Practical guidance for the use of potassium binders in the management of hyperkalaemia in patients with heart failure and/or chronic kidney disease

Author(s):  
Patricia Campbell ◽  
Paul McKeveney ◽  
Kay Donegan ◽  
Charlie Ataliotis ◽  
Carol Patton ◽  
...  

Given the critical physiological role of potassium, it is understandable that the development of severe hyperkalaemia requires effective management to reduce its effects, which include muscle weakness, paralysis and cardiac arrhythmias. Hyperkalaemia most often results from the failure of renal adaptation to potassium imbalance. Patients who are most susceptible to the development of hyperkalaemia include those with chronic kidney disease and those with heart failure. These patients are often treated with renin–angiotensin–aldosterone system (RAAS) inhibitors, such as angiotensin-converting enzyme inhibitors and angiotensin II-receptor blockers, but the development of hyperkalaemia can require down-titration or cessation of RAAS inhibitors. This presents a significant challenge to nephrologists, cardiologists and healthcare professionals treating these patients as this can prevent them from receiving maximum guideline-directed RAAS inhibitor therapy. Panellists in this roundtable discussion shared their clinical experiences of using potassium binders to manage hyperkalaemia in patients with chronic kidney disease and patients with heart failure (illustrated with case studies) in Northern Ireland and considered recommendations for the implementation and maintenance of chronic potassium-lowering treatment.

Author(s):  
Ejin Kim ◽  
Yong Chul Kim ◽  
Jae Yoon Park ◽  
Jiyun Jung ◽  
Jung Pyo Lee ◽  
...  

Certain underlying diseases such as diabetic mellitus and hypertension are a risk factor for the severity and mortality of coronavirus disease (COVID-19) patients. Furthermore, both angiotensin converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) are controversial at role in the process of COVID-19 cases. The aim of the study was to investigate whether underlying diseases and taking ACEi/ARBs, affect the duration of hospitalization and mortality in patients with confirmed COVID-19. Medical usage claims data for the past three years until 15 May, 2020, from the “CORONA-19 International Cooperation Research” project was used. We analyzed the medical insurance claims data for all 7590 coronavirus (COVID-19) patients confirmed by RT-PCR tests nationwide up to May 15, 2020. Among the comorbidities, a history of hypertension (hazard ratio [HR], 1.51; 95% confidence interval [CI], 1.056–2.158) and diabetes (HR, 1.867; 95% CI, 1.408–2.475) were associated significantly with mortality. Furthermore, heart failure (HR, 1.391; 95% CI, 1.027–1.884), chronic obstructive pulmonary disease (HR, 1.615; 95% CI, 1.185–2.202), chronic kidney disease (HR, 1.451; 95% CI, 1.018–2.069), mental disorder (HR, 1.61; 95% CI, 1.106–2.343), end stage renal disease (HR, 5.353; 95% CI, 2.185–13.12) were also associated significantly with mortality. The underlying disease has increased the risk of mortality in patients with COVID-19. Diabetes, hypertension, cancer, chronic kidney disease, heart failure, and mental disorders increased mortality. Controversial whether taking ACEi/ARBs would benefit COVID-19 patients, in our study, patients taking ACEi/ARBs had a higher risk of mortality.


Author(s):  
Samantha Hider ◽  
Edward Roddy

Gout is the most prevalent inflammatory arthritis in men. Data from epidemiological studies conducted in several countries suggest that the prevalence and incidence of gout have risen over the last few decades, although incidence may have stabilized recently. Dietary factors (animal purines, alcohol, and fructose), co-morbid medical conditions (obesity, metabolic syndrome, hypertension, and chronic kidney disease), and medications (diuretics, aspirin, beta blockers, angiotensin converting-enzyme inhibitors, and non-losartan angiotensin II receptor blockers) have been confirmed to be risk factors for both hyperuricaemia and gout. In contrast, low-fat dairy products, coffee, vitamin C, calcium channel antagonists, and losartan appear to reduce the risk of developing gout. People with gout are themselves at increased risk of developing cardiovascular disease and chronic kidney disease, independent of traditional risk factors for these conditions.


2002 ◽  
Vol 15 (4) ◽  
pp. 318-325
Author(s):  
Jodie M. Fink

Angiotensin-II receptor blockers (ARBs) have recently been evaluated in large trials to determine their role in the treatment of heart failure. It is clear that angiotensin-converting enzyme inhibitors (ACE-Is) prevent the effects of an overactive renin-angiotensin aldosterone system and therefore prevent disease progression. Despite this evidence, intolerance (eg, cough) limits the use of ACE-Is in heart failure patients. Improved tolerability makes ARBs attractive alternatives in patients intolerant to ACE-Is. ARBs are also hypothesized to have additional benefits when used in combination with ACE-Is through more complete inhibition of angiotensin-II. However, studies of ARBs in patients with heart failure have not confirmed this hypothesis. This article describes the rationale and evaluates the literature for the use of ARBs in heart failure.


Heart & Lung ◽  
2017 ◽  
Vol 46 (3) ◽  
pp. 215
Author(s):  
Dahlia Garza ◽  
Coleman Gross ◽  
Martha Mayo ◽  
Jinwei Yuan ◽  
Daniel Wilson ◽  
...  

2021 ◽  
Vol 7 ◽  
Author(s):  
Umar Ismail ◽  
Kiran Sidhu ◽  
Shelley Zieroth

Hyperkalaemia has become an increasingly prevalent finding in patients with heart failure (HF), especially with renin–angiotensin–aldosterone system (RAAS) inhibitors and angiotensin–neprilysin inhibitors being the cornerstone of medical therapy. Patients living with HF often have other comorbidities, such as diabetes and chronic kidney disease, which predispose to hyperkalaemia. Until now, we have not had any reliable or tolerable therapies for the treatment of hyperkalaemia to facilitate implementation or achievement of target doses of RAAS inhibition. Patiromer sorbitex calcium and sodium zirconium cyclosilicate are two novel potassium-binding resins that have shown promise in the management of patients predisposed to developing recurrent hyperkalaemia, and their use may allow for further optimisation of guideline directed medical therapy.


2014 ◽  
Vol 4 (1) ◽  
pp. 45-55
Author(s):  
Sheikh Salahuddin Ahmed ◽  
Md Aminul Haque Khan ◽  
Tarafdar Runa Laila

Chronic kidney disease (CKD) is a worldwide public health problem with an increasing incidence and prevalence. Outcomes of CKD include not only complications of decreased kidney function and cardiovascular disease but also kidney failure causing increased morbidity and mortality. Unfortunately, CKD is often undetected and undertreated because of its insidious onset, variable progression, and length of time to overt kidney failure. Diabetes is now the leading cause of CKD requiring renal replacement therapy in many parts of the world, and its prevalence is increasing disproportionately in the developing countries. This review article outlines the current recommendations from various clinical guidelines and research studies for treatment, prevention and delaying the progression of both CKD and its common complications such as hypertension, anemia, renal osteodystrophy, electrolyte and acid-base imbalance, and hyperlipidemia. Recommendations for nutrition in CKD and measures adopted for early diabetic kidney disease to prevent further progression have also been reviewed. There is strong evidence that early detection and management of CKD can prevent or reduce disease progression, decrease complications and improve outcomes. Evidence supports that achieving optimal glucose control, blood pressure, reduction in albuminuria with a multifactorial intervention slows the progression of CKD. Angiotensin-converting enzyme inhibitors and angiotensin-II receptor antagonists are most effective because of their unique ability to decrease proteinuria, a factor important for the progression of CKD. DOI: http://dx.doi.org/10.3329/jemc.v4i1.18069 J Enam Med Col 2014; 4(1): 45-55


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