Changes In Serum Potassium Levels Research Articles

#2986 Patiromer for hyperkalemia in the early post-transplant period

Abstract Background and Aims Hyperkalemia is a serious condition among kidney transplant (KT) recipients, which can lead to life-threatening complications such as cardiac arrhythmias. Following kidney transplantation, the causes of hyperkalemia are multifactorial owing to graft function, excess potassium repletion, comorbidities, and medications used in the peri- and post-operative setting. The risk for hyperkalemia is increased immediately post-transplantation, particularly in those with suboptimal graft function and higher calcineurin inhibitors levels. A rapidly rising potassium refractory to medical therapy can be an indication for dialysis. Managing hyperkalemia after kidney transplantation is associated with increased morbidity and healthcare costs. In that manner, newer alternatives such as patiromer and sodium zirconium cyclosilicate have emerged due to their potentially superior efficacy and safety profiles. Method This is an observational, retrospective, single-center study aimed to evaluate the efficacy and safety of patiromer for hyperkalemia management in adult transplant recipients over the first 3 months post-transplant period, between January and December 2022 (since patiromer is available in our hospital pharmacy). We included all the kidney transplant recipients of our hospital, with the exception of those with primary graft failure. Information concerning the donor, recipient, graft, drugs pre and post-transplant, fluid therapy, transfusions, and blood tests (ions, blood gases, glycemia, kidney function measurements, anticalcineurin inhibitors levels) were collected. Patiromer was administered in a single-daily dose, diluted in 250 cc of water, in the afternoon, at least 2 hours separated of other drugs. Results In total, 69 recipients were included in the analysis. 94% were from deceased donors and 54% from donation after cardiac death. The average age of the entire cohort was 55 years and 66% were male. Medical history of each KT recipients reveal that 89% has hypertension, 32% diabetes, and 35% previous cardiopathy. Hypertension treatment before the KT included beta-blockers (39%) and angiotensin-converting enzyme inhibitors (37%). The incidence of hyperkalemia (K ≥ 5.5 mmol/L) was 29.7% in the first three months, mostly in the first week (21.6%). Patiromer was administered to 37% of them. For the 88.5% an initial dose of 8.4 g/day was enough. Although, 27% required an increase of the dose to 16.8 g/day and 8% to 25.2 g/day. The changes in serum potassium levels following the first patiromer dose are shown in Graphic 1. The mean time duration of the patiromer treatment was 14.5 days (3.7-36.7). However, 27% continue with patiromer beyond three months. There was no significant difference in the dose/levels of tacrolimus neither in the serum magnesium levels between patients with or without patiromer. No gastrointestinal complications were observed following the use of patiromer. Conclusion Patiromer may play an important role in the management of hyperkalemia over the first weeks after KT, allowing a significant and sustained reduction of the serum potassium levels, although additional long-term studies are necessary to confirm these effects.

A multicentral prospective cohort trial of a pharmacist-led nutritional intervention on serum potassium levels in outpatients with chronic kidney disease: The MieYaku-Chronic Kidney Disease project.

Although dietary potassium restriction is an acceptable approach to hyperkalemia prevention, it may be insufficient for outpatients with chronic kidney disease (CKD). Most outpatients with CKD use community pharmacies owing to the free access scheme in Japan. The MieYaku-CKD project included a community pharmacist-led nutritional intervention for dietary potassium restriction, with the goal of determining its efficacy for patients' awareness of potassium restriction and serum potassium levels in outpatients with CKD. This was a five-community pharmacy multicenter prospective cohort study with an open-label, before-and-after comparison design. Eligible patients (n = 25) with an estimated glomerular filtration rate (eGFR) < 45 mL/min/1.73 m2 received nutritional guidance from community pharmacists. The primary outcome was a change in serum potassium levels at 12 weeks post-intervention. The eligible patients' knowledge, awareness, and implementation of potassium restriction were evaluated using a questionnaire. The median value of serum potassium was significantly reduced from 4.7 mEq/L before to 4.4 mEq/L after the intervention [p < 0.001, 95% confidence interval (CI): 0.156-0.500], with no changes in eGFR (p = 0.563, 95% CI: -2.427-2.555) and blood urine nitrogen/serum creatinine ratio (p = 0.904, 95% CI: -1.793-1.214). The value of serum potassium had a tendency of attenuation from 5.3 to 4.6 mEq/L (p = 0.046, 95% CI: 0.272-1.114) in the eGFR < 30 mL/min/1.73 m2 group. A questionnaire revealed that after the intervention, knowledge and attitudes regarding dietary potassium restriction were much greater than before, suggesting that the decrease in serum potassium levels may be related to this nutritional guidance. Our findings indicate that implementing a dietary potassium restriction guidance program in community pharmacies is feasible and may result in lower serum potassium levels in outpatients with CKD.

Efficacy and Safety of Ocedurenone: Subgroup Analysis of the BLOCK-CKD Study.

Ocedurenone (KBP-5074), a nonsteroidal mineralocorticoid receptor antagonist, is documented to lower blood pressure in patients with stage 3b/4 chronic kidney disease (CKD) with uncontrolled or resistant hypertension (BLOCK-CKD study). However, the efficacy and safety of Ocedurenone in subgroups such as Hispanic patients or those with stage 4 CKD, diabetes, or very high albuminuria have not been reported. A total of 162 patients were enrolled in the BLOCK-CKD study. The primary endpoint of these analyses was change in systolic blood pressure (SBP) from baseline to day 84. Prespecified subgroup analysis of SBP focused on demographic (e.g., ethnicity, age) and medical (e.g., CKD stage, diabetes, albuminuria, baseline estimated glomerular filtration rate [eGFR]). The safety analysis focused on changes in serum potassium levels from baseline. SBP reductions were consistent across subgroups compared with the overall study cohort. Placebo-adjusted SBP reductions were observed in Hispanic patients (-8.1 and -9.9 mm Hg for 0.25 and 0.5 mg, respectively, total n = 35) and patients with CKD stage 4 (-9.3 and -10.4 mm Hg for 0.25 and 0.5 mg, respectively, total n = 64), diabetes (-6.9 and -11.6 mm Hg for 0.25 and 0.5 mg, respectively, total n = 51), and very high albuminuria (-13.1 and -12.3 mm Hg for 0.25 and 0.5 mg, respectively, total n = 85). Changes in serum potassium were similar across all patient subgroups regardless of baseline eGFR, diabetes status, or degree of proteinuria. No cases of hyperkalemia required intervention or resulted in study discontinuation. Ocedurenone consistently reduced in SBP in all patient subgroups. Moreover, while small elevations in serum potassium occurred, they were not associated with Ocedurenone or study discontinuation.

Patiromer utilization in patients with advanced chronic kidney disease under nephrology care in Germany.

Hyperkalemia (HK) is a frequent condition in patients with chronic kidney disease (CKD) that is associated with high morbidity and mortality. Patiromer has recently been introduced as a potassium binder. Data on patiromer use in patients with CKD in the real-world setting in Europe are lacking. We describe time to discontinuation and changes in serum potassium levels among German CKD stage 3-5 patients starting patiromer. Duration of patiromer use was estimated by Kaplan-Meier curve, starting at patiromer initiation and censoring for death, dialysis, transplant or loss to follow-up. Serum potassium levels and renin-angiotensin-aldosterone system inhibitor (RAASi) use are described at baseline and during follow-up, restricted to patients remaining on patiromer. We identified 140 patiromer users within our analysis sample [81% CKD stage 4/5, 83% receiving RAASi, and median K+ 5.7 (5.4, 6.3) mmol/L]. Thirty percent of patiromer users had prior history of polystyrene sulfonate use. Overall, 95% of patiromer users stayed on treatment past 1 month, with 53% continuing for over a year. Mean serum potassium levels decreased after patiromer initiation and remained stable under treatment during follow-up (up to 180 days). Among these patients, 73%-82% used RAASis during the time periods before and after patiromer initiation, with no obvious trend indicating discontinuation. Real-world evidence of patiromer use in Germany shows that, in line with what has been observed in clinical trials, patients on patiromer have a reduction in serum potassium when used long-term. Moreover, most patients on patiromer do not discontinue treatment prior to 1 year after initiation.

Low-dose of magnesium sulfate solution was not inferior to standard regime of polyethylene glycol for bowel preparation in elderly patients: a randomized, controlled study

Background Large polyethylene glycol (PEG) is a standard regimen for bowel preparation. However, elderly patients suffered from adverse events. This study was to compare the efficacy and safety of oral magnesium sulfate solution (MSS) vs standard PEG in elderly patients undergoing colonoscopy. Methods Elderly patients aged 60–90 years, from two endoscopic centers, were enrolled in China. Patients were randomized to take a low dose of MSS or a standard PEG regime in a split-dose regime. The primary endpoint was the proportion of patients with adequate bowel preparation, which was defined as the total Boston Bowel Preparation Scale (BBPS) ≥6 and each segmental BBPS was ≥2. Secondary outcomes included adenoma detection rate (ADR), safety, adverse events, cecal intubation rate, willingness to repeat BP, and so on. Results 1174 elderly patients were randomly allocated to the MSS group (n = 588) or the standard group (n = 586). Adequate BP was achieved in 94.0% of patients in the MSS group and 92.5% in the control (p = .287). ADR was also comparable between the two groups (43.0% and 39.9%, p = .282). Compared with the standard group, MSS group reported less abdominal discomfort (1.7% vs 6.0%), less nausea (13.6% vs 21.0%) and vomiting (1.2% vs 4.2%). The change in serum potassium levels after preparation in the standard group was significantly lower than that in the MSS group (−0.19 ± 0.08 vs −0.41 ± 0.11, p = .037). Conclusions Low dose of MSS was not inferior to the standard PEG regime in terms of bowel preparation quality for elderly patients. Low-dose MSS offered fewer adverse events and better tolerability. It is a preferable choice for the elderly to undergo bowel preparation for colonoscopy. Clinical trial registration number NCT 04948567

Potassium Level Variation Following Packed Cell Transfusion in Critically Ill Adult Patients-How Alert Should We Be?

One of the most clinically important effects following the administration of packed cell transfusion (PCT) is hyperkalemia, which can cause severe life-threatening cardiac arrhythmias. This retrospective population-based cohort study included adults hospitalized between January 2007 and December 2019 in a general intensive care unit for 24 h or more, with normal levels of serum potassium on admission. We assessed changes in serum potassium levels after administration of one unit of packed cells and sought to identify clinical parameters that may affect these changes. We applied adjusted linear mixed models to assess changes in serum potassium. The mean increase in serum potassium was 0.09 mEq/L (C.U 0.04–0.14, p-value < 0.001) among the 366 patients who were treated with a single PCT compared to those not treated with PCT. Increased serum potassium levels were also found in patients who required mechanical ventilation, and to a lesser degree in those treated with vasopressors. Hypertension, the occurrence of a cerebrovascular accident, and increased creatinine levels were all associated with reduced serum potassium levels. Due to the small rise in serum potassium levels following PCT, we do not suggest any particular follow-up measures for critically ill patients who receive PCT.

ПЕРИОДИЧЕСКИЕ ПАРАЛИЧИ

Periodic paralysis (paroxysmal myoplegia) is a rare neuromuscular disorder caused by mutations in the sodium, calcium, and potassium channel genes of skeletal muscle. Common features of primary periodic paralysis are autosomal dominant inheritance, changes in serum potassium levels as a result of a defect in ion channels, and the onset of the disease in the first or second decade of life. Clinically, PP is manifested by episodic attacks of muscle weakness that occur at irregular intervals, attacks are often associated with food or rest after exercise, sometimes accompanied by myotonia. Periodic paralysis is rare in the general population and, as a result, prospective clinical trials of treatment interventions are limited. Due to the low prevalence of primary PCBs and limited treatment options, few prospective studies are available to develop treatment recommendations based on anecdotal evidence and patient case reports. Treatment options include provocation prevention, potassium and carbonic anhydrase inhibitors.

Extent of Fall in Serum Potassium by Medical Therapy in End Stage Renal Disease

Aim: To observe the mean alteration in potassium levels one-hour post-antihyperkalemic treatment in end stage renal disease patients presenting with hyperkalemia. Study design: Quazi interventional (experimental) study. Place and duration of study: Department of Medicine, Sir Ganga Ram Hospital Lahore from 28th June 2018 to 27th December 2018. Methodology: Sixty patients of both genders with age range between 14 to 70 years having stage 5 CKD (thrice-weekly dialysis dependent) for at least 6 months with raised serum potassium (&gt;5.5 mEq/L). These patients were given medical treatment in the form of salbutamol nebulization, injectable calcium gluconate, and 100ml 25% dextrose water solution neutralized with Humulin R Insulin 12 units. Serum potassium was reassessed 1 hour after the treatment. Mean change in serum potassium was observed and was compared across various subgroups of patients. A written informed consent was taken from each patient. Results: In the current study, mean age of our studied population was 50.6±10.4 years with male-gender dominance (81.7%). Mean ESRD duration was 11.8±3.7 months while the mean BMI was 27.6±3.6Kg/m2. 15 (25.0%) patients were obese. The serum potassium level at presentation ranged from 5.6mEq/L to 6.9mEq/L with a mean of 6.25±0.39mEq/L. The serum potassium level 1 hour after medical treatment ranged from 4.8mEq/L to 6.3mEq/L with a mean of 5.58±0.43mEq/L. This change in mean serum potassium was significant (p-value&lt;0.001) on paired sample t-test. The change in serum potassium level ranged from 0.5-0.9mEq/L with a mean of 0.676±0.123mEq/L. Similar mean change in serum potassium level was observed when stratified for age, gender, BMI and duration of ESRD. Keywords: End Stage Renal Disease, Hemodialysis, Hyperkalemia, Medical Treatment

Preventing potential pitfalls of a liberalized potassium diet in the hemodialysis population.

Emerging research suggests that a more liberalized diet, specifically a more plant-based diet resulting in liberalization of potassium intake, for people receiving hemodialysis is necessary and the benefits outweigh previously thought risks. If the prescribed hemodialysis diet is to be liberalized, the need to illuminate and prevent potential pitfalls of a liberalized potassium diet is warranted. This paper explores such topics as partial to full adherence to a liberalized diet and its consequences if any, the advantages of a high-fiber intake, the theoretical risk of anemia when consuming a more plant-dominant diet, the potential benefits against renal acid load and effect on metabolic acidosis with increased fruit and vegetable intake, the putative change in serum potassium levels, carbohydrate quality, and the healthfulness of meat substitutes. The benefits of a more plant-based diet for the hemodialysis population are multifold; however, the possible pitfalls of this type of diet must be reviewed and addressed upon meal planning in order to be avoided.

A comparison of insulin doses for treatment of hyperkalaemia in intensive care unit patients with renal insufficiency

BackgroundHyperkalaemia is a complication in patients with chronic kidney disease or acute kidney injury and occurs frequently in the intensive care unit. One treatment approach includes intravenous (IV) insulin to shift potassium intracellularly. ObjectivesThe primary outcome was hypoglycaemia (blood glucose <70 mg/dL) after insulin administration. Secondary outcomes included change in serum potassium levels and incidence of severe hypoglycaemia. MethodsThis was a single-centre, retrospective study evaluating critically ill adult patients with chronic kidney disease stage III–V, end-stage renal disease, or acute kidney injury who received IV insulin for treatment of hyperkalaemia from March 2008 to September 2018. Patients were divided into two insulin-dosing regimen groups: 5 units or 10 units. ResultsOf the 174 patients included, hypoglycaemia after insulin administration occurred in eight of 87 patients (9.2%) in the 5-unit group and 17 of 87 patients (19.5%) in the 10-unit group (p = 0.052). There was no difference in rates of severe hypoglycaemia or change in serum potassium levels. ConclusionsIn critically ill patients requiring treatment for hyperkalaemia, a lower dose of IV insulin does not result in lower statistically significant rates of hypoglycaemia. However, lower insulin doses provide a similar potassium-lowering effect and cause a meaningful decrease in hypoglycaemic episodes. Intensive care unit providers may consider 5 units of IV insulin over 10 units although further larger controlled studies are needed.

THE TOXIC EFFECTS OF MULTIPLE DOSES OF DIMINAZENE ACETURATE ON THE HAEMATOLOGICAL VALUES OF RATS.

The haematological effects of increasing doses of diminazene aceturate on the blood of swiss albino rats was examined. Following the administration of the drug there was a significant increase in white blood cell (WBC) count (P&lt;0.05). The increase in WBC count occured at all dose levels of 3.5, 7.0), 14.0 and 28.0mg/kg body weight. There was minor change in serum sodium and significant changes in serum potassium levels. All these changes were found not to be strictly dose dependent. This study shows that administration of diminazene aceturate produces increases in white blood cells.

Hyperkalemia in heart failure patients in Spain and its impact on guidelines and recommendations: ESC-EORP-HFA Heart Failure Long-Term Registry.

Hyperkalemia is a growing concern in the treatment of patients with heart failure and reduced ejection fraction because it limits the use of effective drugs. We report estimates of the magnitude of this problem in routine clinical practice in Spain, as well as changes in potassium levels during follow-up and associated factors. This study included patients with acute (n=881) or chronic (n=3587) heart failure recruited in 28 Spanish hospitals of the European heart failure registry of the European Society of Cardiology and followed up for 1 year. Various outcomes were analyzed, including changes in serum potassium levels and their impact on treatment. Hyperkalemia (K+> 5.4 mEq/L) was identified in 4.3% (95%CI, 3.7%-5.0%) and 8.2% (6.5%-10.2%) of patients with chronic and acute heart failure, respectively, and was responsible for 28.9% of all cases of contraindication to mineralocorticoid receptor antagonist use and for 10.8% of all cases of failure to reach the target dose. Serum potassium levels were not recorded in 291 (10.8%) of the 2693 chronic heart failure patients with reduced ejection fraction. During follow-up, potassium levels increased in 179 of 1431 patients (12.5%, 95%CI, 10.8%-14.3%). This increase was directly related to age, diabetes, and history of stroke and was inversely related to history of hyperkalemia. This study highlights the magnitude of the problem of hyperkalemia in patients with heart failure in everyday clinical practice and the need to improve monitoring of this factor in these patients due to its interference with the possibility of receiving optimal treatment.

Hiperpotasemia en pacientes con insuficiencia cardiaca en España y su impacto en las recomendaciones. Registro ESC-EORP-HFA Heart Failure Long-Term

Introduction and objectivesHyperkalemia is a growing concern in the treatment of patients with heart failure and reduced ejection fraction because it limits the use of effective drugs. We report estimates of the magnitude of this problem in routine clinical practice in Spain, as well as changes in potassium levels during follow-up and associated factors. MethodsThis study included patients with acute (n=881) or chronic (n=3587) heart failure recruited in 28 Spanish hospitals of the European heart failure registry of the European Society of Cardiology and followed up for 1 year. Various outcomes were analyzed, including changes in serum potassium levels and their impact on treatment. ResultsHyperkalemia (K+> 5.4 mEq/L) was identified in 4.3% (95%CI, 3.7%-5.0%) and 8.2% (6.5%-10.2%) of patients with chronic and acute heart failure, respectively, and was responsible for 28.9% of all cases of contraindication to mineralocorticoid receptor antagonist use and for 10.8% of all cases of failure to reach the target dose. Serum potassium levels were not recorded in 291 (10.8%) of the 2693 chronic heart failure patients with reduced ejection fraction. During follow-up, potassium levels increased in 179 of 1431 patients (12.5%, 95%CI, 10.8%-14.3%). This increase was directly related to age, diabetes, and history of stroke and was inversely related to history of hyperkalemia. ConclusionsThis study highlights the magnitude of the problem of hyperkalemia in patients with heart failure in everyday clinical practice and the need to improve monitoring of this factor in these patients due to its interference with the possibility of receiving optimal treatment.

Evaluation of Thiopentone Sodium, Propofol and Midazolam for Modified Electro Convulsive Therapy

Background: Modified Electroconvulsive therapy (MECT), is evidence based, safe and established treatment for varieties of psychiatric diseases that includes acute mania, major depressive disorder, schizophrenia, suicidal tendency and many more conditions. Government of India and world health organization has mandated use of sedative / anesthetic drug to make MECT acceptable method of treatment. MECT is administered under anesthesia to control acute cardiovascular, cerebrovascular and musculoskeletal changes occurring subsequent to delivery of electric current across the cerebral cortex. This also prevents respiratory and traumatic complications. Subjects and Methods: In the present clinical observational study we analyzed 113 MECT administrations for evaluating suitability of thiopentone sodium, propofol and midazolam with succinyl choline chloride; on 45 patients belonging to ASA grade II with no associated systemic diseases. Results: We observed the induction characteristics, induction and recovery time, associated changes in hemodynamic parameters during and after procedure, duration and energy required to induce muscular convulsions and changes in serum potassium level. Our observations indicates that induction was quicker with propofol than with thiopentone 43.67 ± 9.13v/s 61.31 ± 15.58 seconds and recovery time was also quicker with propofol than thiopentone 518.73 ± 69.67 v/s 595.25 ± 112.68 seconds . Only on one occasion in thiopentone group induction was turbulent. Acute but short lasting changes in heart rate, systolic, diastolic and mean arterial pressure was observed in both thiopentone and propofol groups. The energy requirement was less than 100 joules on 34 sittings in thiopentone group while in propofol group it was observed on 47 sittings. In thiopentone group on 17 occasion energy required were more than 100 joules and 5 sittings in propofol group. There was transient elevation of mean serum potassium of 0.55 mEq/lit after MECT in all patients. Midazolam did not produce satisfactory condition in dose of 5 mg and needed thiopentone supplement on 10 occasions. Conclusion: The findings allowed us to conclude that both thiopentone and propofol along with sub-paralytic dose of succinyl choline chloride produced satisfactory conditions for MECT sittings without complications. However propofol provided quick induction and recovery and lesser energy requirement.

STUDY ON EFFECTS OF REPEATED SALBUTAMOL NEBULIZATIONS ON SERUM POTASSIUM LEVELS AND QTC ON ELECTROCARDIOGRAM IN CHILDREN WITH ACUTE WHEEZE

Objective: Acute wheeze is a common problem in young children with respiratory disorders. This study emphasizes on whether there are any significant changes in serum potassium levels and QTc interval during repeated salbutamol nebulizations. Methods: A cross-sectional observational study was conducted at a tertiary care teaching hospital. The study group comprised of 41 children in the age group of 6 months–12 years. Pediatric asthma score and vital parameters (heart rate, respiratory rate, and SpO2) were recorded at the onset and end of salbutamol nebulizations. Baseline serum potassium levels were taken at the onset and then at the end. An electrocardiogram (ECG) was taken at 1 h and another at 3 h, for those who continued to require repeated nebulizations until then. Results: The mean fall in serum potassium levels after repeated salbutamol nebulizations was 0.3±0.4 (p<0.05). The mean fall after 3, 4, 5, and 6 salbutamol nebulizations was 0.06, 0.44, 0.66, and 0.43 mEq/L, respectively. There were no significant changes in ECG patterns in these children. The mean QTc at 1 h of repeated salbutamol nebulizations was 0.41±0.02 (s) and that after 3 h (for children requiring repeated nebulizations until then) was 0.43±0.01 (s). The mean rise in QTc at 3 h was 0.004 s, which was not statistically significant (p=0.137). Conclusion: We conclude that serum potassium levels should be monitored in children receiving repeated salbutamol nebulizations for acute wheeze.

Calcium-Polystyrene Sulfonate Decreases Inter-Dialytic Hyperkalemia in Patients Undergoing Maintenance Hemodialysis: A Prospective, Randomized, Crossover Study.

Hyperkalemia is a life-threatening emergency in maintenance hemodialysis (MHD) patients. This clinical trial investigated the efficacy and safety of calcium-polystyrene sulfonate (Ca-PS) in MHD patients with interdialytic hyperkalemia. A total of 58 hemodialysis patients with hyperkalemia (≥5.5 mol/L) were selected and administered either a 3-week Ca-PS (3 × 5 g/day) or a blank control following the model of a prospective, randomized, crossover clinical trial with a 1-week washout period. All patients were followed up for another 3 weeks for safety evaluations. The primary outcome was the magnitude of the change in serum potassium levels. The secondary outcomes were electrocardiography (ECG) changes and treatment safety (volume overload, electrolyte imbalance). Compared with the control group, Ca-PS treatment significantly reduced serum potassium levels (P <0.01). More patients in the Ca-PS group had lower serum potassium levels than the safety level of <5.5 mmol/L (32% for control vs. 61% for Ca-PS, P <0.01). Peaked T-wave occurred less frequently in patients in the Ca-PS group (13.8% for Ca-PS vs. 31.03% for control, P <0.01). In addition, Ca-PS reduced serum phosphorus levels with no effects on serum levels of calcium and sodium, fluid volume, blood pressure, or interdialytic weight gain. Ca-PS treatment decreases serum levels of potassium and phosphorus in MHD patients with interdialytic hyperkalemia. Ca-PS does not induce volume overload or disrupt electrolyte balance.

A retrospective analysis of postoperative hypokalemia in pituitary adenomas after transsphenoidal surgery.

BackgroundPituitary adenoma is one of the most common intracranial neoplasms, and its primary treatment is endoscopic endonasal transsphenoidal tumorectomy. Postoperative hypokalemia in these patients is a common complication, and is associated with morbidity and mortality. This study aimed to analyze the etiopathology of postoperative hypokalemia in pituitary adenomas after endoscopic transsphenoidal surgery.Methods and MaterialsThis retrospective study included 181 pituitary adenomas confirmed by histopathology. Unconditional logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Repeated measures ANOVA was used to analyze change in serum potassium levels at different time points.ResultsMultiple Logistic regression analysis revealed that only ACTH-pituitary adenoma (OR = 4.92, 95% CI [1.18–20.48], P = 0.029) had a significant association with postoperative hypokalemia. Moreover, the overall mean serum potassium concentration was significantly lower in the ACTH versus the non-ACTH group (3.34 mmol/L vs. 3.79 mmol/L, P = 0.001). Postoperative hypokalemia was predominantly found in patients with ACTH-pituitary adenoma (P = 0.033).ConclusionsACTH-pituitary adenomas may be an independent factor related postoperative hypokalemia in patients despite conventional potassium supplementation in the immediate postoperative period.

Consequences of Different Corticosteroids on Serum Potassium and Prostate-Specific Antigen in Patients Receiving Abiraterone for Castration-Resistant Prostate Cancer: A Retrospective Observational Study.

Background:Abiraterone acetate is an androgen synthesis inhibitor approved for the treatment of castration-resistant prostate cancer (CRPC). Although co-administration of either prednisone or prednisolone at 10 mg/d has been recommended to reduce the risk of abiraterone-induced hyperaldosteronism (notably hypokalemia) and to give adjunctive pain relief effects, whether these glucocorticoids can be substituted by dexamethasone remains unknown.Methods:We performed a retrospective review of medical records of patients who were given abiraterone for the treatment of CRPC with either prednisolone (ABI/PSL) 10 mg/d or dexamethasone (ABI/DEX) 0.5 or 1 mg/d between 2014 and 2017 in Juntendo University Nerima Hospital. Demographic and biochemical data including prostate-specific antigen (PSA) level were retrieved from the electronic medical records.Results:Fifty-three eligible patients (27 in ABI/PSL group and 26 in ABI/DEX group) were extracted from the records. Both groups showed no significant changes in serum potassium level before and after starting treatment. In the ABI/PSL group, 12 patients (46%) showed elevations of PSA and 7 patients (27%) discontinued treatment within 3 months. In contrast, in the ABI/DEX group, only 6 patients (25%) showed elevations of PSA and 3 patients (13%, all were given dexamethasone 1 mg/d) discontinued treatment.Conclusions:Dexamethasone and prednisolone may be equally effective in preventing abiraterone-induced hypokalemia.

Effect of Patiromer on Serum Potassium Level in Patients With Hyperkalemia and Diabetic Kidney Disease

ImportanceHyperkalemia is a potentially life-threatening condition predominantly seen in patients treated with renin-angiotensin-aldosterone system (RAAS) inhibitors with stage 3 or greater chronic kidney disease (CKD) who may also have diabetes, heart failure, or both.ObjectivesTo select starting doses for a phase 3 study and to evaluate the long-term safety and efficacy of a potassium-binding polymer, patiromer, in outpatients with hyperkalemia.Design, Setting, and ParticipantsPhase 2, multicenter, open-label, dose-ranging, randomized clinical trial (AMETHYST-DN), conducted at 48 sites in Europe from June 2011 to June 2013 evaluating patiromer in 306 outpatients with type 2 diabetes (estimated glomerular filtration rate, 15 to <60 mL/min/1.73 m2 and serum potassium level >5.0 mEq/L). All patients received RAAS inhibitors prior to and during study treatment.InterventionsPatients were stratified by baseline serum potassium level into mild or moderate hyperkalemia groups and received 1 of 3 randomized starting doses of patiromer (4.2 g [n = 74], 8.4 g [n = 74], or 12.6 g [n = 74] twice daily [mild hyperkalemia] or 8.4 g [n = 26], 12.6 g [n = 28], or 16.8 g [n = 30] twice daily [moderate hyperkalemia]). Patiromer was titrated to achieve and maintain serum potassium level 5.0 mEq/L or lower.Main Outcomes and MeasuresThe primary efficacy end point was mean change in serum potassium level from baseline to week 4 or prior to initiation of dose titration. The primary safety end point was adverse events through 52 weeks. Secondary efficacy end points included mean change in serum potassium level through 52 weeks.ResultsA total of 306 patients were randomized. The least squares mean reduction from baseline in serum potassium level at week 4 or time of first dose titration in patients with mild hyperkalemia was 0.35 (95% CI, 0.22-0.48) mEq/L for the 4.2 g twice daily starting-dose group, 0.51 (95% CI, 0.38-0.64) mEq/L for the 8.4 g twice daily starting-dose group, and 0.55 (95% CI, 0.42-0.68) mEq/L for the 12.6 g twice daily starting-dose group. In those with moderate hyperkalemia, the reduction was 0.87 (95% CI, 0.60-1.14) mEq/L for the 8.4 g twice daily starting-dose group, 0.97 (95% CI, 0.70-1.23) mEq/L for the 12.6 g twice daily starting-dose group, and 0.92 (95% CI, 0.67-1.17) mEq/L for the 16.8 g twice daily starting-dose group (P < .001 for all changes vs baseline by hyperkalemia starting-dose groups within strata). From week 4 through week 52, statistically significant mean decreases in serum potassium levels were observed at each monthly point in patients with mild and moderate hyperkalemia. Over the 52 weeks, hypomagnesemia (7.2%) was the most common treatment-related adverse event, mild to moderate constipation (6.3%) was the most common gastrointestinal adverse event, and hypokalemia (<3.5 mEq/L) occurred in 5.6% of patients.Conclusions and RelevanceAmong patients with hyperkalemia and diabetic kidney disease, patiromer starting doses of 4.2 to 16.8 g twice daily resulted in statistically significant decreases in serum potassium level after 4 weeks of treatment, lasting through 52 weeks.Trial Registrationclinicaltrials.gov Identifier: NCT01371747

Adverse reactions among patients being treated for multi-drug resistant tuberculosis in Egypt from July 2006 to January 2009

BackgroundMDR-TB is regarded as a high-priority medical and public health issue, its treatment is frequently associated with prolonged illness and disability. Second-line TB drugs have a greater incidence of adverse reactions, which increases the morbidity as well as cost. ObjectiveTo assess adverse reactions of second-line TB drugs in patients treated for MDR-TB in Egypt from 1st of July 2006 to 1st of January 2009. MethodsA retrospective study included 138 patients enrolled into the MDR-TB department at the Abbassia Chest Hospital during the study period. The patient was treated with 5 drugs according to results of the drug susceptibility test as follows: Any drug of the 1st line if not resistant, One of the injectable aminoglycosides (Kanamycin, Amikacin, Capreomycin or Streptomycin), Quinolones (Ofloxacin), Ethionamide, Cycloserine, and PAS. During the course of treatment, the patients were followed up by radiological and laboratory investigation and adverse reactions were determined by clinical and or laboratory criteria. Severity of adverse reactions was graded according to the National Tuberculosis Program. ResultsMajority of cases were cured (88.4%), one patient was lost to follow-up, 4 patients completed treatment and 7 patients died. There was a significant weight gain beginning from the 3rd month of treatment. There were statistically significant elevations of SGPT beginning from the 6th month, there were significant elevations of creatinine beginning from the 3rd month while there were no significant changes in serum Potassium levels. Gastrointestinal manifestations were the most frequent adverse reaction, followed by PN, hypokalemia, IBS, Ototoxicity, Hypothyroidism, Skin manifestations, Hepatotoxicity then by nephrotoxicity. Hyponatremia and dizziness were the least adverse reactions, the majority of adverse reactions did not affect daily activity of the patients. There was a significant relation between smoking and peripheral neuropathy while there were no significant relation between smoking, DM and used antituberculosis drugs with the other adverse reactions. ConclusionThe most common type of resistance was acquired resistance, There was a relation between both tobacco smoking and drug addiction, and MDR TB, The most common side effect of anti TB drugs was GIT manifestations and the least complication was dizziness. Adverse reactions did not negatively impact treatment outcome among individuals who were adherent to treatment.