scholarly journals Potassium-lowering agents for the treatment of nonemergent hyperkalemia: pharmacology, dosing and comparative efficacy

2019 ◽  
Vol 34 (Supplement_3) ◽  
pp. iii45-iii50 ◽  
Author(s):  
Mary Barna Bridgeman ◽  
Milisha Shah ◽  
Edward Foote
Keyword(s):  
Heart Failure ◽  
Elevated Serum ◽  
Severe Heart Failure ◽  
Sodium Polystyrene Sulfonate ◽  
Potential Safety ◽  
Urinary Potassium ◽  
Patients With Heart Failure ◽  
Cation Exchange Resins ◽  
Exchange Resins ◽  
Sodium Zirconium Cyclosilicate

Abstract Hyperkalemia represents a common and potentially life-threating electrolyte abnormality, a complication frequently observed in patients with heart failure, kidney disease, diabetes or in those receiving drug therapies influencing the renin–angiotensin–aldosterone system. Elevated serum potassium levels are often the result of impaired urinary potassium elimination, inadequate or reduced cellular potassium uptake, severe heart failure, use of medications influencing potassium levels in the circulation, or, more commonly, a combination of these factors. Strategies for the treatment of nonemergent hyperkalemia include the use of cation-exchange resins, polymers or other novel mechanisms of potassium trapping, including sodium polystyrene sulfonate, patiromer and sodium zirconium cyclosilicate. These agents differ in their pharmacology and mechanism of action, clinical efficacy, including onset and extent of potassium-lowering effect, dosage and administration, and potential safety and adverse effect profiles. In this review, an evaluation of these characteristics, including clinical evidence and safety concerns, in the management of nonemergent hyperkalemia will be explored.

scholarly journals Patiromer in a Patient with Severe Hyperkalemia on Incremental Hemodialysis with 1 Session per Week: A Case Report and Literature Review

2021 ◽  
pp. 158-166
Author(s):  
José C. De La Flor ◽  
Javier Deira ◽  
Alexander Marschall ◽  
Francisco Valga ◽  
Tania Linares ◽  
...  
Keyword(s):  
Volume Overload ◽  
Sodium Polystyrene Sulfonate ◽  
Dialysis Dose ◽  
Cation Exchange Resins ◽  
Incremental Hemodialysis ◽  
Severe Hyperkalemia ◽  
Exchange Resins ◽  
Potassium Binders ◽  
Sodium Zirconium Cyclosilicate

Hyperkalemia is common in patients with ESRD, undergoing hemodialysis (HD), and is associated with an increase in hospitalization and mortality. Residual kidney function in long-term dialysis patients is associated with lower morbidity and mortality in HD patients. Although the 2015 National Kidney Foundation-Kidney Disease Outcomes Quality Initiate (NKD-KDOQI) guidelines allow the reduction in the weekly HD dose for patients with a residual kidney urea clearance (Kur) &#x3e;3 mL/min/1.73 m<sup>2</sup>, very few centers adjust the dialysis dose based on these criteria. In our center, the pattern of incremental hemodialysis (iHD) with once-a-week schedule (1 HD/W) has been an option for a group of patients showing very good results. This pattern is maintained as long as residual diuresis is &#x3e;1,000 mL/24 h, Kur is &#x3e;4 mL/min, and there is no presence of edema or volume overload, as well as no analytical parameters persistently outside the advisable range (serum phosphorus &#x3e;6 mg/dL or potassium [K<sup>+</sup>] &#x3e;6.5 mmol/L). Management of hyperkalemia in HD patients includes reduction of dietary intake, dosing of medications that contribute to hyperkalemia, and use of cation-exchange resins such as calcium or sodium polystyrene sulfonate. Two newer potassium binders, patiromer sorbitex calcium and sodium zirconium cyclosilicate, have been safely used for potassium imbalance treatment in patients with ESRD in HD with a conventional regimen of thrice weekly, but has not yet been studied in 1 HD/W schedules. We present the case of a 76-year-old woman in iHD (1 HD/W) treated with patiromer for severe HK and describe her clinical characteristics and outcomes. In addition, we review the corresponding literature. Based on these data, it can be anticipated that the use of patiromer may overcome the risk of hyperkalemia in patients with incident ESRD treated with less-frequent HD regimens.

Anaemia and heart failure

Open Medicine ◽  
2011 ◽  
Vol 6 (1) ◽  
pp. 11-25
Author(s):  
Enrico Vizzardi ◽  
Tania Bordonali ◽  
Elena Tanghetti ◽  
Marco Metra ◽  
Livio Cas
Keyword(s):  
Heart Failure ◽  
Ventricular Dysfunction ◽  
Severe Heart Failure ◽  
Left Ventricular ◽  
Favourable Effect ◽  
Heart Failure Trial ◽  
Patients With Heart Failure ◽  
Darbepoetin Alpha ◽  
Main Determinants ◽  
Independent Determinant

AbstractAnaemia is one of the most frequent co-morbidities in patients with heart failure. Its prevalence increases from 4% to7% in subjects with asymptomatic left ventricular dysfunction to >30% in patients with severe heart failure. Renal insufficiency, activation of inflammatory mediators and treatment with renin-angiotensin antagonists seem to be its main determinants. The results of many studies agree in providing evidence that anaemia is a powerful independent determinant of survival in patients with heart failure. However, the mechanisms of this relation are still not fully understood. Moreover a favourable effect of the correction of anaemia on prognosis has not yet been shown. Also In addition to this, controlled studies assessing its effects on exercise tolerance have yielded controversial results. Further research is needed to assess the effect of correcting anaemia in chronic heart failure (CHF) patients; ongoing reduction of events with RED-HF (Darbepoetin alpha in heart failure) trial will help define the role.

Elevated Serum CA 125 Levels in Mitral Stenotic Patients with Heart Failure

Cardiology ◽  
2003 ◽  
Vol 100 (1) ◽  
pp. 7-10 ◽  
Author(s):  
Can Duman ◽  
Ertugrul Ercan ◽  
Istemihan Tengiz ◽  
Huseyin Bozdemir ◽  
H. Ekin Ercan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Elevated Serum ◽  
Ca 125 ◽  
Patients With Heart Failure

scholarly journals Prognostic Value of Elevated Serum Ceruloplasmin Levels in Patients With Heart Failure

2014 ◽  
Vol 20 (12) ◽  
pp. 946-952 ◽  
Author(s):  
Muhammad Hammadah ◽  
Yiying Fan ◽  
Yuping Wu ◽  
Stanley L. Hazen ◽  
W.H. Wilson Tang
Keyword(s):  
Heart Failure ◽  
Prognostic Value ◽  
Elevated Serum ◽  
Serum Ceruloplasmin ◽  
Patients With Heart Failure

ACE Insertion/Deletion, But Not −240A>T Polymorphism, Modulates the Severity in Heart Failure

2008 ◽  
Vol 56 (8) ◽  
pp. 1004-1010 ◽  
Author(s):  
Cinzia Fatini ◽  
Elena Sticchi ◽  
Rossella Marcucci ◽  
Abdihakim Abdullahi Said ◽  
Stefano Del Pace ◽  
...  
Keyword(s):  
Heart Failure ◽  
Allele Frequency ◽  
Nyha Class ◽  
Severe Heart Failure ◽  
Genotype Distribution ◽  
Multinomial Regression ◽  
Predisposing Factor ◽  
Significant Difference ◽  
Patients With Heart Failure

ObjectiveACE gene is reported to be a candidate gene in heart failure. The insertion/deletion (I/D) polymorphism has been observed to be a predictor of mortality in this disease, but no data are available concerning the role of ACE −240A>T polymorphism. In this study, we investigated the role of ACE I/D and −240A>T polymorphisms in influencing both severity and clinical outcomes in patients with heart failure, according to New York Heart Association (NYHA) class.PatientsWe studied 323 patients with heart failure (258 men/65 women; age, 70.8 ± 11.5 years) followed-up for 11.9 ± 6.6 months.ResultsThe ACE D and −240T allele frequency significantly increased according to the NYHA functional class (P = 0.0002 and P < 0.0001, respectively).No significant difference in ACE polymorphism genotype distribution and allele frequency according to N-terminal pro-brain natriuretic peptide tertiles was observed. At multinomial regression analysis, ACE D but not −240T allele has been evidenced to be a significant and independent predictor of severity for both NYHA III and IV classes (P = 0.01 and P = 0.004, respectively). The ACE D allele prevalence was higher, even if not significantly in both death and rehospitalization groups in comparison with survivors and nonrehospitalized (P = 0.6 and P = 0.9, respectively). No difference in −240T allele frequency has been observed for the ACE −240A>T polymorphism, in relation to both death and rehospitalization (P = 0.1 and P = 0.6, respectively).ConclusionsThis study suggests that ACE I/D polymorphism might represent a predisposing factor to severe heart failure, independently of well-known prognostic markers.

scholarly journals Kayexalate-Induced Esophageal Ulceration in a Patient with Decompensated Cirrhosis: A Review of the Literature

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Kishore Kumar ◽  
Harish Patel ◽  
Muhammad Saad ◽  
Ahmed Baiomi ◽  
Anil Dev
Keyword(s):  
Clinical Medicine ◽  
The Body ◽  
Decompensated Cirrhosis ◽  
Sodium Polystyrene Sulfonate ◽  
Esophageal Ulcer ◽  
Polystyrene Sulfonate ◽  
Colonic Necrosis ◽  
Cation Exchange Resins ◽  
Gastrointestinal Side Effects ◽  
Exchange Resins

Hyperkalemia is one of the most common electrolyte abnormalities encountered in clinical practice. The treatment of hyperkalemia includes removal of excess potassium from the body using cation exchange resins, e.g., sodium polystyrene sulfonate (Kayexalate) is one of the most practiced modalities in clinical medicine. Colonic mucosal necrosis and perforation are the serious gastrointestinal side effects associated with sodium polystyrene sulfonate (SPS) use, which have been reported with or without concomitant use of sorbitol. However, the catastrophic bleeding esophageal ulcer has been rarely described in our literature search. Due to the risk of colonic necrosis, the FDA has issued a warning to avoid concomitant sorbitol use with Kayexalate. We present an individual with acute hematemesis due to bleeding esophageal ulcer immediately after treatment with Kayexalate therapy. Though the exact mechanism by which Kayexalate causes esophageal ulcer to be elucidated, nonetheless it is worthwhile to be vigilant about its potential adverse effects. Our case highlights the rare but certainly the life-threatening complication of Kayexalate therapy.

Role of endothelins in congestive heart failure

2003 ◽  
Vol 81 (6) ◽  
pp. 588-597 ◽  
Author(s):  
Gordon W Moe ◽  
Jean L Rouleau ◽  
Quang T Nguyen ◽  
Peter Cernacek ◽  
Duncan J Stewart
Keyword(s):  
Heart Failure ◽  
Large Scale ◽  
Severe Heart Failure ◽  
Endothelin Antagonists ◽  
Short Period ◽  
Patients With Heart Failure ◽  
Conventional Medical Therapy ◽  
Receptor Blockers ◽  
Novel Therapeutic Strategies

Despite major advances in conventional medical therapy, patients with heart failure continue to experience significant morbidity and mortality. Endothelin-1 (ET-1) is a potent vasocontrictor and mitogenic peptide that is activated in heart failure. There is increasing experimental and clinical evidence in support of an important role of ET-1 in the pathophysiology of heart failure. Manipulation of the activity of ET-1, especially using endothelin receptor blockers, has allowed for the further elucidation of the role of this neurohormonal system and development of novel therapeutic strategies in heart failure. Published clinical studies of these agents to date have involved relatively small numbers of patients with severe heart failure, followed for a relatively short period of time, and have mainly examined surrogate endpoints. Large-scale trials that address to hard clinical outcomes are ongoing and their results forthcoming. A key question that remains concerns whether selective ETA or dual ETA–ETB receptor blockade will be more effective.Key words: heart failure, endothelins, endothelin antagonists.

Elevated Serum Endothelial Glycocalyx Is Associated with Decreased Survival in Patients with Heart Failure with Reduced Ejection Fraction

2020 ◽  
Vol 26 (10) ◽  
pp. S15-S16
Author(s):  
Thanat Chaikijurajai ◽  
Yong-Hyun Kim ◽  
Takeshi Kitai ◽  
Rommel Morales ◽  
Kathryn Morales ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Elevated Serum ◽  
Endothelial Glycocalyx ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure
Sign in / Sign up

Export Citation Format

Share Document