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Korean J Intern Med 2021 Jun 22. Epub 2021 Jun 22.

Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA.

High dietary protein intake may lead to increased intraglomerular pressure and glomerular hyperfiltration, which in the long-term can lead to de novo or aggravating preexisting chronic kidney disease (CKD). Hence, a low protein diet (LPD, 0.6 to 0. Read More

Front Med (Lausanne) 2021 4;8:653634. Epub 2021 Jun 4.

Nephrology Department, Complejo Hospitalario de Navarra, Pamplona, Spain.

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. Read More

J Geriatr Cardiol 2021 May;18(5):327-337

College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea.

Objectives: To investigate the prevalence of potentially inappropriate prescribing (PIP) for cardiovascular system (CVS) and antiplatelet/anticoagulant (AP/AC) drugs among Korean elderly patients, using the Screening Tool of Older Persons' Prescriptions (STOPP) criteria version 2 and to identify the risk factors related to PIP.

Methods: The 2016 National Aged Patient Sample data, comprising National Health Insurance claim records for a random sample of 20% of patients aged ≥ 65 years, were used to calculate PIP prevalence of outpatient prescriptions. For criteria including drug-disease interactions, PIP prevalence per indication was estimated. Read More

J Ren Nutr 2021 May 5. Epub 2021 May 5.

Nutrition Department, Nephrocare, Lisbon, Portugal.

Objective: The purpose of this study was to assess the effect of a telehealth-delivered nutritional intervention via telephone in maintenance hemodialysis (HD) patients during the coronavirus outbreak.

Methods: This was a multicenter, observational, prospective, and longitudinal study of 156 patients undergoing maintenance HD from 15 dialysis units conducted during the COVID-19 pandemic. We assigned patients to receive dietary counseling through a phone call, according to their biochemical and nutritional parameters. Read More

Lancet Oncol 2021 Jun 15. Epub 2021 Jun 15.

Live Surgery Ward, Peking Union Medical College Hospital, Beijing, China.

Background: China has a high burden of hepatocellular carcinoma, and hepatitis B virus (HBV) infection is the main causative factor. Patients with hepatocellular carcinoma have a poor prognosis and a substantial unmet clinical need. The phase 2-3 ORIENT-32 study aimed to assess sintilimab (a PD-1 inhibitor) plus IBI305, a bevacizumab biosimilar, versus sorafenib as a first-line treatment for unresectable HBV-associated hepatocellular carcinoma. Read More

Cureus 2021 May 16;13(5):e15066. Epub 2021 May 16.

Interventional Cardiology, Unity Health, Searcy, USA.

Brugada syndrome is a congenital cardiac channelopathy characterized by ST-segment elevation (≥2 mm) and subsequent inverted T wave in a minimum of two right precordial leads (Brugada type 1 ECG [electrocardiogram] pattern) on ECG. Brugada syndrome is estimated to be responsible for 4%-12% of all sudden cardiac deaths and up to 20% in patients with structurally normal hearts. Development of a temporary Brugada pattern, known as Brugada phenocopy, has been observed in individuals presenting with reversible underlying conditions such as hyperkalemia, hyponatremia, acidosis, ischemia, and pulmonary embolism, among others. Read More

Kidney Med 2021 May-Jun;3(3):360-367.e1. Epub 2021 Mar 13.

Symbria, Warrenville, IL.

Rationale & Objective: Older people are more likely to have reduced kidney function and multiple comorbid conditions predisposing them to hyperkalemia. This post hoc subgroup analysis aimed to evaluate the effectiveness of patiromer, a sodium-free nonabsorbed polymer, in lowering serum potassium levels in older patients receiving a renin-angiotensin-aldosterone system inhibitor with chronic kidney disease (CKD), type 2 diabetes mellitus (T2DM), and hypertension.

Study Design: Post hoc subgroup analysis of the randomized open-label AMETHYST-DN clinical trial. Read More

Front Pharmacol 2021 31;12:632978. Epub 2021 May 31.

Cardiovascular Medicine, First Affiliated Hospital of Wenzhou Medical University, The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China.

Mineralocorticoid receptor antagonists (MRA) improve outcomes in chronic kidney disease (CKD) and acute myocardial infarction (AMI) patients. However, the lack of evidence regarding long-term clinical outcomes in the use of MRA, including spironolactone, in patients with AMI combined with CKD. This study aimed to investigate whether spironolactone could significantly reduce the risk of all-cause mortality and re-admission in patients with AMI and CKD. Read More

Ital J Pediatr 2021 Jun 16;47(1):138. Epub 2021 Jun 16.

Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy.

Introduction: Pseudohypoaldosteronism type 1 (PHA1) is a rare genetic disease due to the peripheral resistance to aldosterone. Its clinical spectrum includes neonatal salt loss syndrome with hyponatremia and hypochloraemia, hyperkalemia, metabolic acidosis and increased plasmatic levels of aldosterone. Two genetically distinct forms of disease, renal and systemic, have been described, showing a wide clinical expressivity. Read More

Notf Rett Med 2021 Jun 10:1-77. Epub 2021 Jun 10.

Southmead Hospital, North Bristol NHS Trust, Bristol, Großbritannien.

These guidelines of the European Resuscitation Council (ERC) Cardiac Arrest under Special Circumstances are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the modifications required for basic and advanced life support for the prevention and treatment of cardiac arrest under special circumstances; in particular, specific causes (hypoxia, trauma, anaphylaxis, sepsis, hypo-/hyperkalaemia and other electrolyte disorders, hypothermia, avalanche, hyperthermia and malignant hyperthermia, pulmonary embolism, coronary thrombosis, cardiac tamponade, tension pneumothorax, toxic agents), specific settings (operating room, cardiac surgery, cardiac catheterization laboratory, dialysis unit, dental clinics, transportation [in-flight, cruise ships], sport, drowning, mass casualty incidents), and specific patient groups (asthma and chronic obstructive pulmonary disease, neurological disease, morbid obesity, pregnancy). Read More

Curr Med Chem 2021 Jun 14. Epub 2021 Jun 14.

Department of Nephrology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, No.1, R. Xiyuancaochang, District Haidian, Beijing 100091, China.

Background: It is unclear whether angiotensin-converting enzyme inhibitors (ACEIs) in combination with angiotensin II receptor blockers (ARBs) are superior to ACEIs or ARBs alone in the treatment of nondiabetic chronic kidney disease (CKD). The present meta-analysis was designed to assess the efficacy and safety of ACEIs in combination with ARBs in nondiabetic CKD.

Methods: The PubMed, Embase, and Cochrane Library databases were searched to identify randomized controlled trials (RCTs) published prior to March 2020. Read More

Am J Trop Med Hyg 2021 Jun 14. Epub 2021 Jun 14.

Division of Infectious Disease, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.

Dengue viral infection (DVI) among adult patients is increasingly problematic in tropical and subtropical regions. Acute kidney injury (AKI) after DVI poses substantial clinical outcomes and economic impact. This prospective study focused on the characteristics, risk factors, and outcomes of adult patients with AKI due to DVI hospitalized in nine network hospitals within Southern Thailand from January 2017 to December 2019. Read More

Cardiovasc Drugs Ther 2021 Jun 14. Epub 2021 Jun 14.

Beth Israel Lahey Health, Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA.

Purpose: In PARADIGM-HF, sacubitril/valsartan showed a significant reduction in mortality and hospitalization for patients with heart failure with reduced ejection fraction. Despite proven efficacy, sacubitril/valsartan has moderate uptake in clinical practice. This study explores the safety profile of sacubitril/valsartan by comparing adverse events in RCT and real-world use. Read More

Clin J Am Soc Nephrol 2021 Jun 11;16(6):916-925. Epub 2021 Jun 11.

Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan

Background And Objectives: Patients with kidney failure have a high risk of cardiovascular disease due to cardiac remodeling, left ventricular fibrosis, and hyperaldosteronism, all of which can be potentially mitigated by mineralocorticoid receptor antagonists. However, because of the fear of hyperkalemia, the use of mineralocorticoid receptor antagonists in patients with kidney failure is limited in current clinical practice, and few studies have investigated the efficacy and safety. Thus, we aimed to determine the benefits and side effects of mineralocorticoid receptor antagonists in patients with kidney failure treated with dialysis. Read More

Aging (Albany NY) 2021 Jun 11;13. Epub 2021 Jun 11.

Department of Thyroid Surgery, The First Hospital of Jilin University, Jilin Province, China.

Background: Anemia is a common complication of chronic kidney disease (CKD). Treating renal anemia with erythropoiesis-stimulating agents (ESAs) or erythropoietin analogs is effective but has side effects. Therefore, we performed a meta-analysis to assess the efficacy and safety of roxadustat in treating CKD-induced anemia. Read More

J Nephrol 2021 Jun 11. Epub 2021 Jun 11.

CliCon S.r.l. Health, Economics and Outcomes Research, Bologna, Italy.

Background: Hyperkalemia is relatively frequent in CKD patients treated with renin-angiotensin-aldosterone-system inhibitors (RAASi).

Aim: The aim of the present study was to estimate the increased risk of cardiovascular events and mortality due to sub-optimal adherence to RAASi in CKD patients with hyperkalemia.

Methods: An observational retrospective cohort study was conducted, based on administrative and laboratory databases of five Local Health Units. Read More

Clinicoecon Outcomes Res 2021 4;13:475-486. Epub 2021 Jun 4.

Managed Care Health Outcomes, Vifor Pharma, Inc., Redwood City, CA, USA.

Background: To create an appropriate chronic kidney disease (CKD) management program, we developed a predictive model to identify patients in a large administrative claims database with CKD stages 3 or 4 who were at high risk for progression to kidney failure.

Methods: The predictive model was developed and validated utilizing a subset of patients with CKD stages 3 or 4 derived from a large Aetna claims database. The study spanned 36 months, comprised of a 12-month (2015) baseline period and a 24-month (2016-2017) prediction period. Read More

Clin Exp Nephrol 2021 Jun 10. Epub 2021 Jun 10.

Clinical Development Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan.

Background: Esaxerenone has potential renoprotective effects and reduces the urinary albumin-to-creatinine ratio (UACR) in patients with diabetic kidney disease and overt nephropathy. We investigated the efficacy and safety of esaxerenone in Japanese patients with type 2 diabetes (T2D) and macroalbuminuria (UACR ≥ 300 mg/g creatinine).

Methods: We conducted a multicenter, single-arm, open-label phase III study in 56 patients with T2D and UACR ≥ 300 mg/g creatinine with estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1. Read More

Eur Heart J Case Rep 2020 Dec 6;4(6):1-5. Epub 2020 Nov 6.

Department of Critical Care Medicine, Albert Einstein Medical Center, 5501 Old York Rd, Philadelphia, PA 19141, USA.

Background: Coronavirus disease 2019 (COVID-19) is a rapidly spreading pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is a multisystemic disease associated with micro- and macrovascular thrombo-embolic complications, including intracardiac thrombosis, which has not been previously reported in the literature.

Case Summary: We report a case of a 68-year-old woman with COVID-19 admitted to our intensive care unit with acute respiratory distress, undifferentiated shock, hyperkalaemia, acute kidney injury, and coagulopathy. Read More

Can J Kidney Health Dis 2021 27;8:20543581211017408. Epub 2021 May 27.

Department of Medicine, University of Ottawa, ON, Canada.

Background: The risk of hyperkalemia is elevated in chronic kidney disease (CKD); however, the initial and recurrent risk among older individuals is less clear.

Objectives: We set out to examine the initial and 1-year recurrent risk of hyperkalemia by level of kidney function (estimated glomerular filtration rate, eGFR) in older adults (≥66 years old).

Design: Population-based, retrospective cohort study. Read More

Cancer Genet 2021 May 26;256-257:100-105. Epub 2021 May 26.

Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Szpitalna Street 27/33, 60-572 Poznan, Poland. Electronic address:

IMAGe syndrome is a rare congenital disorder, presenting with intrauterine growth restriction, metaphyseal dysplasia, adrenal hypoplasia congenita and genital anomalies (in males). So far only 17 individuals have been diagnosed molecularly with IMAGe syndrome, this patient is the first case of an individual diagnosed with IMAGe and concurrent rhabdomyosarcoma. The patient was born at 30 weeks' gestation and received treatment for hyponatremia and hyperkalemia. Read More

Cureus 2021 May 2;13(5):e14806. Epub 2021 May 2.

Internal Medicine, Centro Hospitalar Universitário de São João, Porto, PRT.

We report the case of a 61-year-old man with rapidly progressing glomerulonephritis (RPGN) due to double-positive anti-neutrophil cytoplasmic antibodies (ANCA) and anti-glomerular basement membrane antibodies (GBM) vasculitis. The past medical history included stable untreated psoriatic arthritis and arterial hypertension. He presented with asthenia, anorexia, and rapidly deteriorating renal function with metabolic acidosis and hyperkalemia evolving with the need for hemodialysis. Read More

Card Fail Rev 2021 Mar 12;7:e10. Epub 2021 May 12.

Section of Cardiology, Max Rady College of Medicine, University of Manitoba Winnipeg, Manitoba, Canada.

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. Read More

J Nephrol 2021 Jun 5. Epub 2021 Jun 5.

Nephrology, Dialysis and Transplantation Unit, Department of Medicine-DIMED, University of Padua, Via Giustiniani n° 2, 35128, Padua, Italy.

Gordon's syndrome, known also as Pseudohypoaldosteronism type II is a rare inherited dominant form of low-renin hypertension associated with hyperkalemia and metabolic acidosis. Four genes related to the regulation of the NaCl co-symporter NCC have been discovered associated to Gordon phenotypes: WINK 1 and WINK4, which, along with WNK2 and WNK3, encode a family of WNK-kinases, and KLHL3 and CUL3 encoding respectively, Kelch-like 3 protein and cullin. Heterozygous mutations in these genes constitutively activate NCC leading to abnormally increased salt reabsorption and salt-sensitive hypertension. Read More

J Investig Med High Impact Case Rep 2021 Jan-Dec;9:23247096211022487

Crouse Hospital, Syracuse, NY, USA.

Retroperitoneal fibrosis is caused by the replacement of normal retroperitoneal tissue with fibrosis. The majority of the cases are idiopathic, but some secondary causes include malignancy, infection, drugs, and radiotherapy. Immunoglobulin G-4 (IgG-4) related disease is a relatively newer disease and one of the rarer causes of retroperitoneal fibrosis. Read More

Cureus 2021 Apr 29;13(4):e14757. Epub 2021 Apr 29.

Nephrology, Creighton University School of Medicine, Omaha, USA.

A 63-year-old woman with a past medical history of invasive ductal carcinoma of the breast, status post lumpectomy and chemoradiation, 15 cm left inguinal-femoral enlarged lymph node consistent with high-grade serous carcinoma of the ovary and 4.7 cm right adnexal mass underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and lymph node dissection with cystoscopy and bilateral ureteral catheter placement. There was no intraoperative complication. Read More

Acta Endocrinol (Buchar) 2020 Oct-Dec;16(4):487-496

"Carol Davila" University of Medicine and Pharmacy, Clinical Emergency Hospital, Bucharest, Romania.

This paper reviews the class of mineralocorticoid receptor (MR) modulators, especially new nonsteroidal antagonists. MR is a nuclear receptor expressed in many tissues and cell types. Aldosterone, the most important mineralocorticoid hormone and MR agonist, has many unfavorable effects, especially on the heart, blood vessels, and kidneys, by promoting fibrosis and tissue remodelling. Read More

Postgrad Med J 2021 Jun 3. Epub 2021 Jun 3.

Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.

The angiotensin receptor neprilysin inhibitor (ARNI) has been recommended as a first-line treatment in patients with heart failure (HF). However, the effects of ARNI on renal function remain controversial.The PubMed, Embase, the Cochrane Library of Trials and Web of Science were searched in the period from inception to 31 January 2021. Read More

Nephron 2021 Jun 3:1-12. Epub 2021 Jun 3.

AstraZeneca, Gaithersburg, Maryland, USA.

Introduction: Further understanding of adverse clinical events in patients with chronic kidney disease (CKD) is needed. This study aimed to describe characteristics of patients with nondialysis-dependent (NDD) and dialysis-dependent (DD) CKD and to assess incidence rates of uncommon adverse clinical events of interest in these patients.

Methods: This retrospective study used electronic medical record data from USA CKD patients (≥18 years) with estimated glomerular filtration rate (eGFR) <60 mL/min/1. Read More

J Pharmacol Toxicol Methods 2021 Jun 1:107082. Epub 2021 Jun 1.

Safety Pharmacology & Animal Research Center, Translational Safety and Bioanalytical Sciences, Amgen Research, Amgen Inc., Thousand Oaks, CA, USA.

Introduction: Cardioplegic solutions were first developed to preserve heart function during cardiac surgeries and heart transplants but have application in the nonclinical setting. Due to lack of lab space in the vivarium, cardioplegic solution was used to conserve cardiac function for ex-vivo studies performed in a separate building. All studies in this report were conducted with isolated female rabbit hearts (IRHs) via retrograde perfusion using the Langendorff apparatus to investigate if cardioplegia usage affects cardiac function. Read More