Chloride In Patients Research Articles

Prognostic Significance of Serum Chloride Level Reduction in Patients with Chronic Heart Failure with Different Ejection Fractions.

Little is known regarding the prognostic value of serum chloride in patients with chronic heart failure (CHF) with different ejection fractions. We sought to determine the postdischarge outcomes associated with lower serum chloride between different CHF types.We reviewed the medical records of 1221 consecutive patients with CHF admitted to the First Affiliated Hospital of Kunming Medical University from January 2017 to October 2021. After excluding patients with in-hospital death, missing follow-up data, missing serum chloride level data, or chronic dialysis therapy, 791 patients were included. Of these patients, 343 had heart failure with reduced ejection fraction (HFrEF; i.e., left ventricular ejection fraction (LVEF) < 40%), and 448 had heart failure with preserved ejection fraction (HFpEF) or heart failure with median ejection fraction (HFmrEF; HFpEF plus HFmrEF; i.e., LVEF ≥40%). Over a median follow-up of 750 days, 344 patients (43.5%) had all-cause mortality. In the univariate analysis, serum sodium and chloride were strongly associated with mortality in both HF subgroups (P < 0.0001). A multivariable model including both serum sodium and chloride showed the highly significant association between serum chloride and survival (P < 0.0001), whereas the association between serum sodium and mortality was not reported (HFpEF plus HFmrEF, hazard ratio (HR) 0.975, 95% confidence interval [CI] 0.942-1.010, P = 0.158; HFrEF, HR 1.007, 95% CI 0.966-1.051, P = 0.734). Kaplan-Meier survival curve analysis revealed a significant difference in mortality risk with decreasing chloride levels in all patients with CHF. The optimal cutoff value of chloride in predicting all-cause mortality was 102.95 mmol/L with area under the curve value of 0.76 [HR 0.760, 95% CI 0.727-0.793, P < 0.0001], sensitivity of 60.2%, and specificity of 78.3%.Lower serum chloride is an independent predictor of death in CHF, regardless of heart failure subtype.

Serum Chloride and Heart Failure.

Despite significant advances in management, heart failure continues to impose a significant epidemiologic burden with high prevalence and mortality rates. For decades, sodium has been the serum electrolyte most commonly associated with outcomes; however, challenging the conventional paradigm of sodium's influence, recent studies have identified a more prominent role in serum chloride in the pathophysiology of heart failure. More specifically, hypochloremia is associated with neurohumoral activation, diuretic resistance, and a worse prognosis in patients with heart failure. This review examines basic science, translational research, and clinical studies to better characterize the role of chloride in patients with heart failure and additionally discusses potential new therapies targeting chloride homeostasis that may impact the future of heart failure care.

Biochemical Study on Fibroblast growth factor 23(FGF23) and its relation with Chronic Kidney Disease

The research involved study the relation between FGF23 and some of the biochemical parameters related to the chronic kidney disease(phosphate, vitamin D, calcium, urea, creatinine, chloride, potassium, albumin, alkaline phosphatase enzyme (ALP), transamination enzymes GOT and GPT)in serum blood patients compared with control group, the result demonstration is a significant increase in the mean concentration rate FGF23(324.06± 291.1pg/ml) in patients compared with mean concentration in control group was ( 273±188.5pg/ml), also the result showed a significant increase in the concentration of (phosphate, urea, creatinine, potassium, ALP) and a significant decrease had been shown in the concentration of (vitamin D, calcium, albumin, GOT and GPT enzymes). while the results had been showed a non-significant increase in chloride in patients compared with control group, Correlation coefficient of FGF23 with these clinical parameters showed a negative significant correlation with( phosphate, vitamin D, Albumin) while FGF23 elucidated a positive significant correlation with calcium while the result showed a non-significant correlation with rest of the biochemical parameters, conclusion of this study was that FGF23 concentration correlated significantly in hyperphosphatemia, decrease vitamin D and calcium in chronic kidney disease CKD.

Effect of renal function on the prognostic importance of chloride in patients with heart failure.

Hypochloremia has recently gained interest as a potential marker of outcomes in patients with heart failure (HF). The exact pathophysiologic mechanism linking hypochloremia to HF is unclear but is thought to be mediated by chloride-sensitive proteins and channels located in kidneys. This analysis aimed to understand whether renal dysfunction (RD) affects the association of hypochloremia with mortality in patients with HF. Using data from a nationwide registry, 438 cases with complete data on serum chloride concentration and 1-year survival were included in the analysis. Patients with an estimated glomerular filtration rate of <60 mL/min/m2 at baseline were accepted as having RD. Hypochloremia was defined as a chloride concentration <96 mEq/L at baseline. For HF patients without RD at baseline, patients with hypochloremia had a significantly higher 1-year all-cause mortality than those without hypochloremia (41.6% vs 13.0%, log-rank p < 0.001) and the association remained significant after multivariate adjustment (odds ratio (OR): 2.55, 95% confidence interval (CI): 1.25-5.21). The evidence supporting the association was very strong in this subgroup (Bayesian Factor (BF)10: 48.25, log OR: 1.56, 95% CI: 0.69-2.43). For patients with RD at baseline, there was no statistically significant difference for 1-year mortality for patients with or without hypochloremia (36.3% vs 29.7, log-rank p = 0.35) and there was no evidence to support an association between hypochloremia and mortality (BF10: 1.18, log OR :0.66, 95% CI: -0.02 to 1.35). In patients with HF, the association between low chloride concentration and mortality is limited to those without RD at baseline.

Results of a clinical study of the combination of flurbiprofen and cetylpyridinium chloride in patients with sore throat

To evaluate the efficacy and safety of a combined topical drug with flurbiprofen and cetylpyridinium chloride in patients with sore throat caused by upper respiratory tract infections. A prospective multicenter open randomized comparative study in parallel groups included 266 adult patients with an established diagnosis of acute pharyngitis or acute tonsillitis aged 18 to 60 years with the main complaint of sore throat caused by viral infections of the upper respiratory tract. The patients included in the study were randomized into two groups of 133 participants each: the 1st group included patients who received the combined agent flurbiprofen 8.75 mg and cetylpyridinium chloride 1.00 mg in the form of tablets for resorption, the 2nd group included patients who received cetylpyridinium chloride 1.2 mg in the form of medicinal lozenges. The effectiveness was evaluated on several scales (RADT, STPIS, TPA, STPR) reflecting subjective and objective indicators of the dynamics of the disease. The studied combination proved to be more effective than the monocomponent agent and was characterized by a more pronounced decrease in sore throat within 2 hours after taking the drug and a decrease in pharyngeal hyperemia. According to the results of the study, the use of a drug based on a combination of flurbiprofen and cetylpyridinium chloride was accompanied by a rapid and pronounced decrease in sore throat and pharyngeal hyperemia in patients with upper respiratory tract infections.

The effect of HES130/0.4 sodium chloride solution on kidney function following early fluid resuscitation in shock patients.

BackgroundDoctors often use a small dose of hydroxyethyl starch (HES) 130/0.4 sodium chloride solution in the emergency room; however, its effect on kidney function remains controversial. This study aimed to evaluate the effect of a small dose of HES130/0.4 sodium chloride solution on kidney function in shock patients during early fluid resuscitation.MethodsThis cohort study retrospectively analyzed the data of 129 shock patients requiring fluid resuscitation who had been admitted to the Emergency Department of the Affiliated Hospital of Nantong University from January 2019 to December 2020. Patients were divided into the observation group (n=40) and control group (n=89) according to the type of fluid resuscitation. In relation to the fluid resuscitation treatment, the observation group was treated with crystalloid solution, while the control group was treated with crystalloid and HES130/0.4 sodium chloride solution. To further explore the effect of a small dose of HES130/0.4 sodium chloride solution, the patients were further divided into the following 4 groups based on the specific fluid administered: (I) the HES(+), lactated Ringer’s (LR)(+) group (n=85); (II) the HES(+), LR(–) group (n=4); (III) the HES(–), LR(+) group (n=31); and (IV) the HES(–), LR(–) group (n=9). The outcomes were in-hospital mortality and changes in creatinine (CR) level after fluid resuscitation.ResultsThere were no significant differences in the in-hospital mortality rates between the observation and control groups (P=0.343). The CR levels of patients in the control and HES(+), LR(+) groups were reduced after fluid resuscitation (P=0.034; P=0.028). There was no significant change in patients’ CR levels in the HES(+), LR(–) group after fluid resuscitation (P=0.999).ConclusionsAdministering a small dose of HES 130/0.4 sodium chloride in patients with shock does not appear to affect kidney function and in-hospital mortality; however, these findings should be considered exploratory, and further studies should be conducted to confirm these results.

Rationale and validation of predicting high sodium intake by spot urinary chloride in patients with chronic kidney disease.

To analyze the rationale and evaluate the validity of spot urinary chloride or derived formulas to predict high sodium intake in patients with chronic kidney disease (CKD). We collected consecutive CKD patients at stages 1-4 who were admitted to our Nephrology department in a single center from January 01, 2014, to December 31, 2017, and tested spot and 24-hour urinary analysis on the same day. The feasibility of urinary chloride to predict urinary sodium was firstly analyzed by calculating their correlations. The validity of predicting excessive sodium intake by spot urinary sodium and chloride, two derived formulas based on spot urinary sodium or chloride, and our previous "CKDSALT" equation were accessed. We finally conducted Receiver operating characteristic (ROC) curves to compare their performance in detecting high sodium intake. All 5204 patients were eventually analyzed. In the derivation cohort (n=2447), a strong positive linear correlation existed between urinary sodium and chloride in both spot urine (R2=0.804) and 24-hour urine samples (R2=0.905), and two predictive equations based on spot urinary sodium or chloride were derived. In the validation cohort (n=2757), spot urinary sodium and chloride only showed "fair" performance. However, both urinary sodium and chloride equations had a "good" performance in ICC, Pearson's correlation, Bland-Altman plots, and ROC curves, while and CKDSALT equation showed the best performance. Spot urinary chloride is a feasible method to predict and monitor high sodium intake in CKD patients, while a novel derived formula could elevate its diagnostic accuracy.

Relationship between Admission Electrolyte Level and Short-term Prognosis of Patients with Acute ST-segment Elevation Myocardial Infarction after Percutaneous Coronary Intervention.

Objective The objective of this study is to analyze the relationship between the electrolyte level of patients with acute ST-segment elevation myocardial infarction (STEMI) and short-term prognosis after percutaneous coronary intervention (PCI). Methods The clinical data of 142 patients with acute STEMI who underwent PCI in our hospital from September 2018 to September 2019 were retrospectively analyzed. According to the level of serum sodium, potassium, and chloride in patients admitted to the hospital, they were divided into the normal electrolyte group (n = 78), the mild decline group (n = 46), and the severe decline group (n = 16). Univariate and logistic regression multivariate analysis of the relationship between patient electrolyte levels and general clinical data is performed. Statistical analysis of patients' adverse events within 90 days was performed. The Kaplan–Meier survival curve analyzed the relationship between the survival period and electrolyte levels in patients with acute STEMI without major acute cardiovascular events (MACE) within 90 days. Results The levels of creatine kinase-MB (CK-MB), cardiac troponin I (cTnI), myocardial infarction area, and Gensini score in patients with mild decline were significantly higher than those in the normal group, left ventricle ejection fractions (LVEF) value was significantly lower than the normal group, and patients with severe decline were significantly higher in creatine kinase (CK) level than the normal group (P < 0.05). The levels of CK-MB, CK, cTnI, and myocardial infarction area of the patients in the severe decline group were significantly higher than those in the mild decline group, and the LVEF values were significantly lower than those in the mild decline group (P < 0.05). The levels of CK-MB, CK, cTnI, the area of myocardial infarction, and Gensini score in patients with acute STEMI have an independent effect on their electrolyte levels. The patients in the mild decline group and severe decline group had significantly higher rates of cardiogenic shock, heart failure, ventricular aneurysm formation, ventricular septal perforation, or death within 90 days after PCI. The median without MACE survival time of patients with mildly and severely reduced electrolyte levels was significantly lower than that of patients with normal electrolyte levels. Conclusion Patients with acute STEMI are prone to electrolyte disturbances, and their CK-MB, CK, and cTnI levels; myocardial infarction area; and Gensini score have independent effects on electrolyte levels. Patients with electrolyte disturbances are prone to poor prognosis after PCI, and their survival period without MACE at 90 days is significantly lower than that of normal patients.

Altered Taste Perception for Sodium Chloride in Patients With Primary Aldosteronism: A Prospective Cohort Study.

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P1592HYPOCHLOREMIA AND INFLAMMATION: RELATIONSHIP BETWEEN SERUM CHLORIDE LEVELS AND NEUTROPHIL-TO-LYMPHOCYTE RATIO IN INCIDENT CHRONIC HEMODIALYSIS PATIENTS

Abstract Background and Aims Recently the role of chloride in patients with heart failure has been reevaluated. Some studies have linked it to higher mortality in these patients, being more important, even, than sodium. On the other hand, some authors have found a higher mortality in patients with low chloride levels and sepsis. The underlying mechanisms in both cases are unknown. Some authors attribute it to concomitance with metabolic alkalosis, however, this is not a reason that fully explains these findings. Neutrophil-to-Lymphocyte Ratio (NLR) is an emerging marker of inflammation comparable to established ones such as C-reactive protein, ferritin, etc. It is also a good biomarker of mortality in certain populations such as cancer, cardiovascular and renal. Patients with chronic kidney disease on hemodialysis have high cardiovascular comorbidity and a high rate of inflammation. However, there are no studies that correlate chloride levels to inflammation markers, such as NLR, in this population. Therefore, the aim of our study was to determine if there is a relationship between chloride and NLR in our population of patients on chronic hemodialysis. Method Restrospective cohort study. We analyzed the values of chloride and NLR of 396 incident patients on hemodialysis over a period of 3 years (between 2016 and 2019). The patients were divided into three groups, depending on the levels of chloride (tertiles): (1: &amp;lt;100, 2: 100.1-103, 3&amp;gt; 103.1 mEq / l). In each group the average of NLR was calculated. Results The mean age in our sample was 64.73 ± 0.57 years, 39.7% were women (N = 157). The average of NLR was 3.84 ± 2.65 and chloride was 101.03 ± 3.91. We found that patients in the lower chloride level tertile were associated with a higher NLR levels (p &amp;lt;0.012). (Figure 1) Conclusion Incident hemodialysis patients with lower chloride levels had higher NLR values. These findings suggest a greater tendency to inflammation in these patients.

Alpha-therapy using radium-223 chloride in patients with castration-resistant prostate cancer. From clinical researches to routine practice

Castration-resistant prostate cancer (CRPC) has a very negative prognosis. The average life expectancy even using modern treatment methods is 1.5–2 years. When the majority of CRPC patients show signs of resistance to therapy aimed at lowering testosterone levels, distant metastases are often determined in the bones. Bone metastases in CRPC patients often worsen life quality due to pain and risk of bone complications, such as pathological fractures and spinal cord compression. Not all treatment regimens to increase their life expectancy patients are effective. Radiopharmacy using alpha-emitting radium-223 chloride is not only one of the methods of palliative treatment, but also one of the most promising therapies that increase life expectancy of these heavy patients. Results of large randomized trials showed that alpha-therapy with radium-223 chloride leads to a significant increase of the overall life expectancy, and significantly improve the patients’ life quality. The article presents literature review as well as the analysis of the results of large randomized trials, which assess the effectiveness of the therapy in CGRG patients, and a clinical case of its use in real clinical practice.

Serum electrolytes in patients with senile cataract

Background: Senile cataract, the world’s leading cause of treatable blindness, is an age-related, vision-impairing disease characterized by gradual progressive thickening of the lens. Disturbance in the concentration of serum electrolytes plays a very important role in the etiopathogenesis of senile cataract. Aims and Objectives: This study aims to study and compare the level of serum sodium, potassium, and chloride in patients with senile cataract and in controls. Materials and Methods: A cross-sectional comparative study was conducted in 100 subjects aged between 50 and 80 years, which include 50 senile cataract patients and 50 healthy controls. The Statistical Package for the Social Sciences version 18 was used for statistical analysis. Results: The mean values of serum sodium and chloride were significantly elevated in senile cataract patients when compared to controls. There was no significant difference in mean potassium level between the two groups. Conclusion: Disturbances in the concentration of serum electrolytes can alter their concentration in aqueous humor, which might exceed the capacity of pumps and channels present in the lens membrane, resulting in volume overload and lens opacities. Therefore, the level of serum sodium and chloride can be used as markers of senile cataract formation. Dietary salt restriction can help to delay the progress of cataract formation.

Effects of intubation with a double-lumen endotracheal tube on intraocular pressure during rapid sequence induction using succinylcholine chloride in patients with or without underlying systemic hypertension.

BackgroundTracheal intubation is closely associated with increases in intraocular pressure (IOP); however, the effects of double-lumen tube (DLT) intubation on IOP have not been validated. Systemic hypertension (HTN) is another factor that may increase IOP. In this study, we observed differences in IOP increases between DLT and singlelumen tube (SLT) intubation, and evaluated the influence of underlying HTN during rapid sequence induction.MethodsSixty-eight patients were allocated into one of the following group: SLT/without HTN (n = 17), SLT/HTN (n = 17), DLT/without HTN (n = 17), and DLT/HTN (n = 17). An SLT was inserted for orthopedic or gynecological surgery, and a DLT was inserted for lung surgery after rapid sequence induction using succinylcholine. IOP was measured before anesthetic induction and until 10 min after intubation using a handheld tonometer (Tono-Pen AVIA®).ResultsIn the DLT/without HTN and DLT/HTN groups, the maximum increases in IOPs after tracheal intubation were 7.9 and 12.2 mmHg, respectively, compared to baseline. In the SLT/without HTN and SLT/HTN groups, the maximum increases were 5.0 and 4.9 mmHg, respectively, compared to baseline. In comparisons between patients with and without underlying HTN, the values of IOPs were comparable.ConclusionsTracheal intubation with a DLT is associated with more increases in IOPs than with an SLT in rapid sequence induction. Well-controlled underlying hypertension did not increase IOP during tracheal intubation.

Serum Potassium, Sodium, and Chloride Levels in Sickle Cell Disease Patients and Healthy Controls: A Case-Control Study at Korle-Bu Teaching Hospital, Accra.

The activity of Na+-K+ ATPase is altered in sickle cell disease (SCD), which affects serum electrolyte levels. This alteration is associated with several complications in sickle cell patients. This study evaluated the serum levels of sodium, potassium, and chloride in patients with SCD. The study was a case-control cross-sectional study involving 120 SCD patients in the steady state and 48 ‘healthy’ controls. The SCD patients were made up of 69 HbSS patients and 41 HbSC patients. Serum electrolyte levels (Na+, K+, and Cl−) were measured using a Flame Atomic Absorption Spectrometer (Variant 240FS; Varian Australia Pty Ltd). Serum sodium levels were significantly lower in the sickle cell patients, compared with their ‘healthy’ counterparts (P = .0001). Although the study found significantly higher serum levels of potassium in the SCD patients (P = .0001), there was no significant difference in serum chloride levels between patients with SCD and the controls (P = .098). Serum sodium and chloride levels were not significantly different in both HbSS and HbSC patients (P = .197 and P = .553, respectively). The level of serum potassium in the HbSS patients was, however, significantly higher compared with those with the HbSC genotype (P = .0001). There is higher efflux of K+ from the intracellular into the extracellular space in HbSS patients, which may lead to red cell membrane dysfunction and associated complications.

Low serum chloride in patients with chronic heart failure: clinical associations and prognostic significance.

Low serum chloride is common in patients with chronic heart failure (CHF) and is associated with worse outcomes. We investigated the clinical and prognostic associations, including cause of death associations, of low serum chloride in patients referred to a secondary care clinic with suspected heart failure. Patients with echocardiogram and serum chloride were evaluated (n = 5613). CHF was defined as signs and symptoms of the disease and either left ventricular systolic dysfunction (LVSD) worse than mild [heart failure with reduced ejection fraction (HFrEF)] or LVSD mild or better and raised amino-terminal pro-B-type natriuretic peptide (NT-proBNP) levels (>125 ng/L) [heart failure with preserved ejection fraction (HFpEF)]. Hypochloraemia was defined as greater than two standard deviations below the mean in the local normal distribution (<96 mmol/L). Of the 5613 patients referred, 908 patients did not have CHF, 1988 had HFrEF, and 2717 had HFpEF. Compared to patients in the fourth quartile (median chloride 106 mmol/L), patients in the first quartile (median chloride 96 mmol/L) had more severe symptoms (38% New York Heart Association class III or IV vs. 25%, P < 0.001) and were more likely to take loop diuretics (79% vs. 55%, P < 0.001). The annual mortality rate for patients with CHF was 11%. Hypochloraemia was associated with an increased risk of death independent of NT-proBNP. Patients in the first quartile had a two-fold increased risk of death compared to patients in the fourth quartile (P < 0.001). Sudden death was a common mode of death amongst patients with hypochloraemia. Hypochloraemia is strongly related to an adverse prognosis and may be a therapeutic target in patients with CHF.

Serum chloride as a novel marker for adding prognostic information of mortality in chronic heart failure

BackgroundSerum chloride concentrations have clinical significance in the prognosis of heart failure (HF). Little is known regarding the prognostic value of serum chloride in patients with chronic heart failure (CHF). This study sought to investigate the prognostic ability of admission serum chloride for long-term mortality in CHF patients. MethodsWe identified 1021 consecutive patients diagnosed with CHF. Participants were followed up for all-cause mortality at 21 ± 9 months to establish the survival models and analyze the association between admission serum chloride concentrations and death risk. ResultsOf the 1021 patients, 905(88.6%) available cases were obtained. Admission serum chloride concentrations of patients were independently and inversely associated with long-term mortality (hazard ratio [HR]: 0.890; 95% CI: 0.863 to 0.918; p < 0.001). After multivariable risk adjustment for age, male sex, history of diabetes, LVEF, loop diuretic use, beta-blocker use, ACEI or ARB use, eGFR and NT-proBNP, chloride concentrations remained independently associated with mortality (HR:0.922; 95% CI:0.887 to 0.958; p < 0.001) but not independent of sodium concentrations (HR: 0.953; 95% CI: 0.900 to 1.009; p = 0.095). The optimal cut-off value of chloride concentrations predicting death was 102.8 mmol/l with an area under the curve (AUC) value of 0.686 (95% CI: 0.635 to 0.737; p < 0.001), with a sensitivity of 62% and specificity of 70%. The lower chloride concentrations could significantly increase the risk ratio of CHF patients in the setting of hyponatremia (p < 0.001). The cumulative survival estimates significantly differed across Na/Cl quartiles (log-rank χ2 19.14, p < 0.001), with higher mortality for higher Na/Cl ratio. Correlation analysis showed a positive correlation between serum chloride concentrations and sodium concentrations (r = 0.598; p < 0.001). An increased AUC was observed by combining chloride and sodium (AUC = 0.704, 95% CI:0.655–0.754, p < 0.001) compared to sodium only (AUC = 0.689, 95% CI:0.639–0.739, p < 0.001). ConclusionsIn a Chinese Han population, admission serum chloride concentrations are inversely associated with all-cause mortality of CHF patients and provide incremental prognostic information of serum sodium.

Urinary incontinence. Methods of treatment

Urinary incontinence is a serious social and medical problem in Russia and throughout the world. However, even a small percentage of women who purposefully go to the doctor about having incontinence symptoms, only 2% of patients receiving the qualified urological aid. Medical therapy is used as the primary method for all patients with an overactive bladder. As the drugs of choice, the use of M-cholinolytics affecting muscarinic receptors of the bladder is recommended. The article presents data indicating the possibility of using trospium chloride in patients of different age categories. Objective - to determine the effectiveness of the use of M-cholinolytic drug (trospium chloride) in women of different age categories. Material and methods. The study included 68 patients with symptoms of a hyperactive bladder, which, depending on their age, were divided into 2 groups. All patients received trospium chloride (Spasmex) for 6 months. Results. After 3 and 6 months of the use of trospium chloride in patients of both groups, the complaints decreased significantly. Attention is drawn to the fact that the decrease in the number of complaints during the treatment significantly decreased more in the first three months. In women of the reproductive period, the results are more significant than in postmenopausal patients, which can be explained by the presence of hypoestrogenic condition in patients of the 2nd group, which can make the pathology worse and require the appointment of etiopathogenetic treatment. Conclusion. Trospium chloride can be recommended to patients reproductive and postmenopausal periods for relief of symptoms of overactive bladder with the contraindications. In postmenopausal women, in addition to taking trospium chloride, the need to prescribe menopausal hormone therapy (systemic, local) should be considered to compensate for the deficiency of estrogen. In the presence of prolapse of the genitals and stress component of urinary incontinence, it is necessary to resolve the issue of the need for timely surgical treatment aimed at coping with stress urinary incontinence and correction of prolapse of the genitals.

Meta-Analysis of Individual Patient Data of Sodium Bicarbonate and Sodium Chloride for All-Cause Mortality After Coronary Angiography

We sought to examine the relation between sodium bicarbonate prophylaxis for contrast-associated nephropathy (CAN) and mortality. We conducted an individual patient data meta-analysis from multiple randomized controlled trials. We obtained individual patient data sets for 7 of 10 eligible trials (2,292 of 2,764 participants). For the remaining 3 trials, time-to-event data were imputed based on follow-up periods described in their original reports. We included all trials that compared periprocedural intravenous sodium bicarbonate to periprocedural intravenous sodium chloride in patients undergoing coronary angiography or other intra-arterial interventions. Included trials were determined by consensus according to predefined eligibility criteria. The primary outcome was all-cause mortality hazard, defined as time from randomization to death. In 10 trials with a total of 2,764 participants, sodium bicarbonate was associated with lower mortality hazard than sodium chloride at 1year (hazard ratio 0.61, 95% confidence interval [CI] 0.41 to 0.89, p=0.011). Although periprocedural sodium bicarbonate was associated with a reduction in the incidence of CAN (relative risk 0.75, 95% CI 0.62 to 0.91, p= 0.003), there exists a statistically significant interaction between the effect on mortality and the occurrence of CAN (hazard ratio 5.65, 95% CI 3.58 to 8.92, p <0.001) for up to 1-year mortality. Periprocedural intravenous sodium bicarbonate seems to be associated with a reduction in long-term mortality in patients undergoing coronary angiography or other intra-arterial interventions.

Antitussive effect of carcainium chloride in patients with chronic cough and idiopathic interstitial pneumonias: A pilot study

BackgroundCough is a common presenting symptom in patients with idiopathic interstitial pneumonia (IIP); it is often disabling, and lacks effective treatment. Studies in animals suggest that carcainium chloride, a quaternary derivative of the local anesthetic lidocaine, is able to inhibit experimentally induced cough by a mechanism of action distinct from that of lidocaine. ObjectiveTo determine the effectiveness of aerosolised carcainium chloride (VRP700) in controlling cough in patients with IIP. MethodsEight female patients (mean age 71 years) with IIP were investigated in a double blind, randomised, placebo controlled crossover, adaptive contingency study design (EudraCT Number 2010-021350-19). The study consisted of a screening visit to assess the eligibility of patients, and two separated (48–72 h) study days. On the two study days, patients were randomised to receive either nebulized VRP700 (1.0 mg/kg) on the first study visit followed by nebulised placebo (sodium chloride 0.9%) on the second visit, or placebo on the first visit followed by VRP700 on the second visit. The primary endpoint was cough frequency over a 4-h assessment period; secondary endpoints were subjective cough-related level of discomfort as assessed by a visual analogue scale (VAS) and the subjective response to treatment as assessed by a quality of life question. Safety (ECG, spirometry, urine and blood tests) and adverse events occurring during the trial were also investigated. ResultsIn all patients both VRP700 and placebo decreased cough frequency; however, mean decreases in cough frequency after treatment with VRP700 were significantly (P < 0.001) higher than with placebo. Similarly, mean reductions in VAS score were significantly (P < 0.001) higher after treatment with VRP 700 compared with placebo. All but one patient indicated that they felt better after receiving VRP700. No adverse events were reported during the study, nor were any changes in ECG variables, spirometry, urine and blood tests noted. ConclusionThe results of this exploratory study indicate that nebulised VRP700 improved cough and quality of life in hospitalised IIP patients with no significant side effects. A larger trial is warranted to assess these promising results.

Effects of potassium citrate or potassium chloride in patients with combined glucose intolerance: A placebo-controlled pilot study

BackgroundExperimental K+ depletion reversibly inhibits insulin secretion, while chronic metabolic acidosis decreases insulin sensitivity. We aimed to investigate the effects of potassium supplementation and alkali supplementation in non-acidotic, normokalemic humans with combined glucose intolerance. Study design and resultsIn this double-blind, placebo-controlled study in 11 subjects (7 male, 4 female, ages 47–63 years), 90meqs of oral KCl or Kcitrate per day for 2weeks each increased insulin production as measured by homeostasis model assessment Beta [KCl=86 (CI 81–91), Kcitrate=88 (82–94), placebo=78 (73–83)%, p<0.04], but only Kcitrate attenuated insulin resistance as assessed by HOMA-IR (insulin resistance, Kcitrate=2.8 (2.5–3.1), placebo=3.2 (2.9–3.5), p<0.03) and only Kcitrate increased quantitative insulin sensitivity check index (Quicki, Kcitrate=0.355 (0.305–0.405), placebo=0.320 (0.265–0.375) p<0.04). These results were confirmed by independent measurements, i.e. HOMA C-peptide and whole body insulin sensitivity index measured during oral glucose tolerance testing. Kcitrate significantly decreased systolic and diastolic 24-hour ambulatory blood pressures (−4.0 (−3 to −5) and −2.7 (−1.9 to −3.5), respectively as compared to placebo, p<0.02) while KCl was without a significant effect. ConclusionsK+ supplementation in the absence of overt K+ depletion improves beta-cell function in subjects with combined glucose intolerance. The insulin-sensitizing and hypotensive effect, however, depend on citrate as the accompanying anion.