Reduction In Potassium Levels Research Articles

Evaluation of Serum Electrolyte Abnormalities and Kidney Function to Assess Risk of Kidney Disease in Hypertensive Patients at Kenyatta National Hospital

HTN is a known leading cause of kidney disease with over 20% of the population aged 20 years or older with HTN developing CKD. Complications from HTN and kidney disease contribute significantly to global mortality. In Kenya, data from WHO shows that about 4 million individuals suffer from CKD, with many progressing to kidney failure. The aim was to assess serum electrolyte abnormalities and kidney function among hypertensive patients at KNH. The study utilized cross-sectional retrospective data from KNH patient records. The CKD-EPI equation was used to calculate eGFR. Fisher et al.’s equation determined sample size. Data were stratified by variables such as DBP, age, sex, SBP, proteinuria, serum creatinine, urea levels, serum electrolytes, and eGFR. Data collection involved 189 patients: 82 males (43.4%) and 107 females (56.6%), with a median age of 54.00 years. 93 patients (49.20%) were <54 years and 96 (50.80%) were ≥54 years. 78.84% of HTN patients had abnormal serum creatinine levels, and 54.5% had abnormal serum urea levels. 58.7% showed proteinuria. Elevated sodium levels (>145 mmol/l) affected 39.68% of patients, while reduced potassium levels (<3.5 mmol/l) were found in 15.34%. 41.27% had elevated chloride levels above 106 mmol/l. CKD stages varied: 3.2% had G1, 17.5% had G2, 14.8% had G3a, 29.1% had G3b, 16.4% had G4, and 19.0% had G5. Reduced renal function, estimated using GFR, was prevalent among hypertensive patients (79.4%) (95% CI:72.9-82.9), notably those ≥54 years. In conclusion, the risk of progressive kidney disease was high amongst hypertensive patients and this was evident from the proportion of patients who have abnormal kidney function including proteinuria. Early screening and implementation of therapeutic strategies can improve patient’s quality of life.

The impact of hyperkalemia on ICU admission and mortality: a retrospective study of Chinese emergency department data

ObjectiveThis study assesses the influence of hyperkalemia on both disease severity and the risk of mortality among patients admitted to the emergency room.MethodsThis retrospective observational study utilized data from the Chinese Emergency Triage Assessment and Treatment database (CETAT, version 2.0), which was designed to evaluate and optimize management strategies for emergency room (ER) patients. Patients were systematically categorized based on serum potassium levels. Relationships between serum potassium levels, risk of mortality, and the severity of illness were then analyzed using multifactorial logistic regression and through Receiver Operating Characteristic (ROC) analysis. The effectiveness of various treatments at lowering potassium levels was also investigated.Results12,799 emergency patients were enrolled, of whom 20.1% (n = 2,577) were hypokalemic and 2.98% (n = 381) were hyperkalemic. Among hyperkalemic patients, the leading reasons for visiting the ER were altered consciousness 23.88% (n = 91), cardiovascular symptoms 22.31% (n = 85), and gastrointestinal symptoms 20.47% (n = 78). Comparative analysis with patients exhibiting normal potassium levels revealed hyperkalemia as an independent factor associated with mortality in the ER. Mortality risk appears to positively correlate with increasing potassium levels, reaching peaks when blood potassium levels ranged between 6.5 and 7.0. Hyperkalemia emerged as a strong predictor of death in the ER, with an Area Under the Curve (AUC) of 0.89. The most frequently prescribed treatment for hyperkalemia patients was diuretics (57.32%, n = 188), followed by intravenous sodium bicarbonate (50.91%, n = 167), IV calcium (37.2%, n = 122), insulin combined with high glucose (27.74%, n = 91), and Continuous Renal Replacement Therapy (CRRT) for 19.82% (n = 65). Among these, CRRT appeared to be the most efficacious at reducing potassium levels. Diuretics appeared relatively ineffective, while high-glucose insulin, sodium bicarbonate, and calcium preparations having no significant effect on the rate of potassium decline.ConclusionHyperkalemia is common in emergency situations, especially among patients with altered consciousness. There is a strong positive correlation between the severity of hyperkalemia and mortality risk. CRRT appears to be the most effective potassium reducting strategy, while the use of diuretics should be approached with caution.

Manajemen Diet Rendah Kalium pada Pasien dengan Diangnosa Medis Chronic Kidney Disease (CKD) E. C Hiieperkalemia di Ruangan Matahari RSUD dr. TC. HILERS Maumere

Chronic Kidney Disease (CKD) with et causa Hyperkalemia is one of the highest causes of death in Indonesia as well as in Sikka district. Based on data obtained in 2022, there were 300 cases of the largest CKD in 25 sub-districts, based on data in the Matahari room there were 22 cases recorded. The aim of this research is to enable prospective nurses to apply professional practices and manage a low potassium diet in hyperkalemia patients to reduce potassium levels in the Matahari Room at RSUD dr. T.C. HILERS Maumere. This research is a case study research using the case study method which begins with identifying previous nursing care reports or via the internet The results of the study showed that there was a decrease in potassium levels in the participants as evidenced by the results of potassium examinations from 6.5 mmol/L down to 5.0 mmol/L. From the research results it can be concluded that low potassium diet management is very influential in helping to reduce potassium levels in the blood. Suggestions for relevant agencies are that low-chlorium diet management can be used as a nursing care option for patients with Chronic Kidney Disease. It is hoped that by knowing the effect of a low potassium diet on hyperkalemia sufferers, it is hoped that this can be an input for improving the quality of services in further nursing care.

Novel potassium binders to optimize RAASi therapy in heart failure: A systematic review and meta-analysis

AimsHyperkalemia often occurs among heart failure (HF) patients, particularly when treated with renin-angiotensin-aldosterone system inhibitors (RAASi). Even modest potassium levels variations raise the risk of mortality and prompt patients to discontinue disease-modifying treatment, as RAASi. Novel potassium binders (NPB), patiromer and sodium zirconium cyclosilicate, are effective in reducing potassium levels and are approved for the treatment of hyperkalemia in HF, but whether their use results in a real optimization of HF treatment remains to be seen. The aim of the present meta-analysis was to assess the efficacy of NPB on the optimization of RAASi therapy in HF patients. Methods and resultsPubMed, Web of Science and Clinicaltrial.gov were searched without restrictions from inception to 06 August 2022 to identify valuable articles. The studies that met the inclusion criteria were analyzed. The prespecified primary outcome was the optimization of RAASi therapy in HF patients, defined as the proportion of patients on RAASi at the end of follow-up. Secondary outcomes were hyperkalemia events, reduction in potassium levels, and adverse drugs reactions. Six studies with a total of 1390 patients were included. NPB improved RAASi therapy optimization in HF by 14% (95% CI: 4–26%), decreased hyperkalemia events by 29% (95% CI: 55–92%), and reduced potassium levels by 0.31 mEq/L (95% CI: 0.18–0.44) compared to placebo, maintaining a good safety profile. ConclusionNPB are effective in allowing RAASi therapy optimization in patients affected by HF, in reducing hyperkalemia events and potassium levels. Systematic Review registrationCRD42022351811 URL: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=351811

Serum Levels of sodium and Potassium in Patientswith Asthma on Salbutamol Therapy

A total of 150 patients with asthma on salbutamol therapy were included in this study along with 90 apparently healthy adult person ( control group) were investigated for the measurements of serum sodium and potassium levels. All patients and controls were fasting when sampleds Sodium and potassium serum levels have been performed by using flame photometer. All patients showed a normal serum sodium (mean 139.8 mmol/L)while the majority (73.4%) of the patients showed hypokalemia (mean 3.1 mmol/L)when compared to control. This study showed that salbutamol have no deteriorated effect on sodium, while it may reduce potassium levels in the majority of patients.

A cost-effectiveness analysis of patiromer in the UK: evaluation of hyperkalaemia treatment and lifelong RAASi maintenance in chronic kidney disease patients with and without heart failure

BackgroundChronic kidney disease (CKD) patients with and without heart failure (HF) often present with hyperkalaemia (HK) leading to increased risk of hospitalisations, cardiovascular related events and cardiovascular-related mortality. Renin–angiotensin–aldosterone system inhibitor (RAASi) therapy, the mainstay treatment in CKD management, provides significant cardiovascular and renal protection. Nevertheless, its use in the clinic is often suboptimal and treatment is frequently discontinued due to its association with HK. We evaluated the cost-effectiveness of patiromer, a treatment known to reduce potassium levels and increase cardiorenal protection in patients receiving RAASi, in the UK healthcare setting.MethodsA Markov cohort model was generated to assess the pharmacoeconomic impact of patiromer treatment in regulating HK in patients with advanced CKD with and without HF. The model was generated to predict the natural history of both CKD and HF and quantify the costs and clinical benefits associated with the use of patiromer for HK management from a healthcare payer’s perspective in the UK.ResultsEconomic evaluation of patiromer use compared to standard of care (SoC) resulted in increased discounted life years (8.93 versus 8.67) and increased discounted quality-adjusted life years (QALYs) (6.36 versus 6.16). Furthermore, patiromer use resulted in incremental discounted cost of £2,973 per patient and an incremental cost-effectiveness ratio (ICER) of £14,816 per QALY gained. On average, patients remained on patiromer therapy for 7.7 months, and treatment associated with a decrease in overall clinical event incidence and delayed CKD progression. Compared to SoC, patiromer use resulted in 218 fewer HK events per 1,000 patients, when evaluating potassium levels at the 5.5–6 mmol/l; 165 fewer RAASi discontinuation episodes; and 64 fewer RAASi down-titration episodes. In the UK, patiromer treatment was predicted to have a 94.5% and 100% chance of cost-effectiveness at willingness-to-pay thresholds (WTP) of £20,000/QALY and £30,000/QALY, respectively.ConclusionThis study highlights the value of both HK normalisation and RAASi maintenance in CKD patients with and without HF. Results support the guidelines which recommend HK treatment, e.g., patiromer, as a strategy to enable the continuation of RAASi therapy and improve clinical outcomes in CKD patients with and without HF.

Effects of nebulised beta-2 agonists on clinical observations in asthma exacerbations

Background: Despite concerns over their side effects, short-acting beta-2 agonists are still used in high doses in prehospital care internationally to treat asthma exacerbations. This systematic review set out to identify the physiological effects associated with this treatment and determine their potential impact on the patient's presenting or underlying conditions. Methods: A systematic search of literature published from 2010 to 2020 focusing on asthmatic patients receiving nebulised beta-2 agonists during an acute exacerbation was undertaken and relevant articles reviewed. Findings: Eight out of 897 studies met the inclusion criteria. While the studies were heterogeneous with a range of outcome measures, synthesis showed evidence of bronchodilator action throughout, with reductions in potassium levels and cardiovascular changes reported in several studies. Conclusions: Therapeutic effects demonstrated within the data support the use of nebulised beta-2 agonists in these patients and, while adverse effects are frequently seen in the cardiovascular and endocrine systems, their impact on the patient's overall condition remains unclear.

488 NOVEL POTASSIUM BINDERS IMPROVES RAASI THERAPY OPTIMIZATION IN HEART FAILURE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Background Hyperkalemia (HK) often occurs among patients with heart failure (HF), particularly when treated with renin-angiotensin-aldosterone system inhibitors (RAASi). Even modest variations from normal potassium levels raise the risk of mortality and prompt patients to limit or cease disease-modifying treatment. Novel potassium binders (NPB), patiromer and sodium zirconium cyclosilicate, are approved for treatment of HK, but whether this results in a real optimization of HF treatment remains to be seen. Objectives To assess the efficacy of NPB on the persistence of therapy with RAASi in HF patients. Methods PubMed and Web of Science were searched without restrictions from inception to 06 August 2022 to identify valuable articles. The studies that met the inclusion criteria were analyzed. The prespecified main outcome was the proportion of HF patients achieving target dose of RAASi. Secondary outcomes were the reduction in potassium levels, hyperkalemia events and persistence of therapy with RAASi in the overall population. Results Eight studies, with a total of 2247 patients were included. NPB improved optimization of RAASi therapy in HF compared to placebo by 21% (95% CI: 5% – 39%), decreased potassium levels by 0.48 mEq/L (95% CI: 0.28–0.67) and decreased hyperkalemia events by 53% (95% CI: 34% – 64%) and improved the proportion of the overall study population on RAASi therapy by 28% (95% CI: 7% – 52%). Conclusion The present meta-analysis suggests that NPB are favorable in improving the proportion of patients on RAASi therapy, whether they have HF or not, in reducing potassium levels and hyperkalemia events.

Evaluation of Drug Combinations’ Effectiveness in Hyperkalemia Management of Chronic Kidney Disease Patients

Objective: This study aims to compare the effectiveness of hyperkalemia drug combinations in reducing potassium levels in chronic kidney disease (CKD) patients. Methods: This is an observational study on medical records of CKD patients with hyperkalemia at Dr. Saiful Anwar and Lavalette Hospitals, Malang, Indonesia. From 2017 to 2019, 78 hyperkalemia correction data were obtained from 47 patients’ medical records. The hypothesis test used in this study was the one-way ANOVA test. Results: Drug combinations of calcium gluconate, Actrapid® HM, and D40% (∆p = 0.62 mmol/L); calcium gluconate, Actrapid® HM, D40%, and Ventolin® Nebules (∆p = 0.72 mmol/L); and calcium gluconate, NovoRapid®, and D40%® (∆p = 1.03 mmol/L) were able to significantly reduce serum potassium levels (p < 0.05). A drug combination of calcium gluconate, Humulin® R, and D40% (∆p = 0.84 mmol/L) was also able to reduce serum potassium levels but not statistically significant (p > 0.05). The comparison test results of the four groups of drug combinations showed that no combination of drugs was superior to others in lowering potassium levels (p > 0.05). Conclusions: The four groups of hyperkalemia drug combinations can reduce the patient’s serum potassium level and have the same effectiveness.

The Effect of Salinity on Fruit Quality and Yield of Cherry Tomatoes

Hydroponic cultivation of vegetables avoids problems with soil-borne plant pathogens and may allow higher yield. In arid climates and particularly on islands, high concentrations of sodium chloride can be present in the groundwater. For instance, in many sites of Malta, the groundwater contains more than 10 mM sodium chloride. Here we investigated the effects of sodium chloride at levels typically found in Malta on yield, physiology and fruit quality of tomato, the economically most important vegetable. We selected cherry tomatoes since their production is attractive due to their high marketing value. While the yield declined at higher salinity levels tested (17 and 34 mM), the quality increased significantly as indicated by higher total soluble solids and fructose and glucose levels. The type of substrate—coco peat, perlite or Rockwool—had only minor effects. Although the concentration of citric acid and malic acid remained unaffected, the pH dropped by approximately 0.1 unit and the titratable acidity increased slightly. This might be explained by a high uptake of chloride but a lower increase of the sodium content and a reduced potassium level in the fruits, shifting the equilibrium of the organic acids more to their protonated forms. Proline increased significantly, while the level of glutamic acid, which is crucial for the taste, remained unchanged. Our results show that cherry tomatoes can be cultivated in nutrient solutions prepared with salt-containing groundwater, as found in Malta. The yield declined to some extent but the quality of the produced fruits was higher compared to cultivation in salt-free media.

Correlation between potassium administration and resolution in patients with diabetic ketoacidosis

Background: Diabetic ketoacidosis (DKA) is a life-threatening complication of acute diabetes mellitus (DM). Insulin is one of the therapies for DKA, which can reduce potassium levels by shifting potassium from extracellular to intracellular. Consequently, early administration of potassium is important in the resolution of DKA. Objective: To determine the correlation between potassium administration and resolution in patients with DKA and the factors affecting such resolution. Methods: An observational study was employed with a retrospective cohort design for inpatients with a diagnosis of DKA during the period of January 2015-August 2020 at Dr. Sardjito Hospital Yogyakarta. Appraisal of the resolution of DKA variable was based on the achievement of blood glucose targets, followed by 2 criteria of serum bicarbonate, pH, and anion gap during 24 hours of therapy. This study involved 55 patients divided into groups with potassium administration and without potassium administration. Data were analyzed using the chi-square test and multivariate logistic regression. Results: The resolution of DKA achieved in less than equal to 24 hours in the group with potassium was 48.5% (16 patients) while it was 18.2% (4 patients) without potassium. Based on the chi-square analysis, there was a relationship between potassium administration and the resolution of DKA (p=0.045; RR=2.667; 95%CI=1.028-6.920). The multivariate analysis showed that the severity and history of DM were positively related to the resolution of DKA (p=0.025; OR: 8.901; 95%CI=1.318-60.123 and p=0.017; OR: 0.090; 95%CI=0.012-0.652). Conclusion: Potassium administration resulted in 48.5% of the DKA patients achieving a resolution in less than equal to 24 hours from the commencement of DKA therapy. The severity and history of DM became the factors that affected the resolution of DKA. Keywords: diabetic ketoacidosis, potassium, resolution

Efficacy of standard- vs reduced-dose insulin for treatment of hyperkalemia: A quasi-experiment.

DisclaimerIn an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.PurposeHyperkalemia more commonly affects patients with a glomerular filtration rate of less than 60 mL/min. Using intravenous (IV) insulin to shift potassium intracellularly may cause hypoglycemia, requiring additional treatment or longer hospitalization. Literature on insulin dosing in this context is limited, with one previous study indicating that 5 units of IV insulin might be as effective and result in less hypoglycemia than the standard dose of 10 units of IV insulin. The hyperkalemia treatment pathway at our institution was revised in May 2018 to include a reduced-dose option (5 units of insulin) for patients with end-stage renal disease. This study aimed to compare the prevalence of hypoglycemia between patients who received standard-dose vs reduced-dose IV insulin.MethodsThis single-center, retrospective, quasi-experimental study evaluated the impact of revision of the hyperkalemia treatment pathway by assessing rates of hypoglycemia during the 6 months before and after implementation of the revised pathway. The primary endpoint was prevalence of hypoglycemia, defined as a blood glucose level of less than or equal to 70 mg/dL.ResultsThere was no statistically significant difference in the occurrence of hypoglycemia when comparing the pre- and postimplementation groups (36 [17.7%] patients vs 34 [18.7%] patients; P = 0.7924). The postimplementation group had a statistically significant lower reduction in potassium levels after treatment than the preimplementation group (mean [interquartile range], –0.9 [–1.3, –0.5] mEq/L vs –0.6 [–1.2, –0.2] mEq/L; P = 0.0095). Baseline potassium levels were similar between the groups.ConclusionAdministration of reduced-dose IV insulin for treatment of hyperkalemia was significantly less effective in lowering serum potassium levels and did not decrease prevalence of hypoglycemia. When accounting for potential confounders, the only variable that was associated with hypoglycemia was pretreatment glucose level.

Managing patients with diabetes and chronic kidney disease

In late 2020, the nonprofit organization Kidney Disease: Improving Global Outcomes (KDIGO) published a clinical practice guideline in the Annals of Internal Medicine on management of patients with diabetes and chronic kidney disease (CKD). The new guidance focuses on comprehensive care needs, glycemic monitoring and targets, and educational and integrated care approaches. “The 2020 KDIGO clinical practice guideline on diabetes management incorporates recent kidney outcome data to provide specific recommendations on use of glucose-lowering agents to mitigate kidney and cardiovascular risk,” said Joshua J. Neumiller, PharmD, CDCES, FADCES, FASCP, vice-chair and Allen I. White Distinguished Associate Professor in the College of Pharmacy and Pharmaceutical Sciences at Washington State University in Pullman. “Recommendations from KDIGO complement current guidance from the endocrine and cardiology communities, but provides a succinct resource related to the specific care needs of patients with diabetes and CKD. Particularly important to pharmacists is the guideline's discussion of risk mitigation strategies and important counseling points to optimize patient safety,” said Neumiller. Patients with diabetes and CKD often have other comorbidities and a higher cardiovascular burden, so a comprehensive management approach is needed. KDIGO recommends use of an ACE inhibitor (ACEi) or an ARB in patients with diabetes, hypertension, and albuminuria, with these medications titrated to the highest approved dose that is tolerated. Use may also be considered in patients with diabetes, albuminuria, and normal blood pressure. Only one of these agents should be used at a time, as combination therapy with an ACEi and an ARB or one of these agents with a direct renin inhibitor may be potentially harmful. Close monitoring of blood pressure, potassium levels, and serum creatinine is needed within 2 to 4 weeks of initiation of therapy or when there is a dose increase. KDIGO recommends that hyperkalemia be managed by implementing measures to reduce potassium levels (e.g., moderating potassium intake, initiating diuretics) rather than by decreasing or discontinuing the ACEi or ARB immediately. In addition, KDIGO recommends continuation of the ACEi or ARB unless creatinine levels increase by more than 30%. The ACEi or ARB dose should be reduced or withdrawn in patients who develop symptomatic hypotension, uncontrolled hyperkalemia (despite interventions), and acute kidney injury. The guideline discusses tobacco cessation as part of the comprehensive care plan, with patients encouraged to avoid using any tobacco products and to reduce their exposure to secondhand smoke. A section on lifestyle intervention is also included, and clinicians are encouraged to review those recommendations in the full publication. KDIGO recommends that A1C levels be used to monitor glycemic control in patients with diabetes and CKD, with an individualized target ranging from <6.5% to <8.0% for those not treated with dialysis. Assessment twice per year is reasonable, but assessments as often as 4 times per year may be needed if glycemic targets are not met or after a change in antihyperglycemic therapy. For antihyperglycemic therapy, KDIGO recommends metformin in combination with a sodium–glucose cotransporter-2 inhibitor for patients with type 2 diabetes, CKD, and an eGFR of 30 mL/min/1.73 m2 or greater. If patients do not reach their individualized glycemic target or are unable to use those medications, the guideline recommends use of a glucagon-like peptide-1 receptor agonist as the next preferred agent. Other antihyperglycemic agents are also listed with a figure (i.e., Figure 4) that helps guide appropriate selection based on patient and provider preferences (e.g., weight loss, avoid injections, avoid hypoglycemia, potent glucose lowering needed), comorbidities (e.g., high-risk atherosclerotic cardiovascular disease, heart failure), eGFR (e.g., dialysis), and cost. KDIGO recognizes that data on use of newer agents in patients with type 1 diabetes and CKD receiving insulin are sparse and makes no special recommendations for these patients. KDIGO discusses the importance of both a self-management education program and a team-based integrated approach to care. The self-education program should consider local context, cultures, and availability of resources and be tailored to individual preferences and learning styles. These programs can be delivered one-on-one or as a group-based model. The team-based approach should include both physician and nonphysician personnel and focus on regular assessments, control of multiple risk factors, and self-management to protect kidney function and reduce the risk for complications.

Potassium reduction in food by preparation technique for the dietetic management of patients with chronic kidney disease: a review.

Chronic kidney disease patients often use food preparation techniques to reduce potassium intake. However, the most effective techniques have not yet been determined for all food groups. The present study aimed to analyse all of the available information on potassium reduction in the food and identify the best preparation techniques by comparing the trend of change in potassium level. Nine databases were searched from 1976 to May 2020, according to the PRISMA Statement. We included all articles reporting the amount of potassium before and after the application of food preparation techniques. Data were analysed using the Wilcoxon test and statistical simulation. A wide variety of food and culinary processes was observed in the 65 included articles. Cooking in water, pressure cooking and cooking in a microwave oven reduced potassium levels in all food groups, particularly in cereals and derivatives, fruits and derivatives, meats and derivatives, legumes, and leafy and cruciferous vegetables. Soaking food significantly reduced the potassium content in tubers and roots and leafy and cruciferous vegetables. Steam cooking and dry heating cooking also reduced potassium, although at a level lower than the other techniques. The present review shows that, in general, all food preparation techniques can reduce the potassium content, although cooking in water and soaking promotes a greater reduction; however, more studies with standardised techniques and complete data are necessary.

Patiromer and medication optimisation in heart failure with reduced ejection fraction: a Swiss perspective.

Despite medical advances, heart failure remains a major public health issue and is associated with considerable morbidity and mortality. Suboptimal use of evidence-based therapies and lack of medication up-titration play important roles in this regard. Hyperkalaemia is a frequent and potentially harmful finding which hinders treatment optimisation in patients with heart failure. In this review, heart failure experts from two Swiss academic hospitals discuss the principles of general pharmacological therapy in heart failure with reduced ejection fraction and the different treatment options for chronic hyperkalaemia, focusing on patiromer, a recently available potassium binder. Patiromer has been accepted for reimbursement since 1 August 2020 in Switzerland, and has been shown in several clinical trials to safely reduce potassium levels over the long term, thereby allowing up-titration or maintenance of renin-angiotensin-aldosterone inhibitors in patients with chronic kidney disease, including those with heart failure. Whether this promising approach improves outcomes in patients with heart failure and reduced ejection fraction is currently under investigation.

Leaves contents of nutrients in Cryptostegia madagascariensis in different salinized soils

The species C. madagascariensis occurs in humid and arid areas, thus, the species has been standing out as an invasive plant. An experiment was developed in greenhouse with the objective of evaluating the leaf contents (nutritional status) of plants of these invasive plants subjected to different levels of salinity and humidity. The treatments were arranged in randomized blocks, with four repetitions, following the factorial arrangement of 4x4x2, corresponding to the five levels of salinity or incubations (0.3; 1.0; 2.0 and 4.0 dS m-1), four moisture contents (20% of CC; 40% of CC; 70% of CC and 110% of CC) maintained until the end of the test and with two types of soils (Floss Neossol and Vertisolo). Initially, two soils were used, a Floss Neossol and a Vertisol. Leaf samples were analyzed to determine the levels of N, P, K and Na. The soils were placed in pots with a capacity of 21 liters, where each pot contained 19 kg of soil and 4 plants per plot in randomized blocks with 4 repetitions. After elapsed 152 days after sowing, samples of plant tissue (leaves) were taken for chemical analysis. At the end of the experiment, the following leaf variables were carefully evaluated: Nitrogen (N); Phosphorus (P), Potassium (K+) and Sodium (Na+). The increase in humidity in both soils under growth of young plants increased sodium levels and reduced potassium levels in plant tissue resulting from excess sodium in the two soils as a function of salinity and humidity.

P0187COMPARING OPAL-HK DATA TO REAL-WORLD DATA FROM THE UNITED KINGDOM: HOW EFFECTIVE IS PATIROMER AT ACHIEVING NORMOKALAEMIA?

Abstract Background and Aims The first phase of the published OPAL-HK study showed that Patiromer, an oral potassium binder, was effective at reducing serum potassium levels in patients with chronic kidney disease (CKD) stages 3 to 4. This phase was a 4-week, single-group treatment phase. Given the lack of a control arm, the aim of our study was to use real-world data from a large CKD cohort to provide a control comparison to evaluate the efficacy of Patiromer in normalising serum potassium. Method The initial phase of OPAL-HK comprised 243 patients with CKD G3-4 with a baseline serum potassium of 5.1 to &amp;lt;6.5mmol/L. To acquire a comparative matched cohort, patients were selected from the Salford Kidney Study (SKS), a prospective observational cohort study in the United Kingdom that has been recruiting patients aged ≥18 years old with CKD G3-5 since 2002. A 3-step process was applied to generate a propensity matched cohort. First, patients were chosen if they had an outpatient potassium level at any point after recruitment into SKS between 5.1mmol/L to &amp;lt;6.5mmol/L and whose next outpatient potassium level was checked 24 to 42 days (3.5 to 6 weeks) later (n=755). Second, all key OPAL-HK inclusion and exclusion criteria were applied. This left 162 patients who were then accurately matched in a 1:1 fashion to the 243 OPAL-HK patients using propensity score matching based on 6 baseline variables: age, gender, eGFR, diabetes mellitus, heart failure and potassium level. This produced a cohort of 87 SKS patients matched to their 87 OPAL-HK partner patients. We compared the two patient groups for the following OPAL-HK study endpoints: the mean change in serum potassium from baseline to follow-up at week 4, and the proportion of patients with a serum potassium of 3.8 to &amp;lt;5.1mmol/L at week 4. Results The groups were extremely well matched: between SKS vs. OPAL-HK, the mean (±SD) age was 63.9±13.3 vs. 63.7±9.5years (p=0.93); mean eGFR was 30.9±11.6 vs. 31.2±11.7ml/min/1.73m2 (p=0.85); 45 vs. 46 patients were diabetics (p=0.88); 29 vs. 24 had heart failure (p=0.41) and the mean potassium was 5.5±0.3mmol/L in both groups (p=0.68). The follow-up in the SKS cohort was 31±5 days. At the end of follow-up, the mean potassium level remained 5.5±0.3mmol/L in SKS patients but had reduced to 4.5±0.5mmol/L in the OPAL-HK group (p&amp;lt;0.001), a mean (±SE) change of -1.00±0.06mmol/L. For the secondary endpoint, 74% of patients in OPAL-HK reached the target potassium range of 3.8 to &amp;lt;5.1mmol/L at week 4 compared with 0% from the comparator SKS cohort (see Figure). Conclusion Using real-world data as a tightly-matched control arm for the first phase of the OPAL-HK study, Patiromer is shown to be effective at reducing potassium levels in patients with CKD G3-4.

Zero balance ultrafiltration using dialysate during nationwide bicarbonate shortage: a retrospective analysis

BackgroundZero balance ultrafiltration (Z-BUF) utilizing injectable 8.4% sodium bicarbonate is utilized to treat hyperkalemia and metabolic acidosis associated with cardiopulmonary bypass (CPB). The nationwide shortage of injectable 8.4% sodium bicarbonate in 2017 created a predicament for the care of cardiac surgery patients. Given the uncertainty of availability of sodium bicarbonate solutions, our center pro-actively sought a solution to the sodium bicarbonate shortage by performing Z-BUF with dialysate (Z-BUF-D) replacement fluid for patients undergoing cardiopulmonary bypass.MethodsSingle-center, retrospective observational evaluation of the first 46 patients at an academic medical center who underwent Z-BUF using dialysate over a period of 150 days with comparison of these findings to a historical group of 39 patients who underwent Z-BUF with sodium chloride (Z-BUF-S) over the preceding 150 days. The primary outcome was the change in whole blood potassium levels pre- and post-Z-BUF-D. Secondary outcomes included changes in pre- and post-Z-BUF-D serum bicarbonate levels and the amount of serum bicarbonate used in each Z-BUF cohort (Z-BUF-D and Z-BUF-S).ResultsZ-BUF-D and Z-BUF-S both significantly reduced potassium levels during CPB. However, Z-BUF-D resulted in a significantly decreased need for supplemental 8.4% sodium bicarbonate administration during CPB (52 mEq ± 48 vs. 159 mEq ± 85, P < 0.01). There were no complications directly attributed to the Z-BUF procedure.ConclusionZ-BUF with dialysate appears to be analternative to Z-BUF with sodium chloride with marked lower utilization of intravenous sodium bicarbonate.

Boosting the Limited Use of Mineralocorticoid Receptor Antagonists Through New Agents for Hyperkalemia.

Hyperkalemia is an important clinical problem that is associated with significant lifethreatening complications. Several conditions are associated with increased risk for hyperkalemia such as chronic kidney disease, diabetes mellitus, heart failure, and the use of renin-angiotensin-aldosterone system (RAAS) inhibitors. The purpose of this review is to present and critically discuss treatment options for the management of hyperkalemia. A comprehensive review of the literature was performed to identify studies assessing the drug-induced management of hyperkalemia. The management of chronic hyperkalemia seems to be challenging and includes a variety of traditional interventions, such as restriction in the intake of the dietary potassium, loop diuretics or sodium polystyrene sulfonate. In the last few years, several new agents have emerged as promising options to reduce potassium levels in hyperkalemic patients. Patiromer and sodium zirconium cyclosilicate 9 (ZS-9) have been examined in hyperkalemic patients and were found to be efficient and safe. Importantly, the efficacy of these novel drugs might allow the continuation of the use of RAAS inhibitors, morbidity- and mortality-wise beneficial class of drugs in the setting of chronic kidney disease and heart failure. Data support that the recently emerged patiromer and ZS-9 offer significant hyperkalemia-related benefits. Larger trials are needed to unveil the impact of these drugs in other patients' subpopulations, as well.

Survival of human embryonic stem cells implanted in the guinea pig auditory epithelium

Hair cells in the mature cochlea cannot spontaneously regenerate. One potential approach for restoring hair cells is stem cell therapy. However, when cells are transplanted into scala media (SM) of the cochlea, they promptly die due to the high potassium concentration. We previously described a method for conditioning the SM to make it more hospitable to implanted cells and showed that HeLa cells could survive for up to a week using this method. Here, we evaluated the survival of human embryonic stem cells (hESC) constitutively expressing GFP (H9 Cre-LoxP) in deaf guinea pig cochleae that were pre-conditioned to reduce potassium levels. GFP-positive cells could be detected in the cochlea for at least 7 days after the injection. The cells appeared spherical or irregularly shaped, and some were aggregated. Flushing SM with sodium caprate prior to transplantation resulted in a lower proportion of stem cells expressing the pluripotency marker Oct3/4 and increased cell survival. The data demonstrate that conditioning procedures aimed at transiently reducing the concentration of potassium in the SM facilitate survival of hESCs for at least one week. During this time window, additional procedures can be applied to initiate the differentiation of the implanted hESCs into new hair cells.