Decrease In Serum Potassium Research Articles

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.

Efficacy and safety analysis of sodium zirconium cyclosilicate and calcium polystyrene sulfonate on rapid reduction of potassium in moderate to severe hyperkalemia patients with chronic kidney disease without dialysis.

Hyperkalemia is a common complication of chronic kidney disease (CKD). This study aims to investigate the efficacy and safety of sodium zirconium cyclosilicate and calcium polystyrene sulfonate in reducing potassium in patients with acute and severe hyperkalemia in CKD who are not undergoing dialysis. A retrospective real-world study was conducted among 73 patients with non-dialysis chronic kidney disease who were hospitalized in the First Affiliated Hospital of Chengdu Medical College from June 2020 to June 2022. 33 patients treated with sodium zirconium cyclosilicate were categorized as SZC group, and the other 40 patients treated with calcium polystyrene sulfonate were categorized as CPS group. Serum potassium, serum sodium, magnesium, calcium, and phosphorus levels were examined. Adverse reactions were recorded during medication. Significantly decreased serum potassium was observed in both groups, whereas the potassium reduction was higher in the SZC group than in the CPS group at 2, 4, 24, and 48 hours after medication while there was no statistically significant difference in the serum potassium level between the two groups at 72 hours. For those people whose initial potassium exceeded 6 mmol/L, the potassium reduction was more obvious in the SZC group than in the CPS group at 2 and 4 hours after medication. The control rate of hyperkalemia in the SZC group was significantly higher than in the CPS group at 4, 24, and 48 hours. No distinct change was observed in serum sodium, calcium, magnesium, and phosphorus before and 72 hours after medication. No severe adverse reactions occurred. Sodium zirconium cyclosilicate has a more obvious effect on reducing potassium particularly for those patients with moderate to severe hyperkalemia who need rapid potassium reduction.

The Effect of Renastart Formula Supplementation in Serum Electrolytes in Children with Acute Kidney Injury

Abstract Background patients of renal disease suffer from electrolyte disturbances including hyperkalemia, hyperphosphatemia, hyponatremia, hypocalcemia and hypermagnesemia. Unfortunately, patients with kidney disease require close monitoring for serum electrolytes to maintain normal levels; with traditional nutritional interventions they may need receiving potassium and phosphorus binders Aim: This study will concentrate on the effect and tolerability of Renastart formula supplementation on correction and maintaining serum levels of electrolytes in AKI or AKI on top of CKD pediatric patients. Methods Double arm clinical convenient trial, conducted in Pediatric Nephrology Unit,Ain Shams University, Cairo, Egypt, where 24 participants who had AKI or AKI on top of CKD with hyperphosphatemia and / or hyperkalemia were recruited, the mean of age of participants was 4.1±3.15 years ranged from 0.5 to 10 years. Subjects were divided into two groups, 12 patients per group (group A received a calcium carbonate (phosphorus binder) (9 patients) with dosage 45-65 mg/kg/day orally alone or withsodium polystyrene sulfonate (potassium binder) (11 patients) with dosage 0.5-1mg/kg/day oral and group B received Renastart formula supplemented with breast milk, standard infant formula or diet), the dosage ratio was adjusted to be 1:3 (Renastart was 1/4 daily caloric intake) if serum potassium level ≥5.5 - <6 meq/L and / or serum phosphorus > 7mg/dl. But, if potassium level was ≥ 6 meq/L, the ratio was 1:1 (Renastart was ½ daily caloric intake). Readjusting dosage ratio was according to serum electrolyte levels response for treatment. Follow up of serum levels of potassium was every day until its serum level returned to normal then every month for three months and serum phosphorus was every month for three consecutive months. Results All the included subjects in both groups had high serum potassium (> 5.5 meq/L) and / or high serum phosphorus (>7 mg/dl) upon enrollment, mean serum potassium and serum phosphorus were (5.7±0.41 meq/L) (7.2±1.6 mg/dl) respectively. Regarding the decrease of serum potassium, Renastart formula supplementation in group B and potassium binders in group A resulted in equal decrease in serum potassium levels; Potassium after 3 months of management in group B was (4.22±0.28 mEq/L) (p value between 3rd month- baseline month in group B p < 0.01) and potassium binders in group A (4.48±0.27 mEq/L) (p value between 3rd month – baseline month in group A p < 0.01). Renastart formula in group B ((potassium after 1 month of management = 4.7±0.32 meq/L) (p value between 1st month – baseline month in group B p < 0.01)) had more rapid effect than potassium binders in group A during 1st month of the study ((potassium after 1 month of management =5.1±0.41 meq/L) (p value between 1st month – baseline month in group A p > 0.05). Regarding decrease in serum phosphorus, Renastart formula supplementation in group B resulted in more decrease in serum phosphorus levels though both showed significant drop in phosphorus level (( serum phosphorus after 3 months of management = 4.60±0.29 mg/dl (p value between 3rd month – baseline month in group B p = 0.002)) in comparison to that achieved by phosphorus binders in group A ((5.21±0.29mg/dl) (p value between 3rd month – baseline month in group A p = 0.01)), moreover Renastart supplementation in group B was more rapid than phosphorus binders in group A in decrease serum phosphorus (p value between 1st month and baseline in group B p = 0.002) (p value between 1st month and baseline in group A p = 0.17) Conclusion We can conclude that Renastart formula supplementation was more rapid than potassium binders in decreasing serum potassium levels in AKI pediatric patients, moreover more effective and rapid than phosphorus binders in decreasing serum phosphorus.

Diuretic Use and Serum Phosphate: Rotterdam Study and UK Biobank.

Hypophosphatemia (serum phosphate < 0.80 mmol/L) leads to musculoskeletal complaints. The most common drugs linked to hypophosphatemia are thiazide and loop diuretics, but studies in the general population are lacking. Our aim was to study associations between diuretic use and serum phosphate in the Rotterdam Study (RS), a population-based cohort study, with replication in UK Biobank (UKBB). Associations between thiazide and loop diuretic use and serum phosphate and odds of hypophosphatemia were analyzed with cross-sectional multivariate linear and logistic regression in participants without chronic kidney disease in the RS and UKBB. Analyses were adjusted for age, sex, and body mass index (BMI) and pooled in 3 RS cohorts with further adjustment for cohort and serum potassium, which was not available in UKBB. Thiazide diuretics were associated with lower serum phosphate in both sexes. This association lost significance in RS females after adjustment for BMI and in males after adjustment for serum potassium. Thiazide diuretics increased odds of hypophosphatemia in females in both cohorts and in males in UKBB only. Loop diuretics were associated with lower serum phosphate in females but not males. Adjustment for BMI attenuated these associations. Associations between loop diuretics and increased odds of hypophosphatemia in females lost significance after BMI adjustment. Thiazides, but not loop diuretics, and increased BMI and decreased serum potassium should be considered as contributing factors in subjects with hypophosphatemia. Further studies are needed to replicate the findings and elucidate the potential role of hypokalemia as a mediator of this effect.

Phase II Clinical Trial of R-CHOP Combined with Lenalidomide in the First-Line Treatment for Patients with High Risk Diffuse Large B Cell Lymphoma

Introduction: Diffuse large B cell lymphoma (DLBCL) is the most common type of non-Hodgkin's lymphoma (NHL). Currently, R-CHOP (Rituximab-Cyclophosphamide, Epirubicin, Vincristine and Prednisone) is world-widely used in the first-line treatment for DLBCL, producing a long-term survival rate of approximately 60%. The unmet need is focused on high-risk DLBCL patients, having high International Prognostic Index (IPI) scores, non-germinal center-like B cell (non-GCB) origin, double expression of MYC and BCL2 protein, or TP53 aberrations. Lenalidomide is an active agent in the activated B cell-like (ABC) subtype of DLBCL by increasing interferon-stimulated gene transcription and activation of immunomodulatory mechanisms. At present, it has been approved for the treatment of multiple myeloma with good efficacy and safety. This is a prospective single arm, multi-center, phase II clinical trial and the goal of our trial is to assess the efficacy and safety of R-CHOP combined with lenalidomide in the first-line treatment for patients with high risk diffuse large B cell lymphoma. Methods: We did an investigator-initiated, open-label, phase 2 trial at the Affiliated Cancer Hospital of Zhengzhou University in China. Patients were eligible if they were aged over 18 years, had histologically confirmed DLBCL. The key inclusion criteria included untreated and medium to high /high risk DLBCL (International Prognostic Index (IPI) score 3-5, aaIPI score 2-3 or NCCN-IPI score≥ 4/ Immunohistochemical staining of double expression (BCL2 ≥ 50% and C-MYC ≥ 40%) or P53 protein mutation positive ≥ 50%). Participants in RL-CHOP cohort were given Lenalidomide orally 25 mg per day on days 1 through 10 of each cycle and delivered concomitantly with standard dose R-CHOP-21 chemotherapy. We also set another group treated with conventional R-CHOP-21 used as a matched contemporary cohort. The primary clinical endpoint was 2-year progression-free survival (PFS). The secondary efficacy endpoints were objective response rate (ORR), 2-year overall survival (OS) and safety. This trial is registered with ClinicalTrials.gov, number NCT04214626. Results: Between December 2019 and January 2023, 63 patients with untreated DLBCL enrolled and were evaluable in the investigator-initiated phase II study. The median age was 59 years (range: 25-76 years); 49.2% of patients were older than age 60 years. 46 of 63 patients (73.02%) had a ECOG score of 0-1; 43 of 63 patients (68.25%) had stage III-IV disease, and 33 of 63 patients (52.38%) had ≥2 extranodal localizations. The IPI score was high-intermediate and high in 73.02% (46/63) of patients. 51 of 63 patients (80.95%) were non-GCB subtype; 25 of 63 patients (39.68%) were double expressor. The TP53 protein was positive in 34.55% (19/55) of patients. In RL-CHOP cohort, the complete response rate was 80.95%, with overall response rate achieving 100%. The median follow-up time was 18.25 (3.73-42) months, median PFS and OS were not reached, and 2-year PFS and OS was 71.1% (+-6.7) and 87.4% (+-4.5), respectively. Comparing with historical matched contemporary cohort, the 2-year PFS and OS rates were improved for medium to high /high risk DLBCL. The most common adverse events of treatment were hematologic toxicities. Grade 3/4 AEs occurred in ≥20% patients were neutropenia, leukopenia, anemia, thrombocytopenia and decreased serum potassium, without bleeding complications. No grade 4 non-hematological adverse event was reported. Conclusion: RL-CHOP is effective and safe in patients with newly diagnosed DLBCL with high risk. Relevance of molecular biomarkers on RL-CHOP response warrants further investigation in DLBCL.

Effect of standardized Eucalyptus globulus leaf extract on brain oxidative stress and aberrant neurochemistry of fructose-streptozotocin-induced diabetic rats.

The neuro-pharmacological effect of Eucalyptus globulus ethanol leaf extract in fructose-streptozotocin-induced diabetic rats was evaluated in this study. The phytochemical analysis of the extract was carried out using HPLC-DAD. Diabetes was induced in rats with 10% fructose in drinking water and a single intraperitoneal injection of 40 mg/kg streptozotocin (STZ). Diabetic animals were orally treated with 100-400 mg/kg of the extract for 21 days with glibenclamide as the reference drug. Blood and brain tissue were processed for the determination of serum electrolyte levels, hematological indices, and biochemical estimations. Ergosterol, pinitol, catechin, quercetin, robinetinidol, and other polyphenols were identified in the extract. Diabetic animals showed decreased serum potassium and sodium ion levels and decreased hematocrit, hemoglobin, red blood cells, white blood cells and lymphocytes but increased neutrophils. The brains of animals in the untreated diabetic group with increased blood glucose level showed oxidative stress (increased level of MDA and myeloperoxidase but decreased level of reduced glutathione and superoxide dismutase) and disturbed neurochemistry (increased level of acetylcholinesterase and monoamine oxidase but decreased level of Na+K+ATPase, tyrosine hydroxylase and dopamine). Administration of the Eucalyptus globulus leaf extract remarkably ameliorated the observed hyperglycemia, electrolyte, and hematological imbalances in animals. In addition, the administration of the extract attenuated the brain redox imbalance, and neurochemical disturbances in the rats. These results show that Eucalyptus globulus leaves contain antioxidant and neurotransmitter modulating phytochemicals with the potential to be developed as therapeutic agents for the management of diabetic cerebrovascular problems and related complications.

Effects of Psidium guajava and Ribes americanum Aqueous Extracts and Dietary Modification on some Markers of Renal, Cardiac Dysfunction in Rats

The effect of aqueous extract of P. guajava and R. americanum and dietary modification interactions on serum renal function markers levels (urea, creatinine) cardiac function markers (lactate dehydrogenase, creatinine kinase), serum ions (calcium, sodium, and potassium ions) were investigated in rats. Fully grown Wister strain rats were exposed to high fat and salted diet formulation and treated with the aqueous extract for a period of 6 weeks. The diets were formulated by adding 25% animal fat and 5% palm oil to standard feeds (Vital feeds, Bukuru Jos, Plateau. Significant decrease in serum urea, creatinine, and lactate dehydrogenase and creatine kinase activities in the group treated with P. guajava and R. americanum aqueous extract compared to the high fat-salted water group. There was no significant difference in plasma urea and Creatinine, LDH and CK levels between the standard feeds and standard feed plus salted water group. Significant increase in the plasma Creatinine and lactate dehydrogenase levels (at p&lt;0.05) of the high-fat plus salted water group when compared with the high fat group. Significant (at p&lt;0.05) increase in serum sodium of the group exposed to salted water when compared with the non-salted water group. There was a significant (p&lt;0.05) decrease in serum sodium levels of extract administered groups compared to the high fat-salted water and standard feed salted water groups. There was also a significant increase, at p&lt;0.05, in serum potassium and calcium of the extracts administered group when compared with the standard feed salted water, high fat and high fat salted water groups. The study showed that the combined effects of high fat and high salt increased serum sodium and decreased serum potassium and calcium. Administration of the aqueous extract administration reversed by the effects

ODP526 Thyrotoxic Periodic Paralysis in Graves’ Disease: A rare presentation in an African American male

Abstract INTRODUCTION: Thyrotoxic Periodic Paralysis is a rare but life-threatening manifestation of hyperthyroidism characterized by hypokalemia, acute flaccid paralysis, and signs of hyperthyroidism. Despite being commonly seen in East Asian males, TPP has been increasingly reported in other parts of the world including western countries. Early recognition and prompt treatment of TPP is essential in preventing its grave and potentially life-threatening consequences. CASE PRESENTATIONA 21-year-old African American male patient with past medical history significant for hypertension and untreated hyperthyroidism presented to the emergency department with sudden onset bilateral lower extremity weakness and difficulty walking for one day. Upon arrival to the emergency department, vitals were unremarkable. On examination, patient had a decreased muscle tone in bilateral lower extremities with depressed deep tendon reflexes. The thyroid gland was diffusely enlarged. The remainder of physical exam was normal. Electrolyte abnormalities were also present with decreased serum potassium level of 1.2 mEq/L (3.6-5.1 mEq/L) and magnesium of 1.7 mg/dL (1.8-2.5 mg/dL). A low TSH level of &amp;lt;0. 010 mIU/mL (0.350-4.940 mIU/mL) with elevated free T4 levels of 4.30 ng/dL (0.70-1.48 ng/dL) were noted. CT Head/ Brain without contrast and Chest X ray were unremarkable. Potassium replacement was initiated with oral and intravenous potassium chloride. He was also started on oral atenolol (25 mg daily) and methimazole (10 mg daily). The patient's symptoms resolved in few hours after the treatment was started. An ultrasound of the thyroid gland showed diffuse heterogeneity of the gland most consistent with thyroiditis or similar abnormality. No definite focal abnormalities were noted. TSH receptor antibodies were also elevated with levels at 10.70 IU/L (≤1.75 IU/L) making Graves’ disease the most likely diagnosis. The patient's condition significantly improved along his hospitalization with complete resolution of symptoms and electrolyte abnormalities. He was subsequently discharged on atenolol and methimazole with outpatient follow up at the endocrinology clinic. DISCUSSION TPP is an underreported yet possibly fatal medical complication of hyperthyroidism. Prevalence is higher in Asia, however, incidence in Western countries has been increasing. While the underlying pathophysiology is poorly understood, h ypokalemia in TPP results from an intracellular shift of potassium induced by an increased adrenergic sensitization of Na + /K + –ATPase pump. Genetic and environmental factors may possibly play a role. Treatment of TPP entails beta-blockade to prevent intracellular shift of potassium, replenishing potassium stores, as well as correcting the underlying hyperthyroid state. Immediate diagnosis and initiation of treatment prevents serious cardiopulmonary complications and increases the probability of full recovery of muscle weakness. Presentation: No date and time listed

Optimizing Therapies in Heart Failure: The Role of Potassium Binders.

Heart failure (HF) is a worrisome cardiac pandemic with a negative prognostic impact on the overall survival of individuals. International guidelines recommend up-titration of standardized therapies in order to reduce symptoms, hospitalization rates, and cardiac death. Hyperkalemia (HK) has been identified in 3–18% of HF patients from randomized controlled trials and over 25% of HF patients in the “real world” setting. Pharmacological treatments and/or cardio-renal syndrome, as well as chronic kidney disease may be responsible for HK in HF patients. These conditions can prevent the upgrade of pharmacological treatments, thus, negatively impacting on the overall prognosis of patients. Potassium binders may be the best option in patients with HK in order to reduce serum concentrations of K+ and to promote correct upgrades of therapies. In addition to the well-established use of sodium polystyrene sulfonate (SPS), two novel drugs have been recently introduced: sodium zirconium cyclosilicate (SZC) and patiromer. SZC and patiromer are gaining a central role for the treatment of chronic HK. SZC has been shown to reduce K+ levels within 48 h, with guaranteed maintenance of normokalemia for up to12 months. Patiromer has resulted in a statistically significant decrease in serum potassium for up to 52 weeks. Therefore, long-term results seemed to positively promote the implementation of these compounds in clinical practice due to their low rate side effects. The aim of this narrative review is to delineate the impact of new potassium binders in the treatment of patients with HF by providing a critical reappraisal for daily application of novel therapies for hyperkalemia in the HF setting.

Plasma aldosterone concentration is associated with white matter lesions in patients with primary aldosteronism.

Primary aldosteronism (PA) is the most frequent form of secondary hypertension. Hypertension is a risk factor for cognitive decline and dementia. White matter lesions (WMLs) are linked to vascular risk factors, which increase the risk of dementia. We aimed to analyze the association of PA-related parameters and WMLs in patients with PA. We conducted a retrospective analysis of all patients with PA in the Hypertension Center of the People's Hospital of Xinjiang Uygur Autonomous Region from January 1, 2011 to April 1, 2021. We analyzed the relationship between plasma aldosterone concentration (PAC), plasma renin activity (PRA), aldosterone-renin ratio (ARR), serum potassium, and WMLs. We enrolled 138 patients with WMLs and matched these to controls without WMLs at a 1:4 ratio. Among the analytic sample (N = 711) with ages ranging from 30 to 64 years, 69% were male. In the logistic regression analysis, PAC, PRA and serum potassium were treated as continuous variables. The results showed that PAC (OR 1.04, 95% CI 1.01, 1.06, P = 0.008) was positively associated with the risk of WMLs, and serum potassium (OR 0.26, 95% CI 0.16, 0.44, P < 0.001) was inversely associated with the risk of WMLs. PRA (OR 0.86, 95% CI 0.68, 1.08, P = 0.384) was not associated with the risk of WMLs after adjusting for confounders. The results of restricted cubic splines showed the dose-response association between increasing PAC, ARR, decreasing serum potassium, and the risk of WMLs. We also divided PAC, ARR and serum potassium into two groups according to the result of restricted cubic splines. After adjusting for confounders, patients who were in Q2 (≥23.12 ng/dl) of PAC (OR 2.07, 95% CI 1.36, 3.15), Q2 (≥56.81 (ng/dl per ng/ml*h) of ARR (OR 1.82, 95% CI 1.22, 2.72) and Q2 (≤3.58 mmol/l) of serum potassium (OR 2.99, 95% CI 1.95, 4.50) had a significantly higher risk of WMLs than their counterparts. In stratified analyses, there was no evidence of subgroup heterogeneity regarding the change in the risk of WMLs (P > 0.05 for interaction for all). Our results suggested that the PAC and serum potassium were related to the risk of WMLs in patients with PA. In particular, PAC ≥23.12 ng/dl significantly increased the risk of WMLs in patients with PA.

Effects of Dried Aloe Vera Gel and Diclofenac on Sodium and Potassium Homeostasis: An Experimental Study on Hypertensive Rats

Background: Anti-inflammatory role of Aloe vera gel is well established. Diclofenac is extensively used for acute and chronic inflammation. The present study was conducted to compare dried Aloe vera gel and diclofenac effects on sodium and potassium balance in hypertensive rats.&#x0D; Material and Methods: This experimental study was conducted at Sargodha Medical College from May to November 2016. Twenty-four healthy male Sprague Dawley rats 7-8 weeks of age were included in study. Any unhealthy-looking rat was excluded from the study. Rats were equally and randomly divided into four groups Normal control (group A), Model control (group B), Aloe vera (group C) &amp; Diclofenac (group D). Hypertension was induced by a 20 % sucrose diet in all groups except group A in 8 weeks’ time. Group B, C &amp; D received distilled water and Aloe vera dried gel 400 mg/kg &amp; diclofenac powder 12 mg/kg body weight respectively orally between 8 to 10 weeks. Serum and urine analysis was performed for hematocrit, sodium, and potassium concentrations at zero, eight and ten weeks. Twenty-four-hour urinary sodium excretion was calculated. Data was analyzed using Graph Pad Prism version 6.&#x0D; Result: After 2-week administration of aloe vera and diclofenac powder, serum potassium significantly decreased in Group C (p &lt;0.001) while increased in Group B and D (p &lt;0.001) as compared to group A. Urinary sodium concentration and excretion increased significantly in Group C (p &lt;0.01) as compared to Group A whereas result of Group D was insignificant. No significant change in serum sodium and hematocrit of any group was observed.&#x0D; Conclusion: Aloe vera causes less sodium retention than diclofenac but decreases serum potassium contrary to the effect of diclofenac in hypertensive rats.

MO201ANALYSIS OF USAGE OF SODIUM ZIRCONIUM CYCLOSILICATE (SZC) AT HULL UNIVERSITY TEACHING HOSPITALS

Abstract Background and Aims Renin Angiotensin Aldosterone System (RASS) inhibitor therapy is key to the management of several chronic long term conditions; however, RAAS inhibitors can cause hyperkalaemia and thus limiting its use. Sodium zirconium cyclosilicate, was approved in the UK as part of the management of hyperkalaemia in adults. Although the efficacy and safety of SZC has been demonstrated in clinical trials, there isn’t an abundance of data of its use in clinical practice. This study investigated the efficacy and safety of SCZ in the short-term management of hyperkalaemia in patients admitted acutely to hospital. Method This retrospective study analysed prescriptions and medical notes of patients who received SCZ treatment between June and December 2020 at Hull University Teaching Hospitals. Eligible patients (&amp;gt;16years and received SCZ) were identified from pharmacy dispensing data. Data collected included patient demographics, prescribed medication that could affect serum potassium levels prior to starting SZC, indication, dose of SCZ, potassium level at start and 72hrs after treatment and if the patient was on renal replacement therapy (RRT). In addition, speciality of the prescriber and reported adverse effects were noted. Data analysis was descriptive. Results During the study period, SZC was prescribed to 59 patients on 73 different occasions. Fifty-two (71%) were male, mean age was 58 years (range 17 – 88 years). Twenty-two patients (37%) were on RASS inhibitors, six patients on a potassium sparing diuretic, and 21 on a beta-blocker before treatment with SZC. Thirteen patients (22%) were on a combination of at least two of these medicines. Nineteen patients (32%) were on haemodialysis and four patients (7%) were on peritoneal dialysis (PD) prior to treatment with SZC. The documented reason for SZC use included hyperkalaemia secondary to dialysis access failure, acute kidney injury, pharmacotherapy induced hyperkalaemia and pre-emptive prescribing to allow time to create a new RRT access. Thirty-three (56%) patients had their serum potassium level checked at start and 72hrs after treatment with SZC. The remaining patients had their biochemical profiles checked more than 72 hours after starting SZC with inconsistent time frames and thus, were excluded from the further analysis. In haemodialysis patients, the median serum potassium level at start of treatment with SZC was 5.7mmol/L (range 4.6mmol/L – 6.3mmol/L) while in PD patients the median potassium level 6.4mmol/L (range 4.4mmol/L – 6.4mmol/L). The mean decrease in serum potassium was 0.73mmol/L (range 0.1mmolo/L – 3mmol/L) and 1.7mmol/L (range 0.1 -1.6mmol/L) in HD and PD patients respectively. For patients not on RRT prior to treatment with SZC, and median serum potassium level at start of treatment was 6.0mmol/L (range 5.5mmol/L – 6.7mmol/L). In these patients, a mean decrease in serum potassium of 1.1mmol/L (range 0.2mmol/L – 2.4mmol/L) was observed. Twenty-three patients (70%) received 10g and ten patients received the 5g dose of SZC. Patients who had the 10g doses had a mean reduction in serum potassium of 1.0mmol/L (range 0.1mmol/L - 3.0mmol/L) and patients who received 5g doses had a mean reduction of 0.97mmol/L (range 0.2mmol/L – 1.9mmol/L) over the 72-hour period. There were no reported side effects. It was found that SZC was initiated by a range of specialities (see Figure 1). The nephrology team accounted for the majority (45%) of prescriptions. Notably, the cardiology team initiated only one prescription. Conclusion Our data from clinical practice indicates that SZC is effective and well-tolerated treatment in the management of hyperkalaemia. Our results also suggest that the reduction in potassium level was not vastly different for patients started on the 5g dose vs the 10g dose but this requires further research with larger study sample sizes. Limitations of the study included small sample size and retrospective nature of the study.

MO724IS INDIVIDUALIZED DIALYSATE SODIUM REASON FOR BETTER SURVIVAL IN HEMODIALYSIS PATIENTS?

Abstract Background and Aims We are uncertain about whether dialysate sodium improves overall health and well-being for people on haemodialysis, since there are a mixture of probably good and bad effects. Dialysate sodium is one of the most easy changeable parameter which can influence hemodynamic stability, echocardiography and laboratory parameters. The aim of the study was to investigate whether dialysis patients will have some beneficial effects of dialysate sodium set up according to serum sodium. Method 77 nondiabetic subjects (41men; 36women) performed 12 months hemodialysis (HD) sessions with dialysate sodium concentration setup at 138 mmol/L, followed by additional 24 month ssessions wherein dialysate sodium was set up according to pre-HD serum sodium concentration. Interdialytic weight gain (IDWG), echocardiography, laboratory parameters and survival were analysed. Results Sodium individualization resulted in significantly lower IDWG by using individualized sodium according to pre HD serum sodium compared to standard dialysate sodium (2.17±0.79 vs 1.93±0.64 kg, p&amp;lt;0,001). In all patients we confirmed positive sodium gradient and univariate regression analysis showed that by increasing the sodium gradient by 1 mmol/L, IDWG increased by an average of 0.189% and 7,1% changes in IDWG can be explain by changing of the sodium gradient. Echocardiography analysis showed an increase of 2.04 mm of left ventricular diastolic diameter (LVDD) by increasing the sodium gradient for 1mmol/L and significantly increased left ventricular mass (LVM) of 35.69 gr by 1kg increase of IDWG. Laboratory analysis showed statistical significant increase in Kt/V, URR (urea reduction rate), serum albumin and hemoglobin by using individualized dialysed sodium compared to standard dialysate sodium, respectively (1.50±0.24 vs 1.36±0.22; 70.80±5.24 vs 67.00±6.23%; 38.23±3.80 vs 34.46±2.53 g/L; 120.32±10.14 vs 114.62±10.34 g/L, p&amp;lt;0.001). We confirmed significant decrease in serum potassium, with no change in other electrolities (5.62±0.60vs 5.15±0.94). During the study, 7 patients died and binary logistic regression univariate analysis showed that significant predictors of mortality in patients dialyzed with individualized sodium dialysis according to pre-HD plasma sodium concentrations were Kt/V, URR, and CRP (C reactive protein). Analysis showed that patients with Kt/V lower than 1,2 have 8.8 times higher risk for death compared to patients with Kt/V&amp;gt;1,2, URR lower than 65% have 10,9 times higher risk compared to URR&amp;gt;65% and CRP higher than 10 mg/L have 10.2 times higher risk for death compared to patients with CRP lower than 10 mg/L Conclusion Individualization of dialysate sodium according to pre HD serum sodium concentration result in better IDWG control, improvement of fluid overload and regression of left ventricular hypertrophy, better dialysis adequacy and higher survival compared to standard dialysate sodium.

Effect of haemodialysis on renal profile in chronic renal failure patients at a tertiary care centre

: In chronic renal failure there is a steady and continued decrease in renal clearance or glomerular filtration rate (GFR), which leads to the gathering of urea, creatinine and other waste metabolites in the blood. Haemodialysis is considered as a good therapeutic option in the context of the renal replacement therapies in which different body waste products including urea, creatinine and free water are removed from the blood. In view of that, the present study was conducted to evaluate the effect of haemodialysis on different renal biochemical parameter in CRF patients.The present study was a hospital based study including 84 chronic renal failure patients on haemodialysis attending a tertiary care hospital in Bihar. Blood samples were collected before and four hours after haemodialysis and serum urea, creatinine, uric acid, potassium, sodium and calcium were estimated.Our results revealed that there was significant decrease in the serum level of urea, creatinine, uric acid and potassium in post dialysis samples with p-value (&amp;#60;0.001, 0.001 0.003 and 0.001) respectively when compared to pre dialysis samples, while showed significant increase of sodium and calcium level in post dialysis samples with p-value (&amp;#60;0.004 and 0.005)The Study concludes that, haemodialysis increase serum sodium and calcium level and decrease serum urea, creatinine, uric acid and potassium level.

PREVALENCE OF PRIMARY ALDOSTERONISM AND HYPOKALEMIA IN 5,100 PATIENTS REFERRED TO A TERTIARY HYPERTENSION UNIT

Objective: Primary aldosteronism (PA) was considered a rare disorder almost always associated with hypokalemia. After the introduction of aldosterone-to-renin ratio, the widespread screening of hypertensive patients unveiled a higher prevalence of normokalemic PA, which now represents the prevailing phenotype. Many studies have described the prevalence of hypokalemia in patients with PA, conversely the prevalence of PA in patients with hypokalemia is unknown. In this retrospective observational study, we define the prevalence of hypokalemia in referred patients with hypertension and the prevalence of PA in patients with hypokalemia and hypertension. Design and method: For each patient, medical records were reviewed by three independent reviewers, who were blinded to patients’ identification and diagnosis. Hypokalemia was defined for potassium levels lower than 3.7 mmol/L. PA was diagnosed according to the Endocrine Society guideline. Multivariate logistic regression analysis was used to assess the association of hypokalemia and PA with cardiovascular risk indicators. Results: Hypokalemia was present in 15.8% of 5,100 patients with hypertension whereas 76.9% of these patients were normokalemic. PA prevalence in this cohort was significantly higher than in a cohort of 1,672 unselected patients with hypertension in primary care from the PATO study (7.8% vs. 5.9%, P = 0.011). The prevalence of PA in patients with hypokalemia was 28.1% and increased with decreasing serum potassium concentrations up to 88.5% of patients with spontaneous hypokalemia and serum potassium concentrations below 2.5 mmol/L. A multivariate regression analysis demonstrated the association of hypokalemia with the occurrence of cardiovascular events independent of PA diagnosis. An association of PA with the occurrence of cardiovascular events and target organ damage independent of hypokalemia was also demonstrated. Conclusions: Our results confirm that PA is a frequent cause of secondary hypertension in patients with hypokalemia and the presence of hypertension and spontaneous hypokalemia are strong indications for a diagnosis of PA. Finally, we show that PA and hypokalemia are associated with an increased risk of cardiovascular events.

Therapeutic Drug Monitoring-Based Efficacy and Safety of Bedaquiline in Chinese Multidrug-Resistant Tuberculosis

Background: Bedaquiline was approved by the US Food and Drug Administration (FDA) for the treatment of drug-resistant tuberculosis in 2012, and significantly improved multidrug-resistant tuberculosis (MDR-TB) patients treatment outcomes. However, data of the efficacy, safety of bedaquiline for the Chinese tuberculosis patients were still lacked, and the plasma concentration of bedaquiline during the treatment and its elimination after treatment discontinuation also had not yet be elucidated. In this study, we demonstrated the efficacy and safety of bedaquiline for the treatment of MDR-TB or XDR-TB patients based on the therapeutic drug monitoring. Methods: 35 patients who started on bedaquiline for drug-resistant tuberculosis were identified. We extracted the patient's medical record information based on their informed consent, and established a standardized monitoring system to track outcomes of patients started on bedaquiline for MDR-TB. The plasma concentration of bedaquiline were determined by ultra-performance liquid chromatography combined with tandem mass spectrometry. Findings: After the 24 weeks bedaquiline treatment, 80% of these patients’ sputum culture conversed negative, and the median time to culture conversion was 75.5 (IQR 52-126) days. 21 (21/26, 80.8%) patients were eventually cured, 2 (2/26, 7.7%) patients failed. The most frequently adverse events during the treatment included QTc prolongation (16/35, 45.7%), peripheral neuropathy (9/35, 25.7%), and gastrointestinal disturbances (8/35, 22.9%). During treatment, the median plasma bedaquiline were fluctuated around 0.6 µg/ml, and gradually decreased after bedaquiline discontinued, about 0.2 µg/ml of bedaquiline was still undegraded after bedaquiline withdrawal 13 months. Moreover, combination with clofazimine increased the possibility of QTc prolongation during the treatment of MDR-TB with bedaquiline, and the decreased serum potassium concentration was also a reason for the prolonged QTc induction with bedaquiline. Interpretation: This study highlighted the efficacy and safety of bedaquiline based on the plasma concentration monitoring, analyzed the reasons of bedaquiline induced QTc prolongation, which had not yet be elucidated before. Funding: This work was supported by the Hospital Pharmacy Special Project of Zhejiang Pharmaceutical Society (2018ZYY31, 2019ZYY27, 2020ZYY08), Zhejiang Medical and Health Science and Technology Plan (2015PYA008, 2020KY741) and Zhejiang Provincial Natural Science Foundation of China under Grant (LYY18H300001), Medical promising youngster of Hangzhou. Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: This study was approved by the Ethic Committee of Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine.

Association of ACE2 variant rs4646188 with the risks of atrial fibrillation and cardioembolic stroke in Uygur patients with type 2 diabetes

BackgroundAtrial fibrillation (AF) is the most common cardiac arrhythmia. Type 2 diabetes (T2D) is an independent risk factor for AF. The cardioembolic stroke (CS) risk is increased when both conditions coexist. Whether angiotensin-converting enzyme 2 (ACE2) genetic variants predict increased risks AF and CS in Uygur patients with T2D remain elusive.MethodsA total of 547 Uygur subjects (272 controls and 275 T2D patients) were recruited to the study from south Xinjiang. Eight ACE2 variants were identified by MassARRAY system.ResultsACE2 rs2074192 (CC, adjusted RR = 2.55, 95% CI 1.35–4.80, P = 0.004), rs4240157 (CC + CT, adjusted RR = 2.26, 95% CI 1.27–4.04, P = 0.006) and rs4646188 (TT, adjusted RR = 2.37, 95% CI 1.16–4.86, P = 0.018) were associated with higher AF risk. ACE2 rs4240157 (CC + CT, adjusted RR = 2.68, 95% CI 1.36–5.27, P = 0.004) and rs4646188 (TT, adjusted RR = 2.56, 95% CI 1.06–6.20, P = 0.037) were further associated with higher CS risk. The 3 ACE2 variants were related to larger left atrial end-systolic diameter (LAD) (all P < 0.05), but not all of the 3 ACE2 variants were related to increased levels of serum sodium (rs4240157 and rs4646188, all P < 0.05), HsCRP (rs4240157 and rs4646188, all P < 0.05) as well as decreased serum potassium levels (rs2074192 and rs4646188, all P < 0.05). The 3 ACE2 variants exhibited heterogeneity on circulating RAAS activation. In particular, ACE2 rs4646188 was associated with higher levels of ACE (P = 0.017 and 0.037), Ang I (P = 0.002 and 0.001), Ang II (both P < 0.001) and ALD (P = 0.005 and 0.011).ConclusionThese results indicated ACE2 rs4646188 was associated with increased risk of AF and CS among diabetic patients in Uygurs, which could be a promising genetic predisposition marker for early and personalized prevention strategies for the aforementioned clinical pathologies.

Clinical Analysis of Electrolyte Disorders in Patients with Diabetic Ketoacidosis.

The changes in the electrolyte profiles in patients with diabetic ketoacidosis (DKA) have rarely been reported. This study reports the abnormalities in the electrolyte profile, such as serum potassium, sodium, chloride, calcium, magnesium, and phosphorus. Forty individuals in each of the DKA, diabetic ketosis (DK), nonketotic diabetes mellitus, and healthy control groups were included in this study to evaluate their clinical indicators, such as blood glucose, glycated hemoglobin (HbA1c), renal function, electrolytes, and arterial blood gas concentrations. Compared with the other three groups, patients in the DKA group had a longer course of diabetes; significantly higher levels of blood glucose, HbA1c, and serum creatinine (p < 0.05 or p < 0.001); lower estimated glomerular filtration rate (eGFR) (p < 0.001); and higher levels of serum potassium, sodium, phosphorus, magnesium, and effective osmotic pressure (p < 0.05). In the DKA patients, the incidences of hyperkalemia and hypokalemia were 32.5% (p < 0.05 or p < 0.001 vs. the other groups) and 7.5%, respectively. In the DKA patients, type 1 diabetes patients were younger and had higher blood glucose than type 2 patients (p < 0.05), but the electrolyte profiles were not significantly different. There were no significant differences in the serum electrolyte profile between mild to moderate DKA patients and severe DKA patients. Serum potassium was negatively correlated with eGFR (r = -0.378, p = 0.018). Regression analysis showed that eGFR was an important factor affecting serum potassium (β = -0.378, p = 0.018). When DKA occurs in diabetes patients, the renal function deteriorates significantly because the electrolytes are generally elevated due to hemoconcentration. Hyperkalemia is the main manifestation, and it is necessary to prevent the decrease in serum potassium during the treatment.

Traumatic pericarditis in a dairy doe

A two‐year‐old pregnant Toggenberg doe presented for recumbency, anorexia and hypothermia. The owner noted that the doe had been experiencing anorexia for approximately 1 month's duration. Initial diagnostics revealed a leucocytosis with a left shift, ketonaemia, as well as decreased serum potassium and bicarbonate concentrations. Thoracic ultrasound identified moderate pericardial perfusion. The doe expired during an emergency caesarean section. Necropsy revealed a 2.5‐cm‐long hypodermic needle fragment that had migrated from the reticulum to the pericardial cavity and ultimately to the omental fat. While not commonly described in small ruminants, practitioners should be aware of the potential for traumatic pericarditis in goats and, as such, should consider hardware disease a differential for goats with pericardial effusion.

P0601SAFETY AND EFFICACY OF INTRAVENOUS ADMINISTRATION OF RINGER'S LACTATE VERSUS NORMAL SALINE 0.9% SOLUTION IN PATIENTS WITH ACUTE KIDNEY INJURY AND ESTABLISHED CHRONIC KIDNEY DISEASE

Abstract Background and Aims Crystalline solutions, such as normal saline 0.9% (N/S 0.9%) and Ringer's Lactate (L/R), are readily administered for increasing plasma volume. Despite the utility of administering N/S 0.9% to hypovolemic patients, the dose of 154 mmol of sodium (Na) contained in 1 L exceeds the recommended daily dose increasing the risk of sodium overload and hyperchloremic metabolic acidosis. In contrast, L/R solution has the advantage of lower Na content, significantly less chlorine and contains lactates which may be advantageous in patients with significant acidemia such as patients with acute kidney injury (AKI) and chronic kidney disease (CKD). The aim of the present study is to investigate the safety and efficacy of administration of L/R versus N/S 0.9% in patients with prerenal AKI and established CKD. Method The study included adult patients with known CKD stage II to V without need for dialysis, with prerenal AKI (AKIN Stage I to III Criteria). Patients with other forms of AKI as well as hypervolemia, heart congestion or hyperkalemia (serum K&amp;gt;5.5 meq/l) were excluded from the study. Patients were randomized in 1:1 ratio to receive intravenously either N/S 0.9% or L/R solution at a dose of 20 ml/kg body weight/day. We studied kidney function (eGFR: CKD-EPI) and response to treatment at discharge and at 30 days after discharge, duration of hospitalization, improvement in serum bicarbonate levels (HCO3), acid-base balance, serum potassium levels and the need for dialysis. Results The study included 26 patients (17 males) with a mean age of 59.1 ± 16.1 years. Thirteen patients received treatment with N/S 0.9% and the rest with L/R solution. Baseline demographic and clinical characteristics at hospital admission and historical data did not show any significant differences in both groups of patients. Renal function at the onset of AKI did not show significant differences between the two groups (16.4 ± 5.8 vs 16.9 ± 5.7 ml/min/1.73 m2, p=ns, treatment with N/S and L/R respectively). The mean volume of solutions received by the two groups (N/S 0.9% 1119 ± 374 vs L/R 1338 ± 364 ml/day, p=ns) as well as the mean total volume of liquids received per day, did not differ significantly (2888 ± 821 vs 3069 ± 728 ml/d, p=ns). Patients treated with L/R were discharged 1 day earlier than patients treated with N/S (5.2 ± 3.2 vs 6.2 ± 4.9 days of hospitalization, p=ns). Renal function improvement during hospitalization and 30 days after discharge did not differ significantly between the two groups. Patients that received L/R showed a higher increase in plasma HCO3 (ΔHCO3) concentration at discharge than those that received N/S 0.9% (4.9 ± 4.1 vs 2.46 ± 3.7 meq/l, p=ns) and pH increase (ΔpH) was slightly higher in those that received L/R solution (0.052 ± 0.066 vs 0.023 ± 0.071, p=ns). Patients treated with N/S 0.9% showed a greater decrease in serum potassium (ΔK) at discharge compared to those treated with L/R (-0.39 ± 1.03 vs -0.17 ± 0.43 meq/l, p=ns, respectively). No patient received acute dialysis treatment. Conclusion Administration of L/R solution as a hydration treatment to patients with prerenal AKI and established CKD is not inferior concerning safety and efficacy to N/S 0.9% solution. In addition, L/R administration seems to marginally improve acid-base balance in this specific group of patients.