Treatment Of Hyperkalemia Research Articles

Hyperkalaemia in Cardiological Patients: New Solutions for an Old Problem.

Hyperkalaemia is one of the most common electrolyte disorders in patients with cardiovascular disease (CVD). The true burden of hyperkalaemia in the real-world setting can be difficult to assess, but in population-based cohort studies up to 4 in 10 patients developed hyperkalaemia. In addition to drugs interfering with potassium metabolism and food intake, several conditions can cause or worsen hyperkalaemia, such as advanced age, diabetes, and chronic kidney disease. Mortality, cardiovascular morbidity, and hospitalisation are higher in patients with hyperkalaemia. Hyperkalaemia represents a major contraindication or a withholding cause for disease-modifying therapies like renin-angiotensin-aldosterone inhibitors (RAASi), mainly mineralocorticoid receptor antagonists. Hyperkalaemia can be also classified as acute and chronic, according to the onset. Acute hyperkalaemia is often a life-threatening emergency requiring immediate treatment to avoid lethal arrhythmias. Therapy goal is cell membrane stabilisation by calcium administration, cellular intake, shift of extracellular potassium to the intracellular space (insulin, beta-adrenergic agents, sodium bicarbonate), and increased elimination with diuretics or dialysis. Chronic hyperkalaemia was often managed with dietary counselling to prevent potassium-rich food intake and tapering of potassium-increasing drugs, mostly RAASi. Sodium polystyrene sulphonate, a potassium binder, was the only therapeutic option. Recently, new drugs such as patiromer and sodium zirconium cyclosilicate give new opportunities for the treatment of hyperkalaemia, as they proved to be safe, well tolerated, and effective. Aim of this review is to describe the burden of hyperkalaemia in cardiovascular patients, its direct and indirect effects, and the therapeutic options now available in the acute and chronic setting.

A Retrospective Analysis of Intravenous Insulin versus Insulin and Nebulized Albuterol for the Treatment of Hyperkalemia in the Emergency Department.

There is limited literature evaluating the use of nebulized albuterol in the management of hyperkalemia. The objective was to evaluate the efficacy of insulin alone compared with the addition of nebulized albuterol for the treatment of hyperkalemia. This is a retrospective, single-center evaluation of adult patients with hyperkalemia attending the Emergency Department of a large urban academic medical center. Consecutive patients with a potassium level of >5mmol/L were included. Patients without a repeat potassium level within 4hours of medication administration, those receiving hemodialysis before a repeat serum potassium, or those that had a hemolyzed blood sample were excluded. The primary outcome was the change in potassium level within 4hours in patients who received insulin monotherapy versus patients who received insulin and albuterol. The secondary outcomes included hospital length of stay, intensive care unit (ICU) admission, and mortality. Out of the 204 patients, 141 received insulin, whereas 63 received insulin and nebulized albuterol. There was no difference in the change in potassium level between the insulin and the insulin and nebulized albuterol groups (0.85±0.6 vs 0.96±0.78mmol/L; P=.36). There was no difference in median hospital length of stay (8.6days, IQR13.2days, vs 5.6days, IQR8.2days; P=.09), ICU admission (31.9% vs 38.1%; P=.39), and all-cause mortality (14.9% vs 17.5%; P=.64). In this retrospective analysis, the addition of albuterol to insulin for the treatment of hyperkalemia did not result in a greater change in potassium level within 4hours of therapy.

Evaluating Risk Factors for Developing Hypoglycemia During Treatment of Hyperkalemia With Intravenous Regular Insulin

Background: The conventional dose of 10 units of intravenous (IV) regular insulin to treat hyperkalemia has been associated with hypoglycemia. There have been retrospective studies evaluating weight-based dose vs conventional dose of IV regular insulin but the comparative efficacy and safety is not well established. Objective: Evaluate the difference in weight-based dosing of IV regular insulin between patients who experienced hypoglycemia vs. patients who did not experience hypoglycemia after the administration of IV regular insulin. Methods: This was a retrospective, electronic chart review at a single academic medical center which included patients ≥18 years of age with an emergency department or inpatient encounter who were administered IV regular insulin within 6 hours of a pre-treatment potassium of ≥5 mmol/L. Results: There was no significant difference in the weight-based insulin dose between patients who experienced a hypoglycemic event and patients who did not experience a hypoglycemic event (.14 vs .22 units/kg; P = .44). The potassium-lowering effect was similar between the two groups (1.02 vs .96 mmol/L; P = .56). A regression analysis revealed that female sex, low baseline blood glucose (glucose <140 mg/dL), and those who received a repeat dose of IV regular insulin were independent risk factors for development of hypoglycemia. Conclusion: This study found no difference in hypoglycemic events and potassium lowering based on IV weight-based regular insulin dosing, however other risk factors may predict hypoglycemia.

Intestinal perforation secondary to the use of sodium polystyrene sulfonate, case report

Background: The use of cation exchange resins such as sodium polystyrene sulfonate (SPS) in the treatment of hyperkalemia has been associated with potential damage to the gastrointestinal tract. Case Presentation: We present a clinical case of a 63-year-old male patient admitted following a single-lung transplant who presented a complex postoperative period associated with renal failure and hyperkalemia, therefore administering SPS. 17 days afterward, the patient presented a clinical exacerbation with acute abdominal pain, due to a sigmoid perforation. The patient underwent urgent surgery, performing an open sigmoidectomy and terminal colostomy. The anatomo-pathological study of the surgical specimen revealed abundant SPS crystals in the depth of the colonic wall. Conclusion: Close patient surveillance and high clinical suspicion are essential to prevent potentially fatal complications from the use of SPS. Due to the low incidence of this complication, the evidence in the literature is limited to case reports and retrospective studies.

Intestinal perforation secondary to the use of sodium polystyrene sulfonate, case report

Background: The use of cation exchange resins such as sodium polystyrene sulfonate (SPS) in the treatment of hyperkalemia has been associated with potential damage to the gastrointestinal tract. Case Presentation: We present a clinical case of a 63-year-old male patient admitted following a single-lung transplant who presented a complex postoperative period associated with renal failure and hyperkalemia, therefore administering SPS. 17 days afterward, the patient presented a clinical exacerbation with acute abdominal pain, due to a sigmoid perforation. The patient underwent urgent surgery, performing an open sigmoidectomy and terminal colostomy. The anatomo-pathological study of the surgical specimen revealed abundant SPS crystals in the depth of the colonic wall. Conclusion: Close patient surveillance and high clinical suspicion are essential to prevent potentially fatal complications from the use of SPS. Due to the low incidence of this complication, the evidence in the literature is limited to case reports and retrospective studies.

Acute Hyperkalemia Management in the Emergency Department.

Acute hyperkalemia is characterized by high concentrations of potassium in the blood that can potentially lead to life-threatening arrhythmias that require emergent treatment. Therapy involves the utilization of a constellation of different agents, all targeting different goals of care. The first, and most important step in the treatment of severe hyperkalemia with electrocardiographic (ECG) changes, is to stabilize the myocardium with calcium in order to resolve or mitigate the development of arrythmias. Next, it is vital to target the underlying etiology of any ECG changes by redistributing potassium from the extracellular space with the use of intravenous regular insulin and inhaled beta-2 agonists. Finally, the focus should shift to the elimination of excess potassium from the body through the use of intravenous furosemide, oral potassium-binding agents, or renal replacement therapy. Multiple nuances and controversies exist with these therapies, and it is important to have a robust understanding of the underlying support and recommendations for each of these agents to ensure optimal efficacy and minimize the potential for adverse effects and medication errors.

Effectiveness, safety, and treatment pattern of sodium zirconium cyclosilicate in Chinese patients with hyperkalemia: interim analysis from a multicenter, prospective, real-world study (Actualize Study).

Introduction: Sodium zirconium cyclosilicate (SZC) is a nonabsorbed cation-exchanger approved in China for the treatment of hyperkalemia [HK; serum potassium (sK+) levels >5.0mmol/L]. This is the first real-world study aimed to assess the effectiveness, safety, and treatment patterns of SZC in Chinese patients with HK. Here we present the results of the first interim analysis. Methods: This multicenter, prospective, cohort study included patients aged ≥18years with documented HK within 1-year before study enrollment day. These patients were followed up for 6months from the enrollment day after initiating SZC treatment. The treatment was categorized into correction phase (FAS-P1) and maintenance phase (FAS-P2 new and ongoing users). Subgroup analysis was performed in patients on hemodialysis (FAS-H). The primary objective was evaluation of safety profile of SZC; secondary objectives included assessment of treatment patterns of SZC and its effectiveness. Results: Of 421 screened patients, 193, 354, and 162 patients were enrolled in the FAS-P1, FAS-P2, and FAS-H groups, respectively. sK+ levels were reduced significantly from 5.9mmol/L to 5.0mmol/L after the correction phase. For the maintenance phase, the mean sK+ levels were maintained at 5.2mmol/L and 5.0mmol/L in the FAS-P2 new and ongoing user, respectively, and 5.3mmol/L in the FAS-H subgroup. A considerable proportion of patients showed normokalemia after 48h of SZC treatment (FAS-P1:51.3%) which was maintained up to 6months in the maintenance phase (FAS-P2:44%). SZC was well-tolerated. Conclusion: SZC was effective and safe for the treatment of HK in real-world clinical practice in China.

Re-Thinking Hyperkalaemia Management in Chronic Kidney Disease-Beyond Food Tables and Nutrition Myths: An Evidence-Based Practice Review.

Potassium dysregulation can be life-threatening. Dietary potassium modification is a management strategy for hyperkalaemia. However, a 2017 review for clinical guidelines found no trials evaluating dietary restriction for managing hyperkalaemia in chronic kidney disease (CKD). Evidence regarding dietary hyperkalaemia management was reviewed and practice recommendations disseminated. A literature search using terms for potassium, hyperkalaemia, and CKD was undertaken from 2018 to October 2022. Researchers extracted data, discussed findings, and formulated practice recommendations. A consumer resource, a clinician education webinar, and workplace education sessions were developed. Eighteen studies were included. Observational studies found no association between dietary and serum potassium in CKD populations. In two studies, 40-60 mmol increases in dietary/supplemental potassium increased serum potassium by 0.2-0.4 mmol/L. No studies examined lowering dietary potassium as a therapeutic treatment for hyperkalaemia. Healthy dietary patterns were associated with improved outcomes and may predict lower serum potassium, as dietary co-factors may support potassium shifts intracellularly, and increase excretion through the bowel. The resource recommended limiting potassium additives, large servings of meat and milk, and including high-fibre foods: wholegrains, fruits, and vegetables. In seven months, the resource received > 3300 views and the webinar > 290 views. This review highlights the need for prompt review of consumer resources, hospital diets, and health professionals' knowledge.

Impact of a Hyperkalemia Protocol Tailored to Glucose Concentration and Renal Function on Insulin-Induced Hypoglycemia in Patients with Low Pretreatment Glucose

BackgroundHyperkalemia is a common electrolyte abnormality that requires urgent treatment. Insulin is an effective treatment for hyperkalemia, but risk factors for developing insulin-induced hypoglycemia exist (e.g., low pretreatment glucose or renal impairment). ObjectiveThis study evaluated the impact of a hyperkalemia protocol tailored to glucose concentration and renal function on insulin-induced hypoglycemia. MethodsThis was a retrospective cohort study of emergency department patients with glucose ≤ 100 mg/dL treated with insulin for hyperkalemia. The primary outcome was incidence of hypoglycemia in patients treated prior to (July 1, 2018–June 30, 2019) vs. after (January 1, 2020–December 31, 2020) the protocol update, which individualized insulin and dextrose doses by glucose concentration and renal function. Secondary outcomes included change in potassium and protocol safety. We assessed factors associated with hypoglycemia using multiple logistic regression. ResultsWe included 202 total patients (preimplementation: 114, postimplementation: 88). Initial insulin dose was lower in the postimplementation group (p < 0.001). We found a nonsignificant reduction in hypoglycemia in the postimplementation group (42.1% vs. 30.7%, p = 0.10). Degree of potassium reduction was similar in patients who received insulin 5 units vs. 10 units (p = 0.72). Higher pretreatment glucose (log odds ratio [OR] −0.05, 95% confidence interval [CI] −0.08 to −0.02) and additional insulin administration (log OR −1.55, 95% CI −3.01 to −0.25) were associated with reduced risk of developing hypoglycemia. ConclusionA hyperkalemia protocol update was not associated with a significant reduction in hypoglycemia, and the incidence of hypoglycemia remained higher than anticipated. Future studies attempting to optimize treatment in this high-risk population are warranted.

Cost-effectiveness analysis of sodium zirconium cyclosilicate for treating hyperkalemia among Chinese patients.

Hyperkalemia most commonly develops in chronic kidney disease (CKD) or heart failure (HF) patients. Sodium zirconium cyclosilicate (SZC) is a new selective potassium (K+) binder for treating hyperkalemia. The aim of this study was to evaluate the cost-effectiveness of SZC vs. usual care for the treatment of hyperkalemia among CKD patients or HF patients in China. Individual patient microsimulation models were constructed to simulate a CKD cohort until the initiation of renal replacement therapy (RRT) and a HF cohort across the lifetime horizon. K+ levels were based on two phase 3 clinical trials. Health state utility and event incidence rates were retrieved from literature. Drug costs and healthcare utilization costs were obtained from negotiated price, literature, and expert interviews. Costs and quality-adjusted life-years (QALYs) were both discounted at 5%. The main outcomes were overall costs, QALYs, and incremental cost-effectiveness ratio (ICER). The willingness-to-pay (WTP) threshold in China is CNY 80,976-242,928/QALY, which is one to three times the gross domestic product per capita. Sensitivity analyses were performed to characterize the models' uncertainty. In the HF cohort, the base case results revealed that SZC was associated with 2.86 QALYs and the total cost was CNY 92671.58; usual care was associated with 1.81 QALYs and CNY 54101.26. In the CKD cohort, SZC was associated with 3.23 QALYs and CNY 121416.82 total cost; usual care was associated with 2.91 QALYs and CNY 111464.57. SZC resulted in an ICER of CNY 36735.87/QALY for the HF cohort and CNY 31181.55/QALY for the CKD cohort, respectively. The one-way and probability sensitivity analyses found that the results were robust. SZC is a cost-effective treatment compared to usual care in HF and CKD patients. SZC is an important novel treatment option for managing patients with hyperkalemia in China.

Impact of adding reduced and weight-based insulin dosing options to the emergency department and inpatient hyperkalemia order-set

Purpose: To compare the effects of weight-based, reduced, and standard IV insulin doses on potassium reduction and hypoglycemia incidence in the treatment of acute hyperkalemia. Methods: The hyperkalemia treatment order-set was updated to include reduced and weight-based insulin dose options. Patients ≥ 18 years old with acute hyperkalemia treated with insulin using the order-set were included. Patients with missing data or who started dialysis before follow-up potassium monitoring were excluded. The primary efficacy outcome was reduction in serum potassium. The primary safety outcome was incidence of hypoglycemia and severe hypoglycemia. Secondary outcomes included insulin dose administered, completion of hourly glucose checks, and dextrose use. Results: The pre-protocol group included 60 patients and the post-protocol group included 76 patients. Potassium reduction was similar with a mean reduction of 0.9 mEq/L in the pre-protocol group and 0.85 mEq/L in the post-protocol group. The incidence of hypoglycemia was 18% in the pre-protocol group with 2% of patients developing severe hypoglycemia. The incidence of hypoglycemia was 13% in the post-protocol group with 3% of patients developing severe hypoglycemia. The mean insulin dose administered was 9.5 units in the pre-protocol group and 7.7 units in the post-protocol group. In the post-protocol group, weight-based and reduced insulin doses were administered to 84% and 13% of patients, respectively. Less than 25% of patients completed all glucose checks. Only about 50% of patients with hypoglycemia were treated with dextrose. Conclusions: Using weight-based and reduced insulin doses in the treatment of acute hyperkalemia results in comparable potassium reduction and reduced hypoglycemia incidence.

Impact of treatment of hyperkalaemia on quality of life: design of a prospective observational cohort study of long-term management of hyperkalaemia in patients with chronic kidney disease or chronic heart failure in Japan

IntroductionHyperkalaemia (HK) is a frequent complication in patients with chronic kidney disease (CKD) and/or chronic heart failure (CHF). HK must be managed, both to protect patients from its direct clinical...

Abstract 17295: In Situ Recovery of Multiple Organs Using Venoarterial ECMO in a Murine Model of Uncontrolled DCD

Introduction: The utilization of extracorporeal membrane oxygenation (ECMO) for Donation after Circulatory Death (DCD) can substantially increase the donor pool, organ yield per donor, and organ shelf life. Clinical attempts to recover organs for transplantation after uncontrolled DCD are very complex and hard to reproduce. As a preliminary strategy for completing this endeavor, experimental protocols employing feasible animal models are strongly recommended. Hypothesis: The objective of the investigation was to develop a mouse model of ECMO-based cadaver management protocol for uncontrolled DCD donation after "out-of-hospital" death. Methods: Following 10 min after confirmed death, murine cadavers (C57BL/6 background) were administered with heparin-streptokinase and cannulated for veno-arterial ECMO. Cadaver bodies were connected to a murine ECMO machine 1 h post-mortem and subjected to extracorporeal circulation for subsequent 2 hrs. Blood gas parameters, cardiac activity, and general organ state were assessed using BGA analysis, ECG, and histology, accordingly. We have designed and incorporated into an ECMO circuit a previously unreported, miniaturized murine hemodialysis for the treatment of severe hyperkalemia and metabolic acidosis that arose following death. Results: Control BGA parameters recorded 1 h after death were incompatible with normal physiology: extremely low blood pH, profound negative base excess, and extraordinarily high lactate and K + levels. Two hours after ECMO support, blood pH values of a cadaver body restored from &lt;6.5 to 7.3 ± 0.05, pCO 2 was lowered from &gt;130 to 41.7 ± 10.5 mmHg, sO2, base excess, and HCO 3 were all elevated from below detection thresholds to 99.5 ± 0.6%, -4 ± 6.2 and 22.0 ± 6.0 mmol/L, respectively (Student T-test, p &lt; 0.05). The implementation of hemodialysis resulted in a significant decrease in both hyperlactatemia and hyperkalemia. Conclusions: Our model presents novel opportunities for the management of cadaver organs in order to promote uncontrolled DCD donation, thereby contributing to the resolution of the organ shortage problem. Our approach enables the implementation of a variety of modern blood purification techniques in cadaveric organ recovery using ECLS.

Effect of sodium zirconium cyclosilicate in combination with insulin and glucose infusion on hyperkalemia treatment

Purpose: To evaluate the efficacy of sodium zirconium cyclosilicate (SZC) in combination with insulinand glucose infusion in managing hyperkalemia.&#x0D; Methods: A total of 126 patients, who were admitted with hyperkalemia (≥ 5 mmol/L) to the Yongchuan District Hospital of Traditional Chinese Medicine, Chongqing, China from January 2021 to December 2022, were retrospectively studied. Participants were divided into three groups based on different potassium-lowering regimens, viz, SZC group (40 patients), insulin with glucose (IG) group (38 patients) and SZC + IG group (48 patients). Changes in potassium levels, other serum electrolytes (magnesium, sodium, phosphate, calcium), alanine aminotransferase (ALT) and albumin before and after treatment were recorded. Adverse reactions during treatment were also recorded.&#x0D; Results: Post-treatment, the potassium levels in all three groups exhibited a significant reduction when compared to pre- treatment values (p &lt; 0.05). The SZC + IG group showed the highest efficacy, with a significant reduction in blood potassium levels observed 4 h after administration, which was more pronounced compared to other groups. The SZC + IG group, maintained potassium ion concentration at a normal level for a longer duration and no serious adverse reactions were observed during treatment.&#x0D; Conclusion: Intervention with SZC + IG lowers blood potassium levels, maintains it within normal range, and is more effective than the individual use of SZC or IG. A combination of sodium zirconium cyclosilicate, insulin and glucose infusion for treating hyperkalemia will need to be investigated further in a large-scale multicenter study.

Economic impact of the use of patiromer in chronic kidney disease or heart failure for the treatment of chronic hyperkalemia in Spain

IntroductionChronic hyperkalemia has negative consequences in the medium and long term, and determines the suspension of nephro and cardioprotective drugs, such as renin–angiotensin–aldosterone system inhibitors (RAASi). There is an alternative to the suspension or dose reduction of these treatments: the administration of potassium chelators. The aim of this study is to estimate the economic impact of the use of patiromer in patients with chronic kidney disease (CKD) or heart failure (HF) and hyperkalemia in Spain. Materials and methodThe annual economic impact of the use of patiromer has been estimated from the perspective of the Spanish society. Two scenarios were compared: patients with CKD or HF and hyperkalemia treated with and without patiromer. The costs have been updated to 2020 euros, using the Health Consumer Price Index. Direct healthcare costs related to the use of resources (treatment with RAASi, CKD progression, cardiovascular events and hospitalization due to hyperkalemia), direct non-healthcare costs (informal care: costs derived from time dedicated by patient’s relatives), the indirect costs (productivity loss), as well as an intangible cost (due to premature mortality) were considered. A deterministic sensitivity analysis was performed to validate the robustness of the study results. ResultsThe mean annual cost per patient in the scenario without patiromer is €9,834.09 and €10,739.37 in CKD and HF, respectively. The use of patiromer would lead to cost savings of over 30% in both diseases. The greatest savings in CKD come from the delay in the progression of CKD. While in the case of HF, 80.1% of these savings come from premature mortality reduction. The sensitivity analyses carried out show the robustness of the results, obtaining savings in all cases. ConclusionsThe incorporation of patiromer allows better control of hyperkalemia and, as a consequence, maintain treatment with RAASi in patients with CKD or HF. This would generate a 32% of annual savings in Spain (€3,127 in CKD; €3,466 in HF). The results support the positive contribution of patiromer to health cost in patients with only CKD or in patients with only HF.

Minimizing Hypoglycemia Associated with Insulin Use for the Treatment of Hyperkalemia in the Inpatient Setting

Minimizing Hypoglycemia Associated with Insulin Use for the Treatment of Hyperkalemia in the Inpatient Setting

Pseudohyperkalemia Revisited: An Updated Review of a Foremost Preanalytical Error of Serum or Plasma Potassium Measurement in the Clinical Laboratory

Abstract Background: Potassium is one of the most abundant cations in the human body. Increased plasma potassium concentration (hyperkalemia) is one of the most common electrolyte abnormalities in contemporary clinical practice. Moderate and severe hyperkalemia are potentially life-threatening conditions and constitute medical emergencies. Measured hyperkalemia may be true hyperkalemia or false hyperkalemia (pseudohyperkalemia). Pseudohyperkalemia is due to false elevation of measured potassium concentration in vitro and it is a fairly common source of preanalytical error of potassium determination in the clinical laboratory. Objective: To review the general and recent concepts/mechanisms that underlie the phenomenon of pseudohyperkalemia in contemporary clinical practice. Methods: An up-to-date review of available literature and selected references on the phenomenon of pseudohyperkalemia, its causes, variants, mechanisms, clinical implications, identification, management, and prevention. Conclusion: Pseudohyperkalemia is a fairly common preanalytical error of potassium measurement in the clinical laboratory and a potential cause of misdiagnosis and unnecessary treatment of hyperkalemia. Exclusion of pseudohyperkalemia before the diagnosis of hyperkalemia (true hyperkalemia) is highly recommended.

A98Lessons learned from hyperkalaemia simulation: improving policy &amp;amp;amp; practice

Following an investigation where ten times the amount of prescribed insulin was given to a patient during the administration of treatment for hyperkalaemia, learning needs were identified. It was from this incident outcome that the aim for this project arose. Create a hypokalaemia simulation that can be delivered trust wide with only one facilitator. The simulation was run on the medical wards that the staff were familiar with to allow us to identify policies and process gaps as well as learning needs. The simulation only required two registered nurses and with the debriefing session usually took around 40 minutes. This limits the impact on busy wards allowing for safe staffing levels to be maintained. Simulation incident forms were completed for each session to highlight and raise awareness of identified learning points to both ward managers and local governance leads. The first error that impacted the simulation was the spelling effecting the access to treatment guidelines contained within a Trust policy. The Trust we work for is proud to be multinational, and we found that the majority of our colleagues that have received education oversees used the more widely recognized spelling in Europe of hyperkalemia. This was escalated and the second spelling was added as a keyword, after this change the problem was not repeated in subsequent simulations. It led to further reviews of Trust policies and has driven a change in keywords within the policy portfolio. The second and third errors were around lack policy and treatment flowchart awareness and poor knowledge on how to navigate the intranet to find policies. Although the participants in the simulation left with a good awareness of the policy and practices accessing the policy and flowchart during the session, it had become apparent that this was a wider Trust issue. Therefore, communication posters were made to highlight the policy and treatment flowchart for hyperkalaemia. Using a QR code staff could play a short video showing how to access the Trust policies from the intranet page after the sessions. Future plans include collaboratively using simulation to test systems and highlight learning points for other incidents or errors that arise throughout the Trust. Also, we look to utilize Dynamic QR codes [1] that allow for the content connect to the QR code to be updated without the poster having to be reprinted and laminated allowing for a live document. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Chronic Hyperkalaemia with Patiromer in Haemodialysis: A Single-Center, Prospective Observational Study in the Clinical Practice

Introduction: Chronic Kidney Disease (CKD) patients on Hemodialysis (HD) experience increased risk of hyperkalemia, a serious potential fatal electrolyte disorder. Although novel effective strategies for managing hyperkalaemia are available, experience in routine clinical practice is still insufficient. Here we report chronic hyperkalemia prevalence and analyze the effects of different treatments on potassium management, adherence ratio and gastrointestinal symptoms in HD population. Methods: 12-week, prospective, single-center study in HD patients with chronic hyperkalaemia (&gt;5.5 mmol/l). Three study phases were established: Phase 1, Dietary Advice (DA); Phase 2, Calcium Polystyrene Sulfonate Resins (CPSRs); and Phase 3, patiromer. Sociodemographic and biochemical data, treatment adherence and compliance (Simplified Medication Adherence Questionnaire), gastrointestinal symptoms (Gastrointestinal Symptom Rating Scale, GSRS), HD characteristics and usual medical treatment were analyzed in each phase. Results: Serum potassium values decreased significantly (p&lt;0.05) only in phase 3 (–0.75 mmol/l), with a higher patient percentage reaching optimal K range. Compared with CPSRs, patiromer yielded significantly better overall GSRS scores: abdominal pain (3.7 versus 2.5), constipation (7.1 versus 5.3), indigestion (6.2 versus 5.6); and better treatment compliance. No significant changes were found in other biochemical data, HD characteristics or usual medication over the course of the study. Conclusions: Chronic hyperkalemia is a highly prevalent disorder on our HD unit. Compared to DA and traditional potassium binders; patiromer was effective in managing chronic hyperkalemia, improving gastrointestinal symptoms and treatment adherence with no associated severe adverse effects. Therefore, patiromer can be considered a first-line treatment for chronic hyperkalemia in patients with HD.

SAT138 “Zero”Ing On Hypoglycemia Caused By Hyperkalemia Treatments In The Inpatient Setting

Abstract Disclosure: S. Kim: None. H. Tran: None. R.Y. Gianchandani: None. Background: Severe hyperkalemia can be life-threatening, therefore, is urgently treated in the hospital with intravenous (IV) insulin. An insulin dose of 10 units given with dextrose is considered standard of care. Hypoglycemia associated with hyperkalemia treatment was identified as a significant contributing factor to our overall hypoglycemia rate in the hospital. We designed a hyperkalemia quality improvement (QI) project based on recent studies demonstrating improvement in hypoglycemia rates with weight-based insulin dosing, without clinically impacting potassium-lowering effects. Methods: 5 months of retrospective data was collected before and after implementing a revised hyperkalemia orderset. Prior to implementation, regular insulin was dosed at 10 units intravenously along with 25 g of 50 percent dextrose (D50W). In the updated orderset, regular insulin was dosed at 0.1 units/kg of body weight up to a maximum of 10 units with 25 g of D50W. Additionally, the revised orderset included options for ordering alternative hyperkalemia treatment modalities along with monitoring parameters. A point of care BG was ordered at one hour post treatment. A utilization report was generated for pre- and post-implementation when IV insulin was ordered from hyperkalemia orderset. Additionally, patients who received IV insulin independent of the orderset during the post-implementation period were evaluated. The primary endpoint is the rate of hypoglycemia (BG &amp;lt;70 mg/dL) within 6 hours of IV insulin and D50W administration for hyperkalemia treatment. Results: In the pre-implementation period, 604 doses of insulin were administered from the original orderset with a hypoglycemia rate of 9.8% at 6 hours. Post-implementation, 322 doses were administered from the revised orderset which had a hypoglycemia rate of 5% at 6 hours. Partial adoption of the revised hyperkalemia orderset resulted in 281 doses of insulin treatment ordered independent of the new orderset and hypoglycemia rates remained high at 9.6% at 6 hours in this group. Most of these were in the emergency room where there was low orderset adoption.95% (21/22) of patients who experienced hypoglycemia despite using weight-based insulin dosing for hyperkalemia treatment had an initial BG ≤150 mg/dL and 59.1% (13/22) had a CrCl &amp;lt;30 mL/min or ESRD. Conclusion: A QI process utilizing weight-based insulin dosing for the treatment hyperkalemia reduced hypoglycemia rates by half. Patients who continued to have low BG post intervention were those with a pretreatment BG ≤150 mg/dL. We further revised our orderset to utilize a higher dose of dextrose (D50W 50 g) if pretreatment BG was less than 150 mg/dL and will be implementing this shortly. Additionally, we will work with the emergency room to assist in their hyperkalemia management. With follow-up data, we plan to reach negligible rates of iatrogenic hypoglycemia with our hyperkalemia interventions. Presentation: Saturday, June 17, 2023