Serum Potassium Levels In Patients Research Articles

Spironolactone versus Eplerenone in Patients with Resistant Hypertension: A Systematic Review and Indirect Meta-analysis

Background: Spironolactone and eplerenone, both mineralocorticoid receptor antagonists (MRAs), have been shown to be effective in the management of resistant hypertension (RH), although there is a lack of randomised controlled trials (RCTs) that directly comparing the two. This systematic review and indirect meta-analysis compares the two MRAs and their effectiveness in lowering blood pressure (BP) in patients with RH. Methods: RCTs comparing eplerenone or spironolactone with a placebo in RH patients were included in the review. The primary outcome was the mean difference (MD) of systolic blood pressure (SBP) and diastolic blood pressure (DBP). The secondary outcome was the MD of serum potassium levels. The pooled estimates of mean BP and mean potassium level difference were then analysed to attain the adjusted indirect comparisons. Results: Six RCTs involving 665 patients were included in the systematic review. The pooled MD of systolic and diastolic BP between eplerenone and placebo showed a reduction of −0.38 (p=0.0007) and −4.45 (p<0.0001), respectively. The pooled MD of systolic and diastolic BP between spironolactone and placebo showed a reduction of −4.82 (p=0.01) and −2.31 (p=0.006), respectively. The pooled MD of serum potassium levels between eplerenone and placebo as well as spironolactone and placebo was 0.16 (p=0.39) and −0.08 (p=0.59), respectively. An indirect comparison meta-analyses of the MD in systolic and diastolic BP (systolic MD 1.66; 95% CI [−3.46–6.78]; p=0.5250 and diastolic MD 2.14; 95% Cl [−0.63–4.91]; p=0.1293) as well as mean serum potassium levels (MD 0.24; 95% Cl, [−0.23–0.71]; p=0.313) between spironolactone and eplerenone, showed no significant difference. Conclusion: Spironolactone and eplerenone showed an equal reduction in systolic and diastolic BP, as well as serum potassium levels in patients with RH.

Effect of banana intake on serum potassium level in patients undergoing maintenance hemodialysis: A randomized controlled trial

ObjectiveThis study aimed to assess the effect of banana intake during hemodialysis on serum potassium levels in maintenance hemodialysis (MHD) patients. MethodsThis study was a single-center, randomized controlled clinical trial conducted from September 15 to December 15, 2021, at a tertiary hospital in southern China. A total of 126 MHD patients were randomly assigned to either the intervention group (n = 64) or the control group (n = 62). Patients in the intervention group consumed approximately 250 g of bananas during hemodialysis, while those in the control group did not consume any food during hemodialysis. Demographic information and hemodialysis-related parameters were collected through case information collection before hemodialysis. Laboratory indicators (such as complete blood count, biochemical indicators, inflammation markers, liver function, kidney function, etc.) were evaluated by collecting pre-hemodialysis blood samples from patients. Serum potassium and blood glucose levels were measured at 2 h and 4 h of hemodialysis, as well as before the next hemodialysis session, and hemodialysis-related complications were recorded. The blood potassium and blood glucose indicators during hemodialysis were compared using repeated measures analysis. ResultsA total of 122 MHD patients completed the study (61 in each group). The results showed that there was no significant interaction between group and time on serum potassium levels. However, serum potassium levels in the intervention group were higher than those in the control group at 2 h (3.9 ± 0.5 mmol/L vs. 3.6 ± 0.3 mmol/L, P < 0.01) and 4 h (3.5 ± 0.4 mmol/L vs. 3.3 ± 0.3 mmol/L, P < 0.01) of hemodialysis. There was no interaction between group and time on blood glucose levels. The incidence of arrhythmias (8.2% vs. 29.5%, P = 0.003) and hypokalemia (52.5% vs. 80.3%, P = 0.002) during hemodialysis was significantly lower in the intervention group compared to the control group. ConclusionConsuming approximately 250 g of bananas at the start of hemodialysis does not lead to hyperkalemia. It can effectively reduce the incidence of hypokalemia and arrhythmias, and prevent a rapid decline in serum potassium levels during hemodialysis.

Effect of Fluoxetine and Escitalopram on Heart Rate Variability (HRV) and Serum Potassium Level in Patients of Depression and Anxiety Disorders

Background The present study was conducted to generate data regarding the effect of fluoxetine as an anti-depressant and escitalopram as an antianxiety agent on heart rate variability (HRV). There is a scarcity of data regarding the correlation between selective serotonin reuptake inhibitors (SSRIs) and serum potassium levels. Purpose To find out the effect of SSRIs on HRV, and whether it is either dependent or independent of serum potassium level. Materials and Methods In this prospective, open-label, observational study, 70 participants were enrolled and divided into two groups, the fluoxetine group ( n = 35) and the escitalopram group ( n = 35) suffering from depression and anxiety, respectively. Parameters, like HRV, serum potassium level, heart rate, respiratory rate, and blood pressure, were measured baseline and after the first, second, and third months of treatment. HRV was calculated by root mean square deviation of successive differences between adjacent RR intervals (RMSSD). ECG (electrocardiogram) was recorded by Physio Pac Digital Polygraph software. All values were expressed as mean ± SD, and statistical analysis was done by using the repeated measure analysis of variance (ANOVA) test with Greenhouse–Geisser correction, post hoc analysis with Bonferroni correction, and SPSS 20.0 software. Results Among a total of 70 participants, post hoc tests using the Bonferroni correction showed a statistically significant difference between the HRV of the pretreatment group and after the second, and third month of fluoxetine therapy ( p &lt; 0.05). In the escitalopram group, the Bonferroni correction showed a significant difference between the HRV of the pretreatment and third-month value ( p &lt; 0.05). Repeated measure ANOVA with Greenhouse–Geisser correction showed no statistical significance of serum potassium at different time points ( p &gt; 0.05). There were also no significant changes in heart rate, respiratory rate, and blood pressure at different points of time in both groups. Pearson’s correlation coefficient test for a relationship between HRV and serum potassium was negative at different time points. Conclusion Fluoxetine significantly increased HRV from the pretreatment value to the second and third months of treatment, whereas in the escitalopram group of participants, the third-month value of HRV was increased compared to the first month. The effect of SSRIs on HRV was independent of serum potassium levels at different time points suggesting that the effect of SSRIs on HRV was independent of serum potassium level.

300 Determinants of Serum Potassium Levels in Patients With Chronic Kidney Disease

300 Determinants of Serum Potassium Levels in Patients With Chronic Kidney Disease

Experience of using different dosages of the drug kalimate in order to correct hyperkalemia in chronic kidney disease

THE AIM: to evaluate the efficacy, safety, and tolerability of the preparation of calcium polystyrene sulfonate (Kalimate ® ), clinical observation was conducted in patients with chronic kidney disease who do not need dialysis, using different dosages of the drug with incomplete effectiveness of the hypokalemic diet as monotherapy for hyperkalemia. PATIENTS AND METHODS: the study included 70 patients suffering from chronic kidney disease who do not need renal replacement therapy, and with a plasma potassium level of 5.5 mmol/l or higher, after the use of hypokalemic diet therapy was ineffective. The patients were divided into 4 groups depending on the dose of calcium polystyrene sulfate. The 3 groups differed in the dose of the drug taken, the 4th group consisted of patients with reduced nutrition. Patients in all groups underwent control studies of serum potassium concentration before the start of the study, after 1 week, after 2 weeks, after 1 month, after 3, and after 6 months of treatment. RESULTS: The decrease in the level of potassium in the blood serum of group 1 patients for 6 months was 24.15 % (95 % CI 16.32-31.4 %), which in absolute value was 1.485± 0.513 mmol/l. Similar parameters for groups 2, 3 and 4 were, respectively: 22.59 % (95 %CI 15.57–31.12 %) and 1.38±0.487 mmol/L, 19.72 % (95 %CI 12.08–25.32 %) and 1.215±0.45 mmol/L, 25.24 % (95 % CI 17.86–30.24 %) and 1.58±0.502 mmol/l. CONCLUSION: the effectiveness of reducing serum potassium levels in patients with hyperkalemia on the background of chronic kidney disease who do not receive dialysis and follow only a hypokalemic diet, when using the drug polystyrene sulfate according to the instructions for 15-30 grams per day for at least 1 week with subsequent dose adjustment is an effective way of treating and correcting hyperkalemia.

The prevalence, influencing factors and prognosis of abnormal serum potassium levels in patients with chronic kidney disease

Objective: To estimate the prevalence of hyperkalemia and hypokalemia in patients with chronic kidney disease (CKD), analyze the influencing factors and explore the impact on disease prognosis. Methods: A total of 3 190 patients with CKD stage 1-4 from 39 tertiary clinical centers in China between November 2011 and December 2016 were recruited. The baseline characteristics of the patients were collected through face-to-face questionnaire investigation, physical examination and laboratory test. Meanwhile, the data of patient's end-stage renal disease, cardiovascular disease events and deaths were obtained up to December 2017 through active monitoring. The patients were categorized into three groups based on their baseline level of serum potassium (hypokalemia:<3.5 mmol/L, normal range: 3.5-<5.0 mmol/L, hyperkalemia: ≥5 mmol/L). Multi-nominal logistic regression was employed to evaluate the association between clinical characteristics and the presence of hyperkalemia or hypokalemia. The competing risk-based subdistribution Cox proportional hazards regression was used to assess the association between baseline level of serum potassium and various outcomes. Results: The mean age of the patients was (50±14) years, with a male rate of 57.6% (1 839/3 190) and a majority of glomerulonephritis (59.7%, 1 668/2 792). Patients with CKD stage 3-4 accounted for 70.8% (2 260/3 190), and the mean level of serum potassium was (4.4±0.7) mmol/L. The prevalence of hypokalemia and hyperkalemia was 3.7% (n=118) and 17.6% (n=561), respectively. In the multivariable adjusted analysis, presence of history of cardiovascular disease (OR=0.33, 95%CI: 0.13-0.83, P=0.019) and estimated glomerular filtration rate (OR=0.95, 95%CI: 0.91-0.98, P=0.001) were inversely associated with hypokalemia, while use of thiazide or loop diuretic (OR=2.06, 95%CI: 1.51-2.81, P<0.001) and estimated glomerular filtration rate (OR=1.13, 95%CI: 1.12-1.16, P<0.001) were positively associated with hyperkalemia. After adjusting for relevant cardiovascular and renal risk factors, the result only showed a significant association between hypokalemia and risk of all-cause mortality (HR=2.12, 95%CI: 1.06-4.24, P=0.034). Conclusions: Hypokalemia and hyperkalemia were not rare in patients with CKD in China, with the latter more prevalent. Hypokalemia was independently associated with the risk of death.

PENGARUH PEMBERIAN INFUSED WATER KURMA TERHADAP PERUBAHAN KADAR KALIUM PADA MAHASISWA POLTEKKES KEMENKES YOGYAKARTA DENGAN PREHIPERTENSI

Effect of Infused Water Dates to Change Potassium Levels in The Students of Yogyakarta Ministry of Health with Prehypertension Background . Hypertension not only occurs in the age of adulthood or elderly but can occur from adolescent age. Riskesdas results in 2018, the prevalence of hypertension at age ≥ 18 years in Indonesia showed an increase from the year 2013 which is from 25.8% to 34.1%. According to research, serum potassium levels in patients with hypertension are lower than those with normal blood pressure. Dates can be used as alternative hypertension treatment, one example is made infused water. The introduction of infused water dates is one way to increase the intake of potassium as well as potassium levels in the blood so it is hoped that the increased intake can lower blood pressure. O bjectives . To determine the influence of infused water dates on the change of potassium levels in the students of Yogyakarta Kemenkes Poltekkes. M ethod . This research is quasi experiment by using one group before and after. The research took place in February 2020. The research population is the level student of the Poltekkes Kemenkes Yogyakarta, with a sample of 21 people. Data analysis using Wilcoxon test. Results . Average levels of potassium before intervention is 4,024 ± 0,4847 and average levels of potassium after intervention is 4,276 ± 0,2322. The results showed the influence of infused water dates on potassium levels (P = 0,002). Conclusion: There is the influence of infused water dates on the change of potassium levels in students.

English

BACKGROUND Organophosphorus (OP) pesticides are one of the most common cause of morbidity and mortality due to poisoning worldwide especially in agrarian countries like India. Hence it is prudent to undertake a detailed study of clinico-pathological evaluation of OP poisoning and assess the role of serum potassium as an alternative, easy and convenient prognostic indicator in estimating the severity of OP poisoning. This study was undertaken to assess serum potassium levels in patients of acute organophosphorus poisoning and determine association between serum potassium level and outcome in cases of acute organophosphorus poisoning. METHODS This was a prospective observational study conducted in Department of General Medicine, Silchar Medical College &amp; Hospital for one year from 1st June 2019 to 31st May 2020 with a sample size of 100 after satisfying the inclusion and exclusion criteria. Peradeniya organophosphorus poisoning (POP) scale was used for categorizing study population according to severity. RESULTS Among patients who were admitted with organophosphorus poisoning, 72 % of the patients discharged were having normal serum potassium levels on admission, whereas 22 % (n = 22) patients who died had hypokalaemia at the time of admission. The chi-square value for the association between serum potassium and outcome is statistically significant [P value is 0.001 (P &lt; 0.05)]. CONCLUSIONS The serum potassium level on the day of admission was significantly correlated with the severity of the acute organophosphate poisoning as determined by Peradeniya OP poisoning scale. The cases that had lower serum potassium levels on admission had poor outcome. Reduced serum potassium levels also had significant association with the need for ventilator support. Therefore, serum potassium can be used as a predictive marker of severity in organophosphorus poisoning. This can help in early triage of patients and will be helpful in reducing mortality and morbidity. KEYWORDS Organophosphorus Compound Poisoning, Serum Potassium, POP Scale

Hypokalemia in patients with anorexia nervosa during refeeding is associated with binge\u2013purge behavior, lower body mass index, and hypoalbuminemia

BackgroundHypokalemia is frequently found in patients with anorexia nervosa and sometimes leads to life-threatening conditions. Although their serum potassium levels are considered to further decrease during refeeding, no previous studies have addressed actual changes in the serum potassium levels and potential mechanisms underlying hypokalemia during the refeeding period of patients with anorexia nervosa. In this study, we investigated factors associated with hypokalemia during refeeding of patients with anorexia nervosa.MethodsWe recruited 52 independent patients from 89 admissions with anorexia nervosa (body mass index, 13.0 ± 3.3) from the psychiatry unit in Ashikaga Red Cross Hospital during the period from April 2003 to March 2018 and analyzed serum potassium levels at admission. Of the 89 admissions, 66 admissions with > 1-week hospitalization were recruited to determine the lowest potassium levels during the refeeding period. We analyzed these levels with multiple linear regression analysis with explanatory variables, including data upon admission and treatment-related indicators.ResultsThe initial serum potassium level of 3.6 ± 0.9 mg/dl decreased to 3.1 ± 0.7 mg/dl at nadir hypophosphatemia, which was observed an average of 2.5 days after admission. A lower serum potassium level at admission and a lower nadir potassium level during refeeding were associated with a lower body mass index, hypoalbuminemia, and binge–purge behavior. Similar results were obtained when the analysis included restrictive or binge–purge types as well as the independent patient group.ConclusionsLower body mass index, hypoalbuminemia, and binge–purge behavior might be used as indicators to guide clinical approaches for controlling serum potassium levels in patients with anorexia nervosa during refeeding.Plain English summaryHypokalemia, low levels of serum potassium, in patients with anorexia nervosa sometimes leads to life-threatening conditions. Thus, it is of great importance to predict the risk of hypokalemia in patients with anorexia nervosa during the refeeding period. Our study found that hypokalemia in patients with anorexia nervosa during refeeding is associated with a lower body mass index and hypoalbuminemia (low levels of serum albumin), in addition to binge–purge behavior.

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.

Hematological Profile and Serum Potassium Level in Patients of Chronic Renal Failure at a Tertiary Health Care Center

Background: Chronic Kidney Disease (CKD) can be defined as an estimated glomerular Filtration Rate (eGFR) of less than ml/min/1.73 m2 for a minimum period of three months. CKD is commonly associated with various hematological abnormalities especially anemia. Aim: The present study was planned to assess the hematological variations in CKD patients as compared to healthy subjects. Method: Fifty patients diagnosed with CKD were enrolled for the study. Fifty age and sex-matched healthy subjects constituted the control group. Result: On comparison of the hematological profile, it was observed that all enrolled CKD patients were anemic with hemoglobin (Hb) less than 13g/dL in males and less than 12 g/dL in females. The mean Hb levels were as low as 7.50 + 1.55 g/dL (P&lt; 0.0001). Correspondingly, the total RBC count of CKD patients was also low. It was also observed that the platelet count was slightly low among CKD patients. However, the mean level was comparable with the control group (P=NS). On further analysis, it was observed that among fifty CKD patients, 46% (n=23) suffered from severe anemia i.e. Hb &lt; 7 gm/dL whereas 48% had moderate anemia i.e. Hb between 7-9.9 gm/dL. However, only 12 % (n=6) CKD patients suffered from thrombocytopenia i.e. platelets count &lt; 1.50 lack/ cmm. Conclusion: Hematological abnormalities may lead to several associated morbidities and may pose a challenge for the maintenance of overall health status for CKD patients. Hence, there is a need to monitor the hematological profile of CKD patients especially those on dialysis so that any abnormality can be detected and managed accordingly.&#x0D; Keywords: Chronic kidney disease, Anemia, Hematological changes, Potassium, Platelets.

SUN-319 SOURSOP SUPPLEMENTATION HAS BENEFIT EFFECTS ON BLOOD PRESSURE AND SERUM URIC ACID BUT DOES NOT AFFECT KIDNEY FUNCTIONS AND SERUM POTASSIUM LEVELS: AN RCT STUDY

Soursop consumption is beneficial to health, but clinical study observing its benefit in human subject was still little. Consumption of fruits is considered to increase serum potassium levels in patients with chronic kidney disease undergoing hemodialysis. Several survey-based studies have been conducted in various places on the use of soursop in the traditional treatment of kidney disease. This study was a randomized controlled trial study. A total of 143 subjects were involved for this study. Subjects were collected from prehypertension population data (n=4,190) from the “Mlati Study Database” in 2007. After 10 years, 143 samples showed essential prehypertension combined with high normal serum uric acid (SUA) levels. Subjects were randomly allocated into two groups i.e. the treatment group and the control group. For a 3 months period, the treatment group was given 2x100g soursop fruit juice per day and the control group was left without treatment. A total of 31 subjects were dropped out by the end of the study. After 12 weeks of treatment, there was no significant different in kidney functions (both CKD-Epi and uric acid excretion) and serum potassium levels between treatment and control group (p>0.05). Treatment group showed a significantly lower systolic and diastolic blood pressure after 12 weeks of treatment compared to control group (p=<0.001 and p=0.026, respectively). Furthermore, the treatment group was more likely to have normal tension and SUA levels after 12 weeks (RR=1.41, CI=1.03-1.92 and RR=2.28, CI=1.07-4.85, respectively) compared to the control group. Soursop supplementation did not affect kidney functions and serum potassium levels, yet could lower blood pressure and SUA levels after 12 weeks of treatment.

Urinary angiotensinogen level is associated with potassium homeostasis and clinical outcome in patients with polycystic kidney disease: a prospective cohort study

BackgroundGuidelines for general hypertension treatment do not recommend the combined use of renin-angiotensin-aldosterone system (RAAS) inhibitors due to the risk of hyperkalemia. However, a recent clinical trial showed that polycystic kidney disease (PKD) patients had infrequent episodes of hyperkalemia despite receiving combined RAAS inhibitors. Because intrarenal RAAS is a main component for renal potassium handling, we further investigated the association between intrarenal RAAS activity and serum potassium level in patients with chronic kidney disease, particularly in PKD patients, and examined whether intrarenal RAAS activity has a prognostic role in patients with PKD.MethodsA total of 1788 subjects from the KoreaN cohort study for Outcome in patients With Chronic Kidney Disease (KNOW-CKD) were enrolled in this study. Intrarenal RAAS activity was assessed by the measurement of urinary angiotensinogen (AGT). The primary outcome was the composite of all-cause mortality and renal function decline.ResultsPatients with PKD had a significantly lower serum potassium level in chronic kidney disease stages 1 to 3b than non-PKD patients. In logistic regression analysis, after adjusting for multiple confounders, PKD patients had a significantly lower risk of hyperkalemia than non-PKD patients. In multivariable linear regression analysis, the urinary AGT/creatinine (Cr) ratio was negatively correlated with the serum potassium level (β = − 0.058, P = 0.017) and positively correlated with the transtubular potassium gradient (TTKG, β = 0.087, P = 0.001). In propensity score matching analysis, after matching factors associated with serum potassium and TTKG, PKD patients had a significantly higher TTKG (P = 0.021) despite a lower serum potassium level (P = 0.004). Additionally, the urinary AGT/Cr ratio was significantly higher in PKD patients than in non-PKD patients (P = 0.011). In 293 patients with PKD, high urinary AGT/Cr ratio was associated with increased risk of the composite outcome (hazard ratio 1.29; 95% confidence interval, 1.07–1.55; P = 0.007).ConclusionsHigh activity of intrarenal RAAS is associated with increased urinary potassium excretion and low serum potassium level in patients with PKD. In addition, intrarenal RAAS activity can be a prognostic marker for mortality and renal function decline in these patients.

Perioperative hyperkalemia in hemodialysis patients undergoing parathyroidectomy for renal hyperparathyroidism.

The present study investigates the incidence of perioperative hyperkalemia and the influence factors of serum potassium levels during and after parathyroidectomy (PTX) in hemodialysis patients with renal hyperparathyroidism (rHPT). A total of 204 hemodialysis patients with refractory rHPT undergoing successful total parathyroidectomy with autotransplantation (tPTX + AT) were analyzed retrospectively. Hyperkalemia was defined as serum potassium levels ≥ 5.5mmol/L. The preoperative baseline level of serum potassium (K base+ ) was defined as a mean of the three preoperative prehemodialysis serum potassium levels. The higher levels of serum potassium during and immediately after surgery were recorded as K d0+ and the peak prehemodialysis serum potassium levels 3days after surgery as K d3+ . 136/204 (66.7%) patients suffered from hyperkalemia during or immediately after surgery and 65/204 (31.9%) patients were affected with prehemodialysis hyperkalemia 3days after surgery. K base+ was the only influencing factor for K d0+ . Serum K base+ , preoperative serum alkaline phosphatase, and total calcium supplement dosage during intravenous calcium supplement were the influencing factors for K d3+ . In the case of PTX, the serum potassium levels of patients with higher serum K base+ and severe postoperative hypocalcemia need to be monitored with extended attention perioperatively.

Effect of Serum Potassium Level on Hemodynamic Stability during the Hemodialysis Session

Potassium is the major intracellular cation with concentrations reaching 120-150 mEq/L. On the contrary, the extracellular fluid potassium concentration is much lower and kept within very narrow levels between 3.5-5.0mEq/L (1). Aim of the work: this work aimed to assess serum potassium level in patients on regular hemodialysis and to determine its clinical impact on hemodynamic stability during the hemodialysis session. Patient and method: serum (K) level of 30 patients on regular hemodialysis was measured before and after dialysis and the results were correlated with electrocardiographic (ECG) changes. Results: there was no change in P wave, PR interval or QT interval in all the patients, while QRS was found to be shortened in 3 patients (10 %) in the post-dialysis ECG and elongated in one patient (3.3%) in the post dialysis ECG, T wave showed dynamic changes in the form of reduction in the amplitude of T wave in 11 patients (36.7%). Conclusion: the absence of electrocardiographic changes in hyperkalaemic haemodialysis patients should be interpreted with caution.

Correction of Serum Potassium Level in Hypokalaemic Patients with Hypomagnesaemia and Normomagnesaemia

Objective: To determine the extent of increase in potassium level after intravenous infusion of potassium chloride in hypokalaemic patients with hypomagnesaemia and normomagnesaemia and to overview the impact of different concentrations and dilutions of potassium chloride infusion for rapid correction of hypokalaemia.&#x0D; Methods: A prospective, cohort study was conducted in Abbasi Shaheed Hospital, Karachi from January to March 2016. Convenience sampling was done, 46 patients were included who had a Serum Potassium level less than 3.5 meq/L at the time of admission to the hospital. Protocols of potassium chloride infusion such as such as 20 mEq/200 ml, 30 mEq/300 ml, 40 mEq/400 ml and 50 mEq/500 ml were given to three groups of hypokalaemic patients having hypomagnesaemia, normomagnesaemia and hypermagnesaemia to figure out the correlation of potassium correction with serum magnesium level. The pre and post-infusion serum potassium levels were checked along with the outcome of the extent of increase in potassium levels.&#x0D; Results: For 46 patients (mean age 60 ± 3 (r= 21-96 years), the mean pre-infusion serum potassium and magnesium levels were found to be 3.12 ± 0.04 (r= 2.30-3.5) mmol/L and 0.81 ± 0.03 (r= 0.52- 1.58) mmol/L respectively. The difference in the pre/post-infusion serum potassium levels in hypokalaemic patients with hypomagnesemia (n= 46) was not found be significant (p&gt;0.05) whereas the pre/post-infusion serum potassium level was significant (p&lt;0.05) in hypokalaemic patients with normomagnesaemia or hypermagnesaemia.&#x0D; Conclusion: Serum magnesium level needs to be concurrently monitored and corrected in mild to moderate hypokalaemic patients as low magnesium levels were found to have profound effect on serum potassium level in patients receiving potassium supplement for correction of potassium level back to normal.

Predictive Risk Factors in the Development of Intraoperative Hyperkalemia in Adult Living Donor Liver Transplantation

BackgroundHyperkalemia, defined as a serum potassium level higher than 5 mEq/L, is common in the liver transplantation setting. Severe hyperkalemia may induce fatal cardiac arrhythmias; therefore, it should be monitored and treated accordingly. The aim of the current retrospective study is to evaluate and indentify the predictive risk factors of hyperkalemia during living-donor liver transplantation (LDLT). Methods and PatientsFour hundred eighty-seven adult LDLT patients were included in the study. Intraoperative serum potassium levels were monitored at least five times during LDLT; patients with a potassium level higher than 5 mEq/L were included in group 1, and the others with normokalemia in group 2. Patients' categorical characteristics and intraoperative numeric variables with a P value <.1 were selected into a multiple binary logistic regression model. In multivariate analysis, a P value of <.05 is regarded as a risk factor in the development of hyperkalemia. ResultsFifty-one of 487 (10.4%) patients had hyperkalemia with a serum potassium level higher than 5.0 mEq/L during LDLT. Predictive factors with P < .1 in univariate analysis (Table 1), such as anesthesia time, preoperative albumin level, Model for End-stage Liver Disease score, preoperative bilirubin level, amount of blood loss, red blood cell (RBC) and fresh frozen plasma transfused, 5% albumin administered, hemoglobin at the end of surgery, and the amount of furosemide used, were further analyzed by multivariate binary regression. Results show that the anesthesia time, preoperative serum albumin level, and RBC count are determinant risk factors in the development of the hyperkalemia in our LDLT serials. ConclusionProlonged anesthesia time, preoperative serum albumin level, and intraoperative RBC transfusion are three determinant factors in the development of intraoperative hyperkalemia, and close monitoring of serum potassium levels in patients with abovementioned risk factors are recommended.

The Colon as the Potassium Target: Entering the Colonic Age of Hyperkalemia Treatment?

The Colon as the Potassium Target: Entering the Colonic Age of Hyperkalemia Treatment?

Spironolactone for resistant hypertension—hard to resist?

Spironolactone for resistant hypertension—hard to resist?

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

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