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Gîrleanu I, Trifan A, Huiban L, Muzîca C, Petrea OC, Sîngeap AM, Cojocariu C, Chiriac S, Cuciureanu T, Costache II, Stanciu C. Ischemic Heart Disease and Liver Cirrhosis: Adding Insult to Injury. LIFE (BASEL, SWITZERLAND) 2022; 12:life12071036. [PMID: 35888123 PMCID: PMC9315506 DOI: 10.3390/life12071036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 12/13/2022]
Abstract
The link between heart and liver cirrhosis was recognized decades ago, although much data regarding atherosclerosis and ischemic heart disease are still missing. Ischemic heart disease or coronary artery disease (CAD) and liver cirrhosis could be associated with characteristic epidemiological and pathophysiological features. This connection determines increased rates of morbidity and all-cause mortality in patients with liver cirrhosis. In the era of a metabolic syndrome and non-alcoholic fatty liver disease pandemic, primary prevention and early diagnosis of coronary artery disease could improve the prognosis of liver cirrhosis patients. This review outlines a summary of the literature regarding prevalence, risk assessment and medical and interventional treatment options in this particular population. A collaborative heart–liver team-based approach is imperative for critical management decisions for patients with CAD and liver cirrhosis.
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Affiliation(s)
- Irina Gîrleanu
- Depatment of Internal Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iaşi, Romania; (I.G.); (L.H.); (C.M.); (O.C.P.); (A.M.S.); (C.C.); (S.C.); (T.C.); (I.I.C.); (C.S.)
- Institute of Gastroenterology and Hepatology, Saint Spiridon University Hospital, 700115 Iaşi, Romania
| | - Anca Trifan
- Depatment of Internal Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iaşi, Romania; (I.G.); (L.H.); (C.M.); (O.C.P.); (A.M.S.); (C.C.); (S.C.); (T.C.); (I.I.C.); (C.S.)
- Institute of Gastroenterology and Hepatology, Saint Spiridon University Hospital, 700115 Iaşi, Romania
- Correspondence: ; Tel.: +40-762278575
| | - Laura Huiban
- Depatment of Internal Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iaşi, Romania; (I.G.); (L.H.); (C.M.); (O.C.P.); (A.M.S.); (C.C.); (S.C.); (T.C.); (I.I.C.); (C.S.)
- Institute of Gastroenterology and Hepatology, Saint Spiridon University Hospital, 700115 Iaşi, Romania
| | - Cristina Muzîca
- Depatment of Internal Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iaşi, Romania; (I.G.); (L.H.); (C.M.); (O.C.P.); (A.M.S.); (C.C.); (S.C.); (T.C.); (I.I.C.); (C.S.)
- Institute of Gastroenterology and Hepatology, Saint Spiridon University Hospital, 700115 Iaşi, Romania
| | - Oana Cristina Petrea
- Depatment of Internal Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iaşi, Romania; (I.G.); (L.H.); (C.M.); (O.C.P.); (A.M.S.); (C.C.); (S.C.); (T.C.); (I.I.C.); (C.S.)
- Institute of Gastroenterology and Hepatology, Saint Spiridon University Hospital, 700115 Iaşi, Romania
| | - Ana Maria Sîngeap
- Depatment of Internal Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iaşi, Romania; (I.G.); (L.H.); (C.M.); (O.C.P.); (A.M.S.); (C.C.); (S.C.); (T.C.); (I.I.C.); (C.S.)
- Institute of Gastroenterology and Hepatology, Saint Spiridon University Hospital, 700115 Iaşi, Romania
| | - Camelia Cojocariu
- Depatment of Internal Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iaşi, Romania; (I.G.); (L.H.); (C.M.); (O.C.P.); (A.M.S.); (C.C.); (S.C.); (T.C.); (I.I.C.); (C.S.)
- Institute of Gastroenterology and Hepatology, Saint Spiridon University Hospital, 700115 Iaşi, Romania
| | - Stefan Chiriac
- Depatment of Internal Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iaşi, Romania; (I.G.); (L.H.); (C.M.); (O.C.P.); (A.M.S.); (C.C.); (S.C.); (T.C.); (I.I.C.); (C.S.)
- Institute of Gastroenterology and Hepatology, Saint Spiridon University Hospital, 700115 Iaşi, Romania
| | - Tudor Cuciureanu
- Depatment of Internal Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iaşi, Romania; (I.G.); (L.H.); (C.M.); (O.C.P.); (A.M.S.); (C.C.); (S.C.); (T.C.); (I.I.C.); (C.S.)
- Institute of Gastroenterology and Hepatology, Saint Spiridon University Hospital, 700115 Iaşi, Romania
| | - Irina Iuliana Costache
- Depatment of Internal Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iaşi, Romania; (I.G.); (L.H.); (C.M.); (O.C.P.); (A.M.S.); (C.C.); (S.C.); (T.C.); (I.I.C.); (C.S.)
- Cardiology Department, Saint Spiridon University Hospital, 700115 Iaşi, Romania
| | - Carol Stanciu
- Depatment of Internal Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iaşi, Romania; (I.G.); (L.H.); (C.M.); (O.C.P.); (A.M.S.); (C.C.); (S.C.); (T.C.); (I.I.C.); (C.S.)
- Institute of Gastroenterology and Hepatology, Saint Spiridon University Hospital, 700115 Iaşi, Romania
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Adverse Effects of Angiotensin-Converting Enzyme Inhibitors in Humans: A Systematic Review and Meta-Analysis of 378 Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148373. [PMID: 35886227 PMCID: PMC9324875 DOI: 10.3390/ijerph19148373] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/06/2022] [Accepted: 07/06/2022] [Indexed: 11/29/2022]
Abstract
Background: Although angiotensin-converting enzyme (ACE) inhibitors are among the most-prescribed medications in the world, the extent to which they increase the risk of adverse effects remains uncertain. This study aimed to systematically determine the adverse effects of ACE inhibitors versus placebo across a wide range of therapeutic settings. Methods: Systematic searches were conducted on PubMed, Web of Science, and Cochrane Library databases. Randomized controlled trials (RCTs) comparing an ACE inhibitor to a placebo were retrieved. The relative risk (RR) and its 95% confidence interval (95% CI) were utilized as a summary effect measure. A random-effects model was used to calculate pooled-effect estimates. Results: A total of 378 RCTs fulfilled the eligibility criteria, with 257 RCTs included in the meta-analysis. Compared with a placebo, ACE inhibitors were associated with an significantly increased risk of dry cough (RR = 2.66, 95% CI = 2.20 to 3.20, p < 0.001), hypotension (RR = 1.98, 95% CI = 1.66 to 2.35, p < 0.001), dizziness (RR = 1.46, 95% CI = 1.26 to 1.70, p < 0.001), and hyperkalemia (RR = 1.24, 95% CI = 1.01 to 1.52, p = 0.037). The risk difference was quantified to be 0.037, 0.030, 0.017, and 0.009, respectively. Conclusions: We quantified the relative risk of numerous adverse events associated with the use of ACE inhibitors in a variety of demographics. This information can help healthcare providers be fully informed about any potential adverse consequences and make appropriate suggestions for their patients requiring ACE inhibitor therapy.
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Balla Z, Zsilinszky Z, Pólai Z, Andrási N, Kőhalmi KV, Csuka D, Varga L, Farkas H. The Importance of Complement Testing in Acquired Angioedema Related to Angiotensin-Converting Enzyme Inhibitors. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:947-955. [DOI: 10.1016/j.jaip.2020.08.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 02/02/2023]
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Rafiq S, Gulzar N, Sameen A, Huma N, Hayat I, Ijaz R. Functional role of bioactive peptides with special reference to cheeses. INT J DAIRY TECHNOL 2020. [DOI: 10.1111/1471-0307.12732] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Saima Rafiq
- Department of Food Science and Technology Faculty of Agriculture University of Poonch Rawalakot 12350 Azad kashmirPakistan
| | - Nabila Gulzar
- Department of Dairy Technology University of Veterinary and Animal Sciences Lahore Lahore55300Pakistan
| | - Aysha Sameen
- National Institute of Food Science and Technology University of Agriculture Faisalabad38040Pakistan
| | - Nuzhat Huma
- National Institute of Food Science and Technology University of Agriculture Faisalabad38040Pakistan
| | - Imran Hayat
- Department of Food Science and Technology Faculty of Agriculture University of Poonch Rawalakot 12350 Azad kashmirPakistan
| | - Raina Ijaz
- Department of Horticulture Faculty of Agriculture University of Poonch Rawalakot 12350 Azad Kashmir Pakistan
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Fang G, Annis IE, Farley JF, Mahendraratnam N, Hickson RP, Stürmer T, Robinson JG. Incidence of and Risk Factors for Severe Adverse Events in Elderly Patients Taking Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers after an Acute Myocardial Infarction. Pharmacotherapy 2017; 38:29-41. [PMID: 29059475 DOI: 10.1002/phar.2051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
STUDY OBJECTIVE To assess the incidence of and risk factors associated with severe adverse events in elderly patients who used angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) after an acute myocardial infarction (AMI). DESIGN Retrospective cohort study. DATA SOURCES Centers for Medicare & Medicaid Services Chronic Conditions Data Warehouse (Medicare service claims database), American Community Survey of the U.S. Census Bureau, and Multum Lexicon Drug database. PATIENTS A total of 101,588 eligible Medicare fee-for-service beneficiaries 66 years or older, who were hospitalized for AMI between January 1, 2008, and December 31, 2009, and used ACEIs or ARBs within 30 days after discharge. MEASUREMENTS AND MAIN RESULTS Primary outcomes were hospitalizations for acute renal failure (ARF) and hyperkalemia. The secondary outcome was discontinuation or suspension of ACEI/ARB therapy after a visit to a health care provider. The primary risk factors of interest were age, sex, race/ethnicity, and chronic kidney disease (CKD). Cumulative incidence curves and multivariable Fine-Gray proportional hazards models with 95% confidence intervals (CIs) were used with death as a competing risk in both intention-to-treat (ITT) and as-treated (AT) analyses. In the study cohort, 2.8% experienced ARF, 0.5% experienced hyperkalemia, and 63.7% discontinued ACEI/ARB therapy within 1 year after hospital discharge. Approximately half of the incidence of ARF and hyperkalemia occurred within 6 months after hospital discharge, but the cumulative incidence increased after 6 months. Patients older than 85 years had a higher rate of ARF (ITT hazard ratio [HR] 1.15, 95% CI 1.04-1.28) and hyperkalemia (ITT HR 1.33, 95% CI 1.05-1.68) compared with those aged 65-74 years. Patients with baseline CKD had higher rates of ARF (ITT HR 1.61, 95% CI 1.42-1.82), hyperkalemia (ITT HR 1.41, 95% CI 1.11-1.77), and ACEI/ARB therapy discontinuation or suspension (ITT HR 1.05, 95% CI 1.02-1.09). CONCLUSION We found a low incidence of ARF and hyperkalemia in elderly patients treated with ACEIs or ARBs after AMI hospitalization. However, a high rate of treatment discontinuation might prevent a higher rate of occurrence of these events. Long-term careful monitoring of severe adverse events and timely discontinuation of ACEIs or ARBs among elderly patients with advancing age and CKD after an AMI is warranted in clinical practice.
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Affiliation(s)
- Gang Fang
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Izabela E Annis
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Joel F Farley
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nirosha Mahendraratnam
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ryan P Hickson
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Til Stürmer
- Department of Epidemiology, UNC Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer G Robinson
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa.,Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
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Rafiq S, Huma N, Pasha I, Shahid M, Xiao H. Angiotensin-converting enzyme-inhibitory and antithrombotic activities of soluble peptide extracts from buffalo and cow milk Cheddar cheeses. INT J DAIRY TECHNOL 2016. [DOI: 10.1111/1471-0307.12373] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Saima Rafiq
- National Institute of Food Science and Technology; University of Agriculture; Faisalabad 38040 Pakistan
| | - Nuzhat Huma
- National Institute of Food Science and Technology; University of Agriculture; Faisalabad 38040 Pakistan
| | - Imran Pasha
- National Institute of Food Science and Technology; University of Agriculture; Faisalabad 38040 Pakistan
| | - Muhammad Shahid
- Department of Biochemistry; University of Agriculture; Faisalabad 38040 Pakistan
| | - Hang Xiao
- Department of Food Science; College of Natural Sciences; University of Massachusetts Amherst; Amherst MA 01003 USA
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The Canadian Cardiovascular Society Heart Failure Companion: Bridging Guidelines to Your Practice. Can J Cardiol 2016; 32:296-310. [DOI: 10.1016/j.cjca.2015.06.019] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 06/15/2015] [Accepted: 06/15/2015] [Indexed: 01/09/2023] Open
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Abstract
Hyperkalemia is a common electrolyte disturbance with multiple potential etiologies. It is usually observed in the setting of reduced renal function. Mild to moderate hyperkalemia is usually asymptomatic, but is associated with poor prognosis. When severe, hyperkalemia may cause serious acute cardiac arrhythmias and conduction abnormalities, and may result in sudden death. The rising prevalence of conditions associated with hyperkalemia (heart failure, chronic kidney disease, and diabetes) and broad use of renin-angiotensin-aldosterone system (RAAS) inhibitors and mineralocorticoid receptor antagonists (MRAs), which improve patient outcomes but increase the risk of hyperkalemia, have led to a significant rise in hyperkalemia-related hospitalizations and deaths. Current non-invasive therapies for hyperkalemia either do not remove excess potassium or have poor efficacy and tolerability. There is a clear need for safer, more effective potassium-lowering therapies suitable for both acute and chronic settings. Patiromer sorbitex calcium and sodium zirconium cyclosilicate (ZS-9) are two new potassium-lowering compounds currently in development. Although they have not yet been approved by the US FDA, both have demonstrated efficacy and safety in recent trials. Patiromer sorbitex calcium is a polymer resin and sorbitol complex that binds potassium in exchange for calcium; ZS-9, a non-absorbed, highly selective inorganic cation exchanger, traps potassium in exchange for sodium and hydrogen. This review discusses the merits of both novel drugs and how they may help optimize the future management of patients with hyperkalemia.
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Affiliation(s)
- David K Packham
- The Melbourne Renal Research Group, Department of Medicine, University of Melbourne, 73 Pine St., Reservoir, Melbourne, VIC, 3073, Australia.
- Department of Nephrology, Royal Melbourne Hospital, Melbourne, VIC, Australia.
| | - Mikhail Kosiborod
- Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
- Department of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
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Complete inhibition of the renin-angiotensin-aldosterone system; where do we stand? Curr Opin Nephrol Hypertens 2015; 23:449-55. [PMID: 25014549 DOI: 10.1097/mnh.0000000000000043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW This review presents the role of combination therapy of renin-angiotensin-aldosterone system blockade on cardiovascular and kidney disease. RECENT FINDINGS Three large randomized controlled trials comparing combination therapy of renin-angiotensin-aldosterone system blockade to monotherapy in individuals with increased cardiovascular risk, chronic kidney disease, or diabetic nephropathy have been reported. These trials - ONTARGET, ALTITUDE, and VA NEPHRON-D - demonstrated an excess risk of adverse effects [especially acute kidney injury (AKI) and hyperkalemia] with combination therapy, without significant benefit in reducing cardiovascular and renal morbidity. SUMMARY Current evidence supports avoiding dual renin-angiotensin-aldosterone system blockade in patients with chronic kidney disease. Subsequent studies of dual renin-angiotensin-aldosterone system blockade should examine adverse event risks and renal progression endpoints.
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Elliott RA, Putman KD, Franklin M, Annemans L, Verhaeghe N, Eden M, Hayre J, Rodgers S, Sheikh A, Avery AJ. Cost effectiveness of a pharmacist-led information technology intervention for reducing rates of clinically important errors in medicines management in general practices (PINCER). PHARMACOECONOMICS 2014; 32:573-590. [PMID: 24639038 DOI: 10.1007/s40273-014-0148-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND OBJECTIVE We recently showed that a pharmacist-led information technology-based intervention (PINCER) was significantly more effective in reducing medication errors in general practices than providing simple feedback on errors, with cost per error avoided at £79 (US$131). We aimed to estimate cost effectiveness of the PINCER intervention by combining effectiveness in error reduction and intervention costs with the effect of the individual errors on patient outcomes and healthcare costs, to estimate the effect on costs and QALYs. METHODS We developed Markov models for each of six medication errors targeted by PINCER. Clinical event probability, treatment pathway, resource use and costs were extracted from literature and costing tariffs. A composite probabilistic model combined patient-level error models with practice-level error rates and intervention costs from the trial. Cost per extra QALY and cost-effectiveness acceptability curves were generated from the perspective of NHS England, with a 5-year time horizon. RESULTS The PINCER intervention generated £2,679 less cost and 0.81 more QALYs per practice [incremental cost-effectiveness ratio (ICER): -£3,037 per QALY] in the deterministic analysis. In the probabilistic analysis, PINCER generated 0.001 extra QALYs per practice compared with simple feedback, at £4.20 less per practice. Despite this extremely small set of differences in costs and outcomes, PINCER dominated simple feedback with a mean ICER of -£3,936 (standard error £2,970). At a ceiling 'willingness-to-pay' of £20,000/QALY, PINCER reaches 59 % probability of being cost effective. CONCLUSIONS PINCER produced marginal health gain at slightly reduced overall cost. Results are uncertain due to the poor quality of data to inform the effect of avoiding errors.
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Affiliation(s)
- Rachel A Elliott
- Division for Social Research in Medicines and Health, The School of Pharmacy, University of Nottingham, University Park, East Drive, Nottingham, NG7 2RD, UK,
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Seliger SL, Fried LF. Serum potassium in dual renin-angiotensin-aldosterone system blockade. Clin J Am Soc Nephrol 2014; 9:219-21. [PMID: 24408119 DOI: 10.2215/cjn.12411213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Stephen L Seliger
- Veterans Affairs Maryland Healthcare System and University of Maryland School of Medicine, Baltimore, Maryland, †Veterans Affairs Pittsburgh Healthcare System and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Kuijvenhoven MA, Haak EAF, Gombert-Handoko KB, Crul M. Evaluation of the concurrent use of potassium-influencing drugs as risk factors for the development of hyperkalemia. Int J Clin Pharm 2013; 35:1099-104. [DOI: 10.1007/s11096-013-9830-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
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Franz CC, Egger S, Born C, Rätz Bravo AE, Krähenbühl S. Potential drug-drug interactions and adverse drug reactions in patients with liver cirrhosis. Eur J Clin Pharmacol 2011; 68:179-88. [DOI: 10.1007/s00228-011-1105-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 07/21/2011] [Indexed: 01/08/2023]
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Noize P, Bagheri H, Durrieu G, Haramburu F, Moore N, Giraud P, Galinier M, Pourrat J, Montastruc JL. Life-threatening drug-associated hyperkalemia: a retrospective study from laboratory signals. Pharmacoepidemiol Drug Saf 2011; 20:747-53. [PMID: 21438068 DOI: 10.1002/pds.2128] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 02/07/2011] [Accepted: 02/09/2011] [Indexed: 11/10/2022]
Abstract
PURPOSE Life-threatening hyperkalemia may be induced by drugs and preventable in at-risk patients. This study was designed to describe cases of 'serious' drug-associated hyperkalemia. METHODS Adult subjects with a serum potassium concentration above 6.5 mmol/L detected at admission or during hospital stay in nephrology, cardiology, geriatric, emergency or intensive care units were identified by biology laboratories of hospitals and clinics located in Midi-Pyrenees (southwest France). Patients dialyzed for end-stage kidney disease were excluded. Data were collected from medical files. Hyperkalemia was defined as drug-associated if at least one drug known to increase serum potassium concentration was taken when hyperkalemia occurred (among drugs taken in outpatient care for hyperkalemia detected at admission and among drugs taken in outpatient care and continued at hospital and drugs introduced from admission for hyperkalemia detected during hospital stay). RESULTS Of 168 hyperkalemia cases, 102 (60.7%) were classified as drug-associated. They concerned elderly patients (mean age: 76.1 years) often having arterial hypertension and/or cardiac diseases (88.2%). Risk factors, mainly acute kidney failure, were observed in almost all cases (98.0%). Drugs predominantly involved were angiotensin-converting enzyme inhibitors (47.1%), spironolactone (41.2%), angiotensin II receptor antagonists (23.5%) and potassium supplements (23.5%). In 10% of cases, death could be attributed to hyperkalemia. CONCLUSIONS Laboratory databases allowed an exhaustive identification of hyperkalemia cases. The frequency of drug-related hyperkalemia and their characteristics suggest that treatment with drugs known to increase serum potassium concentration can be inappropriate, especially regarding associations or indications, and is highly risky for predisposed patients.
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Affiliation(s)
- Pernelle Noize
- CHU de Toulouse, Service de Pharmacologie Clinique, Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, F-31000 Toulouse, France
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Tripathy S, Dash SC. Etoricoxib-induced life-threatening hyperkalemia and acute kidney dysfunction against the background of telmisartan and a low sodium diet. Int J Emerg Med 2010; 3:443-6. [PMID: 21373319 PMCID: PMC3047866 DOI: 10.1007/s12245-010-0208-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Accepted: 06/15/2010] [Indexed: 11/25/2022] Open
Abstract
Drug-induced hyperkalemia is not uncommon and may be life-threatening when presenting acutely in the emergency department. We present a case of severe hyperkalemia precipitated acutely by etoricoxib in a patient who was on telmisartan and a low sodium (potassium chloride-rich) diet. A 75-year-old male with a past medical history of well-controlled diabetes and hypertension was prescribed etoricoxib (90 mg daily) for 3 days for musculoskeletal backache. He had been taking his routine medications including telmisartan and a potassium-rich salt substitute for many years, without any recent change in dosage or quantity. There was evidence of microalbuminurea; however, the renal functions and electrolytes prior to starting etoricoxib were normal. He presented to the emergency department with signs and symptoms of life-threatening hyperkalemia (serum potassium 7.7 mEq/dl), accelerated hypertension, congestive heart failure, pulmonary edema and acute renal failure. Acute medical management and withholding all drugs that could cause hyperkalemia improved his serum potassium levels over 24 h and renal parameters within 5 days. All the other drugs except etoricoxib were restarted under observation over 8 weeks with no recurrence of the acute episode. Non-steroidal analgesics and other COX-2 inhibitors (rofecoxib and celecoxib) have been known to precipitate renal failure and hyperkalemia specially in patients at risk for the same; although not unexpected, this may be the first reported case of life-threatening hyperkalemia precipitated by etoricoxib in a previously stable patient having increased risk of renal failure and hyperkalemia.
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Affiliation(s)
- Swagata Tripathy
- Department of Anaesthesia, Kalinga Institute of Medical Sciences, Bhubaneswar, India
| | - Suresh Chandra Dash
- Department Nephrology, Kalinga Institute of Medical Sciences, Bhubaneswar, India
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Sterling JA. Recent Publications on Medications and Pharmacy. Hosp Pharm 2009. [DOI: 10.1310/hpj4408-711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hospital Pharmacy presents this feature to keep pharmacists abreast of new publications in the medical/pharmacy literature. Articles of interest regarding a broad scope of topics are abstracted monthly.
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