Changes In Potassium Research Articles

Association of furosemide versus chlorothiazide exposures with serum sodium, potassium, and chloride among infants with bronchopulmonary dysplasia.

To examine the association of novel furosemide versus thiazide diuretic exposure with changes in serum sodium, potassium, and chloride levels among infants with grade 2/3 bronchopulmonary dysplasia (BPD). Retrospective cohort study of infants admitted to a level IV neonatal intensive care unit (NICU) with grade 2/3 BPD. We measured within-subject change in serum sodium, potassium, and chloride before and after diuretic initiation using multivariable regression to adjust for differences in dosing and clinical covariates. We identified 94 infants contributing 137 novel diuretic exposures. No significant difference was noted in the association between chlorothiazide versus furosemide and serum sodium, potassium, or chloride change in multivariable modeling. Changes in serum electrolytes were similar for chlorothiazide and furosemide, questioning the perception that chlorothiazide leads to less electrolyte derangement among preterm infants with grade 2/3 BPD.

Evaluation of Monotherapy Sodium Zirconium Cyclosilicate Versus Sodium Polystyrene Sulfonate for Acute Hyperkalemia: A Cohort Study.

Comparison of monotherapy sodium zirconium cyclosilicate (SZC) versus sodium polystyrene sulfonate (SPS) is lacking. We aimed to evaluate the effectiveness of SZC versus SPS for acute potassium lowering. This retrospective cohort study included hospitalized adult patients with acute hyperkalemia treated with SZC or SPS monotherapy. The primary outcome was time to normalization of serum potassium. Secondary outcomes included necessity of additional treatment, achievement of normokalemia at 1, 2, 4, 8, and 24 hours, and change in serum potassium from baseline to 1, 2, 4, 8, and 24 hours. Fifty-one patients received SZC and 50 received SPS. Mean baseline potassium was 5.4 mmol/L for both groups. Median time to normokalemia was 14 (IQR 8-20) hours in the SZC group versus 17 (IQR 10-21) hours in the SPS group (P = .26). Normokalemia was achieved at 24 hours in 80% versus 77% in each group, respectively (P = .56). Six patients per group required additional treatment (P = .97). Mean serum potassium at all time points was numerically lower with SZC, but statistical significance was only observed at hour 8 (4.6 vs 5.0 mmol/L, P = .005), which was associated with a -0.77 versus -0.51 mmol/L decrease in serum potassium from baseline in each group, respectively (P = .026). SZC monotherapy is at least as effective as SPS in treating mild hyperkalemia and may reduce serum potassium more quickly and to a greater degree than SPS. Future research in more severe hyperkalemia and with monitoring of potassium at regular intervals is needed to better understand the role and potential advantages of SZC over SPS.

Sacubitril/valsartan reduces proteinuria depending on blood pressure in patients with stage 4-5 chronic kidney disease.

Blood pressure (BP) control is an important factor in the management of chronic kidney disease (CKD). Several studies have shown that BP in many patients with CKD remained uncontrolled even with multiple medications. Sacubitril/valsartan, an angiotensin receptor neprilysin inhibitor (ARNI), has been newly approved for treating hypertension in Japan. However, the renoprotective effects remain unclear, particularly in patients with advanced CKD. Here, we investigated the effects on proteinuria of this ARNI in patients with stage 4-5 CKD. We retrospectively collected data from outpatients with stage 4-5 CKD who started ARNI from January until December 2023. The primary outcome was the change in urine protein creatinine ratio (UPCR) at 6months after ARNI initiation. Secondary outcomes were systolic and diastolic BP, estimated glomerular filtration rate (eGFR), serum potassium, and serum uric acid (UA). We analyzed factors associated with 50% UPCR reduction by multivariate analysis. In total, 47 patients were analyzed. ARNI reduced UPCR from 2.14g/gCr (interquartile range; 1.09-2.91) to 1.05g/gCr (0.42-1.95; p < 0.001). Systolic BP fell from 150.0mmHg (139.5-160.0) to 134.0mmHg (124.5-140.0; p < 0.001). No significant changes in eGFR, serum potassium, and serum uric acid were observed, except for a slight decrease in eGFR among patients with conversion from a renin-angiotensin system inhibitor to ARNI. In multivariate regression analysis, higher systolic BP (per 10-mmHg increase) was significantly associated with reduced proteinuria (odds ratio 2.51, 95% confidence interval 1.35-4.66; p = 0.004). ARNI reduced proteinuria in patients with stage 4-5 CKD, particularly for those with uncontrolled hypertension.

Changes in 24-hour Urine Chemistry in Patients with Nephrolithiasis during Weight Loss with Glucagon-Like Peptide-1 Based Therapies

Background: Obesity is an independent risk factor for incident and recurrent nephrolithiasis. The impact of weight loss through glucagon-like peptide 1 (GLP-1) receptor agonists and dual GLP-1/ gastric inhibitory polypeptide receptor agonists (GLP-based therapies) on nephrolithiasis is not well-understood. This study examined the changes in 24-hour urine chemistry assessing for stone risk during weight loss through GLP-based therapies. Methods: This retrospective analysis identified adult stone formers followed at our academic institution’s weight wellness clinic between September 2015 and August 2023 and included patients with at least two 24-hour urine collections for stone risk assessment. 24-hour urine parameters before and during weight loss in patients on GLP-based therapies were compared. Results: Forty-four obese patients with nephrolithiasis experienced significant weight reduction (-6.6±7.3 kg, p&lt;0.001) over a median 1.1 years of follow-up with GLP-based therapies. During this period, there was a significant decrease in 24-hour urine oxalate (40±16 to 32±11 mg/day, p=0.002), sulfate (21±10 to 17±9 mmol/day, p=0005), and ammonium (35±22 to 29±15 mEq/day, p=0.01). There were non-significant changes in urine calcium, citrate, uric acid, pH, phosphorus, sodium, potassium, magnesium, chloride, creatinine or total volume. Additionally, there was no statistical difference in urine supersaturation indices with respect to calcium oxalate, calcium phosphate and uric acid. Conclusion: Our results indicate that weight loss through GLP-based therapies is not associated with pro-lithogenic changes in 24-hour urine chemistry in patients with nephrolithiasis, unlike what happens with other weight loss modalities.

Serum Electrolytes and Calcium Levels in Neonates Receiving Phototherapy for Neonatal Jaundice

Background: Neonatal Jaundice (NJ) is one of the most common causes of neonatal admission. Phototherapy is an important treatment modality for NJ. However, this treatment modality may itself result in changes of different biochemical parameters. The study aimed to evaluate the changes in serum electrolytes (Sodium, potassium and chloride) and calcium in neonates receiving phototherapy for NJ. Materials and methods: One hundred and two term neonates admitted to the Special Care Newborn Unit, Chattogram Medical College Hospital for the management of NJ by phototherapy were enrolled in this prospective observational study. Serum bilirubin, sodium, potassium, chloride and calcium were measured before and after 48 hours of phototherapy and compared. Results: The mean gestational age and mean age of admission of the neonates were 38.6±0.6 weeks and 6.42 ± .67 day respectively. The mean sodium, potassium and calcium level before therapy was respectively, 138.4±1.8 mmol/L, 4.1±0.3 mmol/L and 8.8±0.3 mg/dl. There was significant decrease in the level of mean sodium (136.4±1.6 mmol/L), potassium (3.8 ± 0.3 mmol/L) and calcium (8.4±0.4 mg/dL) after phototherapy. All neonates had normal level of serum calcium, sodium, potassium and chloride before phototherapy. After 48 hours of phototherapy, 46 (45.1%) of them had abnormal values with the incidence hypocalcaemia, hyponatraemia and hypokalemia respectively in 21.6%, 25.5% and 10.8% of the neonates. Conclusion: Neonates undergoing phototherapy are at risk of developing hyponatraemia, hypokalaemia and hypocalcaemia. Closed monitoring is essential to observe the changes in sodium, potassium and calcium and should be managed accordingly. IAHS Medical Journal Volume 6(2) December 2023; 83-86

Mild dehydration does not alter acute changes in sweat electrolyte concentrations during exercise.

The purpose of this study was to determine the effect of hydration status on the change in sweat sodium (Na+), chloride (Cl-), and potassium (K+) concentrations during exercise-heat stress. Fifteen subjects (Six female, nine male; 29 ± 9 y; 71 ± 14 kg) completed 90 min of cycling (81% HRmax) in the heat (~33°C, 42% rh) with fluid replacement to maintain euhydration (EUH) or without fluid to dehydrate to 2.4 ± 0.4% body mass loss (DEH). Sweat was collected from the forehead (FH), right scapula (SCAP), and left (LVFA) and right (RVFA) ventral forearms using the absorbent pad technique at the beginning (0-30 min) and end of exercise (60-90 min). Sweat was analyzed for Na+, Cl-, and K+ concentrations using ion chromatography. Data are reported as mean ± SD or median ± IQR. There were no differences (Paired t-tests or Wilcoxon signed-rank tests) between EUH and DEH in the change in sweat Na+ (FH: 24.3 ± 21.5 vs. 30.8 ± 22.4 mmol/L; SCAP: 9.7 ± 6.2 vs. 9.6 ± 8.2 mmol/L; LVFA: 7.5 ± 6.0 vs. 5.6 ± 5.9 mmol/L; RVFA: 8.2 ± 8.6 vs. 7.8 ± 5.2 mmol/L), sweat Cl-, or sweat K+ at any site (p = 0.07-0.99). The change in sweat electrolyte concentrations during 90 min of exercise in the heat was not significantly influenced by mild dehydration in recreational to moderately-trained male and female athletes.

Distribution characteristics of soil crusts under two kinds of aerial seeding plants in the northeastern margin of Tengger Desert

In order to explore the effects of two plants on the spatial distribution and nutrient distribution of crusts in different directions and distances after 30 years of aerial seeding, as well as the relationship between crust thickness and nutrient content, this paper takes the aerial seeding afforestation area in the northeastern margin of Tengger Desert as the research area, and the crusts under the plants of Hedysarum scoparium and Calligonum mongolicum as the research objects. The distribution of crust thickness and nutrients was analyzed, and the relationship between them was constructed. The thickness of the crust of H. scoparium and C. mongolicum was the largest in the southeast direction and the smallest in the northwest direction. With increasing distance from the plant, it shows a significant decreasing trend. The crust thickness of H. scoparium was higher than that of C. mongolicum. The nutrient indexes in the southeast direction of the crust of H. scoparium and C. mongolicum were significantly higher than those in the northwest direction; With the increase of the distance from the root of the plant, the nutrient content showed a significant decreasing trend. The contents of organic matter and available nitrogen in the crust of C. mongolicum were higher than those of H. scoparium, and the contents of available potassium and available phosphorus were lower than those of H. scoparium. The trend of nutrient enrichment rate of the crusts of the two plants was consistent with the trend of nutrient distribution. There was a significant positive correlation between the crust thickness and nutrients in the four directions under C. mongolicum. There was a significant positive correlation between the crust thickness and nutrients in the southwest direction under H. scoparium. The changes of available nitrogen, available phosphorus, available potassium and organic matter content in the crust under H. scoparium can explain 52.5% of the change of its thickness. The changes of available nitrogen, available phosphorus, available potassium and organic matter content in the crust under C. mongolicum can explain 78.5% of the change of its thickness. After 30 years of aerial seeding in Tengger Desert, the thickness and nutrients of the crust in the southeast direction of H. scoparium and C. mongolicum were significantly higher than those in the northwest direction and showed a decreasing trend with the increase of distance from the root of the plant. There was a positive correlation between crust nutrient and thickness.

Short-term impact of vitamin K2 supplementation on biochemical parameters and lipoprotein fractions.

This study explored the short-term effects of vitamin K2 (VK2) supplementation on biochemical parameters (vitamin D, vitamin E, vitamin A, alkaline phosphatase, calcium, phosphorus (P), magnesium, metallothionein, triglycerides, cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and lipoprotein fractions (albumin, HDL, very low-density lipoprotein (VLDL), LDL, and chylomicrons). A short-term experiment (24h, six probands) was performed to track changes in VK2 levels after a single-dose intake (360µg/day). Liquid chromatography-tandem mass spectrometry was used to monitor vitamin K levels (menaquinone-4 (MK-4), menaquinone-7 (MK-7), and vitamin K1 [VK1]) with a limit of detection of 1.9pg/mL for VK1 and 3.8pg/mL for the two forms of VK2. Results showed that MK-7 levels significantly increased within 2-6h post-administration and then gradually declined. MK-4 levels were initially low, showing a slight increase, whereas VK1 levels rose initially and then decreased. Biochemical analyses indicated no significant changes in sodium, chloride, potassium, calcium, magnesium, albumin, or total protein levels. A transient increase in P was observed, peaking at 12h before returning to baseline. Agarose gel electrophoresis of lipoprotein fractions revealed distinct chylomicron bands and variations in VLDL and HDL mobility, influenced by dietary lipids and VK2 supplementation. These findings suggest effective absorption and metabolism of MK-7 with potential implications for bone metabolism and cardiovascular health.

Detecção de Reações Adversas a Medicamentos em pacientes hospitalizados: uma abordagem de análise em rede

Objective: We aimed to investigate whether network analysis can be used to estimate patterns of Adverse Drug Reactions and drugs involved. Methods: Patients admitted from 18 years of age or older, hospitalized for more than 24 hours, and using at least one drug during hospitalization were included. Results: 8060 patients were observed, and 358 cases of Adverse Drug Reactions were identified (4.43%). The network graph shows that the occurrence of hypotension induced by furosemide, spironolactone and enalapril is related to serum changes in potassium and the occurrence of renal failure. Centered around nausea and vomiting node, there is a great variety of drugs from different classes involved with this Adverse Drug Reaction and without other connections. Conclusion: Network analysis is a promising strategy for identifying patterns that correlate adverse reactions to drugs administered during hospitalization.

Activity-dependent extracellular potassium changes in unmyelinated versus myelinated areas in olfactory regions of the isolated female guinea-pig brain

The potassium released in the extracellular space during neuronal activity is rapidly removed by glia and neurons to maintain tissue homeostasis. Oligodendrocyte-derived myelin axonal coating contributes to potassium buffering and is therefore crucial to control brain excitability.We studied activity-dependent extracellular potassium ([K+]o) changes in the piriform cortex (PC), a region that features highly segregated bundles of myelinated and unmyelinated fibers. Four-aminopyridine (4AP; 50 μM) treatment or patterned high-frequency stimulations (hfST) were utilized to generate [K+]o changes measured with potassium-sensitive electrodes in the myelinated lateral olfactory tract (LOT), in the unmyelinated PC layer I and in the myelinated deep PC layers in the ex vivo isolated guinea-pig brain.Seizure-like events induced by 4AP are initiated by the abrupt [K+]o rise in the layer I formed by unmyelinated fibers (Uva et al., 2017). Larger [K+]o shifts occurred in unmyelinated layers compared to the myelinated LOT. LOT hfST that mimicks pre-seizure discharges also generated higher [K+]o changes in unmyelinated PC layer I than in LOT and deep PC layers. The treatment with the Kir4.1 potassium channel blocker BaCl2 (100 μM) enhanced the [K+]o changes generated by hfST in myelinated structures.Our data show that activity-dependent [K+]o changes are intrinsically different in myelinated vs unmyelinated cortical regions. The larger [K+]o shifts generated in unmyelinated structures may represent a vehicle for seizure generation.

Increased Spironolactone Dosing in Acute Heart Failure Alters Potassium Homeostasis but Does not Enhance Decongestion

The ATHENA-HF (Aldosterone Targeted Neurohormonal Combined with Natriuresis Therapy in Heart Failure) clinical trial found no improvements in natriuretic peptide levels or clinical congestion when spironolactone 100 mg/day for 96 hours was used in addition to usual treatment for acute heart failure. We performed a post hoc analysis of ATHENA-HF to determine whether spironolactone treatment induced any detectable pharmacodynamic effects and whether patients with potentially greater aldosterone activity experienced additional decongestion. Trial subjects previously treated with spironolactone were excluded. We first examined for changes in renal potassium handling. Using the baseline serum potassium level as a surrogate marker of spironolactone activity, we then divided each treatment arm into tertiles of baseline serum potassium and explored for differences in laboratory and clinical congestion outcomes. Among spironolactone-naïve patients, the change in serum potassium did not differ after 24 hours or 48 hours but was significantly greater with spironolactone treatment compared to placebo at 72 hours (0.23 ± 0.55 vs 0.03 ± 0.60 mEq/L; P = 0.042) and 96 hours (0.32 ± 0.51 vs 0.13 ± 0.72 mEq/L; P = 0.046). Potassium supplementation was similar at treatment start and at 24 hours, but spironolactone-treated patients required substantially less potassium replacement at 48 hours (24% vs 36%; P = 0.048), 72 hours (21% vs 37%; P = 0.013), and 96 hours (11% vs 38%; P < 0.001). When the treatment arms were divided into tertiles of baseline serum potassium, there were no differences in the 96-hour log N-terminal pro-B-type natriuretic peptide levels, net fluid loss, urine output, or dyspnea relief in any of the potassium groups, with no effect modification by treatment exposure. Spironolactone 100 mg/day for 96 hours in patients receiving intravenous loop diuresis for acute heart failure has no clear added decongestive ability but does meaningfully limit potassium wasting.

Low potassium activation of proximal mTOR/AKT signaling is mediated by Kir4.2

The renal epithelium is sensitive to changes in blood potassium (K+). We identify the basolateral K+ channel, Kir4.2, as a mediator of the proximal tubule response to K+ deficiency. Mice lacking Kir4.2 have a compensated baseline phenotype whereby they increase their distal transport burden to maintain homeostasis. Upon dietary K+ depletion, knockout animals decompensate as evidenced by increased urinary K+ excretion and development of a proximal renal tubular acidosis. Potassium wasting is not proximal in origin but is caused by higher ENaC activity and depends upon increased distal sodium delivery. Three-dimensional imaging reveals Kir4.2 knockouts fail to undergo proximal tubule expansion, while the distal convoluted tubule response is exaggerated. AKT signaling mediates the dietary K+ response, which is blunted in Kir4.2 knockouts. Lastly, we demonstrate in isolated tubules that AKT phosphorylation in response to low K+ depends upon mTORC2 activation by secondary changes in Cl- transport. Data support a proximal role for cell Cl- which, as it does along the distal nephron, responds to K+ changes to activate kinase signaling.

Association Between the Chemical Composition of Saliva and Serum in Patients with Kidney Failure

Background: End-Stage Renal Disease (ESRD) is a severe nephrological condition that can lead to permanent kidney damage. Therefore, early disease diagnosis is key to preventing casualties. The gold standard method of diagnosis tends to evaluate changes in sodium, potassium, calcium, phosphorus, urea, creatinine, and parathormone hormones in blood after dialysis. However, serum evaluation is not always possible or easy for patients. Therefore, saliva evaluation has been proposed in recent years as an alternative. Objectives: The current article aims to evaluate metabolite in the saliva of ESRD patients. Methods: In this descriptive-analytical study, 29 ESRD patients undergoing hemodialysis treatment were selected. Their saliva and serum samples were taken. The number of biochemical factors, including sodium, potassium, calcium, phosphorus, urea, creatinine, and parathormone hormone, was measured with an autoanalyzer device and related kits. Finally, the correlation of parameters in serum and saliva was examined using the Pearson test. Results: The results showed a significant positive relationship between the levels of sodium, urea, and creatinine in serum and saliva samples (P &lt; 0.05). On the other hand, there was no significant relationship between the serum and saliva levels of potassium, calcium, phosphorus, and PTH (P &gt; 0.05). Conclusions: Due to the significant correlation between some prominent biochemical factors in saliva and serum after hemodialysis in ESRD patients, saliva could be considered a non-invasive diagnostic fluid for monitoring kidney disease in the future.

#857 How low can we go with dialysate flow? Does that mean we can make nephrology green?

Abstract Background and Aims Green nephrology encompasses all initiatives in kidney care that have a positive impact on the climate and environment. We know that environmental impact of dialysis is particularly high, considering water consumption and disposable waste production during each session. All that suggests a great opportunity where many improvements should be made. To prepare the dialysate 240 liters of water are needed for one four-hour session with a dialysate flow (Qd) set at 500 ml/min. Including additional water needed to rinse and sterilize the system, this gives approximately 500 liters of water used for one hemodialysis. Lower dialysate flow rate is associated with a significant reduction in the amount of water used for the hemodialysis procedure. An increase in Qd from 500 ml/min to 800 ml/min has been recommended to increase dialysis efficiency. It's benefit was not confirmed in in vivo studies which suggested that increasing the dialysate flow rate offers no benefit in terms of delivered Kt/V. Similarly, studies with a Qd of 400 ml/min showed comparable efficiency. If hemodialysis could be performed equally effectively with less dialysate consumption, water could be significantly saved. The aim of this study was to check whether change of dialysate flow from 500 ml/min to 300 ml/min has a significant impact on dialysis adequacy (measured by Kt/V). Method The study was a retrospective analysis. During the COVID19 surge in January 2022 due to administrative issues in a satellite dialysis center the dialysate flow was reduced to 300 ml/min. The center again increased Qd to 500 ml/min in February 2022. We analyzed laboratory data from 3 months before dialysate flow reduction, in the month with reduced Qd to 300 ml/min, and from 3 months thereafter with Qd set at 500 ml/min. Results 26 patients (10 men and 16 women – all dialysis patients from a satellite dialysis center) were enrolled in the study. Two of them died during observation, therefore 24 people were included in final analysis. Their median age was 72 (66-78) years. ANOVA with repeated measures showed lack of differences between three time points in terms of Kt/V (Qd 500 ml/min - 1.285±0.202, Qd 300 ml/min - 1.275±0.192 and Qd 500 ml/min - 1.337±0.199; p=0.093). Change in serum potassium during hemodialysis did not depend on dialysate flow (ΔK Qd 500ml/min - 1.5±0.5 mmol/l, Qd 300 ml//min - 1.7±0.5 mmol/l, Qd 500 ml/min - 1.6±0.4 mmol/l; p=0.197). Serum phosphorus was comparable between three time points (Qd 500 ml/min - 5.99±1.68 mg/l, Qd 300 ml/min - 5.65±1.4mg/l, Qd 500 ml/min - 6.01±1.67 mg/l; p=0.066). Conclusion Reduction in dialysate flow rate to 300 ml/min is safe for the patients and probably does not cause any short-term negative effects. Thus we can achieve the same therapeutic effect saving water consumption. Larger, long-term studies are needed to confirm the efficacy of this approach.

#1786 Correlation of electrolyte disturbances in community-acquired acute kidney injury

Abstract Background and Aims Acute renal injury can cause electrolyte disorders that increase patient morbidity and mortality. There are few data in the literature describing these alterations and the possible correlation between them in patients with community-acquired AKI (CA-AKI). The purpose of this study is to analyze the correlation between electrolyte disorders in a cohort of patients with CA-AKI admitted to the nephrology service of a tertiary level hospital. Method This is a single-center, observational, longitudinal, and retrospective study based on a cohort of patients with CA-AKI admitted to the Nephology Service of a third level hospital from January 2010 to December 2018. We analyzed the incidence of changes in sodium, potassium, chloride, bicarbonate, calcium, and phosphorus in these patients and their correlations. Results A total of 639 patients were included in the final analyses. The mean age was 72.93 ± 13.38 years. 61.7% were men. Charlson comorbidity index was 5.87 ± 2.4 points. The length of stay was 11.63 ± 10.14 days. In view of the Etiology of AKI, 72.1% had prerenal AKI and 27.9% non-prerenal. 436 patients had a history of previous chronic kidney disease (CKD) (68.23%). AKI KDIGO stages were: stage I, 105 cases (16.4%); stage II, 67 cases (10.5%); stage III 467 cases (63.1%). Hemodialysis (HD) was required in 114 patients (17.8%). 62 patients (9.7%) died during hospital stay. The most frequent ionic alterations at a global level were low bicarbonate (78.3%), hyperkalemia (53.05%), hypocalcemia (49.6%) and hyponatremia (41.5%). When analyzing whether electrolyte alterations occurred simultaneously: 2.2% of cases did not present any, 6.3% only one, 18.2% two, 26.4% three, 26.1% four, 14.9% five and 5.9% six simultaneous alterations. There were no statistically significant differences between groups on mortality during admission. Higher mortality at discharge has been found in patients with a greater number of ionic alterations (p = 0.046). In our sample, positive correlations were found between sodium-bicarbonate (r = 0.184; p &amp;lt; 0.001), peak creatinine-potassium (r = 0.182; p &amp;lt; 0.001), potassium-chloride (r = 0.167 p &amp;lt; 0.001), sodium-chloride (r = 0.614; p &amp;lt; 0.001), phosphorus-peak creatinine (r = 0.394; p &amp;lt; 0.001), pH-bicarbonate (r = 0.747, p &amp;lt; 0.001) and phosphorus–PTH (r = 0.330; p &amp;lt; 0.001). Negative correlations were found between sodium–potassium (r = −0,123; p = 0.002), bicarbonate-potassium (r = −0.354; p &amp;lt; 0.001), potassium-pH (r = −0.390; p &amp;lt; 0.001), peak creatinine–chlorine (r = −0.013; p = 0.004), bicarbonate–chlorine (r = −0.236; p &amp;lt; 0.001), calcium–phosphorus (r = −0.174; p &amp;lt; 0.001), calcium–peak creatinine (r = −0.138; p = 0.001) and bicarbonate–peak creatinine (r = −0.274; p &amp;lt; 0.001). Conclusion In our series of patients with CA-AKI, many statistically significant correlations were found between altered electrolytes in acute renal failure. Most of these associations can be explained by the pathophysiology of acute kidney injury. However, it should be noted that not all cases have such a clear explanation. It is important to consider that all patients in our study had already developed acute renal failure upon admission. Therefore, these results should be interpreted with caution and confirmed through further evaluations. We suggest that additional research in this area is necessary to improve the management and prognosis of this condition.

#694 Effects of nonsteroidal mineralocorticoid receptor antagonists on kidney of cirrhotic rats

Abstract Background and Aims Aldosterone binds to renal mineralocorticoid receptors (MRs) to regulate fluid and electrolytes homeostasis. In addition, aldosterone can be deleterious as a driver of inflammation and tissue fibrosis in several organs. Thus, blockade of aldosterone represents an important option to mitigate the target-organ damage. Mineralocorticoid receptor antagonists (MRAs) have been widely used as diuretic drugs for the management of hypertension, cirrhosis, and heart failure. However, the use of MRAs is limited by adverse events such as hyperkalemia. More recently, novel nonsteroidal selective MRAs with improved safety profiles have been developed. This nonsteroidal MRA (finerenone) has higher selectivity and stronger affinity for the MR, leading to lower risk of hyperkalemia. Recent evidences showed that finerenone reduces albuminuria, risk of CKD progression, and cardiovascular events in patients with chronic kidney disease and type 2 diabetes with a low incidence of hyperkalemia related treatment discontinuation. The pathophysiology of cirrhosis is very similar to that of cardiac failure. Decompensated cirrhosis is frequently treated with the MRAs. In addition to fluid management, MRAs showed hepatoprotective actions via reducing oxidative stress and inflammatory responses in CCl4-induced and common bile duct ligation (CBDL)-induced liver injury models. The potential beneficial effects of nonsteroidal MRA on cirrhosis had never been studied. This study aims to explore the renal protective role of nonsteroidal selective MRA and associated mechanisms in common bile duct ligation-related liver injury in rat model. Method CBDL was used to create liver injury in the Male Sprague-Dawley Drats. Finerenone (10 mg/kg/day) or vehicle was administered since the 1st day after CBDL. The effects of nonsteroidal selective MRA on kidneys were surveyed in two paralleled series on the 7th day (inflammation) and the 28th day (cirrhosis), respectively. The following parameters were evaluated: (a) hemodynamic parameters; (b) serum potassium, liver and renal function; (c) in-situ kidney perfusion; (d) western analyses of renal cortex and medulla. Results Compared with the vehicle-treated group, there was significantly lower renal vascular responsiveness to ET-1 in CBDL rats receiving 28 days of MRA (p&amp;lt;0.05) (Fig. 1B), but not in those receiving 7 days of MRA (Fig. 1A). MRA treatment led to no significant change in mean arterial pressure, portal pressure, serum potassium, liver, and renal function in CBDL rats (Table 1). The expressions of vasoactive mediators, such as iNOS, eNOS, ETA, and ETB in both renal cortex and medulla showed no significant change in CBDL rats following 28 days of MRA treatment (Fig. 2). Conclusion MRA treatment led to no significant effects on hemodynamics, liver, and renal function, but lower renal vascular responsiveness to ET-1 in CBDL rats receiving 28 days of MRA. The exact mechanisms remained to be further studied.

Perioperative Dyselectrolytemia in Patients Undergoing Transurethral Resection of the Prostate Using 0.9% Normal Saline Irrigation.

The choice of irrigation fluid used in transurethral resection of the prostate (TURP) has a significant impact on serum electrolyte levels. Among the many available options, 0.9% normal saline (NS) is considered to be more physiological. This observational study was conducted on 60 adult males aged 50-70 years, classified as American Society of Anesthesiologists grade 1 and 2, undergoing TURP with 0.9% NS irrigation under spinal anesthesia achieved with a mixture of 0.5% heavy bupivacaine. The patients' hematocrit and serum electrolyte levels were obtained after six hours and compared with preoperative values. Hematocrit reduced from 40.32 ± 6.27 to 31.07 ± 5.40 (p < 0.001). Both serum sodium and potassium decreased from 136.77 ± 3.27 to 128.31 ± 5.91 and from 4.02 ± 0.26 to 3.81 ± 0.36, respectively (p < 0.001). However, serum chloride showed only a minimal increase from 101.58 ± 2.88 to 102.25 ± 1.66 (p < 0.12). Although the changes in serum sodium and potassium were statistically significant, they did not have any physiological consequences in our study. However, this emphasizes the importance of vigilant electrolyte monitoring to identify and mitigate the risk of electrolyte disturbances during TURP surgeries.

THREE-YEAR NIGHTTIME BLOOD PRESSURE REDUCTIONS AFTER RADIOFREQUENCY RENAL DENERVATION IN PATIENTS WITH UNCONTROLLED HYPERTENSION AND CHRONIC KIDNEY DISEASE

Objective: Nocturnal hypertension (HTN), highly prevalent in chronic kidney disease (CKD), is strongly associated with cardiovascular risk, and is difficult to control with pharmacotherapy. An additional therapy such as radiofrequency renal denervation (RF RDN) may effectively lower nighttime BP in hypertensive patients with CKD, long-term. Design and method: Patients with uncontrolled HTN enrolled into the Global SYMPLICITY Registry (GSR) DEFINE were evaluated. All patients underwent RF RDN and were grouped by their estimated glomerular filtration rate (eGFR): &lt;60mL/min/1.73m2 (CKD) or eGFR more than or equal to 60mL/min/1.73m2 (non-CKD). Nighttime systolic BP (NSBP) changes at 3yrs after RF RDN were compared between groups. Results: As of March 2023, a total of 3331 patients with uncontrolled BP were enrolled of which 805 (24.2%) had CKD. CKD group were 64±12yrs old, 47.3% female, 54.9% had diabetes, and 56.9% had cardiac disease. Of those, 12.3% had eGFR &lt;30mL/min/1.73m2 (Figure 1A). The baseline NSBP was higher in the CKD vs non-CKD groups (149.0±22.9mmHg vs 144.9 ± 21.0mmHg; p=0.0002), whilst prescribed 5.2±1.7 vs 4.8 ± 1.7 antihypertensive drugs, respectively (p&lt;0.0001). 3yrs after RF RDN, significant NSBP change was observed in the CKD group (-7.8mmHg), similar to the non-CKD group (-8.4mmHg; adjusted p=0.64; Figure 1B). The eGFR changed similarly in both groups (CKD -4.7±17.4mL/min/1.73m2 vs non-CKD -7.0±17.0mL/min/1.73m2; p=0.34). There was also no significant difference between groups for changes in daytime SBP, sodium, potassium, or creatinine. Conclusions: In this large registry cohort of patients with CKD and uncontrolled BP, nocturnal HTN was prevalent, and RF RDN significantly reduced NSBP after 3 years. RDN, in addition to pharmacotherapy, may help to reduce the risk of long-term cardiovascular events in these high risk patients.

Interdependence of cellular and network properties in respiratory rhythm generation

How breathing is generated by the preBötzinger complex (preBötC) remains divided between two ideological frameworks, and a persistent sodium current (INaP) lies at the heart of this debate. Although INaP is widely expressed, the pacemaker hypothesis considers it essential because it endows a small subset of neurons with intrinsic bursting or "pacemaker" activity. In contrast, burstlet theory considers INaP dispensable because rhythm emerges from "preinspiratory" spiking activity driven by feed-forward network interactions. Using computational modeling, we find that small changes in spike shape can dissociate INaP from intrinsic bursting. Consistent with many experimental benchmarks, conditional effects on spike shape during simulated changes in oxygenation, development, extracellular potassium, and temperature alter the prevalence of intrinsic bursting and preinspiratory spiking without altering the role of INaP. Our results support a unifying hypothesis where INaP and excitatory network interactions, but not intrinsic bursting or preinspiratory spiking, are critical interdependent features of preBötC rhythmogenesis.

Soil quality evaluation for irrigated agroecological zones of Punjab, Pakistan: The Luenberger indicator approach

AbstractThis article describes the construction of the Luenberger soil quality indicator (SQI) using data on crop yield, non‐soil inputs, and soil profile from three irrigated agroecological zones of Punjab, Pakistan, namely, rice–wheat, maize–wheat–mix, and cotton–mix zones. Plot level data are used to construct a soil quality indicator by estimating directional distance functions within a data envelopment analysis (DEA) framework. We find that the SQI and crop yield relationships exhibit diminishing returns to improving soil quality levels. Using the constructed SQI values, we estimate linear regression models to generate weights that could be used directly to aggregate individual soil attributes into soil quality indicators without the necessity of fitting a frontier to the crop production data. For wheat and rice production, we find that SQI is most sensitive to changes in soil electrical conductivity (EC) and potassium (K). The SQI has direct relevance for site‐specific decision‐making problems where policymakers need to price land resources and conservation services to achieve agricultural and environmental goals.