MO727EFFECT OF SACUBITRIL/VALSARTAN ON SERUM POTASSIUM AND BLOOD PRESSURE LEVELS OF DIALYSIS PATIENTS WITH HEART FAILURE

Abstract Background and Aims Heart failure is a frequent complication in patients with chronic kidney disease (CKD). As the kidney function declines, the incidence of heart failure and all-cause mortality increases. Heart failure is treated based on the ejection fraction and most of the treatments are often dependent on the renal function. The treatment guidelines of heart failure are not entirely applicable to those with CKD, since this population is usually not included in the randomized control trials. The introduction of neprilysin-inhibitor changed the paradigm of heart failure with reduced ejection fraction (HFrEF) treatment but the effects on dialysis patients is still under studied. Sacubitril/Valsartan is an ARNI that has been recommended as a treatment for symptomatic HFrEF. Monitoring of renal function and potassium is recommended for patients who will take Sacubitril/Valsartan and the two most common side effects are hyperkalemia and hypotension. This study evaluated the safety of Sacubitril/Valsartan by assessing the incidence of hyperkalemia and hypotension on patients undergoing maintenance dialysis - peritoneal or hemodialysis. The objective of the study was to compare the effect of losartan against sacubitril/valsartan on the systolic blood pressure (SBP), diastolic blood pressure (DBP), and serum potassium level across three time points (1st, 2nd, and 3rd month follow-up). Method This retrospective, cohort, single-center study of dialysis patients with HFrEF is designed to assess the safety of Sacubitril/Valsartan versus Losartan based on the blood pressure and serum potassium level. A total of 96 patients on dialysis diagnosed with HFrEF was included in the study. Half was prescribed with Sacubitril/Valsartan while half was prescribed with Losartan. Serum potassium, systolic and diastolic blood pressure were recorded at baseline and monthly on the first three months of follow-up. Baseline 2d echocardiography was also reviewed. Results There were 96 chronic kidney disease patients with HF; 48 were on peritoneal dialysis and 48 on hemodialysis. Per group, 24 were given Losartan and 24 were given Sacubitril/Valsartan for 3 months. The mean age was 47.5 (15.5) years and ranges from 19 to 78 years old. Sixty two percent were males. The most common diagnosis were glomerulonephritis (36.5%), hypertensive nephrosclerosis (27.1%) and diabetic nephropathy (26%). In this retrospective study, we found that there were no episodes of hypotension and hyperkalemia on both hemodialysis and peritoneal dialysis patients who were prescribed with Sacubitril/Valsartan. All the hemodialysis patients included in this study were maintained on thrice a week hemodialysis sessions and the peritoneal dialysis patients had at least 3 exchanges per day. There were no significant change at three points in time (1st, 2nd, and 3rd month follow-up) in the levels of systolic blood pressure (p-value= 0.780, 0.609, 0.926), diastolic blood pressure (p-value= 0.692, 0.206, 0.527), and serum potassium (p-value= 0.212, 0.084, 0.095) on patients maintained on Sacubitril/Valsartan compared to Losartan. There was no evidence of hyperkalemia or hypotension on dialysis patients taking both medications. Conclusion Sacubitril/Valsartan is recommended in the therapy for HFrEF because of the documented benefits in the non-CKD and non-dialysis CKD patients. In this study, Sacubitril/Valsartan is well tolerated and has same effect on the serum potassium and blood pressure compared to Losartan. We concluded that there was no episode of hyperkalemia and hypotension on dialysis patients taking both medications. For the first time, this study demonstrated that Sacubitril/Valsartan is safe to be used in dialysis patients.

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Effect on serum potassium level in patients of diabetic nephropathy on spironolactone and ramipril over follow up period

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20195540 ◽

2019 ◽

Vol 7 (12) ◽

pp. 4691

Author(s):

Ashish Naresh ◽

Mahendra Pal Singh ◽

Richa Giri

Keyword(s):

Diabetes Mellitus ◽

Diabetic Nephropathy ◽

Serum Potassium ◽

Potassium Level ◽

Serum Potassium Level ◽

P Value ◽

Base Line ◽

Group A ◽

Group B

Background: The study was conducted to evaluate the change in serum potassium level over follow up period in patients of diabetic nephropathy on spironolactone (25 mg) and ramipril (5 mg) and compare the results with diabetic nephropathy patients on Spironolactone (25 mg) alone.Methods: A comparative, prospective, non-randomized, non-blinded experimental study was conducted on 56 patients (30-70 yr.) of diagnosed type 2 diabetes mellitus showing proteinuria. Total duration of study was about one year from October 2017 to October 2018. Inclusion criteria followed in study were Age 30-70 years, diagnosed type 2 diabetes mellitus, serum potassium level <5 meq/l, estimated GFR >30 ml/min/1.73m2 and HbA1c <10%. Exclusion criteria were type 1 diabetes mellitus, impaired glucose tolerance secondary to endocrine disease, exocrine pancreatic disease, SBP >180 mmHg DBP >110 mmHg, UTI, hematuria, acute febrile illness, vigorous exercise, short-term pronounced hyperglycemia, obstructive uropathy, confirmed or suspected renal artery disease by USG doppler study, Serum potassium level >5.5 meq/l. Patients were divided in two groups, group A (n= 28, spironolactone 25 mg and ramipril 5 mg) and group B (n=27, spironolactone 25 mg). Subjects were followed over 12 weeks and baseline and 12-week serum potassium being compared. Other baseline base line laboratory investigation such as serum lipid profile, HbA1c, eGFR, fundus examination, ultrasonography (KUB), serum urea, serum creatinine, hemoglobin, were taken at the starting point.Results: Both the group after receiving respective drug were followed for 3-month duration and serum potassium level measured at end of 3 months. Mean values of baseline and follow up serum potassium for group A and group B were 4.24±0.59, 4.07±0.61 and 4.35±0.55, 4.16±0.61 respectively, p value found to be >0.05 at 95% CI.Conclusions: In the study it was concluded that p value found to be >0.05 at 95% C.I denoting that there is no significant difference between mean value of base line and follow up serum potassium value in both group. None of patients in either group had experienced hyperkalaemia over follow up period though serum potassium level were slightly higher in group A, but this difference was statistically not significant. Follow up period of study should be long enough to comment on safety profile of combining spironolactone and ACE inhibitors in diabetic nephropathy patients.

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ASSOCIATION BETWEEN SERUM POTASSIUM LEVEL AND OUTCOMES IN HEART FAILURE WITH REDUCED EJECTION FRACTION: A COHORT STUDY FROM THE SWEDISH HEART FAILURE REGISTRY

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(17)34067-6 ◽

2017 ◽

Vol 69 (11) ◽

pp. 678 ◽

Cited By ~ 1

Author(s):

Lauren Beth Cooper ◽

Lina Benson ◽

Robert Mentz ◽

Gianluigi Savarese ◽

Adam DeVore ◽

...

Keyword(s):

Heart Failure ◽

Cohort Study ◽

Ejection Fraction ◽

Serum Potassium ◽

Potassium Level ◽

Serum Potassium Level ◽

Reduced Ejection Fraction

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Serum Potassium Concentration and Use of Ouabain in Experimental Tourniquet Shock

American Journal of Physiology-Legacy Content ◽

10.1152/ajplegacy.1957.189.3.605 ◽

1957 ◽

Vol 189 (3) ◽

pp. 605-608 ◽

Cited By ~ 1

Author(s):

W. F. Rosse ◽

A. L. Bennett ◽

A. R. McIntyre

Keyword(s):

Blood Pressure ◽

Serum Potassium ◽

Potassium Level ◽

Serum Potassium Level ◽

Potassium Concentration ◽

Mean Blood Pressure ◽

Serum Potassium Concentration ◽

Average Value ◽

Tourniquet Shock ◽

The Mean

Shock was induced in dogs by the release of tourniquets which had been applied to the hind legs for 5 hours. The serum potassium level was followed by spaced sampling. It was seen to rise slightly (from an average of 4.02 mEq/l. to an average of 4.66 mEq/l.) during the prerelease period. Five minutes after the release of the tourniquets, the level had risen to an average of 7.50 mEq/l. and thirty minutes after the release, it had risen to an average of 8.56 mEq/l. At the critical point in the progress of the syndrome (when the mean blood pressure was approximately 50 mm Hg) the average value was 8.46 mEq/l. Ouabain was administered and the level of serum potassium was seen to rise, attaining values as high as 14.67 mEq/l. in one case. The results and significance of these increased levels are briefly discussed as well as an animadversion upon the effects of ouabain on the mean blood pressure.

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Tolvaptan-induced hypernatremia related to low serum potassium level accompanying high blood pressure in patients with acute decompensated heart failure

BMC Cardiovascular Disorders ◽

10.1186/s12872-020-01751-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Hidetada Fukuoka ◽

Koichi Tachibana ◽

Yukinori Shinoda ◽

Tomoko Minamisaka ◽

Hirooki Inui ◽

...

Keyword(s):

Blood Pressure ◽

Serum Potassium ◽

Potassium Level ◽

Sodium Level ◽

Serum Sodium Level ◽

Serum Potassium Level ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Clinical Factors ◽

Low Serum

Abstract Backgrounds Tolvaptan significantly increases urine volume in acute decompensated heart failure (ADHF); serum sodium level increases due to aquaresis in almost all cases. We aimed to elucidate clinical factors associated with hypernatremia in ADHF patients treated with tolvaptan. Methods We enrolled 117 ADHF patients treated with tolvaptan in addition to standard therapy. We examined differences in clinical factors at baseline between patients with and without hypernatremia in the initial three days of hospitalization. Results Systolic (p = 0.045) and diastolic (p = 0.004) blood pressure, serum sodium level (p = 0.002), and negative water balance (p = 0.036) were significantly higher and serum potassium level (p = 0.026) was significantly lower on admission day in patients with hypernatremia (n = 22). In multivariate regression analysis, hypernatremia was associated with low serum potassium level (p = 0.034). Among patients with serum potassium level ≤ 3.8 mEq/L, the cutoff value obtained using receiver operating characteristic curve analysis, those with hypernatremia related to tolvaptan treatment showed significantly higher diastolic blood pressure on admission day (p = 0.004). Conclusion In tolvaptan treatment combined with standard therapy in ADHF patients, serum potassium level ≤ 3.8 mEq/L may be a determinant factor for hypernatremia development. Among hypokalemic patients, those with higher diastolic blood pressure on admission may be carefully managed to prevent hypernatremia.

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Significance of Serum Potassium Level at Admission in Organophosphorus Poisoning and Impact on Outcome - A Hospital Based Study from North East India

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/596 ◽

2021 ◽

Vol 8 (36) ◽

pp. 3282-3287

Author(s):

Bijush Difoesa ◽

Dibya Jyoti Sharma ◽

Hari S ◽

Dipankar Deb

Keyword(s):

Serum Potassium ◽

Potassium Level ◽

Serum Potassium Level ◽

Normal Serum ◽

Organophosphate Poisoning ◽

P Value ◽

Mortality And Morbidity ◽

North East ◽

Organophosphorus Poisoning ◽

Acute Organophosphorus Poisoning

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 & 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 < 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

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MO053GITELMAN'S SYNDROME AND PREGNANCY: TWO SUCCESSFUL CASE REPORTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab080.0025 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Chaofan Wang ◽

Xueyan Chen ◽

Xubin Yang ◽

Jinhua Yan ◽

Bin Yao

Keyword(s):

Blood Pressure ◽

Serum Potassium ◽

Potassium Level ◽

Serum Potassium Level ◽

Renal Ultrasound ◽

Normal Range ◽

Urine Calcium ◽

Potassium Supplementation ◽

Healthy Female ◽

Urine Potassium

Abstract Background and Aims Gitelman’s Syndrome (GS) is a rare autosomal recessive hereditary salt-losing tubulopathy characterized by hypokalemic metabolic alkalosis with hypomagnesemia and hypocalciuria. Pregnancy in women with GS often aggravates hypokalemia and hypomagnesemia. However, there are few reports of pregnancies in GS. Here, we report the course of two Chinese women who were diagnosed as GS during pregnancy in 2019 and 2020 respectively. Method Case 1: A 21-year-old woman was referred to our hospital at 9 weeks gestation of her first pregnancy. She had complained of muscle weakness and cramps for one year. Before the referral she was diagnosed as hypokalemia and treated by oral potassium supplementation. However, her symptoms became severer after pregnancy. Case 2: A 20-year-old woman was admitted to the hospital because of elevated plasma glucose level and hypokalemia at 27 weeks gestation of her first pregnancy. The woman was asymptomatic and denied history of chronic diseases. The laboratory examinations were taken after admission. Genetic testing was conducted for pathogenic mutations in SLC12A3 (GS) and SLC12A1, KCNJ1, CLCKNB and BSND (Bartter syndrome 1-4). Results Case 1: Initial biochemistry examinations revealed hypokalemia (2.3 mmol/L, normal range 3.5-5.3 mmol/L) with inappropriate renal potassium wasting (urine potassium 254 mmol/24h, normal range < 20 mmol/24h), alkalosis (arterial blood gas pH 7.49), hypomagnesemia (0.55 mmol/L, normal range 0.67-1.04 mmol/L), hypocalciuria (urine calcium 1.6 mmol/24h, normal range 2.5-7.5 mmol/24h) and elevated renin (276 pg/ml, normal range 4-24 pg/ml) and aldosterone (825 pg/ml, normal range 10-160 pg/ml) levels. The blood pressure was normal-low (97/68 mmHg, 12.9/9.0 kPa) and the renal ultrasound was normal. Homozygous mutations [c.179C>T (Thr60Met)] were identified. The woman’s father and sister had a heterozygous c.179C>T, but had no electrolyte disorders. After the treatment of oral potassium supplementation (KCl 3g tid) and spironolactone (40mg bid), her serum potassium level increased to 3.4-4.0 mmol/L and muscle weakness was relieved. The woman delivered a healthy female infant weighing 2600 g at 39 weeks gestation via cesarean section. Maternal serum potassium level remained normal and no symptoms reoccured after delivery. Case 2: Initial biochemistry examinations identified hypokalemia (2.3 mmol/L, normal range 3.5-5.3 mmol/L) with inappropriate renal potassium wasting (urine potassium 81 mmol/24h, normal range < 20 mmol/24h), hypomagnesemia (0.49 mmol/L, normal range 0.67-1.04 mmol/L), hypocalciuria (urine calcium 0.3 mmol/24h, normal range 2.5-7.5 mmol/24h) and elevated renin (54 pg/ml, normal range 4-24 pg/ml) and aldosterone (834 pg/ml, normal range 10-160 pg/ml) levels. The blood pressure and renal ultrasound were normal. Heterozygous mutations [c.179C>T (Thr60Met), c.658G>A (Gly220Ser)] were identified. The woman was treated by oral potassium supplementation (KCl 3g tid) and her serum potassium level maintained normal during pregnancy. She had a normal delivery of a healthy female infant weighing 3050 g at 40 weeks gestation. After delivery she discontinued oral potassium supplementation and her serum potassium level ranged from 3.0-3.4 mmol/L without symptoms. Conclusion The outcome of mother and fetus of GS pregnancies appears favorable. Intensive monitoring of electrolyte levels and sufficient electrolyte supplementation are advised during pregnancy.

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Tolvaptan-Induced Hypernatremia Related to Low Serum Potassium Level Accompanying High Blood Pressure in Patients with Acute Decompensated Heart Failure

10.21203/rs.3.rs-39563/v1 ◽

2020 ◽

Author(s):

Hidetada Fukuoka ◽

Koichi Yachibana ◽

Yukinori Shinoda ◽

Tomoko Minamisaka ◽

Hirooki Inui ◽

...

Keyword(s):

Blood Pressure ◽

Serum Potassium ◽

Potassium Level ◽

Sodium Level ◽

Serum Sodium Level ◽

Serum Potassium Level ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Clinical Factors ◽

Low Serum

Abstract Backgrounds: Tolvaptan significantly increases urine volume in acute decompensated heart failure (ADHF); serum sodium level increases due to aquaresis in almost all cases. We aimed to elucidate clinical factors associated with hypernatremia in ADHF patients treated with tolvaptan.Methods: We enrolled 117 ADHF patients treated with tolvaptan in addition to standard therapy. We examined differences in clinical factors at baseline between patients with and without hypernatremia in the initial three days of hospitalization. Results: Systolic (p=0.045) and diastolic (p=0.004) blood pressure, serum sodium level (p=0.002), and negative water balance (p=0.036) were significantly higher and serum potassium level (p=0.026) was significantly lower on admission day in patients with hypernatremia (n=22). In multivariate regression analysis, hypernatremia was associated with low serum potassium level (p=0.034). Among patients with serum potassium level ≤3.8 mEq/L, the cutoff value obtained using receiver operating characteristic curve analysis, those with hypernatremia related to tolvaptan treatment showed significantly higher diastolic blood pressure on admission day (p=0.004).Conclusion: In tolvaptan treatment combined with standard therapy in ADHF patients, serum potassium level ≤ 3.8mEq/L may be a determinant factor for hypernatremia development. Among hypokalemic patients, those with higher diastolic blood pressure on admission may be carefully managed to prevent hypernatremia.

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