Drug Des Devel Ther 2017 6;11:2663-2673. Epub 2017 Sep 6.

Ardelyx Inc., Fremont, CA, USA.

Background: Hyperkalemia is a potentially life-threatening condition that patients with heart failure or chronic kidney disease, especially those taking renin-angiotensin-aldosterone system inhibitors, are at high risk of developing. Sodium polystyrene sulfonate (SPS), a current treatment, binds potassium within the gastrointestinal tract to reduce potassium absorption. However, poor palatability limits its long-term use. Read More

Am J Med Sci 2017 Sep 19;354(3):268-277. Epub 2017 Jul 19.

Sheba Medical Center, The Leviev Heart Center, Tel Hashomer, Ramat Gan, Israel; Sakler School of Medicine, Tel Aviv University, Ramat Gan, Israel.

Background: Limited, contradictory data exist regarding the effect of hyperkalemia on both short- and long-term all-cause mortality among hospitalized patients with heart failure (HF).

Methods: We analyzed 4,031 patients who were enrolled in the Heart Failure Survey in Israel. The study patients were grouped into 3 different potassium (K) categories. Read More

BMC Nephrol 2017 Sep 12;18(1):295. Epub 2017 Sep 12.

FCRIN INI-CRCT, Paris, France.

Background: Low and high blood potassium levels are common and were both associated with poor outcomes in patients with chronic kidney disease (CKD). Whether such relationships may be altered in CKD patients receiving optimized nephrologist care is unknown.

Methods: NephroTest is a hospital-based prospective cohort study that enrolled 2078 nondialysis patients (mean age: 59 ± 15 years, 66% men) in CKD stages 1 to 5 who underwent repeated extensive renal tests including plasma potassium (PK) and glomerular filtration rate (GFR) measured (mGFR) by (51)Cr-EDTA renal clearance. Read More

Malays J Med Sci 2017 Mar 14;24(2):100-105. Epub 2017 Apr 14.

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.

Barbiturate coma therapy (BCT) is a treatment option that is used for refractory intracranial hypertension after all other options have been exhausted. Although BCT is a brain protection treatment, it also has several side effects such as hypotension, hepatic dysfunction, renal dysfunction, respiratory complications and electrolyte imbalances. One less concerning but potentially life-threatening complication of BCT is dyskalaemia. Read More

Clin J Am Soc Nephrol 2017 Sep 11. Epub 2017 Sep 11.

Prince of Wales Clinical School, UNSW Sydney, Sydney, Australia;

Background And Objectives: Neuromuscular complications are almost universal in CKD by the time that a patient commences dialysis. Recent studies have indicated that chronic hyperkalemia may contribute to the development of neuropathy in CKD. This study was undertaken to determine whether dietary restriction of potassium intake may be a neuroprotective factor in CKD. Read More

J Vet Intern Med 2017 Sep 11. Epub 2017 Sep 11.

Department of Veterinary Medicine and Surgery, Veterinary Health Center, University of Missouri, Columbia, MO.

Background: Clinicians alter dosing for desoxycorticosterone pivalate (DOCP) to mitigate costs, but this practice has not been critically evaluated in a prospective clinical trial.

Hypothesis/objectives: The duration of action of DOCP is longer than 30 days in dogs with primary hypoadrenocorticism (PH).

Animals: A total of 53 client-owned dogs with PH. Read More

Kidney Int Rep 2017 Sep 17;2(5):893-904. Epub 2017 May 17.

Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Introduction: Renal Na(+) retention and extracellular fluid volume expansion are hallmarks of nephrotic syndrome, which occurs even in the absence of activation of hormones that stimulate renal Na(+) transporters. Plasmin-dependent activation of the epithelial Na(+) channel (ENaC) has been proposed to have a role in renal Na(+) retention in the setting of nephrotic syndrome. We hypothesized that the ENaC inhibitor amiloride would be an effective therapeutic agent in inducing a natriuresis and lowering blood pressure in individuals with macroscopic proteinuria. Read More

J Dairy Sci 2017 Sep 6. Epub 2017 Sep 6.

College of Veterinary Medicine, University of Illinois, Urbana-Champaign 61802.

Acidemia and electrolyte imbalances such as hyperkalemia are common in neonatal calves with diarrhea. Acidemia negatively affects the cellular response to insulin and may therefore result in deranged glucose, potassium, and phosphorus homeostasis. The primary aim of this study was to compare indices that characterize the dynamic glucose and insulin response between acidemic and nonacidemic neonatal diarrheic calves and a healthy control group during an intravenous glucose tolerance test (IVGTT) that consisted of i. Read More

PLoS One 2017 6;12(9):e0184402. Epub 2017 Sep 6.

Division of Nephrology, Department of Internal Medicine, St Luke's International Hospital, Tokyo, Japan.

Introduction: Renin-angiotensin system (RAS) inhibitors have been increasingly prescribed due to their beneficial effects on end-organ protection. Iatrogenic hyperkalemia is a well-known life-threatening complication of RAS inhibitor use in chronic kidney disease (CKD) patients. We hypothesized that CKD patients treated with RAS inhibitors frequently develop hyperkalemia after hospital discharge even if they were normokalemic during their hospitalization because their lifestyles change substantially after discharge. Read More

West J Emerg Med 2017 Aug 10;18(5):963-971. Epub 2017 Jul 10.

Kent Hospital, Department of Emergency Medicine, Warwick, Rhode Island.

Introduction: The electrocardiogram (ECG) is often used to identify which hyperkalemic patients are at risk for adverse events. However, there is a paucity of evidence to support this practice. This study analyzes the association between specific hyperkalemic ECG abnormalities and the development of short-term adverse events in patients with severe hyperkalemia. Read More

ESC Heart Fail 2017 Sep 5. Epub 2017 Sep 5.

Renal and Transplantation Unit, St George's University Hospital NHS Foundation Trust, London, UK.

Aims: Inpatients with heart failure and renal impairment have poor outcomes and variable quality of care. We investigate treatment practice and outcomes in an unselected real-world cohort using historical creatinine measurements.

Methods And Results: Admissions between 1/4/2013 and 30/4/2015 diagnosed at discharge with heart failure were retrospectively analysed. Read More

Ann Intensive Care 2017 Sep 4;7(1):90. Epub 2017 Sep 4.

Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan.

Background: Crush syndrome (CS) is a serious medical condition characterized by muscle cell damage resulting from decompression after compression (i.e., ischemia/reperfusion injury). Read More

Am J Nephrol 2017 Sep 2;46(3):213-221. Epub 2017 Sep 2.

Background: The relationship between serum potassium, mortality, and conditions commonly associated with dyskalemias, such as heart failure (HF), chronic kidney disease (CKD), and/or diabetes mellitus (DM) is largely unknown.

Methods: We reviewed electronic medical record data from a geographically diverse population (n = 911,698) receiving medical care, determined the distribution of serum potassium, and the relationship between an index potassium value and mortality over an 18-month period in those with and without HF, CKD, and/or DM. We examined the association between all-cause mortality and potassium using a cubic spline regression analysis in the total population, a control group, and in HF, CKD, DM, and a combined cohort. Read More

Can J Kidney Health Dis 2017 21;4:2054358117722559. Epub 2017 Aug 21.

Department of Pediatrics, Children's Hospital, London Health Sciences Centre, University of Western Ontario, Canada.

Background: Continuous renal replacement therapy (CRRT) is an excellent method used to remove fluid and solutes. It may also reduce the systemic inflammatory response for patients on extracorporeal membrane oxygenation (ECMO) support. The objective of this report is to describe a case where CRRT in combination with ECMO was insufficient to control hyperkalemia. Read More

JAMA Dermatol 2017 Aug 30. Epub 2017 Aug 30.

Center for Blistering Diseases, Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

Importance: Pneumocystis pneumonia (PCP) is a potentially lethal opportunistic infection that primary prophylaxis can help prevent. The risk of prophylactic therapy must be weighed against the incidence of PCP in the patient population. Prophylaxis most frequently involves trimethoprim-sulfamethoxazole, with second-line therapies, including atovaquone, dapsone, and pentamide. Read More

Chin J Physiol 2017 08;60(4):197-206

Gesundheitszentrum St. Gallen, St. Gallen, Switzerland.

Ice Mile swimming (1608 m in water of below 5 °Celsius) is becoming increasingly popular. This case study aimed to identify body core temperature and selected haematological and biochemical parameters before and after repeated Ice Miles. An experienced ice swimmer completed three consecutive Ice Miles within 15 h. Read More

Rev Port Cardiol 2017 Sep 23;36(9):655-668. Epub 2017 Aug 23.

Departamento de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, EPE, Lisboa, Portugal.

Sacubitril/valsartan (LCZ696), a supramolecular sodium salt complex of the neprilysin inhibitor prodrug sacubitril and the angiotensin receptor blocker (ARB) valsartan, was recently approved in the EU and the USA for the treatment of chronic heart failure (HF) with reduced ejection fraction (HFrEF) (NYHA class II-IV). Inhibition of chronically activated neurohormonal pathways (the renin-angiotensin-aldosterone system [RAAS] and sympathetic nervous system [SNS]) is central to the treatment of chronic HFrEF. Furthermore, enhancement of the natriuretic peptide (NP) system, with favorable cardiovascular (CV) and renal effects in HF, is a desirable therapeutic goal to complement RAAS and SNS blockade. Read More

Diab Vasc Dis Res 2017 Sep 27;14(5):400-406. Epub 2017 Aug 27.

4 Department of Primary Care and Public Health Sciences, King's College London, London, UK.

Background: Aliskiren was shown to increase adverse events in patients with diabetes and concomitant renin-angiotensin blockade. We aim to investigate the efficacy and safety of aliskiren in patients with diabetes and increased cardiovascular risk or established cardiovascular disease.

Methods: MEDLINE and Embase were searched for prospective studies comparing addition of aliskiren to standard medical therapy in patients with diabetes and cardiovascular disease, or ⩾1 additional cardiovascular risk factor (hypertension, abnormal lipid profile, microalbuminuria/proteinuria, chronic kidney disease). Read More

Circ J 2017 Aug 19. Epub 2017 Aug 19.

St. Hill Hospital.

Background: The mineralocorticoid receptor antagonist eplerenone improved clinical outcomes among patients with heart failure with reduced ejection faction (HFrEF) in the EMPHASIS-HF (Eplerenone in Mild Patients Hospitalization And SurvIval Study in Heart Failure) study. However, similar efficacy and safety have not been established in Japanese patients. We evaluated the efficacy and safety of eplerenone in patients with HFrEF in a multicenter, randomized, double-blind placebo-controlled outcome study (ClinicalTrials. Read More

Sci Rep 2017 Aug 18;7(1):8807. Epub 2017 Aug 18.

Department of Biology, York University, Toronto, M3J 1P3, Canada.

Chill susceptible insects suffer tissue damage and die at low temperatures. The mechanisms that cause chilling injury are not well understood but a growing body of evidence suggests that a cold-induced loss of ion and water homeostasis leads to hemolymph hyperkalemia that depolarizes cells, leading to cell death. The apparent root of this cascade is the net leak of osmolytes down their concentration gradients in the cold. Read More

PLoS One 2017 17;12(8):e0182938. Epub 2017 Aug 17.

College of Veterinary Medicine, University of Illinois, Urbana-Champaign, Illinois, United States of America.

Profound acidemia impairs cellular and organ function and consequently should be associated with an increased risk of mortality in critically ill humans and animals. Neonatal diarrhea in calves can result in potentially serious metabolic derangements including profound acidemia due to strong ion (metabolic) acidosis, hyper-D-lactatemia, hyper-L-lactatemia, azotemia, hypoglycemia, hyperkalemia and hyponatremia. The aim of this retrospective study was to assess the prognostic relevance of clinical and laboratory findings in 1,400 critically ill neonatal calves with diarrhea admitted to a veterinary teaching hospital. Read More

Case Rep Nephrol 2017 25;2017:9529028. Epub 2017 Jul 25.

Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.

Background: Ethylene glycol intoxication causes severe metabolic acidosis and acute kidney injury. Fomepizole has become available as its antidote. Nevertheless, a prompt diagnosis is not easy because patients are often unconscious. Read More

Mil Med 2017 Jul;182(7):e1836-e1841

U.S. Army Institute of Surgical Research, 3698 Chambers Pass STE B, JBSA Fort Sam Houston, TX 78234.

The standardized mortality rate of rhabdomyolysis (RM) in Active Duty U.S. Army Soldiers is considerably higher than in the civilian population. Read More

J Electrocardiol 2017 Jul 12. Epub 2017 Jul 12.

Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon. Electronic address:

A 38-year-old healthy male presented with vomiting and profuse diarrhea, associated with blurry and yellow coloration of the vision (xanthopsia). Laboratory workup was unremarkable, except for hyperkalemia (K 5.2 mEq/L) and mildly elevated troponin level 0. Read More

FP Essent 2017 Aug;459:21-28

Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28310.

Hypokalemia (ie, potassium levels less than 3.5 mEq/L) occurs in fewer than 1% of healthy individuals, but is present in up to 20% of hospitalized patients, 40% of patients taking diuretics, and 17% of patients with cardiovascular conditions. Hypokalemia often is asymptomatic; symptoms are more common in older adults. Read More

Am J Cardiol 2017 Oct 17;120(7):1110-1113. Epub 2017 Jul 17.

Vanderbilt University Medical Center, Nashville, Tennessee.

Hypokalemia has been consistently reported as a common occurrence during targeted temperature management (TTM) in comatose survivors of cardiac arrest. We sought to better describe changes in serum potassium throughout the different stages of TTM and to assess for any prognostic significance. We analyzed a prospectively collected cohort of 240 patients treated with TTM following cardiac arrest at a tertiary care hospital between 2007 and 2014. Read More

Sci Rep 2017 Aug 11;7(1):7899. Epub 2017 Aug 11.

Faculty of Medicine, University of São Paulo, São Paulo, Brazil.

Aldosterone antagonists slow the progression of chronic kidney disease (CKD), but their use is limited by hyperkalemia, especially when associated with RAS inhibitors. We examined the renoprotective effects of Ly, a novel non-steroidal mineralocorticoid receptor (MR) blocker, through two experimental protocols: In Protocol 1, male Munich-Wistar rats underwent 5/6 renal ablation (Nx), being divided into: Nx+V, receiving vehicle, Nx+Eple, given eplerenone, 150 mg/kg/day, and Nx+Ly, given Ly, 20 mg/kg/day. A group of untreated sham-operated rats was also studied. Read More

BMJ Case Rep 2017 Aug 10;2017. Epub 2017 Aug 10.

Department of Internal Medicine, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.

A 48-year-old man with a 4 months history of asthenia, anorexia, 10 kg weight loss and 1 month of hematuria and dysuria was admitted to another hospital for sudden muscular weakness. He was found to have areflexic tetraparesis and was referred to our hospital.On admission, he was bradycardic, tachypneic, with flaccid tetraplegia. Read More

J Therm Biol 2017 Aug 7;68(Pt B):177-185. Epub 2016 Apr 7.

Zoofysiologi, Aarhus Universitet, Institut for Bioscience, C.F. Mollers Aller 3, 8000 Aarhus C, Danmark. Electronic address:

Thermal tolerance is important in determining the spatial and temporal distributions of insects but the mechanisms which determine upper thermal limits remain poorly understood. In terrestrial insects heat tolerance is unlikely to be limited by oxygen supply but in some arthropods, heat stress has been shown to cause haemolymph hyperkalaemia which is known to have detrimental effects on neuromuscular excitability. It is however unresolved if heat-induced hyperkalemia is the cause or the result of cellular heat injury. Read More

Korean J Anesthesiol 2017 Aug 21;70(4):467-476. Epub 2017 Apr 21.

Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Seoul, Korea.

Since the implementation of the model for end-stage liver disease (MELD) scoring system in 2002, the liver transplantation (LT) society has observed a substantial increase in the number of recipients with renal dysfunction. Intraoperative renal replacement therapy (ioRRT) has emerged as one of the solutions available to manage high-MELD score recipients; however, its usefulness has not yet been proven. To date, we have experienced five cases of simultaneous liver and kidney transplantation (SLKT). Read More

Am Health Drug Benefits 2017 Jun;10(4):202-210

Principal, Milliman.

Background: Hyperkalemia (serum potassium >5.0 mEq/L) may be caused by reduced kidney function and drugs affecting the renin-angiotensin-aldosterone system and is often present in patients with chronic kidney disease (CKD).

Objective: To quantify the burden of hyperkalemia in US Medicare fee-for-service and commercially insured populations using real-world claims data, focusing on prevalence, comorbidities, mortality, medical utilization, and cost. Read More

Int J Nephrol Renovasc Dis 2017 26;10:205-213. Epub 2017 Jul 26.

Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.

In contrast to adults where hypertension is a leading cause of chronic kidney disease, in pediatrics, hypertension is predominantly a sequela, however, an important one that, like in adults, is likely associated with a more rapid decline in kidney function or progression of chronic kidney disease to end stage. There is a significant issue with unrecognized, or masked, hypertension in childhood chronic kidney disease. Recent evidence and, therefore, guidelines now suggest targeting a blood pressure of <50th percentile for age, sex, and height in children with proteinuria and chronic kidney disease. Read More

Card Fail Rev 2017 Apr;3(1):33-39

Faculty of Medicine, University of Ljubljana and Department of Internal Medicine, General Hospital Murska Sobota, Ljubljana, Slovenia.

Medications that affect the renin-angiotensin-aldosterone system (RAAS) form the mainstay of current heart failure (HF) therapy in patients with reduced ejection fraction. Concerns about the risk of hyperkalaemia have created a significant barrier to optimal RAAS inhibitor therapy in patients with HF, however, and many patients are discontinuing or receiving suboptimal doses of these lifesaving therapies. This has serious health and economic implications due to adverse renal and cardiovascular events. Read More

Cochrane Database Syst Rev 2017 08 7;8:CD009904. Epub 2017 Aug 7.

Medical Scientific Office, Diaverum, Lund, Sweden.

Background: Continuous erythropoiesis receptor activator (CERA) is a newer, longer acting ESA which might be preferred to other ESAs (epoetin or darbepoetin) based on its lower frequency of administration. Different dosing requirements and molecular characteristics of CERA compared with other ESAs may lead to different health outcomes (mortality, cardiovascular events, quality of life) in people with anaemia and chronic kidney disease (CKD).

Objectives: To assess benefits and harms of CERA compared with other epoetins (darbepoetin alfa and epoetin alfa or beta) or placebo/no treatment or CERA with differing strategy of administration for anaemia in individuals with CKD. Read More

Intern Med 2017 Aug 1;56(16):2243-2244. Epub 2017 Aug 1.

Department of Rheumatology, Chubu-Rosai Hospital, Japan.

J Am Soc Nephrol 2017 Aug 4. Epub 2017 Aug 4.

Division of Renal Disease and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.

Hyperkalemia is a potentially life-threatening electrolyte disorder appreciated with greater frequency in patients with renal disease, heart failure, and with use of certain medications such as renin angiotensin aldosterone inhibitors. The traditional views that hyperkalemia can be reliably diagnosed by electrocardiogram and that particular levels of hyperkalemia confer cardiotoxic risk have been challenged by several reports of patients with atypic presentations. Epidemiologic data demonstrate strong associations of morbidity and mortality in patients with hyperkalemia but these associations appear disconnected in certain patient populations and in differing clinical presentations. Read More

Mayo Clin Proc 2017 Aug;92(8):1248-1260

Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.

High sodium intake, whether via diet or drugs, augments cardiorenal risk. Regardless of its source, high sodium intake can both lead to hypertension and reduce the efficacy of renin-angiotensin-aldosterone system inhibitors, which are currently guideline-recommended treatments for hypertension, chronic kidney disease, and heart failure. Reducing sodium intake is therefore recommended to reduce the risk of adverse cardiorenal outcomes. Read More

J Vasc Access 2017 Sep 27;18(5):363-365. Epub 2017 Jul 27.

Department of Medicine, Albany Medical College, Albany, NY - USA.

Not infrequently, interventionalists are faced with a patient with increased blood pressure who is about to undergo a dialysis access intervention such as tunneled hemodialysis catheter, percutaneous balloon angioplasty, or declotting procedure for a clotted arteriovenous access. This can frequently create a dilemma as functional dialysis access is needed to provide dialysis therapy and delaying treatment could result in a life-threatening situation, particularly in the presence of hyperkalemia. This article investigates hypertension in patients undergoing percutaneous dialysis access interventions and provides guidance to their management. Read More

Curr Opin Nephrol Hypertens 2017 Sep;26(5):368-374

ASH Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA.

Purpose Of Review: Current data highlight the pathological aspects of excess aldosterone in promoting glomerular hypertrophy, glomerulosclerosis, and proteinuria in diabetic kidney disease (DKD). The role of nonsteroidal mineralocorticoid receptor antagonists (MRAs) in DKD is being evaluated in ongoing clinical trials.

Recent Findings: Recent studies demonstrate beneficial effects of adding MRAs to the treatment regimen of patients with type 2 diabetes with nephropathy. Read More

Case Reports Hepatol 2017 6;2017:9312481. Epub 2017 Jul 6.

Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA.

Calcineurin inhibitors remain an integral component of immunosuppressive therapy regimens following solid organ transplantation. Although nephrotoxicity associated with these agents is well documented, type IV renal tubular acidosis is a rare and potentially underreported complication following liver transplantation. Hepatologists must be able to recognize this adverse effect as it can lead to fatal hyperkalemia. Read More

Pediatrics 2017 Jul;140(1)

Division of Neonatology, Department of Pediatrics, University of Florida, Gainesville, Florida.

We present a 6-week-old male infant with persistent hyperbilirubinemia, hypertriglyceridemia, elevated creatine kinase levels, and transaminitis since the second week of life. When he developed hyperkalemia, clinical suspicion was raised for adrenal insufficiency despite hemodynamic stability. A full endocrine workup revealed nearly absent adrenocorticotropic hormone. Read More

BMJ Case Rep 2017 Jul 27;2017. Epub 2017 Jul 27.

Department of Internal Medicine, Regionshospitalet Randers, Randers, Denmark.

Hypokalaemic paralysis covers a heterogeneous group of disorders caused either by an enhanced shift of potassium into the cells or following a significant renal or gastrointestinal loss of potassium. We present the case of a 48-year-old Caucasian man with paralysis of both upper and lower extremities. ECG showed sinus rhythm and characteristic changes of hypokalaemia with depression of the ST segment, prolonged QTc interval of 581ms and U waves seen as a small positive deflection at the T wave in the middle precordial leads. Read More

Nephrology (Carlton) 2017 Jul 27. Epub 2017 Jul 27.

Dept. of Nephrology, Monash Medical Centre, Clayton, VIC, 3168, Australia.

Haemolysis in haemodialysis, although rare in current times, is associated with significant mortality and morbidity. As such prompt recognition, treatment, analysis of root cause and correction of underlying causative factors is crucial. Dialysate, extracorporeal circuit and patient related factors all contribute to haemolysis risk. Read More

Emerg Med Pract 2016 Nov 22;18(11 Suppl Points & Pearls):S1-S2. Epub 2016 Nov 22.

Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.

Hypokalemia and hyperkalemia are the most common electrolyte disorders managed in the emergency department. The diagnosis of these potentially life-threatening disorders is challenging due to the often vague symptomatology a patient may express, and treatment options may be based upon very little data due to the time it may take for laboratory values to return. This review examines the most current evidence with regard to the pathophysiology, diagnosis, and management of potassium disorders. Read More

Biochem Biophys Res Commun 2017 Sep 22;491(3):727-732. Epub 2017 Jul 22.

Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo, Tokyo, 113-8519, Japan.

WNK-OSR1/SPAK-NCC signaling cascade is important for regulating salt balance and blood pressure. Activation of WNK-OSR1/SPAK-NaCl cotransporter (NCC) cascade increases sodium reabsorption in the kidney, leading to pseudohypoaldosteronism type II (PHA II) characterized by salt-sensitive hypertension and hyperkalemia. It has been previously demonstrated that the amount of phosphorylated and total NCC markedly decreased in WNK4(-/-) mice, indicating that WNK4 plays a major role for activation of OSR1/SPAK-NCC signaling. Read More

BMC Cardiovasc Disord 2017 Jul 24;17(1):198. Epub 2017 Jul 24.

MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany.

Background: Conflicting with clinical practice guidelines, recent studies demonstrated that serum potassium concentrations (SPC) of ≥4.5 mEq/l were associated with increased mortality in patients with acute myocardial infarction (AMI). This study examined the association between SPC and long-term mortality following AMI in patients recruited from a population-based registry. Read More

Am J Nephrol 2017 22;46(2):150-155. Epub 2017 Jul 22.

Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil.

Background: The chronic use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blocker has been associated with hyperkalemia in patients with reduced renal function even after the initiation of hemodialysis. Whether such medications may cause a similar effect in peritoneal dialysis patients is not well established. So, the aim of our study was to analyze the impact of renin-angiotensin-aldosterone inhibitors on the serum levels of potassium in a national cohort of peritoneal dialysis patients. Read More

Int J Cardiol 2017 Oct 15;245:277-284. Epub 2017 Jul 15.

Department of Medical Epidemiology and Biostatistics (MEB), Karolinska Institutet, Sweden. Electronic address:

Background: Hypo- and hyperkalemia in clinical settings are insufficiently characterized and large-scale data from Europe lacking. We studied incidence and determinants of these abnormalities in a large Swedish healthcare system.

Methods: Observational study from the Stockholm CREAtinine Measurements project, including adult individuals from Stockholm accessing healthcare in 2009 (n=364,955). Read More

BMJ Open 2017 Jul 20;7(7):e017602. Epub 2017 Jul 20.

Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada.

Introduction: Observational evidence suggests physiological benefits and lower mortality with lower chloride solutions; however, 0.9% saline remains the most widely used fluid worldwide. Given uncertainty regarding the association of lower chloride on mortality, it is unlikely that practice will change without direct randomised clinical trial (RCT) evidence. Read More

J Am Heart Assoc 2017 Jul 19;6(7). Epub 2017 Jul 19.

Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD

Background: Concerns about hyperkalemia limit the use of angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARBs), but guidelines conflict regarding potassium-monitoring protocols. We quantified hyperkalemia monitoring and risks after ACE-I/ARB initiation and developed and validated a hyperkalemia susceptibility score.

Methods And Results: We evaluated 69 426 new users of ACE-I/ARB therapy in the Stockholm Creatinine Measurements (SCREAM) project with medication initiation from January 1, 2007 to December 31, 2010, and follow-up for 1 year thereafter. Read More