Wang H, He J, Tian S, Wu F, Jiang X, Li L, Zuo L, Wang Z, Xing C, Yin X, Zhao J, Ma C, Long G, Li Q, Hu Y, Shi Y, Lin H. Effectiveness, safety, and treatment pattern of sodium zirconium cyclosilicate in Chinese patients with hyperkalemia: interim analysis from a multicenter, prospective, real-world study (Actualize Study). Front Pharmacol 2024; 15:1398953. [PMID: 39135788 PMCID: PMC11317418 DOI: 10.3389/fphar.2024.1398953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/12/2024] [Indexed: 08/15/2024] Open
Abstract
Introduction: Sodium zirconium cyclosilicate (SZC) is a nonabsorbed cation-exchanger approved in China for the treatment of hyperkalemia [HK; serum potassium (sK+) levels >5.0 mmol/L]. This is the first real-world study aimed to assess the effectiveness, safety, and treatment patterns of SZC in Chinese patients with HK. Here we present the results of the first interim analysis. Methods: This multicenter, prospective, cohort study included patients aged ≥18 years with documented HK within 1-year before study enrollment day. These patients were followed up for 6 months from the enrollment day after initiating SZC treatment. The treatment was categorized into correction phase (FAS-P1) and maintenance phase (FAS-P2 new and ongoing users). Subgroup analysis was performed in patients on hemodialysis (FAS-H). The primary objective was evaluation of safety profile of SZC; secondary objectives included assessment of treatment patterns of SZC and its effectiveness. Results: Of 421 screened patients, 193, 354, and 162 patients were enrolled in the FAS-P1, FAS-P2, and FAS-H groups, respectively. sK+ levels were reduced significantly from 5.9 mmol/L to 5.0 mmol/L after the correction phase. For the maintenance phase, the mean sK+ levels were maintained at 5.2 mmol/L and 5.0 mmol/L in the FAS-P2 new and ongoing user, respectively, and 5.3 mmol/L in the FAS-H subgroup. A considerable proportion of patients showed normokalemia after 48 h of SZC treatment (FAS-P1:51.3%) which was maintained up to 6 months in the maintenance phase (FAS-P2:44%). SZC was well-tolerated. Conclusion: SZC was effective and safe for the treatment of HK in real-world clinical practice in China.
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Affiliation(s)
- Nan Shen
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Lihong Zhang
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jing Yang
- Hefei First People’s Hospital, Hefei, Anhui, China
| | - Yongqiang Lin
- Wenzhou Integrated Chinese and Western Medicine Hospital, Wenzhou, Zhejiang, China
| | - Xinyu Liu
- Nanyang Central Hospital, Nanyang, Henan, China
| | - Xudong Cai
- Ningbo Traditional Chinese Medicine Hospital, Ningbo, Zhejiang, China
| | - Juan Cao
- Taixing People’s Hospital, Taizhou, Jiangsu, China
| | - Qiang Zhu
- Xinghua People’s Hospital, Taizhou, China
| | - Xun Luo
- Hunan Provincial People’s Hospital, Changsha, Hunan, China
| | - Xin Wan
- The First Hospital of Nanjing, Nanjing, Jiangsu, China
| | - Henglan Wu
- The First Hospital of Jiaxing, Jiaxing, Zhejiang, China
| | - Jianming Ye
- The First People’s Hospital of Kunshan, Suzhou, Jiangsu, China
| | - Chunyan Shan
- Chu Hsien-I Memorial Hospital of Tianjin Medical University, Tianjin, China
| | - Hua Xie
- Dalian Ruikaer Renal Disease Hospital, Dalian, Liaoning, China
| | - Yifan Wu
- Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Yanping Cao
- Handan First Hospital, Handan, Heibei, China
| | | | - Xiaoyong Yu
- Shanxi Provincial Hospital of Chinese Medicine, Shanxi, China
| | - Huimin Wang
- Liaoning Health Industry Group Bensteel General Hospital, Benxi, Liaoning, China
| | - Jingdong He
- Nuclear Industry 416 Hospital, Chengdu, Sichuan, China
| | | | - Fenglei Wu
- Qidong People’s Hospital, The First Hospital of Tsinghua University, Beijing, China
| | - Xinxin Jiang
- Sandun District of Zhejiang Hospital, Zhejiang, China
| | - Lu Li
- The First Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi, China
| | - Li Zuo
- Peking University People’s Hospital, Beijing, China
| | - Zhaohua Wang
- Taian City Central Hospital, Tai’an, Shandong, China
| | - Changying Xing
- Jiangsu Province Official Hospital, Nanjing, Jiangsu, China
| | - Xun Yin
- Changshu No.2 People’s Hospital, Suzhou, Jiangsu, China
| | - Jianrong Zhao
- The Affiliated Hospital of Inner Mongolia Medical University, Hohho, Inner Mongolia, China
| | - Cong Ma
- Anshan Central Hospital, Anshan, Liaoning, China
| | - Gang Long
- Tianjin People’s Hospital, Tianjin, China
| | - Qing Li
- Tianjin Teda Hospital, Tianjin, China
| | - Yao Hu
- Clinical Medical College and Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Yifan Shi
- AstraZeneca Investment China Co., Medical Affairs, Shanghai, China
| | - Hongli Lin
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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Agiro A, AN A, Cook EE, Mu F, Chen J, Desai P, Oluwatosin Y, Pollack CV. Real-World Modifications of Renin-Angiotensin-Aldosterone System Inhibitors in Patients with Hyperkalemia Initiating Sodium Zirconium Cyclosilicate Therapy: The OPTIMIZE I Study. Adv Ther 2023; 40:2886-2901. [PMID: 37140706 PMCID: PMC10220114 DOI: 10.1007/s12325-023-02518-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/06/2023] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Hyperkalemia (HK) may result in disruptions of guidelines-concordant renin-angiotensin-aldosterone system inhibitors (RAASi), a standard of care in persons with chronic kidney disease (CKD). Such disruptions-dose reduction or discontinuation-diminish the benefits of RAASi, placing patients at risk of serious events and renal dysfunction. This real-world study evaluated RAASi modifications among patients who initiated sodium zirconium cyclosilicate (SZC) for HK. METHODS Adults (≥ 18 years) initiating outpatient SZC (index date) while on RAASi were identified from a large US claims database (January 2018-June 2020). RAASi optimization (maintain same or up-titration of RAASi dosage), non-optimization (down-titration of RAASi dosage or discontinuation), and persistence were descriptively summarized following index. Predictors of RAASi optimization were assessed using multivariable logistic regression models. Analyses were conducted by subgroups, including patients without end-stage kidney disease (ESKD), with CKD, and with CKD + diabetes. RESULTS A total of 589 patients initiated SZC during RAASi therapy (mean age 61.0 years, 65.2% male), and 82.7% patients (n = 487) kept RAASi after index (mean follow-up = 8.1 months). Most patients (77.4%) optimized RAASi therapy after initiating SZC; 69.6% maintained the same dosage while 7.8% had up-titrations. A similar rate of RAASi optimization was observed among subgroups without ESKD (78.4%), with CKD (78.9%), and with CKD + diabetes (78.1%). At 1-year post-index, 73.9% of all patients who optimized RAASi were still on therapy, while only 17.9% of patients who did not optimize therapy were still on a RAASi. Among all patients, predictors of RAASi optimization included fewer prior hospitalizations (odds ratio = 0.79, 95% CI [0.63-1.00]; p < 0.05) and fewer prior emergency department (ED) visits (0.78 [0.63-0.96]; p < 0.05). CONCLUSION Consistent with clinical trial findings, nearly 80% of patients who initiated SZC for HK optimized their RAASi therapy. Patients may require long-term SZC therapy to encourage continuation of RAASi therapy especially after inpatient and ED visits.
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Affiliation(s)
- Abiy Agiro
- AstraZeneca, US Medical Affairs, 1800 Concord Pike, Wilmington, DE 19850 USA
| | - Amin AN
- University of California Irvine, Irvine, CA 92697 USA
| | - Erin E. Cook
- Analysis Group, Inc., 111 Huntington Ave, 14th Floor, Boston, MA 02199 USA
| | - Fan Mu
- Analysis Group, Inc., 111 Huntington Ave, 14th Floor, Boston, MA 02199 USA
| | - Jingyi Chen
- Analysis Group, Inc., 111 Huntington Ave, 14th Floor, Boston, MA 02199 USA
| | - Pooja Desai
- AstraZeneca, US Medical Affairs, 1800 Concord Pike, Wilmington, DE 19850 USA
| | - Yemmie Oluwatosin
- AstraZeneca, US Medical Affairs, 1800 Concord Pike, Wilmington, DE 19850 USA
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Bjune T, Bøe TB, Kjellevold SA, Heldal K, Abedini S. Hyperkalemia and the Use of New Potassium Binders a Single Center Experience from Vestfold Norway (The PotBind Study). Int J Nephrol Renovasc Dis 2023; 16:73-82. [PMID: 36960344 PMCID: PMC10027611 DOI: 10.2147/ijnrd.s401623] [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: 12/22/2022] [Accepted: 03/03/2023] [Indexed: 03/17/2023] Open
Abstract
Purpose Hyperkalemia is a common metabolic complication of chronic kidney disease (CKD) and is associated with several serious adverse events. We aimed to treat/prevent hyperkalemia using the new of potassium-binders, allowing maintained renin-angiotensin-aldosterone system inhibitors (RAASi) treatment in proteinuric CKD and/or congestive heart failure (CHF) patients. Patients and Methods We conducted a retrospective cohort study in long-term users of potassium binders for chronic hyperkalemia. Patients aged 18 years and older, treated with potassium-binders and who met the reimbursement criteria and indication for RAASi treatment were included. Results Fifty-seven percent of the patients were males and mean age was 65 years. During the study period, no patients were admitted to hospital due to hyperkalemia after initiation of potassium binders. Potassium maximum values were significantly lower after treatment. Few patients reported major side effects, and discontinuation was mostly due to normokalemia. We found no significant changes in bicarbonate, serum creatinine or GFR stage after starting potassium binder treatment. All patients on RAASi treatment before initiating potassium-binders were retained on RAASi treatment. Conclusion New potassium binders in clinical practice are an easy and safe treatment with few side effects and good tolerance, that significantly lowers the risk of hyperkalemia. Furthermore, and most importantly, patients can be maintained on RAASi treatment.
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Affiliation(s)
- Thea Bjune
- Vear General Practitioner Group, Vear, Vestfold, Norway
- Correspondence: Thea Bjune, Vear General Practitioner group, Steinbruddveien 8, Vear, 3173, Norway, Tel +47 33362700, Email
| | | | - Stig Arne Kjellevold
- Vestfold Hospital Trust, Medical Clinic, Section for Kidney Disease, Toensberg, Vestfold, Norway
| | - Kristian Heldal
- Department of Transplantation Medicine, Oslo University Hospital and Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Sadollah Abedini
- Vestfold Hospital Trust, Medical Clinic, Section for Kidney Disease, Toensberg, Vestfold, Norway
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Humphrey TJL, James G, Wittbrodt ET, Zarzuela D, Hiemstra TF. Adverse clinical outcomes associated with RAAS inhibitor discontinuation: analysis of over 400 000 patients from the UK Clinical Practice Research Datalink (CPRD). Clin Kidney J 2021; 14:2203-2212. [PMID: 34804520 PMCID: PMC8598122 DOI: 10.1093/ckj/sfab029] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/11/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Users of guideline-recommended renin-angiotensin-aldosterone system (RAAS) inhibitors may experience disruptions to their treatment, e.g. due to hyperkalaemia, hypotension or acute kidney injury. The risks associated with treatment disruption have not been comprehensively assessed; therefore, we evaluated the risk of adverse clinical outcomes in RAAS inhibitor users experiencing treatment disruptions in a large population-wide database. METHODS This exploratory, retrospective analysis utilized data from the UK's Clinical Practice Research Datalink, linked to Hospital Episodes Statistics and the Office for National Statistics databases. Adults (≥18 years) with first RAAS inhibitor use (defined as angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) between 1 January 2009 and 31 December 2014 were eligible for inclusion. Time to the first occurrence of adverse clinical outcomes [all-cause mortality, all-cause hospitalization, cardiac arrhythmia, heart failure hospitalization, cardiac arrest, advancement in chronic kidney disease (CKD) stage and acute kidney injury] was compared between RAAS inhibitor users with and without interruptions or cessations to treatment during follow-up. Associations between baseline characteristics and adverse clinical outcomes were also assessed. RESULTS Among 434 027 RAAS inhibitor users, the risk of the first occurrence of all clinical outcomes, except advancement in CKD stage, was 8-75% lower in patients without interruptions or cessations versus patients with interruptions/cessations. Baseline characteristics independently associated with increased risk of clinical outcomes included increasing age, smoking, CKD, diabetes and heart failure. CONCLUSIONS These findings highlight the need for effective management of factors associated with RAAS inhibitor interruptions or cessations in patients for whom guideline-recommended RAAS inhibitor treatment is indicated.
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Affiliation(s)
| | - Glen James
- Global Medical Affairs, AstraZeneca, Cambridge, UK
| | - Eric T Wittbrodt
- Biopharmaceuticals Medical Unit, AstraZeneca, Gaithersburg, MD, USA
| | - Donna Zarzuela
- Biopharmaceuticals Medical Unit, AstraZeneca, Gaithersburg, MD, USA
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Rossignol P. [Recurrent hyperkalaemia management and use of renin-angiotensin-aldosterone system inhibitors: Analysis of French data from the PROKALE multinational European study]. Nephrol Ther 2021; 17:422-427. [PMID: 33994135 DOI: 10.1016/j.nephro.2021.01.004] [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: 10/23/2020] [Revised: 11/30/2020] [Accepted: 01/05/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Recurrent hyperkalaemia may result in underutilisation of renin-angiotensin-aldosterone system inhibitors. We report an analysis of French data from the PROKALE retrospective study, which assessed the management of recurrent hyperkalaemia in five European countries. PATIENTS AND METHODS A retrospective chart review including patients not on dialysis with two or more hyperkalaemia episodes≥5.5 mEq/L documented within a 12-month observation period was performed. RESULTS In France, 115 physicians (57 nephrologists et 58 cardiologists) participated in the study and 295 patients were studied in this analysis. Mean age was 68 years; 212 patients (71.9%) had chronic kidney disease, 108 (36.6%) had chronic heart failure and 102 (34.6%) had diabetes mellitus. The mean number of documented hyperkalaemic episodes was 2.3. A total of 90 hospitalizations occurred during the observation period, of which 24 (26.7%) were directly related to a hyperkalaemic episode. At the time of the first documented hyperkalaemic episode, measures used for the management of hyperkalaemia included loop diuretics (144 patients [48.8%]), sodium/calcium polystyrene sulphonate (135 patients [45.8%]), a low-potassium diet (31 patients [10.5%]) and sodium bicarbonate (31 patients [10.5%]). Between the two consecutive hyperkalaemic episodes documented, the proportion of patients on renin-angiotensin-aldosterone system inhibitors treatment decreased from 42.4% to 34.6%. CONCLUSION Renin-angiotensin-aldosterone system inhibitors treatment interruptions were observed in the setting of recurrent hyperkalaemic episodes. Recurrent hyperkalaemia is a major cause of hospitalizations. More effective strategies for the prevention of recurrent hyperkalaemia are needed.
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Affiliation(s)
- Patrick Rossignol
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques - Plurithématique 14-33, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.
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- Université de Lorraine, Inserm, Centre d'Investigations Cliniques - Plurithématique 14-33, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
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Tamargo J, Caballero R, Delpón E. The pharmacotherapeutic management of hyperkalemia in patients with cardiovascular disease. Expert Opin Pharmacother 2021; 22:1319-1341. [PMID: 33620275 DOI: 10.1080/14656566.2021.1891223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Patients with cardiovascular diseases (CVD) are at increased risk of hyperkalemia, particularly when treated with renin-angiotensin-aldosterone inhibitors (RAASIs). Because the occurrence or fear of hyperkalemia, RAASIs are frequently down-titrated or discontinued in patients with CVD, with consequent worse outcomes than patients who remain on maximum doses.Areas covered: This article reviews potassium homeostasis, epidemiology, risk factors, and outcomes of hyperkalemia, and efficacy and safety of the drugs used for acute and chronic treatment of hyperkalemia. A literature search was carried out using the PubMed and guidelines for the management of hyperkalemia.Expert opinion: The emergency treatment of hyperkalemia is not supported by high-quality evidence and clinical trials did not report drug effects on clinical outcomes. Two potassium binders, patiromer and sodium zirconium cyclosilicate, represent a new approach in the treatment of chronic hyperkalemia as they may allow the titration and maintenance of guidelines-recommended doses of RAASIs in patients with CVD who otherwise would not tolerate them due to the risk of hyperkalemia.Further studies are needed to evaluate the safety and efficacy of drug therapy and support the development of guidelines for acute and chronic hyperkalemia.
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Affiliation(s)
- Juan Tamargo
- Department of Pharmacology, School of Medicine, Universidad Complutense, Instituto De Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ricardo Caballero
- Department of Pharmacology, School of Medicine, Universidad Complutense, Instituto De Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Eva Delpón
- Department of Pharmacology, School of Medicine, Universidad Complutense, Instituto De Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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Palmer BF, Carrero JJ, Clegg DJ, Colbert GB, Emmett M, Fishbane S, Hain DJ, Lerma E, Onuigbo M, Rastogi A, Roger SD, Spinowitz BS, Weir MR. Clinical Management of Hyperkalemia. Mayo Clin Proc 2021; 96:744-762. [PMID: 33160639 DOI: 10.1016/j.mayocp.2020.06.014] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/18/2020] [Accepted: 06/10/2020] [Indexed: 12/26/2022]
Abstract
Hyperkalemia is an electrolyte abnormality with potentially life-threatening consequences. Despite various guidelines, no universally accepted consensus exists on best practices for hyperkalemia monitoring, with variations in precise potassium (K+) concentration thresholds or for the management of acute or chronic hyperkalemia. Based on the available evidence, this review identifies several critical issues and unmet needs with regard to the management of hyperkalemia. Real-world studies are needed for a better understanding of the prevalence of hyperkalemia outside the clinical trial setting. There is a need to improve effective management of hyperkalemia, including classification and K+ monitoring, when to reinitiate previously discontinued renin-angiotensin-aldosterone system inhibitor (RAASi) therapy, and when to use oral K+-binding agents. Monitoring serum K+ should be individualized; however, increased frequency of monitoring should be considered for patients with chronic kidney disease, diabetes, heart failure, or a history of hyperkalemia and for those receiving RAASi therapy. Recent clinical studies suggest that the newer K+ binders (patiromer sorbitex calcium and sodium zirconium cyclosilicate) may facilitate optimization of RAASi therapy. Enhancing the knowledge of primary care physicians and internists with respect to the safety profiles of these newer K+ binders may increase confidence in managing patients with hyperkalemia. Lastly, the availability of newer K+-binding agents requires further study to establish whether stringent dietary K+ restrictions are needed in patients receiving K+-binder therapy. Individualized monitoring of serum K+ among patients with an increased risk of hyperkalemia and the use of newer K+-binding agents may allow for optimization of RAASi therapy and more effective management of hyperkalemia.
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Affiliation(s)
- Biff F Palmer
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.
| | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Deborah J Clegg
- Drexel University College of Nursing and Health Professions, Philadelphia, PA
| | | | | | - Steven Fishbane
- Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY
| | - Debra J Hain
- Christine E. Lynn College of Nursing, Florida Atlantic University, and Cleveland Clinic Florida, Weston, FL
| | - Edgar Lerma
- Department of Medicine, University of Illinois at Chicago/Advocate Christ Medical Center, Oak Lawn
| | - Macaulay Onuigbo
- Robert Larner College of Medicine, University of Vermont Medical Center, Burlington
| | - Anjay Rastogi
- David Geffen School of Medicine, University of California, Los Angeles
| | - Simon D Roger
- Renal Research, Gosford Hospital, Gosford, Australia
| | | | - Matthew R Weir
- Department of Medicine, University of Maryland School of Medicine, Baltimore
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Ibrahim A, Ghaleb R, Mansour H, Hanafy A, Mahmoud NM, Abdelfatah Elsharef M, Kamal Salama M, Elsaughier SM, Abdel-Wahid L, Embarek Mohamed M, Ibrahim AK, Abdel-Galeel A. Safety and Efficacy of Adding Dapagliflozin to Furosemide in Type 2 Diabetic Patients With Decompensated Heart Failure and Reduced Ejection Fraction. Front Cardiovasc Med 2020; 7:602251. [PMID: 33426003 PMCID: PMC7793915 DOI: 10.3389/fcvm.2020.602251] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/02/2020] [Indexed: 01/10/2023] Open
Abstract
Background: Heart failure is the most common cause of hospitalization in elderly patients. It is likely that many of the mechanisms that contribute to reductions in systolic and diastolic function, seen in diabetic patients, place them at an increased risk of heart failure. Diuretic therapy, especially loop diuretics, is the usual way of managing congestion, particularly in volume-overloaded patients. Little is known about the beneficial effect of dapagliflozin when added to loop diuretics in managing patients with decompensated heart failure. Aim: To assess the effect of the addition of dapagliflozin to furosemide in managing decompensated patient with heart failure and reduced left ventricular ejection fraction in terms of weight loss and dyspnea improvement. Patients and Methods: The study included 100 type 2 diabetic patients who were admitted with decompensated heart failure. The study population was randomly divided into two arms. Serum electrolytes and kidney functions were followed up during their hospital stay. Results: With dapagliflozin, there was a statistically significant difference between the two groups regarding the change in body weight and body mass index. The diuresis parameters including urine output, total fluid loss, and fluid balance also showed a statistically significant difference in favor of the use of dapagliflozin, with no significant change in serum potassium or kidney functions. There was significant improvement in patient-reported dyspnea scores with the use of dapagliflozin. Conclusions: Dapagliflozin may provide a new drug option in the treatment of heart failure especially among vulnerable group of diabetics. It had no remarkable effects on serum potassium level and kidney functions. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT04385589.
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Affiliation(s)
- Ayman Ibrahim
- Cardiology Department, Aswan University, Aswan, Egypt
| | | | | | - Amr Hanafy
- Cardiology Department, Aswan University, Aswan, Egypt
| | | | | | | | | | | | - Mona Embarek Mohamed
- Microbiology and Immunology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Ahmed Abdel-Galeel
- Cardiovascular Medicine Department, Assiut University Heart Hospital, Assiut University, Assiut, Egypt
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Yurista SR, Silljé HHW, van Goor H, Hillebrands JL, Heerspink HJL, de Menezes Montenegro L, Oberdorf-Maass SU, de Boer RA, Westenbrink BD. Effects of Sodium-Glucose Co-transporter 2 Inhibition with Empaglifozin on Renal Structure and Function in Non-diabetic Rats with Left Ventricular Dysfunction After Myocardial Infarction. Cardiovasc Drugs Ther 2020; 34:311-321. [PMID: 32185580 PMCID: PMC7242237 DOI: 10.1007/s10557-020-06954-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background The use of sodium–glucose co-transporter 2 inhibitors (SGLT2i) is currently expanding to cardiovascular risk reduction in non-diabetic subjects, but renal (side-)effects are less well studied in this setting. Methods Male non-diabetic Sprague Dawley rats underwent permanent coronary artery ligation to induce MI, or sham surgery. Rats received chow containing empagliflozin (EMPA) (30 mg/kg/day) or control chow. Renal function and electrolyte balance were measured in metabolic cages. Histological and molecular markers of kidney injury, parameters of phosphate homeostasis and bone resorption were also assessed. Results EMPA resulted in a twofold increase in diuresis, without evidence for plasma volume contraction or impediments in renal function in both sham and MI animals. EMPA increased plasma magnesium levels, while the levels of glucose and other major electrolytes were comparable among the groups. Urinary protein excretion was similar in all treatment groups and no histomorphological alterations were identified in the kidney. Accordingly, molecular markers for cellular injury, fibrosis, inflammation and oxidative stress in renal tissue were comparable between groups. EMPA resulted in a slight increase in circulating phosphate and PTH levels without activating FGF23–Klotho axis in the kidney and bone mineral resorption, measured with CTX-1, was not increased. Conclusions EMPA exerts profound diuretic effects without compromising renal structure and function or causing significant electrolyte imbalance in a non-diabetic setting. The slight increase in circulating phosphate and PTH after EMPA treatment was not associated with evidence for increased bone mineral resorption suggesting that EMPA does not affect bone health. Electronic supplementary material The online version of this article (10.1007/s10557-020-06954-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Salva R Yurista
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Herman H W Silljé
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harry van Goor
- Department of Pathology and Medical Biology, Division of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan-Luuk Hillebrands
- Department of Pathology and Medical Biology, Division of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Luiz de Menezes Montenegro
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Silke U Oberdorf-Maass
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - B Daan Westenbrink
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Natale P, Palmer SC, Ruospo M, Saglimbene VM, Strippoli GF. Potassium binders for chronic hyperkalaemia in people with chronic kidney disease. Cochrane Database Syst Rev 2020; 6:CD013165. [PMID: 32588430 PMCID: PMC7386867 DOI: 10.1002/14651858.cd013165.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Hyperkalaemia is a common electrolyte abnormality caused by reduced renal potassium excretion in patients with chronic kidney diseases (CKD). Potassium binders, such as sodium polystyrene sulfonate and calcium polystyrene sulfonate, are widely used but may lead to constipation and other adverse gastrointestinal (GI) symptoms, reducing their tolerability. Patiromer and sodium zirconium cyclosilicate are newer ion exchange resins for treatment of hyperkalaemia which may cause fewer GI side-effects. Although more recent studies are focusing on clinically-relevant endpoints such as cardiac complications or death, the evidence on safety is still limited. Given the recent expansion in the available treatment options, it is appropriate to review the evidence of effectiveness and tolerability of all potassium exchange resins among people with CKD, with the aim to provide guidance to consumers, practitioners, and policy-makers. OBJECTIVES To assess the benefits and harms of potassium binders for treating chronic hyperkalaemia among adults and children with CKD. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies up to 10 March 2020 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-randomised controlled studies (quasi-RCTs) evaluating potassium binders for chronic hyperkalaemia administered in adults and children with CKD. DATA COLLECTION AND ANALYSIS Two authors independently assessed risks of bias and extracted data. Treatment estimates were summarised by random effects meta-analysis and expressed as relative risk (RR) or mean difference (MD), with 95% confidence interval (CI). Evidence certainty was assessed using GRADE processes. MAIN RESULTS Fifteen studies, randomising 1849 adult participants were eligible for inclusion. Twelve studies involved participants with CKD (stages 1 to 5) not requiring dialysis and three studies were among participants treated with haemodialysis. Potassium binders included calcium polystyrene sulfonate, sodium polystyrene sulfonate, patiromer, and sodium zirconium cyclosilicate. A range of routes, doses, and timing of drug administration were used. Study duration varied from 12 hours to 52 weeks (median 4 weeks). Three were cross-over studies. The mean study age ranged from 53.1 years to 73 years. No studies evaluated treatment in children. Some studies had methodological domains that were at high or unclear risks of bias, leading to low certainty in the results. Studies were not designed to measure treatment effects on cardiac arrhythmias or major GI symptoms. Ten studies (1367 randomised participants) compared a potassium binder to placebo. The certainty of the evidence was low for all outcomes. We categorised treatments in newer agents (patiromer or sodium zirconium cyclosilicate) and older agents (calcium polystyrene sulfonate and sodium polystyrene sulfonate). Patiromer or sodium zirconium cyclosilicate may make little or no difference to death (any cause) (4 studies, 688 participants: RR 0.69, 95% CI 0.11, 4.32; I2 = 0%; low certainty evidence) in CKD. The treatment effect of older potassium binders on death (any cause) was unknown. One cardiovascular death was reported with potassium binder in one study, showing that there was no difference between patiromer or sodium zirconium cyclosilicate and placebo for cardiovascular death in CKD and HD. There was no evidence of a difference between patiromer or sodium zirconium cyclosilicate and placebo for health-related quality of life (HRQoL) at the end of treatment (one study) in CKD or HD. Potassium binders had uncertain effects on nausea (3 studies, 229 participants: RR 2.10, 95% CI 0.65, 6.78; I2 = 0%; low certainty evidence), diarrhoea (5 studies, 720 participants: RR 0.84, 95% CI 0.47, 1.48; I2 = 0%; low certainty evidence), and vomiting (2 studies, 122 participants: RR 1.72, 95% CI 0.35 to 8.51; I2 = 0%; low certainty evidence) in CKD. Potassium binders may lower serum potassium levels (at the end of treatment) (3 studies, 277 participants: MD -0.62 mEq/L, 95% CI -0.97, -0.27; I2 = 92%; low certainty evidence) in CKD and HD. Potassium binders had uncertain effects on constipation (4 studies, 425 participants: RR 1.58, 95% CI 0.71, 3.52; I2 = 0%; low certainty evidence) in CKD. Potassium binders may decrease systolic blood pressure (BP) (2 studies, 369 participants: MD -3.73 mmHg, 95%CI -6.64 to -0.83; I2 = 79%; low certainty evidence) and diastolic BP (one study) at the end of the treatment. No study reported outcome data for cardiac arrhythmias or major GI events. Calcium polystyrene sulfonate may make little or no difference to serum potassium levels at end of treatment, compared to sodium polystyrene sulfonate (2 studies, 117 participants: MD 0.38 mEq/L, 95% CI -0.03 to 0.79; I2 = 42%, low certainty evidence). There was no evidence of a difference in systolic BP (one study), diastolic BP (one study), or constipation (one study) between calcium polystyrene sulfonate and sodium polystyrene sulfonate. There was no difference between high-dose and low-dose patiromer for death (sudden death) (one study), stroke (one study), myocardial infarction (one study), or constipation (one study). The comparative effects whether potassium binders were administered with or without food, laxatives, or sorbitol, were very uncertain with insufficient data to perform meta-analysis. AUTHORS' CONCLUSIONS Evidence supporting clinical decision-making for different potassium binders to treat chronic hyperkalaemia in adults with CKD is of low certainty; no studies were identified in children. Available studies have not been designed to measure treatment effects on clinical outcomes such as cardiac arrhythmias or major GI symptoms. This review suggests the need for a large, adequately powered study of potassium binders versus placebo that assesses clinical outcomes of relevance to patients, clinicians and policy-makers. This data could be used to assess cost-effectiveness, given the lack of definitive studies and the clinical importance of potassium binders for chronic hyperkalaemia in people with CKD.
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Affiliation(s)
- Patrizia Natale
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Marinella Ruospo
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Valeria M Saglimbene
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Giovanni Fm Strippoli
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
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11
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Filippini T, Naska A, Kasdagli MI, Torres D, Lopes C, Carvalho C, Moreira P, Malavolti M, Orsini N, Whelton PK, Vinceti M. Potassium Intake and Blood Pressure: A Dose-Response Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc 2020; 9:e015719. [PMID: 32500831 PMCID: PMC7429027 DOI: 10.1161/jaha.119.015719] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Epidemiologic studies, including trials, suggest an association between potassium intake and blood pressure (BP). However, the strength and shape of this relationship is uncertain. Methods and Results We performed a meta‐analysis to explore the dose‐response relationship between potassium supplementation and BP in randomized‐controlled trials with a duration ≥4 weeks using the recently developed 1‐stage cubic spline regression model. This model allows use of trials with at least 2 exposure categories. We identified 32 eligible trials. Most were conducted in adults with hypertension using a crossover design and potassium supplementation doses that ranged from 30 to 140 mmol/d. We observed a U‐shaped relationship between 24‐hour active and control arm differences in potassium excretion and BP levels, with weakening of the BP reduction effect above differences of 30 mmol/d and a BP increase above differences ≈80 mmol/d. Achieved potassium excretion analysis also identified a U‐shaped relationship. The BP‐lowering effects of potassium supplementation were stronger in participants with hypertension and at higher levels of sodium intake. The BP increase with high potassium excretion was noted in participants with antihypertensive drug‐treated hypertension but not in their untreated counterparts. Conclusions We identified a nonlinear relationship between potassium intake and both systolic and diastolic BP, although estimates for BP effects of high potassium intakes should be interpreted with caution because of limited availability of trials. Our findings indicate an adequate intake of potassium is desirable to achieve a lower BP level but suggest excessive potassium supplementation should be avoided, particularly in specific subgroups.
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Affiliation(s)
- Tommaso Filippini
- Environmental, Genetic and Nutritional Epidemiology Research Center Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia Modena Italy
| | - Androniki Naska
- Department of Hygiene, Epidemiology and Medical Statistics School of Medicine National and Kapodistrian University of Athens Athens Greece
| | - Maria-Iosifina Kasdagli
- Department of Hygiene, Epidemiology and Medical Statistics School of Medicine National and Kapodistrian University of Athens Athens Greece
| | - Duarte Torres
- EPIUnit-Institute of Public Health University of Porto Portugal.,Faculty of Nutrition and Food Sciences University of Porto Portugal
| | - Carla Lopes
- EPIUnit-Institute of Public Health University of Porto Portugal.,Unit of Epidemiology Department of Public Health and Forensic Sciences, and Medical Education Faculty of Medicine University of Porto Portugal
| | - Catarina Carvalho
- EPIUnit-Institute of Public Health University of Porto Portugal.,Faculty of Nutrition and Food Sciences University of Porto Portugal
| | - Pedro Moreira
- EPIUnit-Institute of Public Health University of Porto Portugal.,Faculty of Nutrition and Food Sciences University of Porto Portugal
| | - Marcella Malavolti
- Environmental, Genetic and Nutritional Epidemiology Research Center Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia Modena Italy
| | - Nicola Orsini
- Department of Global Public Health Karolinska Institute Stockholm Sweden
| | - Paul K Whelton
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine, and School of Medicine New Orleans LA
| | - Marco Vinceti
- Environmental, Genetic and Nutritional Epidemiology Research Center Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia Modena Italy.,Department of Epidemiology Boston University School of Public Health Boston MA
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12
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Paik J. Sodium zirconium cyclosilicate in hyperkalaemia: a profile of its use. DRUGS & THERAPY PERSPECTIVES 2020. [DOI: 10.1007/s40267-020-00706-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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13
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Zannad F, Hsu BG, Maeda Y, Shin SK, Vishneva EM, Rensfeldt M, Eklund S, Zhao J. Efficacy and safety of sodium zirconium cyclosilicate for hyperkalaemia: the randomized, placebo-controlled HARMONIZE-Global study. ESC Heart Fail 2020; 7:54-64. [PMID: 31944628 PMCID: PMC7083449 DOI: 10.1002/ehf2.12561] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 10/25/2019] [Indexed: 12/17/2022] Open
Abstract
Aims Sodium zirconium cyclosilicate (SZC, formerly ZS‐9) is a selective K+ binder to treat adults with hyperkalaemia. HARMONIZE‐Global examined the efficacy and safety of SZC among outpatients with hyperkalaemia from diverse geographic and ethnic origins. Methods and results This phase 3, randomized, double‐blind, placebo‐controlled study recruited outpatients with serum K+ ≥5.1 mmol/L (measured by point‐of‐care i‐STAT device) at 45 sites in Japan, Russia, South Korea, and Taiwan. Following open‐label treatment with thrice‐daily SZC 10 g during a 48 h correction phase (CP), patients achieving normokalaemia (K+ 3.5–5.0 mmol/L) were randomized 2:2:1 to once‐daily SZC 5 g, SZC 10 g, or placebo during a 28 day maintenance phase (MP). The primary endpoint was mean central‐laboratory K+ level during days 8–29 of the MP. Of 267 patients in the CP, 248 (92.9%) entered the MP. During the CP, mean central‐laboratory K+ was reduced by 1.28 mmol/L at 48 h vs. baseline (P < 0.001). During the MP (days 8–29), SZC 5 and 10 g once‐daily significantly lowered mean central‐laboratory K+ by 9.6% and 17.7%, respectively, vs. placebo (P < 0.001 for both). More patients had normokalaemia (central‐laboratory K+ 3.5–5.0 mmol/L at day 29) with SZC 5 (58.6%) and 10 g (77.3%) vs. placebo (24.0%), with the greatest number of normokalaemic days in the 10‐g group. The most common adverse events with SZC were mild or moderate constipation and oedema. Conclusions Normokalaemia achieved during the CP was maintained over 28 days with SZC treatment among outpatients with hyperkalaemia.
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Affiliation(s)
- Faiez Zannad
- Université de Lorraine, Inserm, Centre d'Investigation Clinique 1433 and Centre Hospitalier Universitaire, Nancy, France
| | - Bang-Gee Hsu
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Yoshitaka Maeda
- Nephrology Division, Department of Internal Medicine, JA Toride Medical Center, Ibaraki, Japan
| | - Sug Kyun Shin
- NHIS Medical Center, Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea
| | | | - Martin Rensfeldt
- Biometrics, Late-Stage Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca Gothenburg, Mölndal, Sweden
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14
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Zhang WW, Zheng RH, Bai F, Sturdivant K, Wang NP, James EA, Bose HS, Zhao ZQ. Steroidogenic acute regulatory protein/aldosterone synthase mediates angiotensin II-induced cardiac fibrosis and hypertrophy. Mol Biol Rep 2019; 47:1207-1222. [PMID: 31820314 DOI: 10.1007/s11033-019-05222-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 11/22/2019] [Accepted: 12/04/2019] [Indexed: 02/07/2023]
Abstract
Aldosterone produced in adrenal glands by angiotensin II (Ang II) is known to elicit myocardial fibrosis and hypertrophy. This study was designed to test the hypothesis that Ang II causes cardiac morphological changes through the steroidogenic acute regulatory protein (StAR)/aldosterone synthase (AS)-dependent aldosterone synthesis primarily initiated in the heart. Sprague-Dawley rats were randomized to following groups: Ang II infusion for a 4-week period, treatment with telmisartan, spironolactone or adrenalectomy during Ang II infusion. Sham-operated rats served as control. Relative to Sham rats, Ang II infusion significantly increased the protein levels of AT1 receptor, StAR, AS and their tissue expression in the adrenal glands and heart. In coincidence with reduced aldosterone level in the heart, telmisartan, an AT1 receptor blocker, significantly down-regulated the protein level and expression of StAR and AS. Ang II induced changes in the expression of AT1/StAR/AS were not altered by an aldosterone receptor antagonist spironolactone. Furthermore, Ang II augmented migration of macrophages, protein level of TGFβ1, phosphorylation of Smad2/3 and proliferation of myofibroblasts, accompanied by enhanced perivascular/interstitial collagen deposition and cardiomyocyte hypertrophy, which all were significantly abrogated by telmisartan or spironolactone. However, adrenalectomy did not fully suppress Ang II-induced cell migration/proliferation and fibrosis/hypertrophy, indicating a role of aldosterone synthesized within the heart in pathogenesis of Ang II induced injury. These results indicate that myocardial fibrosis and hypertrophy stimulated by Ang II is associated with tissue-specific activation of aldosterone synthesis, primarily mediated by AT1/StAR/AS signaling pathways.
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Affiliation(s)
- Wei-Wei Zhang
- Department of Basic Biomedical Sciences, Mercer University School of Medicine, Savannah, GA, USA
- Department of Anesthesiology, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Rong-Hua Zheng
- Department of Physiology, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Feng Bai
- Department of Physiology, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Katelyn Sturdivant
- Department of Basic Biomedical Sciences, Mercer University School of Medicine, Savannah, GA, USA
| | - Ning-Ping Wang
- Department of Basic Biomedical Sciences, Mercer University School of Medicine, Savannah, GA, USA
| | - Erskine A James
- Department of Internal Medicine, Navicent Health, Macon, GA, USA
| | - Himangshu S Bose
- Department of Basic Biomedical Sciences, Mercer University School of Medicine, Savannah, GA, USA
| | - Zhi-Qing Zhao
- Department of Basic Biomedical Sciences, Mercer University School of Medicine, Savannah, GA, USA.
- Department of Physiology, Shanxi Medical University, Taiyuan, Shanxi, China.
- Cardiovascular Research Laboratory, Mercer University School of Medicine, 1250 East 66th Street, Savannah, GA, 31404, USA.
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15
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Rossignol P, Ruilope LM, Cupisti A, Ketteler M, Wheeler DC, Pignot M, Cornea G, Schulmann T, Lund LH. Recurrent hyperkalaemia management and use of renin-angiotensin-aldosterone system inhibitors: a European multi-national targeted chart review. Clin Kidney J 2019; 13:714-719. [PMID: 32905252 PMCID: PMC7467623 DOI: 10.1093/ckj/sfz129] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 08/28/2019] [Indexed: 12/28/2022] Open
Affiliation(s)
- Patrick Rossignol
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-Plurithématique 14-33, Inserm U116, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Luis M Ruilope
- Hypertension Unit, Instituto de Investigación imas12, Hospital Universitario, Madrid, Spain
| | - Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Markus Ketteler
- Department of General Internal Medicine and Nephrology, Robert-Bosch-Krankenhaus, Stuttgart, Germany.,University of Split School of Medicine, Split, Croatia
| | - David C Wheeler
- Clinical Effectiveness Group, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Marc Pignot
- Kantar Health GmbH, Real World Research & Value, Munich, Germany
| | | | | | - Lars H Lund
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Karolinska University Hospital, Heart and Vascular Theme, Stockholm, Sweden
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16
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Tamargo M, Tamargo J. New potassium binders reduce the risk of hyperkalaemia in patients treated with renin-angiotensin-aldosterone system inhibitors. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2019; 4:193-194. [PMID: 29982385 DOI: 10.1093/ehjcvp/pvy019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Maria Tamargo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Juan Tamargo
- Department of Pharmacology, School of Medicine, University Complutense, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Madrid, Spain
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17
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Natale P, Palmer SC, Ruospo M, Saglimbene VM, Strippoli GFM. Potassium binders for chronic hyperkalaemia in people with chronic kidney disease. Hippokratia 2018. [DOI: 10.1002/14651858.cd013165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Patrizia Natale
- Diaverum; Medical Scientific Office; Lund Sweden
- University of Bari; Department of Emergency and Organ Transplantation; Bari Italy
| | - Suetonia C Palmer
- University of Otago Christchurch; Department of Medicine; 2 Riccarton Ave PO Box 4345 Christchurch New Zealand 8140
| | | | - Valeria M Saglimbene
- Diaverum; Medical Scientific Office; Lund Sweden
- The University of Sydney; Sydney School of Public Health; Sydney Australia
| | - Giovanni FM Strippoli
- University of Bari; Department of Emergency and Organ Transplantation; Bari Italy
- The University of Sydney; Sydney School of Public Health; Sydney Australia
- Diaverum Academy; Bari Italy
- The Children's Hospital at Westmead; Cochrane Kidney and Transplant, Centre for Kidney Research; Westmead NSW Australia 2145
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18
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Abstract
Sodium zirconium cyclosilicate (Lokelma™) [hereafter referred to as SZC] is a non-absorbed, non-polymer zirconium silicate compound that preferentially exchanges hydrogen and sodium for potassium and ammonium ions in the gastrointestinal tract (GIT), thereby increasing faecal potassium excretion and lowering serum potassium levels. It is available as a powder for oral suspension (in water) and is approved in the EU and the USA for the treatment of hyperkalaemia in adults. In two multinational, phase III studies in adults with hyperkalaemia, SZC 10 g three times daily lowered serum potassium levels to within the normal range (3.5-5.0 mmol/L) during the first 48 h of treatment, and SZC 5 and 10 g once daily maintained normokalaemia over ≤ 28 days' therapy. These beneficial effects were consistent across all patient subgroups (e.g. chronic kidney disease, diabetes, heart failure, concomitant use of RAAS inhibitor therapy), and appeared to be maintained over the longer term (≤ 12 months). SZC was generally well tolerated in adults with hyperkalaemia. Its tolerability profile was generally similar to that seen with placebo over ≤ 28 day, and its safety profile appeared to remain consistent over the longer term (≤ 12 months). Moreover, the incidence of hypokalemia was low. Current evidence indicates that SZC is a promising therapy for the management of hyperkalaemia in adults.
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Affiliation(s)
- Sheridan M Hoy
- Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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19
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Rosano GMC, Tamargo J, Kjeldsen KP, Lainscak M, Agewall S, Anker SD, Ceconi C, Coats AJS, Drexel H, Filippatos G, Kaski JC, Lund L, Niessner A, Ponikowski P, Savarese G, Schmidt TA, Seferovic P, Wassmann S, Walther T, Lewis BS. Expert consensus document on the management of hyperkalaemia in patients with cardiovascular disease treated with renin angiotensin aldosterone system inhibitors: coordinated by the Working Group on Cardiovascular Pharmacotherapy of the European Society of Cardiology. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2018; 4:180-188. [DOI: 10.1093/ehjcvp/pvy015] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/26/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Giuseppe M C Rosano
- Department of Medical Sciences, IRCCS San Raffaele, via di val cannuta, Roma, Italy
- Cardiology Clinical Academic Group, St George’s Hospitals NHS Trust University of London, Cranmer Terrace, London, UK
| | - Juan Tamargo
- Department of Pharmacology, School of Medicine. University Complutense, CIBERCV, Madrid, Spain
| | - Keld P Kjeldsen
- Department of Medicine, Copenhagen University Hospital (Holbæk Hospital), Holbæk, Denmark
- Institute for Clinical Medicine, Copenhagen University, Blegdamsvej 3B, Copenhagen N, Denmark
- Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej, Aalborg East, Denmark
| | - Mitja Lainscak
- Faculty of Medicine, University of Ljubljana, General Hospital Murska Sobota, Slovenia
- Department of Internal Medicine, General Hospital Murska Sobota, Slovenia
| | - Stefan Agewall
- Oslo University Hospital, Oslo universitetssykehus HF, Postboks 4950 Nydalen, Oslo, Ullevål, Norway
- Institute of Clinical Sciences, University of Oslo, Oslo universitetssykehus HF, Postboks 4950 Nydalen, Oslo, Norway
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité Universitätsmedizin Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité Universitätsmedizin Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Charité Universitätsmedizin Berlin, Germany
- Partner Site Berlin, Charité Universitätsmedizin Berlin, Germany
- Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), Göttingen, Germany
| | - Claudio Ceconi
- University Hospital of Ferrara, U.O. Cardiologia Via Savonarola, 9, Ferrara FE, Italy
| | - Andrew J S Coats
- Department of Medical Sciences, IRCCS San Raffaele, via di val cannuta, Roma, Italy
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Department of Internal Medicine, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, 75 Mikras Asias str., Goudi, Athens, Greece
| | - Juan Carlos Kaski
- Department of Medical Sciences, IRCCS San Raffaele, via di val cannuta, Roma, Italy
| | - Lars Lund
- Karolinska Institutet, and Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, Austria
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Gianluigi Savarese
- Karolinska Institutet, and Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Thomas A Schmidt
- Department of Emergency Medicine, Holbaek Hospital, University of Copenhagen, Holbæk, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Petar Seferovic
- Department of Cardiology, University of Belgrade, Studentski trg 1, Belgrade, Serbia
| | - Sven Wassmann
- Cardiology Pasing, Munich, Germany
- University of the Saarland, Homburg/Saar, Germany
| | - Thomas Walther
- Department of Pharmacology and Therapeutics, School of Medicine and School of Pharmacy, University College Cork, Cork, Ireland
- Institute of Medical Biochemistry and Molecular Biology, University Medicine Greifswald, Greifswald, Germany
| | - Basil S Lewis
- Lady Davis Carmel Medical Center, Mikhal St 7, Haifa, Israel
- Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, 1 Efron St. Bat Galim, Haifa, Israel
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