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Sujang GB, Ramaiya SD, Lee SY, Zakaria MH. Characterization of indigenous Durio species from Sarawak, Borneo: relationships between chemical composition and sensory attributes. PeerJ 2024; 12:e17688. [PMID: 39135954 PMCID: PMC11318588 DOI: 10.7717/peerj.17688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/14/2024] [Indexed: 08/15/2024] Open
Abstract
Sarawak, Borneo, harbours 16 unique Durio species, half of which are edible, with only Durio zibethinus widely cultivated. Despite their nutritional and economic significance to the rural communities in Sarawak, the lesser-known indigenous durians remain underrepresented in the scientific literature while facing the risk of extinction in the wild. Thus, the aim of this study was to conduct comprehensive chemical analyses of these wild edible durians, offering insights into their nutritional and sensory taste attributes. The edible part was separated at optimal ripeness, and the samples were subjected to further analysis. Wild edible durian genotypes exhibit varied characteristics, even within the same species. The majority of wild durians are characterized by a sugar composition consisting predominantly of sucrose, constituting 67.38-96.96%, except for the red-fleshed Durio graveolens renowned for its low total sugar content (0.49 ± 0.17 g per 100 g). Despite its bland taste, this species possessed significantly greater fat (14.50 ± 0.16%) and fibre (12.30 ± 0.14%) content. Durio dulcis exhibited a significantly greater carbohydrate content (29.37-30.60%), and its intense smell was attributed to its low protein content (2.03-2.04%). Indigenous durians offer substantial percentages of daily mineral intake, with 100 g servings providing approximately 15.71-26.80% of potassium, 71.72-86.52% of phosphorus, 9.33-27.31% of magnesium, and sufficient trace minerals. The vibrant flesh colours of yellow-, orange- and red-fleshed Durio graveolens and Durio kutejensis show high levels of ascorbic acid (31.41-61.56 mg 100 g-1), carotenoids (976.36-2627.18 µg 100 g-1) and antioxidant properties, while Durio dulcis and Durio oxleyanus, despite their dull flesh, contained high phenolic (67.95-74.77 mg GAE 100 g-1) and flavonoid (8.71-13.81 QE mg 100 g-1) levels. These endeavours provide a deeper understanding of the nutritional richness of wild edible durians, thereby supporting commercialization and conservation efforts.
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Affiliation(s)
- Gerevieve Bangi Sujang
- Department of Crop Science, Faculty of Agricultural and Forestry Sciences, Universiti Putra Malaysia Bintulu Campus, Bintulu, Sarawak, Malaysia
| | - Shiamala Devi Ramaiya
- Department of Crop Science, Faculty of Agricultural and Forestry Sciences, Universiti Putra Malaysia Bintulu Campus, Bintulu, Sarawak, Malaysia
| | - Shiou Yih Lee
- Faculty of Health and Life Sciences, INTI International University, Nilai, Negeri Sembilan, Malaysia
| | - Muta Harah Zakaria
- Department of Aquaculture, Faculty of Agriculture, Universiti Putra Malaysia, UPM Serdang, Selangor Darul Ehsan, Malaysia
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2
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Guo L, Ji Y, Sun T, Liu Y, Jiang C, Wang G, Xing H, Yang B, Xu A, Xian X, Yang H. Management of Chronic Heart Failure in Dialysis Patients: A Challenging but Rewarding Path. Rev Cardiovasc Med 2024; 25:232. [PMID: 39076321 PMCID: PMC11270084 DOI: 10.31083/j.rcm2506232] [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: 08/20/2023] [Revised: 01/15/2024] [Accepted: 03/04/2024] [Indexed: 07/31/2024] Open
Abstract
Chronic heart failure (CHF) is a common complication and cause of death in dialysis patients. Although several clinical guidelines and expert consensus on heart failure (HF) in the general population have been issued in China and abroad, due to abnormal renal function or even no residual renal function (RRF) in dialysis patients, the high number of chronic complications, as well as the specificity, variability, and limitations of hemodialysis (HD) and peritoneal dialysis (PD) treatments, there are significant differences between dialysis patients and the general population in terms of the treatment and management of HF. The current studies are not relevant to all dialysis-combined HF populations, and there is an urgent need for high-quality studies on managing HF in dialysis patients to guide and standardize treatment. After reviewing the existing guidelines and literature, we focused on the staging and diagnosis of HF, management of risk factors, pharmacotherapy, and dialysis treatment in patients on dialysis. Based on evidence-based medicine and clinical trial data, this report reflects new perspectives and future trends in the diagnosis and treatment of HF in dialysis patients, which will further enhance the clinicians' understanding of HF in dialysis patients.
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Affiliation(s)
- Luxuan Guo
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, 300193 Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, 300193 Tianjin, China
- Tianjin University of Traditional Chinese Medicine, 301617 Tianjin, China
| | - Yue Ji
- Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Institute of Nephrology & Beijing Key Laboratory, 100700 Beijing, China
| | - Tianhao Sun
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, 300193 Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, 300193 Tianjin, China
- Tianjin University of Traditional Chinese Medicine, 301617 Tianjin, China
| | - Yang Liu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, 300193 Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, 300193 Tianjin, China
- Tianjin University of Traditional Chinese Medicine, 301617 Tianjin, China
| | - Chen Jiang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, 300193 Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, 300193 Tianjin, China
- Tianjin University of Traditional Chinese Medicine, 301617 Tianjin, China
| | - Guanran Wang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, 300193 Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, 300193 Tianjin, China
- Tianjin University of Traditional Chinese Medicine, 301617 Tianjin, China
| | - Haitao Xing
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, 300193 Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, 300193 Tianjin, China
- Tianjin University of Traditional Chinese Medicine, 301617 Tianjin, China
| | - Bo Yang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, 300193 Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, 300193 Tianjin, China
- Tianjin University of Traditional Chinese Medicine, 301617 Tianjin, China
| | - Ao Xu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, 300193 Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, 300193 Tianjin, China
- Tianjin University of Traditional Chinese Medicine, 301617 Tianjin, China
| | - Xian Xian
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, 300193 Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, 300193 Tianjin, China
- Tianjin University of Traditional Chinese Medicine, 301617 Tianjin, China
| | - Hongtao Yang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, 300193 Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, 300193 Tianjin, China
- Tianjin University of Traditional Chinese Medicine, 301617 Tianjin, China
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3
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Li D, Zhang Y, Chen Y, Yang B, Chen J, Shi J, Guo X, Liu Y, Zhang L, Lv Q, Fan H. Advancing crush syndrome management: the potent role of Sodium zirconium cyclosilicate in early hyperkalemia intervention and survival enhancement in a rat model. Front Pharmacol 2024; 15:1381954. [PMID: 38803437 PMCID: PMC11128686 DOI: 10.3389/fphar.2024.1381954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Background: Crush Syndrome (CS), a severe trauma resulting from prolonged muscle compression, is commonly seen in large-scale disasters such as earthquakes. It not only causes localized tissue damage but also triggers electrolyte imbalances, particularly hyperkalemia, increasing the risk of early mortality. This study aims to assess the early intervention effects of Sodium Zirconium Cyclosilicate (SZC) on hyperkalemia in rat CS model. Methods: A rat CS model was established using a self-developed multi-channel intelligent small-animal crush injury platform. Rats in the experimental groups were treated with varying doses of SZC before compression and immediately post-decompression. The efficacy of SZC was evaluated by continuous monitoring of blood potassium levels and survival rates. Serum creatinine (Cre) and blood urea nitrogen (BUN) levels were analyzed, and renal damage was assessed through histopathological examination. Results: SZC treatment significantly reduced blood potassium levels and improved survival rates in rats. Compared to the placebo group, the SZC-treated rats showed a significant decrease in blood potassium levels at 6 and 12 h post-decompression, maintaining lower levels at 24 h. Biochemical analysis indicated no significant impact of SZC on renal function, with no notable differences in Cre and BUN levels between groups. Histopathological findings revealed similar levels of renal damage in both groups. Conclusion: SZC demonstrates significant early intervention effects on hyperkalemia in a rat model of crush injury, effectively improving survival rates without adverse effects on renal function. These results provide a new strategic direction for the clinical treatment of Crush Syndrome and lay the foundation for future clinical applications.
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Affiliation(s)
- Duo Li
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China
| | - Yan Zhang
- Department of Nephrology, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Military Logistics Research Key Laboratory of Field Disease Treatment, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yuansen Chen
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China
| | - Bofan Yang
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China
| | - Jianwen Chen
- Department of Nephrology, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Military Logistics Research Key Laboratory of Field Disease Treatment, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jie Shi
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China
| | - Xiaoqin Guo
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China
| | - Yanqing Liu
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China
| | - Li Zhang
- Department of Nephrology, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Military Logistics Research Key Laboratory of Field Disease Treatment, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qi Lv
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China
| | - Haojun Fan
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China
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De Nicola L, Ferraro PM, Montagnani A, Pontremoli R, Dentali F, Sesti G. Recommendations for the management of hyperkalemia in patients receiving renin-angiotensin-aldosterone system inhibitors. Intern Emerg Med 2024; 19:295-306. [PMID: 37775712 PMCID: PMC10954964 DOI: 10.1007/s11739-023-03427-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/04/2023] [Indexed: 10/01/2023]
Abstract
Hyperkalemia is common in clinical practice and can be caused by medications used to treat cardiovascular diseases, particularly renin-angiotensin-aldosterone system inhibitors (RAASis). This narrative review discusses the epidemiology, etiology, and consequences of hyperkalemia, and recommends strategies for the prevention and management of hyperkalemia, mainly focusing on guideline recommendations, while recognizing the gaps or differences between the guidelines. Available evidence emphasizes the importance of healthcare professionals (HCPs) taking a proactive approach to hyperkalemia management by prioritizing patient identification and acknowledging that hyperkalemia is often a long-term condition requiring ongoing treatment. Given the risk of hyperkalemia during RAASi treatment, it is advisable to monitor serum potassium levels prior to initiating these treatments, and then regularly throughout treatment. If RAASi therapy is indicated in patients with cardiorenal disease, HCPs should first treat chronic hyperkalemia before reducing the dose or discontinuing RAASis, as reduction or interruption of RAASi treatment can increase the risk of adverse cardiovascular and renal outcomes or death. Moreover, management of hyperkalemia should involve the use of newer potassium binders, such as sodium zirconium cyclosilicate or patiromer, as these agents can effectively enable optimal RAASi treatment. Finally, patients should receive education regarding hyperkalemia, the risks of discontinuing their current treatments, and need to avoid excessive dietary potassium intake.
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Affiliation(s)
- Luca De Nicola
- Nephrology Unit, Advanced Medical and Surgical Sciences Department, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pietro Manuel Ferraro
- U.O.S. Terapia Conservativa della Malattia Renale Cronica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.
- Section of Nephrology, Department of Medicine, Università degli Studi di Verona, Verona, Italy.
| | - Andrea Montagnani
- Department of Internal Medicine, Hospital Misericordia, Grosseto, Italy
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesco Dentali
- Department of Medicine and Surgery, Insubria University, Varese, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, University of Rome-Sapienza, Rome, Italy
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5
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Harea GT, Thrailkill M, Garcia I, Beely BM, Wendorff DS, Roberts TR, Golobish TD, Gruda M, Kovacs T, Guliashvili T, Chan PP, Stewart IJ, Chung KK, Guda T, Batchinsky AI. K +ontrol rapidly and efficiently reduces potassium in donor blood during ex vivo circulation. Perfusion 2024; 39:134-141. [PMID: 36196521 DOI: 10.1177/02676591221130175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with kidney failure are at risk for lethal complications from hyperkalemia. Resuscitation, medications, and hemodialysis are used to mitigate increased potassium (K+) levels in circulating blood; however, these approaches may not always be readily available or effective, especially in a resource limited environment. We tested a sorbent cartridge (KC, K+ontrol CytoSorbents Medical Inc., Monmouth Junction, New Jersey) which contains a resin adsorber for K+. The objective of this study was to test the utility of KC in an ex vivo circulation system. We hypothesized that KC reduces K+ levels in extracorporeal circulation of donor swine whole blood infused with KCl. METHODS A six-hour circulation study was carried out using KC, a NxStage (NxStage Medical, Inc., Lawrence, MA) membrane, blood bag containing heparinized whole blood with KCl infusion, 3/16-inch ID tubing, a peristaltic pump, and flow sensors. The NxStage permeate line was connected back to the main circuit in the Control group (n = 6), creating a recirculation loop. For KC group (n = 6), KC was added to the recirculation loop, and a continuous infusion of KCl at 10 mEq/hour was administered for two hours. Blood samples were acquired at baseline and every hour for 6 h. RESULTS In the control group, K+ levels remained at ∼9 mmol/L; 9.1 ± 0.4 mmol/L at 6 h. In the KC group, significant decreases in K+ at hour 1 (4.3 ± 0.3 mmol/L) and were sustained for the experiment duration equilibrating at 4.6 ± 0.4 mmol/L after 6 h (p = 0.042). Main loop blood flow was maintained under 400 mL/min; recirculation loop flow varied between 60 and 70 mL/min in the control group and 45-55 mL/min in the KC group. Decreases in recirculation loop flow in KC group required 7% increase of pump RPM. CONCLUSIONS During ex-vivo extracorporeal circulation using donor swine blood, KC removed approximately 50% of K+, normalizing circulating levels.
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Affiliation(s)
- George T Harea
- Autonomous Reanimation and Evacuation Research Program, San Antonio, TX, USA
| | - Marianne Thrailkill
- Autonomous Reanimation and Evacuation Research Program, San Antonio, TX, USA
| | - Isabella Garcia
- Autonomous Reanimation and Evacuation Research Program, San Antonio, TX, USA
| | - Brendan M Beely
- Autonomous Reanimation and Evacuation Research Program, San Antonio, TX, USA
- Department of Translational Medicine, School of Osteopathic Medicine, University of the Incarnate Word, San Antonio, TX, USA
| | - Daniel S Wendorff
- Autonomous Reanimation and Evacuation Research Program, San Antonio, TX, USA
- Department of Translational Medicine, School of Osteopathic Medicine, University of the Incarnate Word, San Antonio, TX, USA
| | - Teryn R Roberts
- Autonomous Reanimation and Evacuation Research Program, San Antonio, TX, USA
- Department of Translational Medicine, School of Osteopathic Medicine, University of the Incarnate Word, San Antonio, TX, USA
| | | | | | - Tim Kovacs
- Cytosorbents Inc., Monmouth Junction, NJ, USA
| | | | | | - Ian J Stewart
- Department of Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Kevin K Chung
- Department of Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Teja Guda
- University of Texas at San Antonio, San Antonio, TX, USA
| | - Andriy I Batchinsky
- Autonomous Reanimation and Evacuation Research Program, San Antonio, TX, USA
- Department of Translational Medicine, School of Osteopathic Medicine, University of the Incarnate Word, San Antonio, TX, USA
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Guida SJ, Bazzle L. Rebound hyperkalemia in a dog with albuterol toxicosis after cessation of potassium supplementation. J Vet Emerg Crit Care (San Antonio) 2023; 33:715-721. [PMID: 37943086 DOI: 10.1111/vec.13352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/03/2022] [Accepted: 09/23/2022] [Indexed: 11/10/2023]
Abstract
OBJECTIVE To describe the presentation of rebound hyperkalemia as a delayed side effect of albuterol toxicity in a dog. CASE SUMMARY A 3-year-old female neutered mixed-breed dog was presented for albuterol toxicosis that led to a severe hypokalemia, hyperlactatemia, and hyperglycemia. The dog also experienced sinus tachycardia and generalized weakness. Treatment was instituted with intravenous fluid therapy and potassium supplementation, and the dog was monitored with a continuous electrocardiogram. Resolution of hypokalemia was documented 12 hours after initial presentation, at which time fluid therapy and potassium supplementation were discontinued. There were no further periods of sinus tachycardia, but instead the dog developed ventricular ectopy with rapid couplets (instantaneous rates of 300/min). An echocardiogram revealed normal cardiac size and function. Twenty-four hours after presentation, the patient developed severe hyperkalemia, despite discontinuation of fluids and potassium supplementation for 12 hours. Serial venous and urinary electrolytes were performed for determination of the fractional excretion of electrolytes. These data confirmed rebound hyperkalemia (7.0 mmol/L), consistent with a markedly increased fractional excretion of potassium, and secondary to the release of potassium from inside the cells. Fluid therapy with dextrose supplementation was provided until 36 hours postpresentation. The hyperkalemia resolved, and the dog was discharged after 44 hours of hospitalization. NEW OR UNIQUE INFORMATION PROVIDED This case documents rebound hyperkalemia following treatment of albuterol toxicosis in a dog. This case highlights the importance of understanding the distribution of total body potassium when treating serum hypokalemia. Transcellular shifts of potassium, as in the case of albuterol toxicosis, can lead to rebound hyperkalemia even after discontinuation of potassium supplementation. This case further explores the utility of fractional excretion of electrolytes in elucidating the etiology and management of electrolyte disturbances.
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Affiliation(s)
- Samantha J Guida
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, Georgia, USA
| | - Lisa Bazzle
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, Georgia, USA
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AlSahow A. Moderate stepwise restriction of potassium intake to reduce risk of hyperkalemia in chronic kidney disease: A literature review. World J Nephrol 2023; 12:73-81. [PMID: 37766841 PMCID: PMC10520754 DOI: 10.5527/wjn.v12.i4.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/13/2023] [Accepted: 06/26/2023] [Indexed: 09/20/2023] Open
Abstract
A potassium-rich diet has several cardiovascular and renal health benefits; however, it is not recommended for patients with advanced chronic kidney disease or end-stage kidney disease because of the risk of life-threatening hyperkalemia. To assess the strength of evidence supporting potassium intake restriction in chronic kidney disease, the medical literature was searched looking for the current recommended approach and for evidence in support for such an approach. There is a lack of strong evidence supporting intense restriction of dietary potassium intake. There are several ways to reduce potassium intake without depriving the patient from fruits and vegetables, such as identifying hidden sources of potassium (processed food and preservatives) and soaking or boiling food to remove potassium. An individualized and gradual reduction of dietary potassium intake in people at risk of hyperkalemia is recommended. The current potassium dietary advice in chronic kidney disease needs to be reevaluated, individualized, and gradually introduced.
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Affiliation(s)
- Ali AlSahow
- Department of Nephrology, Jahra Hospital, Jahra 00004, Kuwait
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Zhao X, Zuo L. Multicentre, observational, retrospective cohort of hyperkalaemia burden at haemodialysis facility-level in China: the Visualize-HD study protocol. BMJ Open 2023; 13:e066394. [PMID: 37734899 PMCID: PMC10514616 DOI: 10.1136/bmjopen-2022-066394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 07/13/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVES Hyperkalaemia is a potentially life-threatening disorder in patients undergoing haemodialysis (HD). Excess mortality and hospitalisation have been associated with hyperkalaemia (HK) after the long (2-day) interdialytic interval (LIDI) in patients on thrice a week HD compared with the short (1-day) interdialytic interval. Moreover, not much research has been conducted in China on the descriptive epidemiology and management of HK among different HD centres. The aim of this study is to address this evidence gap by investigating the risk factors associated with HK clinical burden at the HD facility level, current HD centres management patterns, serum potassium management patterns, as well as the risk factors associated with crude mortality in China. DESIGN Multicentre, observational, retrospective cohort study. SETTING This study plans to enrol 300 HD centres across China. Haemodialysis centres having ≥100 patients on maintenance HD within 3 years before study initiation, with participation willingness, routine blood collection post-LIDI and death records will be included. PARTICIPANTS Patients aged ≥18 years and on chronic HD for ≥3 months will be considered eligible. Summary data about serum potassium, characteristics of patients, facility practice patterns will be collected at HD facility level and death records will be at the patient level. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome will be to examine the association between suspected risk factors and HK prevalence at HD facility level. Suspected risk factors include dialysis prescriptions and serum potassium testing frequency, characteristics of patients and related medication usage. The secondary outcome will be to determine the HK prevalence, serum potassium management pattern and risk factors associated with crude mortality. The primary and secondary outcomes will be analysed using regression models. Exploratory outcomes will further investigate the risk factors associated with serum potassium ≥6.0 and ≥6.5 mmol/L. CONCLUSION The study is expected to provide insights to improve dialysis practice patterns and understand the clinical burden of HK. ETHICS AND DISSEMINATION This study protocol was reviewed and approved by the Institutional Review Boards and Ethics Committee of Peking University People's Hospital (Approval number: 2020PHB324-01). The results will be disseminated through national and international presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT05020717.
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Affiliation(s)
- Xinju Zhao
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Li Zuo
- Department of Nephrology, Peking University People's Hospital, Beijing, China
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9
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Qu X, Hua Y, Khan BA. A Real-World Experience of Hyperkalemia Management Using Sodium Zirconium Cyclosilicate in Chronic Hemodialysis: A Multicenter Clinical Audit. Cureus 2023; 15:e45058. [PMID: 37829953 PMCID: PMC10567123 DOI: 10.7759/cureus.45058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Hyperkalemia, a common condition among hemodialysis (HD) patients, is associated with adverse health outcomes. Evidence of the safety and efficacy of a potassium-binder, sodium zirconium cyclosilicate (SZC), has been limited among Asian (HD) patients beyond phase 3 trials. This article demonstrates real-world evidence of SZC usage in an Asian cohort of HD patients. METHODS A retrospective clinical audit was conducted among 293 patients who received maintenance HD at community-based dialysis centers in Singapore. Patients received SZC for either management of hyperkalemia or hyperkalemia prevention during anticipated disruption to dialysis, such as during traveling. Among patients treated for hyperkalemia (N = 147), serum potassium (K+) prior to SZC initiation and at the endpoint was compared using a paired Student's t-test. Changes in K+ from baseline to endpoint were compared across various categories within each demographic and health-related variables using either Student's t-test or one-way ANOVA. Patients who experienced adverse events after SZC initiation or were deceased during the audit were reviewed to provide a descriptive account. RESULTS Among patients who received SZC for hyperkalemia treatment, SZC use was associated with a significant reduction of 0.812 mmol/L in serum potassium. Patients with ethnicities other than Chinese, Malay, or Indian had a nominal reduction in K+ of 0.7 mmol/L and this can be accounted for the small sample size of this sub-group. The three main ethnicities which represented more than 95% of the sample showed a significant reduction in K+ levels (all three p<0.001). This is consistent with other studies with SZC which showed efficacy across various ethnicities. Patients who received SZC for hyperkalemia treatment or prevention had a significant lowering of mortality rate. This mortality reduction may have inherent biases and confounders, due to the retrospective clinical audit study design. Conclusions: Overall, SZC was safe and effective among the audited patients. The efficacy in the real-world setting was similar to previous trials. The novel use of SZC to manage serum potassium when HD sessions are missed, such as during traveling, warrants further investigation due to potentially significant life-saving implications.
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Affiliation(s)
- XiaoJie Qu
- Medical Affairs, The National Kidney Foundation Singapore, Singapore, SGP
| | - Yan Hua
- Medical Affairs, The National Kidney Foundation Singapore, Singapore, SGP
| | - Behram A Khan
- Nephrology, National University of Singapore, Singapore, SGP
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10
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Ni Z, Jin H, Lu R, Zhang L, Yao L, Shao G, Zuo L, Qin S, Zhang X, Zhang Q, Yu W, Luo Q, Ren Y, Peng H, Xiao J, Yang Q, Chen Q, Shi Y. Hyperkalaemia prevalence and dialysis patterns in Chinese patients on haemodialysis: an interim analysis of a prospective cohort study (PRECEDE-K). BMC Nephrol 2023; 24:233. [PMID: 37559023 PMCID: PMC10411008 DOI: 10.1186/s12882-023-03261-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/30/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Hyperkalaemia is a known risk factor for cardiac arrhythmia and mortality in patients on haemodialysis. Despite standard adequate haemodialysis, hyperkalaemia is common in patients with end-stage renal disease (ESRD) at interdialytic intervals. Data on hyperkalaemia burden and its effects on dialysis patterns and serum potassium (sK) fluctuations in patients on haemodialysis in China remain limited. The prospective, observational cohort study (PRECEDE-K; NCT04799067) investigated the prevalence, recurrence, and treatment patterns of hyperkalaemia in Chinese patients with ESRD on haemodialysis. METHODS Six hundred adult patients were consecutively enrolled from 15 secondary and tertiary hospitals in China. In this interim analysis, we report the baseline characteristics of the cohort, the prevalence of predialysis hyperkalaemia (sK > 5.0 mmol/L), and the trends in serum-dialysate potassium gradient and intradialytic sK shift at Visit 1 (following a long interdialytic interval [LIDI]). RESULTS At baseline, most patients (85.6%) received three-times weekly dialysis; mean duration was 4.0 h. Mean urea reduction ratio was 68.0% and Kt/V was 1.45; 60.0% of patients had prior hyperkalaemia (previous 6 months). At Visit 1, mean predialysis sK was 4.83 mmol/L, and 39.6% of patients had hyperkalaemia. Most patients (97.7%) received a dialysate potassium concentration of 2.0 mmol/L. The serum-dialysate potassium gradient was greater than 3 mmol/L for over 40% of the cohort (1- < 2, 2- < 3, 3- < 4, and ≥ 4 mmol/L in 13.6%, 45.1%, 35.7%, and 5.2% of patients, respectively; mean: 2.8 mmol/L). The intradialytic sK reduction was 1- < 3 mmol/L for most patients (0- < 1, 1- < 2, 2- < 3, and ≥ 3 mmol/L in 24.2%, 62.2%, 12.8%, and 0.9% of patients, respectively; mean: 1.4 mmol/L). CONCLUSIONS Hyperkalaemia after a LIDI was common in this real-world cohort of Chinese patients despite standard adequate haemodialysis, and led to large serum-dialysate potassium gradients and intradialytic sK shifts. Previous studies have shown hyperkalaemia and sK fluctuations are highly correlated with poor prognosis. Effective potassium-lowering treatments should be evaluated for the improvement of long-term prognosis through the control of hyperkalaemia and sK fluctuations. TRIAL REGISTRATION ClinicalTrials.gov, NCT04799067.
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Affiliation(s)
- Zhaohui Ni
- Department of Nephrology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No. 160, Pujian Road, Shanghai, 200127, China.
| | - Haijiao Jin
- Department of Nephrology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No. 160, Pujian Road, Shanghai, 200127, China
| | - Renhua Lu
- Department of Nephrology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No. 160, Pujian Road, Shanghai, 200127, China
| | - Lihong Zhang
- Department of Nephrology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Li Yao
- Department of Nephrology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Guojian Shao
- Department of Nephrology, Wenzhou Central Hospital, Wenzhou, Zhejiang, China
| | - Li Zuo
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Shuguang Qin
- Department of Nephrology, Guangzhou First People's Hospital, Guangzhou, Guangdong, China
| | - Xinzhou Zhang
- Department of Nephrology, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Qinghong Zhang
- Department of Nephrology, Taihe Hospital, Shiyan, Hubei, China
| | - Weimin Yu
- Department of Nephrology, Shanxi Bethune Hospital, Taiyuan, Shanxi, China
| | - Qun Luo
- Department of Nephrology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Yuqing Ren
- Department of Nephrology, Yangquan Coal Industry (Group) General Hospital, Yangquan, Shanxi, China
| | - Hui Peng
- Department of Nephrology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jie Xiao
- Department of Nephrology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Qiongqiong Yang
- Department of Nephrology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Qinkai Chen
- Department of Nephrology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yifan Shi
- Medical Affairs, AstraZeneca Investment China Co, Shanghai, China
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Rafique Z, Budden J, Quinn CM, Duanmu Y, Safdar B, Bischof JJ, Driver BE, Herzog CA, Weir MR, Singer AJ, Boone S, Soto-Ruiz KM, Peacock WF. Patiromer utility as an adjunct treatment in patients needing urgent hyperkalaemia management (PLATINUM): design of a multicentre, randomised, double-blind, placebo-controlled, parallel-group study. BMJ Open 2023; 13:e071311. [PMID: 37308268 PMCID: PMC10277034 DOI: 10.1136/bmjopen-2022-071311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/11/2023] [Indexed: 06/14/2023] Open
Abstract
INTRODUCTION Hyperkalaemia is common, life-threatening and often requires emergency department (ED) management; however, no standardised ED treatment protocol exists. Common treatments transiently reducing serum potassium (K+) (including albuterol, glucose and insulin) may cause hypoglycaemia. We outline the design and rationale of the Patiromer Utility as an Adjunct Treatment in Patients Needing Urgent Hyperkalaemia Management (PLATINUM) study, which will be the largest ED randomised controlled hyperkalaemia trial ever performed, enabling assessment of a standardised approach to hyperkalaemia management, as well as establishing a new evaluation parameter (net clinical benefit) for acute hyperkalaemia treatment investigations. METHODS AND ANALYSIS PLATINUM is a Phase 4, multicentre, randomised, double-blind, placebo-controlled study in participants who present to the ED at approximately 30 US sites. Approximately 300 adult participants with hyperkalaemia (K+ ≥5.8 mEq/L) will be enrolled. Participants will be randomised 1:1 to receive glucose (25 g intravenously <15 min before insulin), insulin (5 units intravenous bolus) and aerosolised albuterol (10 mg over 30 min), followed by a single oral dose of either 25.2 g patiromer or placebo, with a second dose of patiromer (8.4 g) or placebo after 24 hours. The primary endpoint is net clinical benefit, defined as the mean change in the number of additional interventions less the mean change in serum K+, at hour 6. Secondary endpoints are net clinical benefit at hour 4, proportion of participants without additional K+-related medical interventions, number of additional K+-related interventions and proportion of participants with sustained K+ reduction (K+ ≤5.5 mEq/L). Safety endpoints are the incidence of adverse events, and severity of changes in serum K+ and magnesium. ETHICS AND DISSEMINATION A central Institutional Review Board (IRB) and Ethics Committee provided protocol approval (#20201569), with subsequent approval by local IRBs at each site, and participants will provide written consent. Primary results will be published in peer-reviewed manuscripts promptly following study completion. TRIAL REGISTRATION NUMBER NCT04443608.
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Affiliation(s)
- Zubaid Rafique
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
| | | | | | - Youyou Duanmu
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Basmah Safdar
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jason J Bischof
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brian E Driver
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Charles A Herzog
- Division of Cardiology, Department of Internal Medicine, Hennepin Healthcare/University of Minnesota, Minneapolis, Minnesota, USA
| | - Matthew R Weir
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Adam J Singer
- Department of Emergency Medicine, SUNY Stony Brook, Stony Brook, New York, USA
| | - Stephen Boone
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
| | | | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
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12
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Claudino G, Ramos CI, de Andrade LS, Pereira NBF, Teixeira RR, Muniz GAS, Di Medeiros Leal MCB, Cuppari L. The role of residual renal function on potassium intake and excretion in patients on peritoneal dialysis. Int Urol Nephrol 2023; 55:1549-1556. [PMID: 36648740 DOI: 10.1007/s11255-023-03462-y] [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: 03/19/2022] [Accepted: 01/10/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND Patients on chronic dialysis are at increased risk of developing disorders in potassium balance. The preservation of residual renal function (RRF), frequently observed in patients on peritoneal dialysis (PD), may contribute to better control of serum potassium. This study aimed to investigate the role residual renal function on potassium intake and excretion in PD patients. METHODS In this cross-sectional study, dietary potassium was evaluated by the 3-day food record. Potassium concentration was determined in serum, 24 h dialysate, stool ample, and 24 h urine of patients with diuresis > 200 mL/day, who were considered non-anuric. RESULTS Fifty-two patients, 50% men, 52.6 ± 14.0 years, and PD vintage 19.5 [7.0-44.2] months, were enrolled. Compared to the anuric group (n = 17, 33%), the non-anuric group (n = 35, 67%) had lower dialysate potassium excretion (24.8 ± 5.3 vs 30.9 ± 5.9 mEq/d; p = 0.001), higher total potassium intake (44.5 ± 16.7 vs 35.1 ± 8.1 mEq/d; p = 0.009) and potassium intake from fruit (6.2 [2.4-14.7] vs 2.9 [0.0-6.0]mEq/d; p = 0.018), and no difference in serum potassium (4.8 ± 0.6 vs 4.8 ± 0.9 mEq/L; p = 0.799) and fecal potassium (2.2 ± 0.5 vs 2.1 ± 0.7 mEq/L; p = 0.712). In non-anuric patients, potassium intake correlated directly with urinary potassium (r = 0.40; p = 0.017), but not with serum, dialysate, or fecal potassium. In the anuric group, potassium intake tended to correlate positively with serum potassium (r = 0.48; p = 0.051) and there was no correlation with dialysate or fecal potassium. CONCLUSION The presence of residual renal function constitutes an important factor in the excretion of potassium, which may allow the adoption of a less-restrictive diet.
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Affiliation(s)
- Gabriele Claudino
- Division of Nephrology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | - Lilian Cuppari
- Division of Nephrology, Universidade Federal de São Paulo, São Paulo, Brazil. .,Nutrition Program, Universidade Federal de São Paulo, São Paulo, Brazil.
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13
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Khan MS, Ahmed A, Greene SJ, Fiuzat M, Kittleson MM, Butler J, Bakris GL, Fonarow GC. Managing Heart Failure in Patients on Dialysis: State-of-the-Art Review. J Card Fail 2023; 29:87-107. [PMID: 36243339 DOI: 10.1016/j.cardfail.2022.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/28/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022]
Abstract
Heart failure (HF) and end-stage kidney disease (ESKD) frequently coexist; 1 comorbidity worsens the prognosis of the other. HF is responsible for almost half the deaths of patients on dialysis. Despite patients' with ESKD composing an extremely high-risk population, they have been largely excluded from landmark clinical trials of HF, and there is, thus, a paucity of data regarding the management of HF in patients on dialysis, and most of the available evidence is observational. Likewise, in clinical practice, guideline-directed medical therapy for HF is often down-titrated or discontinued in patients with ESKD who are undergoing dialysis; this is due to concerns about safety and tolerability. In this state-of-the-art review, we discuss the available evidence for each of the foundational HF therapies in ESKD, review current challenges and barriers to managing patients with HF on dialysis, and outline future directions to optimize the management of HF in these high-risk patients.
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Affiliation(s)
| | - Aymen Ahmed
- Division of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA
| | - Mona Fiuzat
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute-Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA; Baylor Scott and White Research Institute, Dallas, TX, USA
| | - George L Bakris
- Department of Medicine, University of Chicago Medicine, Chicago, IL
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
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14
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Pinnell D, Patel S, Qualls J, Chen W, Rathod A, Woods SD, Boutin S, Kovesdy CP, Tangri N, Sauer BC. Real-world evaluation of patiromer utilization and its effects on serum potassium in veterans with end stage kidney disease. Medicine (Baltimore) 2022; 101:e32367. [PMID: 36550897 PMCID: PMC9771256 DOI: 10.1097/md.0000000000032367] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Hyperkalemia (serum potassium [K+] ≥5.1) is life-threatening in patients diagnosed with end stage kidney disease (ESKD). Patiromer is approved for the treatment of hyperkalemia, although its role in hyperkalemic patients with ESKD is not well understood. This study describes real-world patiromer utilization in an ESKD population and its corresponding association with serum K+ level changes. The study population was comprised of US veterans with an outpatient dispensing of patiromer and 2 or more International Classification of Diseases diagnostic codes for ESKD. A treatment course of patiromer was defined by serial dispensing events without a 30-day gap. Patiromer utilization was described by duration, average dose, persistence, and proportion of days covered during patiromer course. Mean serum K+ values were described for baseline and 3 follow-up intervals during the 180-day follow-up period. There were 458 patients with ESKD included in the study. On average, patients had 1.24 (95% CI: 1.20-1.29) patiromer courses. Half of the population discontinued their first patiromer course within 30 days, while approximately 10% of patients remained persistent at the end of the 180-day period and 102 (22.3%) patients started a second course during the 180-day follow up period. Average serum K+ concentrations during baseline and the 3 evaluation intervals during the 180-day follow-up were 5.91 mEq/L (5.85-5.97), 4.94 mEq/L (4.86-5.03), 4.89 mEq/L (4.8-4.98) and 4.88 mEq/L (4.8-4.96). Few patients remained persistent on their initial course of patiromer at the end of follow-up, but approximately 20% of patients initiated a second treatment episode after a 30-day gap in treatment during the 180-day follow-up period. Nonetheless, average serum K+ in ESKD patients were sustainably reduced by approximately 1 mEq/L during follow-up.
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Affiliation(s)
- Derek Pinnell
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
- * Correspondence: Derek Pinnell, Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT 84148 (e-mail: )
| | - Shardool Patel
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Joshua Qualls
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Wei Chen
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Anitha Rathod
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Steven D. Woods
- Managed Care and Health Outcomes, Vifor Pharma Group Company, Redwood, CA
| | - Sylvie Boutin
- Medical Affairs, Otsuka Canada Pharmaceutical Inc, Montreal, Canada
| | - Csaba P. Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN
| | - Navdeep Tangri
- Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Brian C. Sauer
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
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15
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Kolak E, Radić J, Vučković M, Bučan Nenadić D, Begović M, Radić M. Nutritional and Hydration Status and Adherence to Dietary Recommendations in Dalmatian Dialysis Patients. Nutrients 2022; 14:nu14173553. [PMID: 36079811 PMCID: PMC9460881 DOI: 10.3390/nu14173553] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/25/2022] [Accepted: 08/25/2022] [Indexed: 11/28/2022] Open
Abstract
Protein-energy wasting (PEW) is considered one of the major complications of chronic kidney disease (CKD), particularly in dialysis patients. Insufficient energy and protein intake, together with clinical complications, may contribute to the onset and severity of PEW. Therefore, the aim of the study was to analyze the differences in nutritional and hydration status and dietary intake among Dalmatian dialysis patients. Fifty-five hemodialysis (HD) and twenty peritoneal dialysis (PD) participants were included. For each study participant, data about body composition, anthropometric, laboratory, and clinical parameters were obtained. The Malnutrition Inflammation Score (MIS) and two separate 24-h dietary recalls were used to assess nutritional status and dietary intake. The Nutrient Adequacy Ratio (NAR) and Mean Adequacy Ratio (MAR) were calculated to compare actual dietary intake with recommended intake. Additionally, the estimated 10-year survival was calculated using the Charlson Comorbidity Index. The prevalence of malnutrition according to MIS was 47.3% in HD and 45% in PD participants. Significant differences in fat tissue parameters were found between HD and PD participants, whereas significant differences in hydration status and muscle mass parameters were not found. A significant difference in NAR between HD and PD participants was noticed for potassium and phosphorus intake, but not for MAR. MIS correlated negatively with anthropometric parameters, fat mass, visceral fat level and trunk fat mass, and iron and uric acid in HD participants, whereas no significant correlations were found in PD participants. The estimated 10-year survival correlated with several parameters of nutritional status in HD and PD participants, as well as nutrient intake in HD participants. These results indicate a high prevalence of malnutrition and inadequate dietary intake in the Dalmatian dialysis population which, furthermore, highlights the urgent need for individualized and structural nutritional support.
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Affiliation(s)
- Ela Kolak
- Department of Nutrition and Dietetics, University Hospital Centre Split, 21000 Split, Croatia
| | - Josipa Radić
- Department of Nephrology and Dialysis, University Hospital Centre Split, 21000 Split, Croatia
- Department of Internal Medicine, School of Medicine, University of Split, 21000 Split, Croatia
- Correspondence:
| | - Marijana Vučković
- Department of Nephrology and Dialysis, University Hospital Centre Split, 21000 Split, Croatia
| | - Dora Bučan Nenadić
- Department of Nutrition and Dietetics, University Hospital Centre Split, 21000 Split, Croatia
| | - Mirna Begović
- Student of School of Medicine, University of Split, 21000 Split, Croatia
| | - Mislav Radić
- Department of Internal Medicine, School of Medicine, University of Split, 21000 Split, Croatia
- Department of Clinical Immunology and Rheumatology, University Hospital Centre Split, 21000 Split, Croatia
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16
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Sarnowski A, Gama RM, Dawson A, Mason H, Banerjee D. Hyperkalemia in Chronic Kidney Disease: Links, Risks and Management. Int J Nephrol Renovasc Dis 2022; 15:215-228. [PMID: 35942480 PMCID: PMC9356601 DOI: 10.2147/ijnrd.s326464] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/22/2022] [Indexed: 12/21/2022] Open
Abstract
Hyperkalemia is a common clinical problem with potentially fatal consequences. The prevalence of hyperkalemia is increasing, partially due to wide-scale utilization of prognostically beneficial medications that inhibit the renin-angiotensin-aldosterone-system (RAASi). Chronic kidney disease (CKD) is one of the multitude of risk factors for and associations with hyperkalemia. Reductions in urinary potassium excretion that occur in CKD can lead to an inability to maintain potassium homeostasis. In CKD patients, there are a variety of strategies to tackle acute and chronic hyperkalemia, including protecting myocardium from arrhythmias, shifting potassium into cells, increasing potassium excretion from the body, addressing dietary intake and treating associated conditions, which may exacerbate problems such as metabolic acidosis. The evidence base is variable but has recently been supplemented with the discovery of novel oral potassium binders, which have shown promise and efficacy in studies. Their use is likely to become widespread and offers another tool to the clinician treating hyperkalemia. Our review article provides an overview of hyperkalemia in CKD patients, including an exploration of relevant guidelines and nuances around management.
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Affiliation(s)
- Alexander Sarnowski
- Department of Renal Medicine and Transplantation, St George’s NHS University Hospitals NHS Foundation Trust, London, UK
| | - Rouvick M Gama
- Department of Renal Medicine and Transplantation, St George’s NHS University Hospitals NHS Foundation Trust, London, UK
| | - Alec Dawson
- Department of Renal Medicine and Transplantation, St George’s NHS University Hospitals NHS Foundation Trust, London, UK
| | - Hannah Mason
- Department of Renal Medicine and Transplantation, St George’s NHS University Hospitals NHS Foundation Trust, London, UK
| | - Debasish Banerjee
- Department of Renal Medicine and Transplantation, St George’s NHS University Hospitals NHS Foundation Trust, London, UK
- Correspondence: Debasish Banerjee, Department of Renal Medicine and Transplantation, St George’s NHS University Hospitals NHS Foundation Trust, Blackshaw Road, SW170QT, London, United Kingdom, Tel +44 2087151673, Email
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Nerbass FB, Lima HDN, Sesso R, Lugon JR. Prevalência elevada de hipercalemia em pacientes brasileiros em diálise crônica e diferenças entre as regiões geográficas. J Bras Nefrol 2022. [DOI: 10.1590/2175-8239-jbn-2022-0053pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Introdução: A hipercalemia é uma condição multifatorial comum em pessoas em diálise crônica e está associada à mortalidade. Nosso objetivo foi informar e discutir a prevalência de hipercalemia em uma grande população de pacientes em diálise crônica no Brasil e diferenças entre as regiões geográficas. Métodos: A prevalência de hipercalemia (potássio sérico ≥6,0 mEq/L) foi avaliada por meio do Censo Brasileiro de Diálise (CBD) em Julho de 2019, uma pesquisa online de participação voluntária na qual foram convidados todos os centros de diálise registrados na Sociedade Brasileira de Nefrologia. Resultados: Aproximadamente um terço (n=263 de 805) das clínicas de diálise brasileiras participaram. A prevalência de hipercalemia na população total foi de 16,1% (n=7.457 de 46.193; IC95%=15,8-16,5%), e variou de 12,1% no Norte a 18,7% no Nordeste. Conclusão: Encontramos uma elevada prevalência de hipercalemia em umagrande população brasileira em diálise crônica. É necessária uma investigação nacional dos fatores de risco, opções de tratamento e se esta alta prevalência contribui para a mortalidade desta população.
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18
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Nerbass FB, Lima HDN, Sesso R, Lugon JR. High prevalence of hyperkalemia in Brazilian chronic dialysis patients and differences across geographic regions. J Bras Nefrol 2022; 45:106-109. [PMID: 35920444 PMCID: PMC10139716 DOI: 10.1590/2175-8239-jbn-2022-0053en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/22/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Hyperkalemia is a common multifactorial condition of people on chronic dialysis and is associated with mortality. We aimed to inform and discuss the prevalence of hyperkalemia in a large population of chronic dialysis patients in Brazil and its geographic regions. METHODS Prevalence of hyperkalemia (serum potassium ≥6.0 mEq/L) was assessed in the Brazilian Dialysis Survey (BDS) in July 2019, an online survey of voluntary participation in which all dialysis centers registered at the Brazilian Society of Nephrology were invited. RESULTS Approximately one-third (n=263 of 805) of the Brazilian dialysis clinics participated. The prevalence of hyperkalemia in the whole population was 16.1% (n=7,457 of 46,193; 95%CI=15.8-16.5%,), and varied from 12.1% in the North to 18.7% in the Northeast. CONCLUSION We found a high prevalence of hyperkalemia in a large Brazilian chronic dialysis population. A nationwide investigation of risk factors, treatment options, and whether this high prevalence contributes to dialysis mortality is warranted.
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Affiliation(s)
| | | | - Ricardo Sesso
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Agiro A, Duling I, Eudicone J, Davis J, Brahmbhatt YG, Cooper K. The prevalence of predialysis hyperkalemia and associated characteristics among hemodialysis patients: The RE-UTILIZE study. Hemodial Int 2022; 26:397-407. [PMID: 35037388 PMCID: PMC9543597 DOI: 10.1111/hdi.13006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 11/30/2022]
Abstract
Introduction Hyperkalemia (HK), defined as serum potassium (K+) >5.0 mEq/L, is an independent predictor of mortality in patients on maintenance hemodialysis (HD). This study investigated the annual prevalence of HK and examined patient characteristics potentially associated with a higher annual HK prevalence. Methods This retrospective observational cohort study used Dialysis Outcomes and Practice Patterns Study (DOPPS) survey data from US patients undergoing in‐center HD thrice weekly from 2018 to 2019. The primary endpoint was the proportion of patients with any predialysis HK (K+ >5.0 mEq/L) within 1 year from the index date (date of DOPPS enrollment), using the first hyperkalemic K+ value. Secondary endpoints were the proportion of patients with moderate‐to‐severe (K+ >5.5 mEq/L) or severe (K+ >6.0 mEq/L) HK. Findings Overall, 9347 patients on HD were included in this analysis (58% male and 49% aged >66 years). Any predialysis HK (K+ >5.0 mEq/L) occurred in 74% of patients within 1 year of the index date, 52% within 3 months, and 38% within 1 month. The annual prevalence of moderate‐to‐severe and severe HK was 43% and 17%, respectively. Recurrent HK (at least two K+ >5.0 mEq/L within 1 year) occurred in 60% of patients, and 2.8% of patients were prescribed an oral K+ binder. Multivariable logistic regression analysis showed younger age, female sex, Hispanic ethnicity, and renin–angiotensin–aldosterone system inhibitor use were significantly associated with a higher annual prevalence of any predialysis HK, while Black race, obesity, recent initiation of HD, and dialysate K+ bath concentration ≥3 mEq/L were associated with a lower prevalence of HK. Discussion The annual prevalence of predialysis HK and recurrence were high among US patients on HD, whereas oral K+ binder use was low. Further studies are needed to understand the impact of dialysate K+ bath concentrations on predialysis HK among patients on HD.
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Ni Z, Jin H, Lu R, Zuo L, Yu W, Ren Y, Yang Q, Xiao J, Zhang Q, Zhang L, Zhang X, Chen Q, Chen C, Shao G, Luo Q, Yao L, Qin S, Peng H, Zhao Q. Hyperkalaemia prevalence, recurrence and treatment in patients on haemodialysis in China: protocol for a prospective multicentre cohort study (PRECEDE-K). BMJ Open 2021; 11:e055770. [PMID: 34937724 PMCID: PMC8705221 DOI: 10.1136/bmjopen-2021-055770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Hyperkalaemia (HK) is a potentially life-threatening electrolyte imbalance associated with several adverse clinical outcomes and is common in patients with kidney failure. However, there is no evidence on the occurrence, recurrence and treatment of HK in patients on haemodialysis (HD) in China. METHODS AND ANALYSIS The HK Prevalence, Recurrence, and Treatment in Haemodialysis Study is a prospective, multicentre, observational, cohort study being conducted across 15-18 sites in China. Approximately 600 patients with end-stage kidney disease on HD are anticipated to be enrolled and will be followed up for 24 weeks. Patients will be in the long interdialytic interval (LIDI) at enrolment and will receive follow-up care every 4 weeks in LIDI for pre-dialysis and post-dialysis (at enrolment only) serum potassium measurements. To obtain pre-dialysis serum potassium levels in the short interdialytic interval (SIDI), a follow-up visit will be performed in the SIDI during the first week. Information on concomitant medications, blood gas analysis and biochemistry measurements will be obtained at enrolment and at each follow-up visit. The primary endpoint will be the proportion of patients experiencing HK (defined as serum potassium level >5.0 mmol/L) at the study enrolment or during the 24-week follow-up. The key secondary endpoint will be the proportion of patients experiencing HK recurrence (defined as any HK event after the first HK event) within 1-6 months (if applicable) during the 24-week follow-up, including enrolment assessment. ETHICS AND DISSEMINATION This study has been approved by Shanghai Jiaotong University School of Medicine, Renji Hospital Ethics Committee (2020-040). Other participating subcentres must also obtain ethics committee approval prior to the start of the study. The Good Clinical Practice regulations shall be strictly followed during the test implementation. Amendments to the protocol will be reviewed by the ethics committees. Written informed consent will be obtained from all participants before collection of any patient data and patient information. The findings of this study will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04799067).
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Affiliation(s)
- Zhaohui Ni
- Department of Nephrology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haijiao Jin
- Department of Nephrology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Renhua Lu
- Department of Nephrology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Zuo
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Weimin Yu
- Department of Nephrology, Shanxi Bethune Hospital, Taiyuan, China
| | - Yuqing Ren
- Department of Nephrology, Yangquan Coal Industry (Group) General Hospital, Yangquan, China
| | - Qiongqiong Yang
- Department of Nephrology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jie Xiao
- Department of Nephrology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Qinghong Zhang
- Department of Nephrology, Taihe Hospital, Shiyan, Hubei, China
| | - Lihong Zhang
- Department of Nephrology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xinzhou Zhang
- Department of Nephrology, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Qinkai Chen
- Department of Nephrology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Chaosheng Chen
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Guojian Shao
- Department of Nephrology, Wenzhou Central Hospital, Wenzhou, Zhejiang, China
| | - Qun Luo
- Department of Nephrology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Li Yao
- Department of Nephrology, The first hospital of China Medical University, Shenyang, China
| | - Shuguang Qin
- Department of Nephrology, Guangzhou First People's Hospital, Guangzhou, Guangdong, China
| | - Hui Peng
- Department of Nephrology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Qing Zhao
- Medical Affaires, AstraZeneca Investment China Co, Shanghai, China
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21
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Fishbane S, Charytan DM, Chertow GM, Ford M, Kovesdy CP, Pergola PE, Pollock C, Spinowitz B. Consensus-Based Recommendations for the Management of Hyperkalemia in the Hemodialysis Setting. J Ren Nutr 2021; 32:e1-e14. [PMID: 34364782 DOI: 10.1053/j.jrn.2021.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/04/2021] [Accepted: 06/02/2021] [Indexed: 12/26/2022] Open
Abstract
Hyperkalemia (serum K+ >5.0 mmol/L) is commonly observed among patients receiving maintenance hemodialysis and associated with increased risk of cardiac arrhythmias. Current international guidelines may not reflect the latest evidence on managing hyperkalemia in patients undergoing hemodialysis, and there is a lack of high-quality published studies in this area. This consensus guideline aims to provide recommendations in relation to clinical practice. Available published evidence was evaluated through a systematic literature review, and the nominal group technique was used to develop consensus recommendations from a panel of experienced nephrologists, covering monitoring, dietary restrictions, prescription of K+ binders, and concomitant prescription of renin-angiotensin-aldosterone system inhibitors. Recent studies have shown that K+ binders reduce the incidence of hyperkalemia, but further evidence is needed in areas including whether reduced-K+ diets or treatment with K+ binders improve patient-centered outcomes. Treatment of hyperkalemia in the hemodialysis setting is complex, and decisions need to be tailored for individual patients.
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Affiliation(s)
- Steven Fishbane
- Zucker School of Medicine at Hofstra/Northwell, New York, New York.
| | - David M Charytan
- NYU Langone Medical Center and New York University Grossman School of Medicine, New York, New York
| | - Glenn M Chertow
- Division of Nephrology, Stanford University School of Medicine, Stanford, California
| | - Martin Ford
- Department of Renal Medicine, King's College Hospital NHS Foundation Trust and Kings College London, London, UK
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Carol Pollock
- The University of Sydney, Sydney, New South Wales, Australia
| | - Bruce Spinowitz
- Division of Nephrology, Department of Medicine, New York Presbyterian Queens, Flushing, New York
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Neves PDMDM, Sesso RDCC, Thomé FS, Lugon JR, Nascimento MM. Brazilian dialysis survey 2019. J Bras Nefrol 2021; 43:217-227. [PMID: 33513218 PMCID: PMC8257289 DOI: 10.1590/2175-8239-jbn-2020-0161] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/02/2020] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION National data on chronic dialysis treatment are essential for the development of health policies that aim to improve the treatment of patients. OBJECTIVE To present data from the Brazilian Dialysis Survey 2019, promoted by the Brazilian Society of Nephrology. METHODS Data collection from dialysis units in the country through a completed online questionnaire for 2019. RESULTS 314 (39%) centers responded the questionnaire. In July 2019, the estimated total number of patients on dialysis was 139,691. Estimates of the prevalence and incidence rates of patients undergoing dialysis treatment per million of the population (pmp) were 665 and 218, respectively, with mean annual increases of 25 pmp and 14 pmp for prevalence and incidence, respectively. The annual gross mortality rate was 18.2%. Of the prevalent patients, 93.2% were on hemodialysis and 6.8% on peritoneal dialysis; and 33,015 (23.6%) on the waiting list for transplantation. 55% of THE centers offered treatment with peritoneal dialysis. Venous catheters were used as access in 24.8% of THE patients on hemodialysis. 17% of the patients had K ≥ 6.0mEq/L; 2.5% required red blood cell transfusion in July 2019 and 10.8% of the patients had serum levels of 25-OH vitamin D < 20 ng/mL. CONCLUSION The absolute number of patients, the incidence and prevalence rates in dialysis in the country continue to increase, as well as the percentage of patients using venous catheter as dialysis access. There was an increase in the number of patients on the list for transplantation and a tendency to reduce gross mortality.
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