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    1 OF 175

    Multiple Myeloma Presenting as Acute Renal Failure in the Absence of Other Characteristic Features.
    Cureus 2017 Sep 20;9(9):e1703. Epub 2017 Sep 20.
    Hematology and Oncology, University of Arizona Cancer Center.
    This case report describes a 54-year-old, asymptomatic man who presented with hyperkalemia on routine lab testing who was later found to have acute renal failure, unresponsive to fluid resuscitation, with minimal improvement after hemodialysis. After a comprehensive evaluation ruled out common causes of acute renal failure, the patient underwent testing with a bone survey, urine protein electrophoresis (UPEP), serum protein electrophoresis (SPEP), and immunoelectrophoresis for suspected plasma cell dyscrasia and received plasmapheresis for hyperviscosity syndrome and nephrotoxicity, which resulted in improved renal function. Lab results showed monoclonal gammopathy, elevated serum free light chains, and Bence Jones protein in the urine with a follow-up bone marrow biopsy indicating plasma cell dyscrasia. Read More

    Aliskiren for heart failure: a systematic review and meta-analysis of randomized controlled trials.
    Oncotarget 2017 Oct 21;8(50):88189-88198. Epub 2017 Sep 21.
    Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, Henan, 450003, China.
    Objective: To systematically review and synthesize the currently available evidence of aliskiren for the treatment of heart failure.

    Materials And Methods: We systematically searched the Cochrane, Embase and PubMed databases to identify the randomized controlled trials (RCT) on the effects of aliskiren on heart failure. Data were synthesized with random effects model and presented in forest plot. Read More

    The Impact of Additives on the Phosphorus, Potassium, and Sodium Content of Commonly Consumed Meat, Poultry, and Fish Products Among Patients With Chronic Kidney Disease.
    J Ren Nutr 2017 Nov 14. Epub 2017 Nov 14.
    School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario. Electronic address:
    Objective: Patients with chronic kidney disease (CKD) are advised to limit their dietary intake of phosphorus and potassium as hyperphosphatemia and hyperkalemia are both associated with an increased risk of mortality. There is uncertainty concerning the actual content of these minerals in the Canadian food supply, as phosphorus and potassium are increasingly being used as food additives. This study aimed to determine the impact of food additives on the chemically analyzed content of phosphorus, potassium, sodium, and protein in commonly consumed meat, poultry, and fish products (MPFs). Read More

    The Unappreciated Role of Extrarenal and Gut Sensors in Modulating Renal Potassium Handling: Implications for Diagnosis of Dyskalemias and Interpreting Clinical Trials.
    Kidney Int Rep 2016 May 8;1(1):43-56. Epub 2016 Apr 8.
    Adult Nephrology Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
    In addition to the classic and well-established "feedback control" of potassium balance, increasing investigative attention has focused on a novel and not widely recognized complementary regulatory paradigm for maintaining potassium homeostasis-the "feed-forward control" of potassium balance. This regulatory mechanism, initially defined in rumen, has recently been validated in normal human subjects. Studies are being conducted to determine the location for this putative potassium sensor and to evaluate potential signals, which might increase renal potassium excretion. Read More

    Safety of the neprilysin/renin-angiotensin system inhibitor LCZ696.
    Oncotarget 2017 Oct 31;8(47):83323-83333. Epub 2017 May 31.
    Department of Cardiology, Qilu Hospital of Shandong University, Ji'nan, 250012, PR China.
    Objectives: The combined neprilysin/rennin-angiotensin system inhibitor sacubitril/valsartan (LCZ696) has shown its superiority over ACEI/ARB therapy. In view of the existing concern of its adverse effects, we aimed to provide evidence of the safety of the new drug.

    Results: A total of 6 randomized trials with 11,821 subjects were included in this analysis. Read More

    Potassium Chloride Sustained Release Dosing Pathway in an Academic Medical Center.
    Crit Pathw Cardiol 2017 Dec;16(4):158-160
    From the Department of Pharmacy, Brigham and Women's Hospital, Boston, MA.
    Potassium supplementation can be administered intravenously or orally with either immediate release or sustained release formulations. Sustained release potassium chloride allows for delayed absorption and peak effects. In the inpatient setting, it is important to monitor and prevent both hypokalemia and hyperkalemia. Read More

    Cardiac Arrest in the Operating Room: Resuscitation and Management for the Anesthesiologist: Part 1.
    Anesth Analg 2017 Nov 10. Epub 2017 Nov 10.
    From the *Columbia University, New York, New York; †Shaare Zedek Medical Center, Jerusalem, Israel; ‡Birmingham Children's Hospital, Birmingham, United Kingdom; §New York University, New York, New York; ‖University of Pennsylvania, Philadelphia, Pennsylvania; ¶Envision Healthcare, Plantation, Florida; #The University of Illinois at Chicago, Chicago, Illinois; **Vanderbilt University, Nashville, Tennessee; ††Cleveland Clinic, Cleveland, Ohio; ‡‡Dalhousie University, Nova Scotia, Canada; and §§University of Chicago, Chicago, Illinois.
    Cardiac arrest in the operating room and procedural areas has a different spectrum of causes (ie, hypovolemia, gas embolism, and hyperkalemia), and rapid and appropriate evaluation and management of these causes require modification of traditional cardiac arrest algorithms. There is a small but growing body of literature describing the incidence, causes, treatments, and outcomes of circulatory crisis and perioperative cardiac arrest. These events are almost always witnessed, frequently known, and involve rescuer providers with knowledge of the patient and their procedure. Read More

    Development of hyperkalemia following treatment with dapagliflozin (DAPA) in a patient with type 2 diabetes after bilateral adrenalectomy.
    CEN Case Rep 2017 Nov 13. Epub 2017 Nov 13.
    Department of Metabolism, Endocrinology and Molecular Medicine, Internal Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
    Dapagliflozin (DAPA), a sodium-glucose co-transporter 2 (SGLT2) inhibitor, is known to have a beneficial diuretic effect, in addition to a glucose-lowering effect. Although SGLT2 inhibitor has been reported, the increase of hyperkalemia in patients treated with renin-angiotensin-aldosterone system (RAAS) inhibitors, their mechanism of action is unclear. We report the first case of a type 2 diabetes (T2DM) patient with potential mineralocorticoid deficiency who developed hyperkalemia after administration of DAPA. Read More

    Evaluation of the Pharmacodynamic Effects of the Potassium Binder RDX7675 in Mice.
    J Cardiovasc Pharmacol Ther 2017 Jan 1:1074248417741685. Epub 2017 Jan 1.
    1 Ardelyx, Inc, Fremont, CA, USA.
    Introduction: Hyperkalemia is a common complication in patients with heart failure or chronic kidney disease, particularly those who are taking inhibitors of the renin-angiotensin-aldosterone system. RDX7675, the calcium salt of a reengineered polystyrene sulfonate-based resin, is a potassium binder that is being investigated as a novel treatment for hyperkalemia. This study evaluated the pharmacodynamic effects of RDX7675 in mice, compared to 2 current treatments, sodium polystyrene sulfonate (SPS) and patiromer. Read More

    Spontaneous Tumor Lysis Syndrome due to Uterine Leiomyosarcoma with Lung Metastases.
    Case Rep Crit Care 2017 11;2017:4141287. Epub 2017 Sep 11.
    Division of Pulmonary-Critical Care Medicine, University of CT Health Center, Farmington, CT 06030, USA.
    Tumor lysis syndrome (TLS) is an oncologic emergency characterized by a combination of metabolic derangements (hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia) caused by rapid turnover from cell destruction in certain cancers. These metabolic derangements can lead to seizures, cardiac arrhythmias, renal failure, and death. TLS is usually seen after the initiation of chemotherapy for hematologic malignancies. Read More

    Contralateral suppression of aldosterone at adrenal venous sampling predicts hyperkalemia following adrenalectomy for primary aldosteronism.
    Surgery 2017 Nov 9. Epub 2017 Nov 9.
    Department of Surgery, Mayo Clinic, Rochester, MN.
    Background: We aimed to determine whether a greater degree of contralateral suppression of aldosterone secretion at adrenal venous sampling predicted the development of postoperative hyperkalemia after unilateral adrenalectomy for primary aldosteronism.

    Methods: A retrospective analysis of patients undergoing unilateral adrenalectomy for primary aldosteronism between 2004-2015 was performed. Clinical and biochemical parameters of patients who developed hyperkalemia (≥5. Read More

    High aldosterone and cortisol levels in salt wasting congenital adrenal hyperplasia: a clinical conundrum.
    J Pediatr Endocrinol Metab 2017 Nov 11. Epub 2017 Nov 11.
    .
    Background: Salt wasting syndrome (hyponatremia, hyperkalemia, dehydration, metabolic acidosis) in early infancy could be caused by either mineralocorticoid deficiency as in congenital adrenal hyperplasia (CAH) and adrenal insufficiency or mineralocorticoid resistance as in pseudohypoaldosteronism (PHA). In salt wasting CAH, serum aldosterone and cortisol levels are expected to be low. Cross reactivity between high levels of adrenal steroid precursors and aldosterone has recently been reported resulting in elevated aldosterone levels in CAH, leading to difficulty in differentiating between CAH and PHA. Read More

    Vancomycin-resistant Enterococcus faecium bacteraemia as a complication of Kayexalate (sodium polystyrene sulfonate, SPS) in sorbitol-induced ischaemic colitis.
    BMJ Case Rep 2017 Nov 9;2017. Epub 2017 Nov 9.
    Department of Internal Medicine, SBH Health System, Bronx, New York, USA.
    We present the case report of an 80-year-old woman with chronic kidney disease stage G5 admitted to the hospital with fluid overload and hyperkalaemia. Sodium polystyrene sulfonate (SPS, Kayexalate) in sorbitol suspension was given orally to treat her hyperkalaemia, which precipitated an episode of SPS in sorbitol-induced ischaemic colitis with the subsequent complication of vancomycin-resistant Enterococcus (VRE) bacteraemia. SPS (Kayexalate) in sorbitol suspension has been implicated in the development of intestinal necrosis. Read More

    Choice of fluids in the perioperative period of kidney transplantation.
    Nefrologia 2017 Nov - Dec;37(6):572-578
    Unidad Polivalente, Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España.
    Normal saline has traditionally been the resuscitation fluid of choice in the perioperative period of kidney transplantation over balanced potassium solutions. However, the problems arising from hyperchloraemia triggered by the infusion of normal saline have led to studies being conducted that compare this solution with balanced solutions. From this narrative review it can be concluded that the use of balanced crystalloids containing potassium in the perioperative period of kidney transplantation can be considered safe. Read More

    Effects of intraoperative and early postoperative normal saline or Plasma-Lyte 148® on hyperkalaemia in deceased donor renal transplantation: a double-blind randomized trial.
    Br J Anaesth 2017 Oct;119(4):606-615
    Department of Nephrology, Austin Hospital, Victoria, Australia.
    Background: Administration of saline in renal transplantation is associated with hyperchloraemic metabolic acidosis, but the effect of normal saline (NS) on the risk of hyperkalaemia or postoperative graft function is uncertain.

    Methods: We compared NS with Plasma-Lyte 148® (PL) given during surgery and for 48 h after surgery in patients undergoing deceased donor renal transplantation. The primary outcome was hyperkalaemia within 48 h after surgery. Read More

    NEBIVOLOL INDUCED HYPERKALEMIA: CASE REPORT.
    Acta Clin Croat 2016 12;55(4):663-6
    In this article, we document a conclusive case of nebivolol-induced hyperkalemia for the first time in the known medical literature. Hyperkalemia is associated with serious conditions such as cardiac arrhythmias and sudden cardiac death. Nebivolol was not known to cause hyperkalemia, and this event is not listed in its summary of product characteristics (SmPC). Read More

    Mediterranean diet as the diet of choice for patients with chronic kidney disease.
    Nephrol Dial Transplant 2017 Jul 2. Epub 2017 Jul 2.
    Division of Renal Medicine, CLINTEC and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Traditional dietary management of chronic kidney disease (CKD) focuses on the quantity within the diet of energy and protein, and the restriction of single micronutrients, with little mention of dietary quality. Dietary patterns that are more plant-based, lower in meat (including processed meat), sodium and refined sugar, and have a higher content of grains and fibres are now included in multiple clinical guidelines for chronic disease prevention. The Mediterranean diet (MD) has been associated with reduced cardiovascular disease incidence in both observational and interventional studies. Read More

    Clues for early detection of autoimmune Addison's disease - myths and realities.
    J Intern Med 2017 Nov 3. Epub 2017 Nov 3.
    Department of Clinical Medicine, University of Bergen, Bergen, Norway.
    Background: Early detection of autoimmune Addison's disease (AAD) is important as delay in diagnosis may result in a life-threatening adrenal crisis and death. The classical clinical picture of untreated AAD is well-described, but methodical investigations are scarce.

    Objective: Perform a retrospective audit of patient records with the aim of identifying biochemical markers for early diagnosis of AAD. Read More

    Hyperglycemic Hyperosmolar State During Induction Chemotherapy for Acute Lymphoblastic Leukemia.
    Pediatr Emerg Care 2017 Oct 31. Epub 2017 Oct 31.
    From the *Department of Pediatrics, University of Southern California Keck School of Medicine; Divisions of †Pediatric Hematology-Oncology, ‡Pediatric Critical Care Medicine, and §Pediatric Endocrinology, Department of Pediatrics, Los Angeles County + University of Southern California Medical Center; and ∥Department of Internal Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA.
    We present the case of a 16-year-old boy who presented with fatigue, polyuria, and polydipsia while on chemotherapy for his relapsed acute lymphoblastic leukemia (ALL). Blood gas examination confirmed the diagnosis of hyperosmolar hyperglycemic state. The etiology for his hyperglycemia was most likely a result of oral glucocorticoid therapy combined with asparaginase therapy-both are a cornerstone of induction chemotherapy for ALL. Read More

    Hyperkalemia in Combat Casualties: Implications for Delayed Evacuation.
    Mil Med 2017 Nov;182(11):e2046-e2051
    Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
    Objective: Fixed facilities and rapid global evacuation ensured that delayed complications of trauma, such as hyperkalemia, occurred late in the evacuation chain where renal replacement therapies were available. However, future conflicts or humanitarian disasters may involve prolonged evacuation times. We sought to quantify one potential risk of delayed evacuation by assessing hyperkalemia in combat casualties. Read More

    The Effect of Remifentanil on Succinylcholine Induced Changes in Serum Potassium and Creatine Kinase: A Prospective Randomized Double blind Study.
    Acta Biomed 2017 Oct 23;88(3):276-280. Epub 2017 Oct 23.
    Kurdistan University of Medical.
    Background And Aim Of The Work: Succinylcholine is still included as drugs favored by anesthetists because of its rapid onset and short duration of action. However, it can bring about complications such as hyperkalemia and increased serum creatine phosphokinase (CPK). This study aims at evaluating the effects of remifentanil on succinylcholine-induced postoperative changes in serum potassium and CPK. Read More

    Association between hypo- and hyperkalemia and outcome in acute heart failure patients: the role of medications.
    Clin Res Cardiol 2017 Oct 28. Epub 2017 Oct 28.
    Department of Anesthesiology and Critical Care and Burn Unit, St-Louis Hospital, Assistance Publique- Hôpitaux de Paris,, Paris, France.
    Background: The interaction between chronic medications on admission and the association between serum potassium level and outcome in patients with acute heart failure (AHF) are unknown.

    Methods: Observational intercontinental study of patients admitted with AHF. 15954 patients were included from 12 cohorts in 4 continents. Read More

    Aldosterone-induced protein kinase signalling and the control of electrolyte balance.
    Steroids 2017 Oct 24. Epub 2017 Oct 24.
    Molecular Medicine Laboratories, Royal College of Surgeons in Ireland, Education Centre, Beaumont Hospital, Dublin, Ireland; Perdana University - Royal College of Surgeons in Ireland School of Medicine, Serdang, Selangor, Malaysia. Electronic address:
    Aldosterone acts through the mineralocorticoid receptor (MR) to modulate gene expression in target tissues. In the kidney, the principal action of aldosterone is to promote sodium conservation in the distal nephron and so indirectly enhance water conservation under conditions of hypotension. Over the last twenty years the rapid activation of protein kinase signalling cascades by aldosterone has been described in various tissues. Read More

    A non-randomized, open-label, single-arm, Phase 2 study of emibetuzumab in Asian patients with MET diagnostic positive, advanced gastric cancer.
    Cancer Chemother Pharmacol 2017 Dec 25;80(6):1197-1207. Epub 2017 Oct 25.
    National Cancer Center Hospital East, 5-1, Kashiwanoha 6-chome, Kashiwa, Chiba, 277-8577, Japan.
    Purpose: Mesenchymal-epithelial transition factor (MET) is expressed in gastric cancer and associated with poor clinical outcomes. We assessed activity, safety, and pharmacokinetics of emibetuzumab, a bivalent monoclonal anti-MET antibody that blocks ligand-dependent and ligand-independent MET signaling.

    Methods: This non-randomized, single-arm, Phase 2 study enrolled Asian patients with MET diagnostic positive advanced gastric adenocarcinoma. Read More

    Perindopril arginine and amlodipine besylate for hypertension: a safety evaluation.
    Expert Opin Drug Saf 2017 Oct 31:1-10. Epub 2017 Oct 31.
    a Department of Biomedical Sciences , Pacific Northwest University of Health Sciences , Yakima , WA , USA.
    Introduction: Controlling blood pressure is a global health priority; single-pill antihypertensive combinations may improve adherence, persistence, and outcomes. Areas covered: A novel combination of perindopril arginine and amlodipine besylate was recently approved. A systematic review of the literature revealed its most common adverse effects as: peripheral edema (depending on the dose of amlodipine, but attenuated by perindopril), cough, dizziness and hypotension. Read More

    Incidence of and Risk Factors for Severe Adverse Events in Elderly Patients Taking Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers after an Acute Myocardial Infarction.
    Pharmacotherapy 2017 Oct 23. Epub 2017 Oct 23.
    Department of Epidemiology, College of Public Health, the University of Iowa.
    Study Objective: To assess the incidence of and risk factors associated with severe adverse events in elderly patients who used angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) after an acute myocardial infarction (AMI).

    Design: Retrospective cohort study.

    Data Sources: Centers for Medicare & Medicaid Services Chronic Conditions Data Warehouse (Medicare service claims database), American Community Survey of the U. Read More

    The Leaky Gut and Altered Microbiome in Chronic Kidney Disease.
    J Ren Nutr 2017 Nov;27(6):458-461
    Division of Nephrology and Hypertension, Department of Medicine, University of California Irvine, Orange, California. Electronic address:
    Chronic kidney disease results in disruption of the intestinal epithelial barrier as well as profound changes in the gut microbial flora. These events are largely mediated by (1) heavy influx of circulating urea to the gut lumen and (2) dietary restrictions of foods containing high fiber (such as fruits and vegetable) and symbiotic organisms (such as yogurt and cheese) imposed to mitigate hyperkalemia and hyperphosphatemia. Collectively, these factors promote systemic inflammation and cardiovascular morbidity by mediating microbial dysbiosis, disruption of the intestinal epithelial barrier, and translocation of endotoxin, bacterial fragments, and uremic toxins across the "leaky gut" into the bloodstream. Read More

    Safety of potassium-bearing citrate in patients with renal transplantation: A case report.
    Medicine (Baltimore) 2017 Oct;96(42):e6933
    Department of Nephropathy, The Second Affiliated Hospital, Henan University of Traditional Chinese Medicine, Zhengzhou, Henan, China.
    Rationale: Urinary lithiasis is one of severe postoperative complications in patients undergoing renal transplantation, possibly leading to anuria, urinary infection, or even acute renal failure. Potassium sodium hydrogen citrate (PSHC), a potassium-bearing citrate, is commonly prescribed to prevent stone formation.

    Patient Concerns: A 25-year-old man (patient 1) and a 31-year-old man (patient 2) receiving renal transplantation for end-stage renal disease (ESRD) were enrolled in this study. Read More

    Obstructive uropathy as initial presentation of genitourinary tuberculosis and masquerading as a postsurgical complication.
    BMJ Case Rep 2017 Oct 15;2017. Epub 2017 Oct 15.
    Department of Internal Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda.
    A 46-year-old woman who had a recent total abdominal hysterectomy presented with a 1 month history of lower abdominal pain, 1 week of nausea and vomiting as well as decreased urinary output preceded by a year of significant unintentional weight loss. On renal imaging, she was found to have bilateral hydronephrosis and hydroureters in the setting of bilateral distal ureteric obstruction complicated with acute kidney injury and severe hyperkalaemia requiring haemodialysis. The initial concern was for ureteric injury, a known complication of abdominal hysterectomy procedures, however, a urological intervention, performed 9 months later to relieve the ureteric obstruction, revealed purulent material within the left ureter that was smear positive for acid fast bacilli. Read More

    Treatment of Abnormalities of Potassium Homeostasis in CKD.
    Adv Chronic Kidney Dis 2017 09;24(5):319-324
    Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; and Biomedical Research Department, Diabetes and Obesity Research Division, Cedars-Sinai Medical Center, Los Angeles, California.
    Hyperkalemia, defined as serum potassium concentrations greater than 5.0 to 5.5 mEq/L, is a frequent occurrence in clinical practice because of the increasing incidence and prevalence of CKD. Read More

    Hyperkalemia and Hypokalemia in CKD: Prevalence, Risk Factors, and Clinical Outcomes.
    Adv Chronic Kidney Dis 2017 09;24(5):315-318
    Division of Nephrology, Department of Medicine, University of Utah, Salt Lake City, UT; and Nephrology Section, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT. Electronic address:
    Abnormalities of serum potassium are common in patients with CKD. Although hyperkalemia is a well-recognized complication of CKD, the prevalence rates of hyperkalemia (14%-20%) and hypokalemia (12%-18%) are similar. CKD severity, use of medications such as renin-angiotensin-aldosterone system inhibitors and diuretics, and dietary potassium intake are major determinants of serum potassium concentration in CKD. Read More

    Regulation of Potassium Homeostasis in CKD.
    Adv Chronic Kidney Dis 2017 09;24(5):305-314
    Section on General Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC, and the Division of Nephrology, University of Virginia School of Medicine, Charlottesville, VA. Electronic address:
    Disturbances of potassium homeostasis can cause either hyperkalemia or hypokalemia and result in serious consequences. Although the consequences of acute and chronic hyperkalemia and treatment of these conditions in CKD have been widely appreciated by nephrologists, more recent information has focused attention on the consequences of chronic hypokalemia. Several recent studies have documented a "U-shaped" relationship between the serum [K(+)] and higher mortality in several clinical studies. Read More

    Potassium homeostasis in health and disease: A scientific workshop cosponsored by the National Kidney Foundation and the American Society of Hypertension.
    J Am Soc Hypertens 2017 Oct 10. Epub 2017 Oct 10.
    Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
    While much emphasis, and some controversy, centers on recommendations for sodium intake, there has been considerably less interest in recommendations for dietary potassium intake, in both the general population and patients with medical conditions, particularly acute and chronic kidney disease. Physiology literature and cohort studies have noted that the relative balance in sodium and potassium intakes is an important determinant of many of the sodium-related outcomes. A noteworthy characteristic of potassium in clinical medicine is the extreme concern shared by many practitioners when confronted by a patient with hyperkalemia. Read More

    Potassium Homeostasis in Health and Disease: A Scientific Workshop Cosponsored by the National Kidney Foundation and the American Society of Hypertension.
    Am J Kidney Dis 2017 Sep 29. Epub 2017 Sep 29.
    Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
    While much emphasis, and some controversy, centers on recommendations for sodium intake, there has been considerably less interest in recommendations for dietary potassium intake, in both the general population and patients with medical conditions, particularly acute and chronic kidney disease. Physiology literature and cohort studies have noted that the relative balance in sodium and potassium intakes is an important determinant of many of the sodium-related outcomes. A noteworthy characteristic of potassium in clinical medicine is the extreme concern shared by many practitioners when confronted by a patient with hyperkalemia. Read More

    Evaluation of the tolerability and efficacy of sodium polystyrene sulfonate for long-term management of hyperkalemia in patients with chronic kidney disease.
    Int Urol Nephrol 2017 Dec 11;49(12):2217-2221. Epub 2017 Oct 11.
    Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, St Kyriakidi 1, 54006, Thessaloníki, Greece.
    Purpose: Sodium polystyrene sulfonate (SPS) is a cation-exchanging resin that has been widely used for several decades as first-line therapy of mild chronic hyperkalemia in patients with chronic kidney disease (CKD). However, evidence to prove the long-term tolerability and efficacy of SPS for the treatment of this condition is still missing.

    Methods: In this retrospective, observational study, we enrolled 26 outpatients with stages 3-4 CKD who received oral therapy with low-dose SPS for mild chronic hyperkalemia in the Outpatient Nephrology clinic of our Department during 2010-2016. Read More

    Study design of Real World Evidence for Treatment of Hyperkalemia in the Emergency Department (REVEAL-ED): a multicenter, prospective, observational study.
    Clin Exp Emerg Med 2017 Sep 30;4(3):154-159. Epub 2017 Sep 30.
    Ben Taub General Hospital, Baylor College of Medicine, Houston, TX, USA.
    Objective: Hyperkalemia affects up to 10% of hospitalized patients and, if left untreated, can lead to serious cardiac arrhythmias or death. Although hyperkalemia is frequently encountered in the emergency department (ED), and is potentially life-threatening, standard of care for the treatment is poorly defined, with little supporting evidence. The main objectives of this observational study are to define the overall burden of hyperkalemia in the ED setting, describe its causes, the variability in treatment patterns and characterize the effectiveness and safety of ED standard of care therapies used in the United States. Read More

    Long-Term Potassium Monitoring and Dynamics in Heart Failure and Risk of Mortality.
    Circulation 2017 Oct 12. Epub 2017 Oct 12.
    Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain & CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain.
    Background -The prognostic value of long-term potassium monitoring and dynamics in heart failure (HF) has not been characterized completely. We sought to determine the association between serum potassium values collected at follow-up with all-cause mortality in a prospective and consecutive cohort of patients discharged from a previous acute HF admission. Methods -Serum potassium was measured at every physician-patient encounter, including hospital admissions and ambulatory settings. Read More

    Sodium Phosphate Enemas do not Worsen Renal Function amongst Hospitalized Patients with Mild to Moderate Renal Failure. A Matched, Case-control study.
    QJM 2017 Aug 16. Epub 2017 Aug 16.
    Department of Internal Medicine T#, Chaim Sheba Medical Center; Ramat Gan, Israel.
    Background: Sodium Phosphate enemas (SPEs) are widely used amongst hospitalized patients despite their potential to worsen renal failure. The extent to which this side effect is clinically relevant is questionable.

    Methods: We conducted a matched case-control, retrospective study in a cohort of hospitalized patients. Read More

    Patiromer Lowers Serum Potassium When Taken without Food: Comparison to Dosing with Food from an Open-Label, Randomized, Parallel Group Hyperkalemia Study.
    Am J Nephrol 2017 11;46(4):323-332. Epub 2017 Oct 11.
    Renal Associates, P.A., San Antonio, TX, USA.
    Background: Patiromer is a sodium-free, nonabsorbed, potassium binder approved for treatment of hyperkalemia. This open-label study compares the efficacy and safety of patiromer administered without food versus with food.

    Methods: Adults with hyperkalemia (potassium ≥5. Read More

    Rhabdomyolysis and compartment syndrome in a bodybuilder undergoing minimally invasive cardiac surgery.
    Ann Card Anaesth 2017 Oct-Dec;20(4):453-455
    Department of Cardiac Surgery, St Thomas' Hospital, London SE1 7EH, United Kingdom.
    Rhabdomyolysis is the result of skeletal muscle tissue injury and is characterized by elevated creatine kinase levels, muscle pain, and myoglobinuria. It is caused by crush injuries, hyperthermia, drugs, toxins, and abnormal metabolic states. This is often difficult to diagnose perioperatively and can result in renal failure and compartment syndrome if not promptly treated. Read More

    Nonclinical safety assessment of SPX-101, a novel peptide promoter of epithelial sodium channel internalization for the treatment of cystic fibrosis.
    Inhal Toxicol 2017 Jul 6;29(8):356-365. Epub 2017 Oct 6.
    c Envigo , Princeton , NJ , USA.
    Background: ENaC inhibition has long been an attractive therapeutic target for the treatment of cystic fibrosis. However, previous attempts at developing ENaC inhibitors have been unsuccessful due to complications arising from systemic circulation of the compounds. Here, we describe the preclinical toxicology assessment of a new inhaled peptide promoter of ENaC internalization delivered as a nebulized aerosol. Read More

    Managing hyperkalemia in high-risk patients in long-term care.
    Am J Manag Care 2017 Feb;23(2 Suppl):S27-S36
    Midwest Geriatrics LLC, 6101 S County Line Rd, Burr Ridge, IL 60527. E-mail:
    Hyperkalemia is common among elderly patients and is associated with an increase in morbidity and mortality. Patients at highest risk for developing hyperkalemia are those with chronic kidney disease (CKD) and heart failure (HF), particularly those on guideline-recommended inhibitors of the renin-angiotensin-aldosterone system (RAAS). Hyperkalemia remains a challenge for clinicians practicing in the long-term care setting as they are often faced with the difficult decision of down-titrating or discontinuing RAAS inhibitors in response to hyperkalemia in the very patients who derive the greatest benefit from these agents. Read More

    All-cause costs increase exponentially with increased chronic kidney disease stage.
    Am J Manag Care 2017 Jun;23(10 Suppl):S163-S172
    Objective: To evaluate the economic impact of chronic kidney disease (CKD) on US health plans.

    Study Design: A retrospective analysis identified patients with a renin-angiotensin-aldosterone system inhibitor (RAASi) prescription from an electronic medical record (EMR) database (Humedica); those with =90 days in =1 CKD stage were selected based on estimated glomerular filtration rate or diagnosis code, and a cohort on RAASi medications without CKD was selected. Costs for specific services obtained from OptumInsight were applied to services in EMR data of patients aged <65 years (commercial) and =65 years (Medicare). Read More

    A comparison of insulin doses for the treatment of hyperkalemia in patients with renal insufficiency.
    Pharmacotherapy 2017 Oct 4. Epub 2017 Oct 4.
    Department of Emergency Medicine, Rush University Medical Center, Chicago, IL.
    Study Objective: To compare the safety and efficacy of 5 units versus 10 units of insulin for the treatment of hyperkalemia in patients with renal insufficiency.

    Design: Retrospective cohort study.

    Setting: Large academic medical center emergency department. Read More

    Normokalemic nondepolarizing long-acting blood cardioplegia.
    Asian Cardiovasc Thorac Ann 2017 Sep-Oct;25(7-8):495-501. Epub 2017 Oct 4.
    4 Department of Cardiac Anesthesia, U N Mehta Institute of Cardiology and Research Center, Civil Hospital, Ahmedabad, Gujarat, India.
    Objective Blood cardioplegia, the gold-standard cardioprotective strategy, requires frequent dosing, resulting in hyperkalemia-induced myocardial edema. The aim of our study was to compare the efficacy and safety of a long-acting blood-based cardioplegia with physiological potassium levels versus the well-established cold blood St. Thomas' Hospital no. Read More

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