scholarly journals Management of Chronic Hyperkalemia in Patients With Chronic Kidney Disease: An Old Problem With News Options

2021 ◽  
Vol 8 ◽  
Author(s):  
Enrique Morales ◽  
Paolo Cravedi ◽  
Joaquin Manrique
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cation Exchange Resin ◽  
Medical Emergency ◽  
European Medicines Agency ◽  
Protective Effects ◽  
Negative Consequences ◽  
Treatment Optimization ◽  
Electrolyte Disorders ◽  
Potassium Binders

Hyperkalemia is one of the main electrolyte disorders in patients with chronic kidney disease (CKD). The prevalence of hyperkalemia increases as the Glomerular Filtration Rate (GFR) declines. Although chronic hyperkalemia is not a medical emergency, it can have negative consequences for the adequate cardio-renal management in the medium and long term. Hyperkalemia is common in patients on renin-angiotensin-aldosterone system inhibitors (RAASi) or Mineralocorticoid Receptor Antagonists (MRAs) and can affect treatment optimization for hypertension, diabetes mellitus, heart failure (HF), and CKD. Mortality rates are higher with suboptimal dosing among patients with CKD, diabetes or HF compared with full RAASi dosing, and are the highest among patients who discontinue RAASis. The treatment of chronic hyperkalemia is still challenging. Therefore, in the real world, discontinuation or reduction of RAASi therapy may lead to adverse cardiorenal outcomes, and current guidelines differ with regard to recommendations on RAASi therapy to enhance cardio and reno-protective effects. Treatment options for hyperkalemia have not changed much since the introduction of the cation exchange resin over 50 years ago. Nowadays, two new potassium binders, Patiromer Sorbitex Calcium, and Sodium Zirconium Cyclosilicate (SZC) already approved by FDA and by the European Medicines Agency, have demonstrated their clinical efficacy in reducing serum potassium with a good safety profile. The use of the newer potassium binders may allow continuing and optimizing RAASi therapy in patients with hyperkalemia keeping the cardio-renal protective effect in patients with CKD and cardiovascular disease. However, further research is needed to address some questions related to potassium disorders (definition of chronic hyperkalemia, monitoring strategies, prediction score for hyperkalemia or length for treatment).

scholarly journals A Whole Food Plant-Based Diet With a Novel Potassium-Binding Resin in a Patient With Advanced Chronic Kidney Disease

2020 ◽  
Vol 14 (6) ◽  
pp. 592-594
Author(s):  
Dario Manley-Casco ◽  
Paul Berkowitz
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Enzyme Inhibitor ◽  
Standard Of Care ◽  
Food Plant ◽  
Major Health Problem ◽  
Progression Of Kidney Disease ◽  
Standard Of Care Treatment ◽  
Potassium Binders ◽  
Potassium Binding

Chronic kidney disease (CKD) is a major health problem with substantial morbidity and mortality. Plant-based diets decrease the incidence of CKD and progression of kidney disease and help prevent and treat the important comorbidities of obesity, type 2 diabetes, hypertension, and cardiovascular disease. However, in patients with CKD, there is concern that a plant-based diet may contribute to life-threatening hyperkalemia. We present a patient with CKD secondary to hypertensive glomerulosclerosis that worsened despite standard of care treatment. Shared decision making was used to initiate a whole food plant-based diet along with a potassium-binding resin (Patiromer) to control the potassium levels. The patient was able to be maintained on the whole food plant-based diet and an angiotensin-converting enzyme inhibitor without the development of hyperkalemia. This case shows that patients with CKD may be able to enjoy the benefits of a whole food plant-based diet while decreasing the risk of hyperkalemia by using the new potassium binders.

Analysing the impact of a guideline for the use of new potassium binders for treatment of chronic hyperkalaemia to maximise inhibition of renin–angiotensin–aldosterone system (RAAS) within the general nephrology clinic?

2020 ◽  
Author(s):  
Priyank Patel ◽  
Andrew Frankel
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Ckd Stage ◽  
The Mean ◽  
Potassium Binders ◽  
The Impact ◽  
Chronic Use

Abstract Background Renin–angiotensin–aldosterone system (RAAS) inhibitors provide significant cardiorenal benefits with improved long-term outcomes for patients. This is most significant for patients receiving maximal RAAS inhibition, but some patients are unable to tolerate this therapy because of hyperkalaemia. Recently published National Institute for Health and Care Excellence (NICE) technology appraisal guidance recommended using sodium zirconium cyclosilicate (SZC) and patiromer for patients with chronic kidney disease (CKD) stage 3b to 5 or heart failure with reduced ejection fraction, who are not taking an optimised dosage of RAAS inhibitor because of hyperkalaemia. Objective Determine the impact of a locally produced guideline on effective implementation of NICE recommendation for use of SZC or patiromer to help maximise inhibition of the renin–angiotensin–aldosterone system within the general nephrology clinic. Methods A local guideline to practically support the implementation of recommendations made by NICE in the chronic use of new potassium binders was produced. One hundred sequential patients in a general nephrology clinic with non-immune chronic kidney disease (CKD 3 to 5) had their electronic records reviewed. Those with an indication for RAAS inhibition were identified. Results Of the 100 consecutive patients audited, 46 were female and 54 were male. The mean age of these patients was 64 and the mean estimated glomerular filtration rate (eGFR) was 33. Sixty-eight patients had an indication for being on RAAS inhibition with only 10 on maximal doses. Of the remaining 58 patients, 26 (45%) were limited by hyperkalaemia. Of these 26 patients, 12 of these patients (46%) had hyperkalaemia associated with an episode of acute kidney injury (AKI). Therefore, 14% of patients attending a general nephrology clinic were identified suitable for SZC and patiromer. Conclusions A significant proportion (14%) of unselected patients attending a general nephrology clinic were not on optimum RAAS inhibition due to hyperkalaemia. These patients would meet the criteria established within a working guideline for the implementation of the chronic use of SZC or patiromer and are likely to attain prognostic long-term benefit by using these new potassium binders to maximise RAAS inhibition. This analysis has implications for renal centres across the UK.

Adverse Safety Event Characteristics and Predictive Factors in Hospital Encounters for Patients with Chronic Kidney Disease

2019 ◽  
Vol 50 (1) ◽  
pp. 72-80
Author(s):  
Mary Lynn Davis-Ajami ◽  
Jeffery C. Fink ◽  
Marianne Baernholdt ◽  
Jun Wu
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Length Of Stay ◽  
Female Gender ◽  
Healthcare Research ◽  
Geographical Region ◽  
Bivariate Analysis ◽  
Total Charge ◽  
Electrolyte Disorders ◽  
Cross Sectional

Background: Adverse safety events (ASE) during hospitalization may contribute to renal decline or poor outcomes. Understanding factors contributing to ASE in chronic kidney disease (CKD) is limited. The objective is to compare differences and determine predictors of renal pertinent ASE in discharges for CKD. Method: A cross-sectional analysis of the National Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality 2012 data. The study included adults age ≥18 years with discharge diagnosis for CKD stages 1–4, excluding cancer of the kidney and renal pelvis, renal transplant, end-stage renal disease. Predictors included study sample characteristics, including patient demographics, comorbidity, and hospitalization-related variables. Outcomes assessed included distribution of ASE (angioedema, confusion, muscle weakness or cramps, lower extremity edema (LEE), falls, hypoglycemia, nausea-vomiting-diarrhea (NVD), and skin rash), mean total charge per hospital event, and length-of-stay. The analytical approach used descriptive statistics (means and proportions) and bivariate analysis to compare differences (ASE versus none). Predictors of ASE were explored using multivariate logistic regression. Results: 10.3% of inpatient discharges for CKD showed an ASE. Mean charges (USD 48,072 vs. 46,996), days length-of-stay (6.8 vs. 5.7), number of diagnosis on record (6.8 vs. 5.7), geographical region (Midwest, and West), and type of hospital (rural) were significantly associated with ASE. Most common ASEs were confusion (18%), LEE (21.3%), and NVD (50.7%). Odds of ASE increased for age, female gender, rural hospitals, geographical region, and diagnosis for anemia, coagulopathies, depression, fluid and electrolyte disorders, neurological disorders, psychoses, and weight loss. Conclusions: We identified key factors that increase the risk of ASE in patients with CKD. Opportunities exist to reduce ASE in CKD.

scholarly journals Prevalence of Depression, Anxiety and Insomnia in Chronic Kidney Disease Patients and their Co-Relation with the Demographic Variables

PRILOZI ◽  
2017 ◽  
Vol 38 (2) ◽  
pp. 35-44 ◽  
Author(s):  
H.K. Aggarwal ◽  
Deepak Jain ◽  
Geeta Dabas ◽  
R K Yadav
Keyword(s):  
Mental Health ◽  
Chronic Kidney Disease ◽  
High Risk ◽  
Kidney Disease ◽  
Low Income ◽  
Multiple Logistic Regression Analysis ◽  
Demographic Variables ◽  
Negative Consequences ◽  
Ckd Stage ◽  
Anxiety Depression

Abstract Background: Chronic kidney disease (CKD) is an emerging health problem in both developed and developing countries. Depression, anxiety and sleep disturbances are highly prevalent in patients with chronic disease, but remain undertreated despite significant negative consequences on patients’ health. Assessment of key components of mental health early in disease course will help to identify high risk subjects in whom modifying these predictors will help in providing active and healthy life in CKD patients. Methods: We did a cross sectional study in 200 patients of CKD stage III to V-D fulfilling the eligibility criteria who were on follow up in a single tertiary care center in the state of Haryana, India. We assessed the prevalence of anxiety, depression and insomnia and their correlation with demographic variables in these patients. The structured questionnaire used in this study gathered information on respondent demographic and disease characteristics, and information obtained from the HADS and PSQI questionnaire. Factors associated with anxiety, depression and insomnia were examined by a multiple logistic regression analysis. Results: The prevalence of anxiety, depression and insomnia were found to be 71%, 69% and 86.5% respectively. As the CKD stage advanced, the prevalence as well as severity of these parameters increased. Anxiety, depression and sleep quality were found to be significantly correlated to unemployment, low income, low education, urban residence and presence of co-morbidities. The anxiety, depression and insomnia scores were found to have a strong negative correlation with eGFR, hemoglobin, serum calcium (p <0.01) and a positive correlation with TLC, blood urea, serum creatinine and serum phosphate (p <0.05). Conclusion: We observed a high prevalence of anxiety, depression and insomnia in CKD patients. There is a need to develop strategies to accurately identify “high risk” subjects who may benefit from preventive measures before complications occur. By identifying CKD patients with high risk of developing these mental health related issues, healthcare provider may be better able to ensure the provision of appropriate rehabilitation to this population.

scholarly journals Effects of canagliflozin on hyperkalaemia and serum potassium in people with diabetes and chronic kidney disease: insights from the CREDENCE trial

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
B L Neuen ◽  
M Oshima ◽  
V Perkovic ◽  
C Arnott ◽  
G Bakris ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Potassium ◽  
Sglt2 Inhibitor ◽  
Renin Angiotensin System ◽  
Renin Angiotensin ◽  
Post Hoc Analysis ◽  
Intention To Treat ◽  
Potassium Binders ◽  
Post Hoc

Abstract Background Hyperkalaemia is a common complication of type 2 diabetes mellitus (T2DM) and limits the optimal use of agents that block the renin-angiotensin aldosterone system (RAAS), particularly in patients with chronic kidney disease (CKD). In patients with CKD, sodium glucose cotransporter 2 (SGLT2) inhibitors provide cardiorenal protection, but whether they affect the risk of hyperkalaemia remains uncertain. Purpose We sought to assess the effect of canagliflozin on hyperkalaemia and other potassium-related outcomes in people with T2DM and CKD by conducting a post-hoc analysis of the CREDENCE trial. Methods The CREDENCE trial randomized 4401 participants with T2DM and CKD to the SGLT2 inhibitor canagliflozin or matching placebo. In this post-hoc analysis using an intention-to-treat approach, we assessed the effect of canagliflozin on a composite outcome of time to either investigator-reported hyperkalaemia or the initiation of potassium binders. We also analysed effects on central laboratory-determined hyper- and hypokalaemia (serum potassium ≥6.0 and &lt;3.5 mmol/L, respectively) and change in serum potassium. Results At baseline the mean serum potassium in canagliflozin and placebo arms was 4.5 mmol/L; 4395 (99.9%) participants were receiving renin angiotensin system blockade. Canagliflozin reduced the risk of investigator-reported hyperkalaemia or initiation of potassium binders (HR 0.78, 95% CI 0.64–0.95, p=0.014; Figure 1). The incidence of laboratory-determined hyperkalaemia was similarly reduced (HR 0.77, 95% CI 0.61–0.98, p=0.031; Figure 2); the risk of hypokalaemia (HR 0.92, 95% CI 0.71–1.20, p=0.53) was not increased. Mean serum potassium over time with canagliflozin was similar to that of placebo. Conclusion Among patients treated with RAAS inhibitors, SGLT2 inhibition with canagliflozin may reduce the risk of hyperkalaemia in people with T2DM and CKD without increasing the risk of hypokalaemia. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

scholarly journals Protective effects of spironolactone on vascular calcification in chronic kidney disease

2021 ◽  
Author(s):  
Fabian Hammer ◽  
Salvatore S. Buehling ◽  
Jaber Masyout ◽  
Uwe Malzahn ◽  
Tobias Hauser ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Vascular Calcification ◽  
Protective Effects

scholarly journals Metformin: od mehanizmov delovanja do napredne klinične uporabe

2017 ◽  
Vol 86 (3-4) ◽  
Author(s):  
Miodrag Janić ◽  
Špela Volčanšek ◽  
Mojca Lunder ◽  
Andrej Janež
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Striated Muscle ◽  
Polycystic Ovary ◽  
Diabetic Patients ◽  
Protective Effects ◽  
Contrast Imaging ◽  
Type 2 Diabetic Patients ◽  
Peripheral Tissues ◽  
Insulin Resistant

Metformin represents the first line of treatment and is the most widely prescribed antihypergycemic drug in type 2 diabetic patients. It can be used as monotherapy or in combination with other oral antihyperglycemic drugs or insulin. Additionally, it is also prescribed in type 1 diabetic patients, it proved to be effective in prediabetes and also provided beneficial effects in other insulin resistant states, for example in polycystic ovary syndrome. Nevertheless, the exact molecular mechanism of its action remains unknown. It was shown that it inhibits liver gluconeogenesis, facilitates glucose uptake into peripheral tissues, such as striated muscle; it also acts in the gut. Besides antihyperglycemic effects, metformin was also shown to possess several beneficial, protective effects, so-called pleiotropic effects: particularly on the cardiovascular system and in cancer patients. Metformin has only few side effects, the most serious being metformin-associated lactic acidosis. The latter appears in rare clinical cases with pre-existing chronic kidney disease or advanced heart failure with tissue hypoperfusion, which consequently represent relative contraindications for metformin use. In the past, metformin treatment was usually discontinued when performing iodine contrast imaging, however recently there is evidence of its safety even in patients with higher stages of chronic kidney disease. All in all, metformin is a drug with a long tradition and a promising future.

Abstract 357: Antioxidant and Anti-inflammatory Strategies Prevent Endothelial Dysfunction in Chronic Kidney Disease

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Marta Palomo ◽  
Susana Martin-Rodriguez ◽  
Manel Vera ◽  
Josep Maria Cruzado ◽  
Jose Rivera ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Endothelial Dysfunction ◽  
Kidney Disease ◽  
Antioxidant Enzyme ◽  
Inhibitory Effect ◽  
Ros Generation ◽  
Protective Effects ◽  
Anti Inflammatory ◽  
Enzyme Mimetics

Accelerated atherosclerosis in chronic kidney disease (CKD) is preceded by the development of endothelial dysfunction (ED), with development of a proinflammatory and prothrombotic phenotype and enhanced oxidative stress. The effect of anti-inflammatory and antioxidant strategies on the endothelium has been evaluated in an in vitro model of ED in uremia. Endothelial cells (ECs) were pretreated with the antioxidant enzyme mimetics ebselen, EUK-134 and EUK-118; the flavonoids apigenin, genistein and quercetin, with both antioxidant and anti-inflammatory potential; and two commercially available compounds: N-acetylcysteine (NAC) and defibrotide (DF). There is increasing evidence demonstrating that both NAC and DF exhibit both properties. ECs were exposed to medium containing serum from patients on dialysis (n=10) or from healthy donors (n=15). Changes in the expression of the adhesion receptor ICAM-1 and the production of intracellular reactive oxygen species (ROS) were assessed. Activation of inflammation-related proteins p38 MAPK and NFkappaB (NFκB) were also evaluated. Exposure of ECs to uremic media resulted in a significantly increased expression of ICAM-1, overproduction of ROS and activation of p38MAPK and NFκB compared to control ECs (p<0.05). Ebselen, EUK 134, and EUK118 inhibited ICAM-1 expression and ROS generation in the uremic condition (p<0.01). Regarding flavonoids, only quercetin showed a moderated but significant inhibitory effect on both parameters (p<0.05). NAC and DF exhibited a protective effect on ECs exposed to the uremic insult (p<0.05 for ICAM-1 expression and ROS generation). All the compounds reduced p38MAPK activation (p<0.05). The antioxidant-enzyme mimetics and NAC were able to inhibit the activation of NFκB induced by the uremic media (p<0.05). Endothelial dysfunction associated with CKD is considered to be the first step in the progression of atherosclerosis. Our results indicate that the antioxidant enzyme mimetics, NAC and DF exhibit not only antioxidant but also anti-inflammatory effects on the endothelium. Therefore, further research on the protective effects of these compounds may provide new strategies for the prevention of the cardiovascular complications in uremia.

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