Electrolyte Abnormality In Patients Research Articles

Patterns and factors associated with electrolyte abnormalities among patients with heart failure in Uganda.

Electrolyte abnormalities (EAs) worsen the clinical course of patients with heart failure (HF). The patterns of EAs vary among patients with HF. This study investigated patterns and factors associated with EAs among patients with HF admitted to Hoima Regional Referral Hospital (HRRH) in western Uganda. This hospital-based cross-sectional study used quantitative data of 384 HF patients admitted at HRRH between 21st February and 15th May 2023. Data on sociodemographic, lifestyle, and medical characteristics were collected and presented as descriptive statistics. EAs were considered electrolyte values below or above the reference normal ranges. Bivariate and multiple logistic regression analyses were conducted to establish associations. An association with a p < 0.05 is considered statistically significant. Of 384 HF patients, 342 (89.1%) had EAs. Hypocalcemia was the most common EA, 165 (43.0%). Among the patients, 69 (18.0%) were on diuretics, 185 (48.2%) were on angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs), and 105 (27.3%) were on calcium channel blockers (CCBs). Additionally, 264 (68.8%) had a history of hypertension, and 20 (5.2%) demonstrated good drug adherence. Patients with good drug adherence had lower odds of EAs (Adjusted Prevalence Odds Ratio [Adjusted POR] = 0.2, 95% CI: 0.1-0.7, p = 0.009). Those on diuretics had higher odds of EAs compared to those on ACEIs/ARBs and CCBs, with an Adjusted POR of 5.7 (95% CI: 1.3-15.0, p = 0.019). A history of hypertension also increased the odds of EAs (Adjusted POR = 4.0, 95% CI: 1.9-8.4, p < 0.001). The prevalence of EAs in patients with HF at HRRH was high, with hypocalcemia being the most common. Patients with good drug adherence had lower odds of EAs. On the other hand, diuretic use and a history of hypertension were associated with increased odds of EAs.

1123 Incidence of Electrolyte Abnormalities in Patients Recovering Form Maxillofacial Resection and Free Flap Reconstruction

Abstract Aim Recovery from resection of head and neck malignancy is fraught with potential complications. Among these are electrolyte disturbances. The majority of junior trainees in Oral &amp; Maxillofacial surgery have qualified in dentistry and will have had little exposure to this topic. We aim to examine the incidence of disturbances in Serum Sodium, Potassium, Calcium, Magnesium and Phosphate. This information will aid in prioritising information for robust induction and educational programmes in Maxillofacial oncology centres. Method Patients were identified in a single centre from January to November 2022 from theatre records. All patients were adults who underwent resection for Head and Neck malignancy with free flap reconstruction. A total of 65 patients were included. The electronic pathology system was integrated for results. Results The most common abnormal result was hypophosphatemia (&amp;lt;0.8 mmol/L) present in 53 patients (81%). The next most common was hypocalcaemia (&amp;lt;2.2 mmol/L) which was present in on 46 patients (71%) Potassium imbalances were seen in fewer patients, with 10 being high (&amp;gt;5.3 mmol/L and 17 low (&amp;lt;3.5mmol/L). Least common were issues with Sodium, being high (&amp;gt;145mmol/L) for 9 patients (14%) and low (&amp;lt;135 mmol/L) for 14 patients (21%). Conclusions Electrolyte abnormalities are commonly encountered when caring for Maxillofacial Head &amp; Neck cancer patients. Prior to surgery many patients have undergone a period of malnutrition due the pain. This makes them high risk of re-feeding syndrome once nutrition is started. Induction programmes should familiarise dental core trainees with the trust’s Re-feeding guidelines and when to escalate more severe problems.

Compared effectiveness of sodium zirconium cyclosilicate and calcium polystyrene sulfonate on hyperkalemia in patients with chronic kidney disease.

Hyperkalemia is a well-recognized electrolyte abnormality in patients with chronic kidney disease (CKD). Potassium binders are often used to prevent and treat hyperkalemia. However, few studies have evaluated the difference in serum potassium (K+) level-lowering effect during the post-acute phase between the novel potassium binder, sodium zirconium cyclosilicate (ZSC), and conventional agents. This retrospective study included patients who received potassium binders (either ZSC or calcium polystyrene sulfonate [CPS]) in our hospital between May 2020 and July 2022. The patients were divided into the ZSC and CPS groups. After propensity score matching, we compared changes from baseline to the first follow-up point, at least 4 weeks after initiating potassium binders, in electrolytes including K+ level between the two groups. Of the 132 patients, ZSC and CPS were administered in 48 and 84 patients, respectively. After matching, 38 patients were allocated to each group. The ZSC group showed greater reduction in K+ levels than did the CPS group (P < 0.05). Moreover, a significant increase in serum sodium minus chloride levels, a surrogate marker for metabolic acidosis, was observed in the ZSC group (P < 0.05). Our results demonstrated that ZSC could potentially improve hyperkalemia and metabolic acidosis in patients with CKD.

Electrolyte Abnormalities in Patients Hospitalised with COVID-19 in the Southern Gaza Strip, Palestine: A Retrospective Case-Control Study

Introduction: Coronavirus Disease-2019 (COVID-19), has caused, nearly 18 million deaths worldwide, many more hospitalisations, and severe economic and social disruption, as of March 2022. Malnutrition and electrolyte imbalance can lead to immune system dysfunction, which can increase the risk of infection. Aim: To evaluate the electrolyte imbalance and other biomarkers in COVID-19 patients and also, to compare these parameters with healthy individuals. Materials and Methods: A retrospective case-control study was conducted in the Department of Medical Laboratory Sciences at European Gaza Hospital, Southern Gaza Strip, Palestine. The duration of the study was four months, from February 2022 to May 2022. A total of 200 participants were included in the study, out of which 100 patients were diagnosed with COVID-19 infection by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) test and 100 healthy individuals were recruited from blood bank donors and comprehensive Screening Department. Biochemical profile; Fasting Blood Glucose (FBG), urea, Creatinine (Cr), Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), total Creatinine Kinase (CK-total), Creatine Kinase (CK) isoenzyme CK and electrolytes (Na, K, phosphorous, and Mg, ionised calcium, total calcium, and Cl) were assayed. Data were statistically analysed using Student’s t-test and Chi-square test. Results: The mean age of the study participants was 54.1±12.2 years for cases and 54.3±12.4 years for controls. A total of 200 subjects, both the groups had 34 (34.0%) males and 66 (66.0%) females, which was not statistically significant (p-value&gt;0.05). COVID-19 patients had significantly higher values of Na (141.9±4.6 vs 139.7±3.1; p&lt;0.001), K (4.6±0.9 vs 4.3±0.5; p-value=0.001), Cl (108.7±5.3 vs 101.1±4.0; p&lt;0.001), P (4.6±0.6 vs 4±1.4; p&lt;0.001), and Mg (2.1±0.2 vs 1.7±0.3; p&lt;0.001). However, they had lower Ca ionised (1.0±0.1 vs 1.1±0.1; p&lt;0.001) and total Ca (8.4±0.9 vs 9.1±1.1; p&lt;0.001). Furthermore, COVID-19 patients had significantly higher levels of biomarkers of other biochemical profiles compared to healthy controls. Conclusion: As compared to healthy individuals, patients hospitalised with COVID-19, exhibited alterations in their electrolyte balance and other biochemical markers. Management of these parameters to get homeostasis, could that warrant opportunities to reduce morbidity and mortality of disease.

Electrolyte abnormalities in patients with perinatal asphyxia

Background: Perinatal hypoxia is still a major cause of death and disability in developing countries. The infant mortality rate fell from 92 per 1000 live births in 1991 to 43 per 1000 live births in 2011. The aim of the study was to study the electrolyte abnormalities in perinatal asphyxia cases.Methods: This cross-sectional descriptive study was conducted at the Department of Obstetrics and Pediatrics, Rangpur Medical College and Hospital, Rangpur, Bangladesh. The study duration was 2 years, from January 2012 to December 2013. The study was conducted with a total of 120 neonates admitted in the neonatal ward of the study hospital, among which, 60 neonates who had perinatal asphyxia were selected for the case group, and the remaining 60 were age and gender-matched control group participants.Results: In 70% of cases, the mother was Primipara. Among the neonates, 61.67% were male, and 38.33% were female. Only 33% of the case neonates had received regular antenatal check-ups, while 55% had irregular check-ups, and 11.67% had no antenatal checkups. According to the grading of asphyxia, 51.67% of neonates had moderate asphyxia, 20% had mild asphyxia, and 28.33% had severe asphyxia. The comparison of mean values between the case, and control groups showed that both blood urea, and serum creatinine levels were significantly higher among the case group participants, compared to control group values. The mean serum sodium value in mild, moderate, and severe asphyxia were 135.33, 123.42, and 121.53 mmol/l respectively. Mean serum potassium values were 4.11, 4.86, and 5.51 mmol/l respectively. Mean serum creatinine 0.72, 1.00, and 1.83 mg/dl respectively. Mean blood urea levels were 36.17, 58.97, and 88.06 mg/dl respectively. A significant difference was observed between the mean values of serum electrolytes and patients’ asphyxia grade.Conclusions: The study findings can conclude that electrolyte abnormalities are common among perinatal asphyxia patients, and babies with perinatal asphyxia developed hyponatremia, and hyperkalemia at a higher frequency, and significant raises of serum creatinine, and blood urea was also observed, which was proportionate to the severity of asphyxia.

A rare case of severe hyperphosphatemia

Hyperphosphatemia is commonly associated with kidney failure. However, many other etiologies should be considered, and include increase tubular reabsorption of phosphate, endogenous or exogenous phosphate loads and transcellular shift. We present a case of a 71-year-old male with a medical history of anemia and constipation who presented to our hospital for abdominal pain. Initial Laboratory evaluation demonstrated a severely elevated serum phosphate level, calcium level within the normal limit, and a mild elevation of serum creatinine. He underwent a bone marrow biopsy confirming a diagnosis of IgG-kappa-type Multiple Myeloma (MM). There is an established association between electrolyte abnormalities in patients with hematological malignancies, however, MM is rarely associated with hyperphosphatemia. Spurious electrolyte abnormalities present a challenge for clinicians, pseudo-hyperphosphatemia in patients with MM has been associated with laboratory artifacts. Our patient did not have clinical characteristics of hyperphosphatemia, after the new diagnosis of multiple myeloma and ruling out other etiologies leading to hyperphosphatemia, the elevated phosphorous level was attributed to a spurious etiology.

Safety and Efficacy of Patiromer in Hyperkalemic Patients with CKD: A Pooled Analysis of Three Randomized Trials.

Hyperkalemia is a common electrolyte abnormality in patients with CKD, which is associated with worse outcomes and limits use of renin-angiotensin-aldosterone system inhibitors (RAASi). This post hoc subgroup analysis of three clinical trials evaluated the efficacy and safety of the sodium-free, potassium-binding polymer, patiromer, for the treatment of hyperkalemia in adults with nondialysis CKD. Data from the 4-week treatment periods of AMETHYST-DN, OPAL-HK, and TOURMALINE studies were combined. Patients had baseline diagnosis of CKD, hyperkalemia (serum potassium >5.0 mEq/L), and received patiromer 8.4-33.6 g/day. Patients were stratified by baseline eGFR into two subgroups: severe/end-stage CKD (stage 3b-5; eGFR <45 ml/min per 1.73 m2) and mild/moderate CKD (stage 1-3a; eGFR ≥45 ml/min per 1.73 m2). Efficacy was assessed by the change in serum potassium (mean±SE) from baseline to week 4. Safety assessments included incidence and severity of adverse events (AEs). Efficacy analyses (n=626; 62% male, mean age 66 years) included 417 (67%) patients with severe/end-stage CKD and 209 (33%) with mild/moderate CKD. Most patients were receiving RAASi therapy at baseline (severe/end-stage CKD 92%; mild/moderate CKD 98%). The mean±SE change in serum potassium (baseline to week 4) was -0.84±0.03 in the severe/end-stage CKD subgroup, and -0.60±0.04 mEq/L in the mild/moderate CKD subgroup. AEs were reported for 40% and 27% patients in the severe/end-stage and mild/moderate CKD subgroups, respectively, with 16% and 12% reporting AEs considered related to patiromer. The most frequent AEs were mild-to-moderate constipation (8% and 3%) and diarrhea (4% and 2%). AEs leading to patiromer discontinuation occurred in 6% and 2% of patients with severe/end-stage CKD, and mild/moderate CKD, respectively. Patiromer was effective for treatment of hyperkalemia and well tolerated in patients across stages of CKD, most of whom were receiving guideline-recommended RAASi therapy.

Canagliflozin independently reduced plasma volume from conventional diuretics in patients with type 2 diabetes and chronic heart failure: a subanalysis of the CANDLE trial.

Sodium-glucose cotransporter 2 inhibitors (SGLT2is) reduce the risk of heart failure progression and mortality rates. Moreover, osmotic diuresis induced by SGLT2 inhibition may result in an improved heart failure prognosis. Independent of conventional diuretics in patients with type 2 diabetes (T2D) and chronic heart failure, especially in patients with heart failure with preserved ejection fraction (HFpEF), it is unclear whether SGLT2i chronically reduces estimated plasma volume (ePV). As a subanalysis of the CANDLE trial, which assessed the effect of canagliflozin on N-terminal pro-brain natriuretic peptide (NT-proBNP), we examined the change (%) in ePV over 24 weeks of treatment based on the baseline level associated with diuretic usage. In the CANDLE trial, nearly all patients were clinically stable (NYHA class I-II), with approximately 70% of participants presenting a baseline phenotype of HFpEF. A total of 99 (42.5%) patients were taking diuretics (mostly furosemide) at baseline, while 134 (57.5%) were not. Relative to glimepiride, canagliflozin significantly reduced ePV without worsening renal function in patients in both groups: -4.00% vs. 1.46% (p = 0.020) for the diuretic group and -6.14% vs. 1.28% (p < 0.001) for the nondiuretic group. Furthermore, canagliflozin significantly reduced serum uric acid without causing major electrolyte abnormalities in patients in both subgroups. The long-term beneficial effect of SGLT2i on intravascular congestion could be independent of conventional diuretic therapy without worsening renal function in patients with T2D and HF (HFpEF predominantly). In addition, the beneficial effects of canagliflozin are accompanied by improved hyperuricemia without causing major electrolyte abnormalities.

Prognostic value of dysnatremia for survival in neuroendocrine neoplasm patients.

Hyponatremia and hypernatremia are common electrolyte abnormalities in patients with malignancy and have been independently associated with worse survival outcomes. To date, there are no data on the impact of dysnatremia on survival outcomes in patients with neuroendocrine neoplasms (NENs). This study involves retrospective cohort analysis from a tertiary care center of NEN patients treated with peptide receptor radionuclide therapy (PRRT) with a cumulative activity of at least 3.7 GBq 177Lu-DOTATATE between the years 2000 and 2015. Comparison of overall survival of patients with the occurrence of hyponatremia (serum sodium < 135 mmol/L) or hypernatremia (serum sodium > 145 mmol/L) before starting or during PRRT was perfomed. A total of 649 patients were included. Hyponatremia occurred in 57 patients during the observation period and was associated with a shorter median overall survival (95% CI) of 25 months (14-36) compared to 55 months (48-61) of the 512 normonatremic patients (P < 0.001), adjusted hazard ratio (HR): 1.48 (95% CI: 1.04-2.12). Overall survival time was reduced regardless of whether hyponatremia was present at baseline or during PRRT. In contrast, hypernatremia occurred in 80 patients and was associated with a longer median overall survival (95% CI) of 94 months (47-140) compared with the 512 normonatremic patients (P = 0.018), adjusted HR: 0.61 (95% CI: 0.40-0.92). This association was driven by the patients with hypernatremia during PRRT. No association between dysnatremia and progression-free survival after PRRT was observed. The occurrence of hypo- or hypernatremia in PRRT-treated NET patients is associated with opposing outcomes with regard to overall survival. Sodium levels might have a prognostic role in these patients.

Efficacy of Potassium Supplementation in Hypokalemic Patients Receiving Peritoneal Dialysis: A Randomized Controlled Trial

Hypokalemia is a common electrolyte abnormality in patients on peritoneal dialysis (PD) and has been associated with increased risks of peritonitis and death. Whether correction of hypokalemia improves these outcomes is unknown. Multicenter, open-label, prospective, randomized controlled trial. Adult (aged≥18 years) PD patients with hypokalemia (defined as at least 3 values or an average value<3.5 mEq/L in the past 6 months). Randomization was stratified according to center and residual urine output (≤100 or >100 mL/day). Random assignment to either protocol-based potassium supplementation (titratable dose of oral potassium chloride to maintain serum potassium of 4-5 mEq/L) or conventional potassium supplementation (reactive supplementation when serum potassium is<3.5 mEq/L) over 52 weeks. Treatment groups were compared using intention-to-treat analyses implemented using Cox proportional hazards regression. The primary outcome was time from randomization to first peritonitis episode (any organism). Secondary outcomes were all-cause mortality, cardiovascular mortality, hospitalization, and conversion to hemodialysis. A total of 167 patients with time-averaged serum potassium concentrations of 3.33 ± 0.28 mEq/L were enrolled from 6 PD centers: 85 were assigned to receive protocol-based treatment, and 82 were assigned to conventional treatment. The median follow-up time was 401 (IQR, 315-417) days. During the study period, serum potassium levels in the protocol-based treatment group increased to 4.36 ± 0.70 mEq/L compared with 3.57 ± 0.65 mEq/L in the group treated conventionally (mean difference, 0.66 [95% CI, 0.53-0.79] mEq/L; P< 0.001). The median time to first peritonitis episode was significantly longer in the protocol-based group (223 [IQR, 147-247] vs 133 [IQR, 41-197] days, P= 0.03). Compared with conventional treatment, the protocol-based group had a significantly lower hazard of peritonitis (HR, 0.47 [95% CI, 0.24-0.93]) but did not differ significantly with respect to any of the secondary outcomes. Asymptomatic hyperkalemia (>6 mEq/L) without characteristic electrocardiographic changes occurred in 3 patients (4%) in the protocol-based treatment group. Not double-masked. Compared with reactive potassium supplementation when the serum potassium level falls below 3.5 mEq/L, protocol-based oral potassium treatment to maintain a serum potassium concentration in the range of 4-5 mEq/L may reduce the risk of peritonitis in patients receiving PD who have hypokalemia. Registered at the Thai Clinical Trials Registry with study number TCTR20190725004.

Outcomes of a Standardized, High-Caloric, Inpatient Re-Alimentation Treatment Protocol in 120 Severely Malnourished Adolescents with Anorexia Nervosa.

Evidence accumulates that, with close medical monitoring and phosphate supplementation, higher-caloric re-alimentation protocols beginning at 2000 kcal/day (HCR) are not associated with an increased incidence of electrolyte abnormalities in patients with anorexia nervosa (AN) but rather result in faster weight gain. These studies are still scant and have largely been performed in adults or moderately malnourished adolescents. Methods: A retrospective chart review of patients with AN aged 12–20 years and with a body mass index (BMI) < 15 kg/m2 alimented according to a standardized treatment protocol in a German clinic specialized in AN was conducted. All patients received 2000 kcal/day from day one. The effect of HCR was examined with respect to laboratory changes and weight development over 4 weeks. Results: In 120 youth (119 (99.2%) females and 1 (0.8%) male, the mean BMI was 13.1 ± 1.1 (range = 10.2–15.0), %mBMI was 62.1 ± 6.0% and weight gain was 0.76 ± 0.22 kg per week, with the highest rate of weight gain during week 1 (1.25 ± 1.28 kg/week). Over 4 weeks, the total weight gain was 3.00 ± 1.92 kg. Nine patients (7.5%) developed mild hypophosphatemia, and none developed refeeding syndrome. Conclusions: Starting re-alimentation with 2000 kcal/d under close medical surveillance, severely malnourished youth with AN met the recommended weight gain targets between 0.5 and 1 kg/week according to current treatment guidelines, without anyone developing refeeding syndrome.

A study of serum electrolytes level in viral hepatitis E patients in a tertiary care hospital of south Gujarat

Background: the aim of the study was to find and understand the relation between electrolytes and viral hepatitis E. To study electrolyte abnormality in patients with hepatitis E virus (HEV).Methods: This study is a single centre cross sectional study on the patients with HEV infection. Consecutive cases affected with HEV-at department of medicine, SMIMER (Surat Municipal institute of medical education and research) hospital, Surat during the period of 1 year (July-2019 to June-2020) are taken up for the study.Results: Abnormal electrolytes are associated with higher mortality in patients infected with HEV.Conclusions: A higher mean serum creatinine, total bilirubin, SGOT, SGPT; lower total protein, albumin, and abnormal electrolytes in body fluid (Na+, K+, Cl-, Ca++) values are associated with higher mortality in patients infected with HEV.

Metabolic Acidosis and Hyponatremia in a Patient With Metastatic Melanoma

Metabolic Acidosis and Hyponatremia in a Patient With Metastatic Melanoma

Serum magnesium levels in hospitalized patients with SARS-CoV-2

Early studies have reported various electrolyte abnormalities at admission in patients with severe COVID-19. 104 out of 193 patients admitted to our institution presented with hypermagnesemia at presentation. It is...

Hypermagnesemia in critically ill patients with cancer: A case report.

Hypermagnesemia is often an under reported finding in critically ill patients with cancer. Hypomagnesemia is a commonly encountered electrolyte abnormality in patients with cancer that is primarily caused by a reduced intake, secondary to chemotherapeutic drugs and malnutrition. Hypermagnesemia is rarely observed in patients with normal renal function, as excess intake can be compensated by renal excretion. However, in critically ill patients with reduced renal function, hypermagnesemia can add further to complications and increase mortality. Drugs such as lactulose, antacids, fentanyl and peptide hormones, including vasopressin, can further increase chances of hypermagnesemia, particularly when patients demonstrate decreased renal function and multiple organ failure. Prudence and caution must therefore be exercised while using these agents in critically ill patients with cancer to avoid increased complications and mortality. Herein, the current study reports three cases of critically ill patients with cancer admitted into intensive care who had refractory hypermagnesemia.

85 Analyzing Acute Kidney Injury and Electrolyte Abnormalities in Patients Who Underwent CAR-T Therapy

85 Analyzing Acute Kidney Injury and Electrolyte Abnormalities in Patients Who Underwent CAR-T Therapy

Electrolyte abnormalities in patients hospitalized with COVID-19.

Electrolyte abnormalities in patients hospitalized with COVID-19.

Acute kidney injury and electrolyte abnormalities in patients with scrub typhus admitted to a tertiary care hospital in southern India.

Introduction:Scrub typhus is an acute febrile illness that is seen in many parts of India. Acute kidney injury (AKI) can occur in patients with scrub typhus who are not diagnosed and treated in the early stage of the disease. Such patients can have associated electrolyte abnormalities also.Objectives:This study was done to find out the incidence of occurrence of AKI and electrolyte abnormalities among patients with scrub typhus and correlate the latter with the severity of AKI.Methods:This prospective, observational study included 38 patients with scrub typhus admitted to a tertiary care hospital in south India. Serum sodium and serum potassium levels of all the patients were measured at hospital admission. Also, serum creatinine levels of patients on all days of the hospital stay was measured along with other parameters like hemoglobin, leucocyte count, and platelet count.Results:The incidence of AKI among patients with scrub typhus was 13.16%. However, electrolyte abnormalities though seen in the patients did not correlate with AKI.Conclusion:AKI is not an uncommon phenomenon in patients with scrub typhus. Electrolyte abnormalities in these patients did not correlate with the severity of AKI.

Hyponatremia and other electrolyte abnormalities in patients receiving immune checkpoint inhibitors.

Hyponatremia due to endocrinopathies such as adrenal insufficiency and hypothyroidism has been reported in patients receiving immune checkpoint inhibitors (ICIs). We determined the risk and predictors of hyponatremia and other electrolyte abnormalities in a 'real-world' sample of patients receiving ICIs to treat advanced malignancies. This was a retrospective observational study of all patients who received ICIs from a single cancer center between 2011 and 2018. Patients were followed for 12 months after initiation of ICIs or until death. Common Terminology for Cancer Adverse Events version 5.0 criteria were used to grade the severity of hyponatremia and other electrolyte abnormalities. The predictors of severe (Grade 3 or 4) hyponatremia were determined using a multivariable logistic regression model. The etiology of Grade 3 or 4 hyponatremia was determined by chart review. A total of 2458 patients were included. Their average age was 64 years [standard deviation (SD) 13], 58% were male and 90% were white. In the first year after starting ICIs, 62% experienced hyponatremia (sodium <134 mEq/L) and 136 (6%) experienced severe hyponatremia (<124 mEq/L). Severe hyponatremia occurred on average 164 days (SD 100) after drug initiation. Only nine cases of severe hyponatremia were due to endocrinopathies (0.3% overall incidence). Risk factors for severe hyponatremia included ipilimumab (a cytotoxic T lymphocyte antigen-4 inhibitor) use, diuretic use and non-White race. Other severe electrolyte abnormalities were also commonly observed: severe hypokalemia (potassium <3.0 mEq/L) occurred in 6%, severe hyperkalemia (potassium ≥6.1 mEq/L) occurred in 0.6%, severe hypophosphatemia (phosphorus <2 mg/dL) occurred in 17% and severe hypocalcemia (corrected calcium <7.0 mg/dL) occurred in 0.2%. Hyponatremia is common in cancer patients receiving ICIs. However, endocrinopathies are an uncommon cause of severe hyponatremia.

Prevalences of hyperuricemia and electrolyte abnormalities in patients with chronic kidney disease in Japan: A nationwide, cross-sectional cohort study using data from the Japan Chronic Kidney Disease Database (J-CKD-DB).

BackgroundThe Japan Chronic Kidney Disease Database (J-CKD-DB) is a nationwide clinical database of patients with chronic kidney disease (CKD) based on electronic health records. The objective of this study was to assess the prevalences of hyperuricemia and electrolyte abnormalities in Japanese patients with CKD.MethodsIn total, 35,508 adult outpatients with estimated glomerular filtration rates of 5–60 ml/min/1.73 m2 in seven university hospitals were included this analysis. The proportions of patients with CKD stages G3b, G4, and G5 were 23.5%, 7.6%, and 3.1%, respectively.ResultsLogistic regression analysis showed that prevalence of hyperuricemia was associated with CKD stages G3b (adjusted odds ratio [95% confidence interval]: 2.12 [1.90–2.37]), G4 (4.57 [3.92–5.32]), and G5 (2.25 [1.80–2.80]). The respective prevalences of hyponatremia, hypercalcemia, hyperphosphatemia, and narrower difference between serum sodium and chloride concentrations were elevated in patients with CKD stages G3b, G4, and G5, compared with those prevalences in patients with CKD stage G3a. The prevalences of hyperkalemia were 8.3% and 11.6% in patients with CKD stages G4 and G5, respectively. In patients with CKD stage G5, the proportions of patients with optimal ranges of serum uric acid, potassium, corrected calcium, and phosphate were 49.6%, 73.5%, 81.9%, and 56.1%, respectively.ConclusionsWe determined the prevalences of hyperuricemia and electrolyte abnormalities in Japanese patients with CKD using data from a nationwide cohort study.