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Hirai T, Yamaga R, Fujita A, Itoh T. Low body mass index is a risk factor for hyperkalaemia associated with angiotensin converting enzyme inhibitors and angiotensin II receptor blockers treatments. J Clin Pharm Ther 2018; 43:829-835. [PMID: 29908131 DOI: 10.1111/jcpt.12720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/14/2018] [Indexed: 12/19/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Angiotensin converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) represent the cornerstones of hypertension and congestive heart failure treatment. Risk factors for hyperkalaemia associated with ACEI and ARB are chronic kidney disease and concomitant medications which increase serum potassium level. Body mass index (BMI) also affects pharmacokinetics of ACEI and ARB and potassium disposition. We evaluated the relationship between BMI and hyperkalaemia associated with ACEI and ARB treatments. METHODS Study design is a retrospective case-control analysis. Patients who had been prescribed ACEI or ARB between June 2015 and June 2017 at Tokyo Women's Medical University, Medical Center East, were included. Patient clinical background was collected from medical records. Hyperkalaemia was defined as serum potassium above 5.5 meq/L. The concomitant use of ACEI and ARB, aldosterone antagonists, direct renin inhibitor, sulfamethoxazole-trimethoprim and non-steroidal anti-inflammatory drugs (NSAIDs) was regarded as hyperkalaemia-inducing medications. The relationship between BMI and hyperkalaemia associated with ACEI and ARB treatments was assessed using multivariable logistic regression analysis. RESULTS AND DISCUSSION The study included 2987 patients aged 70.1 ± 12.9 years, 61.0% were men, and BMI was 23.8 ± 4.4 kg/m2 . The incidence of hyperkalaemia was 7.8%. Multivariable logistic regression analysis revealed that age >65 years, low BMI, diabetes, history of treatment for hyperkalaemia, serum sodium <135 meq/L, eGFR <30 mL/min/1.73m2 and the concomitant use of hyperkalaemia-inducing medications were independent risk factors for hyperkalaemia associated with ACEI and ARB. WHAT IS NEW AND CONCLUSION This study demonstrated that BMI provides useful information for the identification of potential risk for hyperkalaemia associated with ACEI and ARB treatments.
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Affiliation(s)
- T Hirai
- Department of Pharmacy, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - R Yamaga
- Department of Pharmacy, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - A Fujita
- Department of Pharmacy, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - T Itoh
- Department of Pharmacy, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
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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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Sekiyama H, Nagoshi T, Komukai K, Matsushima M, Katoh D, Ogawa K, Minai K, Ogawa T, Yoshimura M. Transient decrease in serum potassium level during ischemic attack of acute coronary syndrome: paradoxical contribution of plasma glucose level and glycohemoglobin. Cardiovasc Diabetol 2013; 12:4. [PMID: 23289667 PMCID: PMC3561250 DOI: 10.1186/1475-2840-12-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 12/30/2012] [Indexed: 11/26/2022] Open
Abstract
Background Although a decrease in serum potassium level has been suggested to be a fairly common observation in acute coronary syndrome (ACS), there have so far been no definitive reports directly demonstrating the transient potassium decrease (the potassium dip) during ischemic attack of ACS compared to stable phase in individual patients. To understand the pathophysiological significance of the potassium dip, we examined the changes in serum potassium level throughout ischemic attack and evaluated the clinical factors affecting it. Methods The degree of the potassium dip during ischemic attack (as indicated by ΔK, ΔK = K at discharge − K on admission) was examined in 311 consecutive patients with ACS who required urgent hospitalization in our institution. Results Serum potassium level during ischemic attack was significantly decreased compared to that during stable phase (P < 0.001). Multiple regression analysis revealed that plasma glucose level during attack was the sole factor which was positively correlated with ΔK (P < 0.01), while HbA1c level was negatively correlated (P < 0.05). The medication profiles and renal function had no impact on ΔK. A longer hospitalization period, higher incidence of myocardial infarction and higher peak creatine kinase level were observed in patients with a larger ΔK. Conclusions We have clearly demonstrated that there is a transient decrease in serum potassium level during ischemic attack of ACS compared to stable phase. The degree of the potassium dip was tightly correlated with glucose level, which overwhelmed the diabetic condition, and it also indicates the disease severity. The present study therefore promotes awareness of the significance of monitoring potassium level in parallel with glucose level in patients with ACS.
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Affiliation(s)
- Hiroshi Sekiyama
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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Banki NF, Ver A, Wagner LJ, Vannay A, Degrell P, Prokai A, Gellai R, Lenart L, Szakal DN, Kenesei E, Rosta K, Reusz G, Szabo AJ, Tulassay T, Baylis C, Fekete A. Aldosterone antagonists in monotherapy are protective against streptozotocin-induced diabetic nephropathy in rats. PLoS One 2012; 7:e39938. [PMID: 22761931 PMCID: PMC3386228 DOI: 10.1371/journal.pone.0039938] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 05/29/2012] [Indexed: 11/30/2022] Open
Abstract
Angiotensin converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) are the standard clinical therapy of diabetic nephropathy (DN), while aldosterone antagonists are only used as adjuncts. Previously in experimental DN we showed that Na/K ATPase (NKA) is mislocated and angiotensin II leads to superimposed renal progression. Here we investigated the monotherapeutic effect of aldosterone blockers on the progression of DN and renal NKA alteration in comparison to ACEi and ARBs. Streptozotocin-diabetic rats developing DN were treated with aldosterone antagonists; ACEi and ARB. Renal function, morphology, protein level and tubular localization of NKA were analyzed. To evaluate the effect of high glucose per se; HK-2 proximal tubular cells were cultured in normal or high concentration of glucose and treated with the same agents. Aldosterone antagonists were the most effective in ameliorating functional and structural kidney damage and they normalized diabetes induced bradycardia and weight loss. Aldosterone blockers also prevented hyperglycemia and diabetes induced increase in NKA protein level and enzyme mislocation. A monotherapy with aldosterone antagonists might be as, or more effective than ACEi or ARBs in the prevention of STZ-induced DN. Furthermore the alteration of the NKA could represent a novel pathophysiological feature of DN and might serve as an additional target of aldosterone blockers.
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Affiliation(s)
- Nora F. Banki
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
- SE-MTA “Lendulet” Diabetes Research Group, Hungarian Academy of Sciences and Semmelweis University, Budapest, Hungary
| | - Agota Ver
- Department of Medical Chemistry, Molecular Biology and Pathobiochemistry, Semmelweis University, Budapest, Hungary
| | - Laszlo J. Wagner
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Adam Vannay
- Research Laboratory for Pediatrics and Nephrology, Hungarian Academy of Sciences and Semmelweis University, Budapest, Hungary
| | - Peter Degrell
- 2nd Department of Medicine and Nephrological Center, Pécs, Hungary
| | - Agnes Prokai
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Renata Gellai
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
- SE-MTA “Lendulet” Diabetes Research Group, Hungarian Academy of Sciences and Semmelweis University, Budapest, Hungary
| | - Lilla Lenart
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
- SE-MTA “Lendulet” Diabetes Research Group, Hungarian Academy of Sciences and Semmelweis University, Budapest, Hungary
| | | | - Eva Kenesei
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Klara Rosta
- Department of Medical Chemistry, Molecular Biology and Pathobiochemistry, Semmelweis University, Budapest, Hungary
| | - Gyorgy Reusz
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Attila J. Szabo
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Tivadar Tulassay
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
- Research Laboratory for Pediatrics and Nephrology, Hungarian Academy of Sciences and Semmelweis University, Budapest, Hungary
| | - Chris Baylis
- Departments of Physiology and Functional Genomics and Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Andrea Fekete
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
- SE-MTA “Lendulet” Diabetes Research Group, Hungarian Academy of Sciences and Semmelweis University, Budapest, Hungary
- * E-mail:
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