Abstract 11689: The Association Between Serum Potassium and Mortality in a Cohort of Patients With Diminished Kidney Function

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Alex Yang ◽  
Jiacong Luo ◽  
Donna E Jensen ◽  
Steven M Brunelli
Keyword(s):  
Renal Disease ◽  
Serum Potassium ◽  
Beta Blockers ◽  
Elevated Serum ◽  
Normal Function ◽  
Channel Blockers ◽  
Lower Egfr ◽  
Rate Ratios ◽  
Stage Renal Disease ◽  
End Stage

Introduction: Serum potassium (K) is tightly regulated by the kidney between 3.5 and 5.0 mEq/L, which is essential for cardiac action potential and normal function. However, due to impaired excretory capacity, patients with chronic kidney disease (CKD) often have elevated serum K that potentially increases morbidity and mortality. Hypothesis: To better understand the burden of hyperkalemia and how this may vary by severity of renal disease, we studied the association of serum K with rates of mortality within narrow strata of estimated glomerular filtration rate (eGFR). Methods: We identified a retrospective cohort of patients with eGFR <60 mL/min/1.73m 2 between Jan-2009 and Jun-2013 (N=55,266). Patients were followed until 30-Jun-2013 or censoring (death, end-stage renal disease, transfer of care). Serum K, eGFR, and 13 covariates including demographics, comorbidities and medication use (beta blockers, centrally acting calcium channel blockers, loop and thiazide diuretics) were considered on a time-varying basis, updated at each K measurement. Death was considered as event per time at-risk. Results: At baseline, 15%, 4%, and 1% of patients had serum K 5.0-5.4, 5.5-5.9, and ≥6.0 mEq/L, respectively; prevalence was greater in lower eGFR strata. In each eGFR stratum, a U-shaped association between serum K and mortality was observed (figure shown for eGFR <30 mL/min/1.73m 2 ). Compared to K 4.5-4.9 mEq/L, adjusted incidence rate ratios (IRRs) for K ≥6.0 mEq/L were 3.08 [95%CI, 2.17-4.37], 2.74 [1.13-6.74], 1.72 [0.76-3.86], and 3.90 [1.23-12.32] in eGFR <30, 30-39, 40-49, and 50-59 mL/min/1.73m 2 strata, respectively. Conclusions: Serum K ≥6.0 mEq/L is potently and independently associated with increased mortality among CKD patients. This association is independent of degree of kidney failure. Future population studies should examine cause-specific mortality according to hyperkalemia strata to identify possible mechanisms of cardiac death.

Abstract 13234: The Association Between Serum Potassium and Major Adverse Cardiovascular Events in Patients With Chronic Kidney Disease

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Alex Yang ◽  
Jiacong Luo ◽  
Donna E Jensen ◽  
Steven M Brunelli
Keyword(s):  
Kidney Disease ◽  
Serum Potassium ◽  
Cardiovascular Events ◽  
Beta Blockers ◽  
High Serum ◽  
Major Adverse Cardiovascular Events ◽  
Channel Blockers ◽  
Increased Risk ◽  
Rate Ratios ◽  
Stage Renal Disease

Introduction: Patients with kidney disease often have high serum potassium (K) due to diminished excretory capacity. Hypothesis: We evaluated the association of high K with rates of arrhythmia and major adverse cardiovascular events (MACE; composite of myocardial infarction, stroke, heart failure, and arrhythmia). Methods: We studied a retrospective cohort of patients with eGFR <60 mL/min/1.73m 2 between Jan-2009 and Jun-2013 (N=55,266). Patients were followed until the end of study (30-Jun-2013), death, end-stage renal disease, or transfer of care. Serum K, eGFR, and 13 covariates including demographics, prevalent comorbidities, and medication use (beta blockers, centrally acting calcium channel blockers, and loop and thiazide diuretics) were considered on a time-varying basis, updated for each K measurement. Results: At baseline, 15%, 4%, and 1% of patients had serum K 5.0-5.4, 5.5-5.9, and ≥6.0 mEq/L, respectively. Prevalence was greater in lower eGFR strata. Within each eGFR stratum serum K demonstrated U-shaped associations with rates of MACE and arrhythmia, displayed for eGFR <30 mL/min/1.73m 2 . Compared to K 4.5-4.9 mEq/L, incidence rate ratios (IRRs) of MACE for K ≥6.0 mEq/L were 2.11 [95%CI, 1.68-2.65], 1.44 [1.12-1.84], 1.56 [1.11-2.17], and 2.11 [1.53-2.89] in the eGFR <30, 30-39, 40-49, and 50-59 strata, respectively. K ≥6.0 mEq/L was associated with increased rate of arrhythmia in the lowest eGFR stratum (Figure); point estimates in other eGFR strata ranged from 1.39 to 1.53, but were not significant. Conclusions: K ≥6.0 mEq/L is associated with increased risk of MACE among patients with eGFR <60 mL/min/1.73m 2 and with arrhythmia among patients with eGFR <30 mL/min/1.73m 2 . Renal impairment should be considered when determining serum K targets with respect to cardiovascular risk.

scholarly journals INF2 p.Arg214Cys mutation in a Chinese family with rapidly progressive renal failure and follow-up of renal transplantation: case report and literature review

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Wenbo Zhao ◽  
Xinxin Ma ◽  
Xiaohao Zhang ◽  
Dan Luo ◽  
Jun Zhang ◽  
...  
Keyword(s):  
Renal Failure ◽  
Renal Disease ◽  
Autosomal Dominant ◽  
Mutational Analysis ◽  
Elevated Serum ◽  
Chinese Family ◽  
Progressive Renal Failure ◽  
Rapidly Progressive Renal Failure ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Heterozygous mutations in the inverted formin 2 (INF2) gene are related to secondary focal segmental glomerulosclerosis (FSGS), a rare secondary disease associated with rapidly progressive renal failure. Case presentation We report a patient with familial autosomal INF2 mutation manifesting nephritic syndromes and elevated serum creatinine levels. Mutational analysis revealed an autosomal dominant (AD) inheritance pattern and a mutation in exon 4 (p.Arg214Cys) of INF2 as the likely cause, which has not been previously described in an Asian family. The patient progressed to end-stage renal disease (ESRD) and received hemodialysis. His mother had undergone renal transplant 3 years earlier, and his grandmother had carried the p.Arg214Cys mutation for more than 80 years without any sign of renal dysfunction. Conclusions This is the first report to identify an association between a familial autosomal dominant INF2 p.Arg214Cys mutation and rapidly progressive renal disease in an Asian family. INF2 mutation analysis should not be restricted to individuals without family history of FSGS, rather it should also be performed on individuals for whom drug-based therapies are not effective. In this case, kidney transplant is an effective alternative.

Mineralocorticoid Therapy Lowers Serum Potassium in Patients with End-Stage Renal Disease

1993 ◽  
Vol 13 (2) ◽  
pp. 138-141 ◽  
Author(s):  
Pravin C. Singhal ◽  
Lionel Desroches ◽  
Joseph Mattana ◽  
Mirel Abramovici ◽  
John D. Wagner ◽  
...  
Keyword(s):  
Renal Disease ◽  
Serum Potassium ◽  
End Stage Renal Disease ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals A case report of congenital nephrotic syndrome caused by new mutations of NPHS1

2021 ◽  
Vol 49 (8) ◽  
pp. 030006052110381
Author(s):  
Zhong Li ◽  
Lanchun Zhuang ◽  
Mei Han ◽  
Feng Li
Keyword(s):  
Nephrotic Syndrome ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Treatment Plan ◽  
Congenital Nephrotic Syndrome ◽  
Immunosuppressive Drugs ◽  
Normal Function ◽  
Heterozygous Mutation ◽  
Stage Renal Disease ◽  
End Stage

Congenital nephrotic syndrome (CNS) is a rare autosomal recessive disorder that occurs in the first 0 to 3 months of life. The course of CNS is progressive, often leading to end-stage renal disease within 2 to 3 years. Most patients with CNS are resistant to glucocorticoids and immunosuppressive drugs. We report a girl aged 1 month and 20 days who was admitted to hospital with a history of abdominal distension and palpebral edema. She was diagnosed with CNS and administered a glucocorticoid (methylprednisolone) for 2 years. Targeted high-throughput next-generation sequencing showed mutations in the NPHS1 gene. She had a favorable outcome after 2 years of treatment. She has remained in complete remission for the last 6 months. From a clinical point of view, the outcome of CNS may be associated with end-stage renal disease or even death. Appropriate pharmacotherapy is beneficial to maintain a normal function and integrity of the glomerular barrier. An aggressive treatment plan is required to save the life of patients with CNS, even if a heterozygous mutation is detected by genetic analysis.

scholarly journals Intradialytic Arrhythmias Among Patients with End Stage Renal Disease on Maintenance Hemodialysis at Muhimbili National Hospital

2021 ◽  
Author(s):  
Wailesy Adam ◽  
Tumaini Nagu ◽  
Reuben Mutagaywa ◽  
Onesmo Kisanga
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Ventricular Hypertrophy ◽  
Beta Blockers ◽  
Left Ventricular ◽  
Clinically Significant ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract BackgroundArrhythmias are responsible for almost 2 out of 3 cardiac deaths among patients on hemodialysis. We report the prevalence and risk factors for clinically significant arrhythmias among end stage renal disease (ESRD) patients on maintenance dialysis at a tertiary dialysis facility in Tanzania. MethodsCross-sectional study, involving consenting adults with ESRD was conducted September 2019 to February 2020. Arrhythmias were assessed using standard 5-leads Holter electrocardiography placed 15 minutes before dialysis and connected throughout dialysis. Clinically Significant Arrhythmias (CSA) was defined as ectopic beats in excess of 10 per hour or any of the ventricular tachycardia or Pause lasting for at least 2.5 seconds or paroxysmal supraventricular tachycardia or atrial flutter or atrial fibrillation. ResultsA total of 71 (44.4%) participants had CSA. Factors associated with increased risk for CSA were: age older than 60 years (OR 34; 95% CI: 5.15-236; P< 0.001), intradialytic blood pressure change of ≥ 10mmHg (OR 3.85; 95% CI: 1.27-11.7; P=0.017) and the presence of Left Ventricular Hypertrophy (OR 5.84; 95% CI: 1.85-18.4; P< 0.01). On the contrary, three dialysis sessions per week (OR 0.14; 95% CI: 0.03-0.67; P=0.013) and use of beta-blockers (OR 0.18; 95% CI: 0.05-0.68; P=0.011) were significantly associated with a decreased risk of CSA. ConclusionClinically significant arrhythmias are not uncommon in ESRD patients undergoing maintenance haemodialysis. We recommend increasing vigilance for CSA among older patients (>60 years) as well as those with left ventricular hypertrophy. Beta blockers among hypertensive ESRD patients with ventricular hypertrophy could be helpful.

Abstract 12810: Beta Blockers and Mortality Benefit in Patients With Heart Failure and End Stage Renal Disease on Hemodialysis

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Chakradhari Inampudi ◽  
Vlad Cotarlan
Keyword(s):  
Heart Failure ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Beta Blockers ◽  
Systolic Heart Failure ◽  
Mortality Benefit ◽  
Survival Curves ◽  
Patients With Heart Failure ◽  
Stage Renal Disease ◽  
End Stage

Background: Post-hoc analysis of Randomized control trials have established safety and efficacy of Beta blockers (BB) in patients with systolic heart failure (HF) and mild to moderate Chronic kidney disease (CKD). However, the mortality benefit in patients with advanced CKD especially those approaching end stage renal disease (ESRD) is limited. The study was sought to identify mortality benefit in patients with Heart failure (HF) and ESRD who progressed to dialysis. Methods: Using electronic medical records, we identified 1,817 patients with end stage renal dialysis(ESRD) who progressed to dialysis over a 6 year period between 2004 and 2011. Kaplan Meyer survival curves were used to assess the association between BB use and mortality. Results: Of 1817 patients (mean age 61+/-15, 57% males) with ESRD who progressed to dialysis, 1329 (73.1%) were treated with BB and 488 (26.5%) were never treated with a BB. Kaplan Meyer Survival curves showed that patients who received treatment with BB had better survival than patients who were never treated with BB despite more HTN and diabetes present in the former group (mean survival time 4.9 years versus 4.4 years, p<0.001, Fig 1). Survival graphs were similar for those with an encounter diagnosis of HF (n=547, Fig 2) and those without an encounter diagnosis of HF (n=1270, graph not shown) with stronger association between BB and survival among those with HF (mean survival 3.1 versus 4.8 years, p=0.001, Fig 2). Conclusion: Treatment with BB is associated with improved survival in heart failure patients with ESRD who progressed to dialysis.

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