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South Med J 2022 Jul;115(7):435-440

From the Department of Chest Diseases and Tuberculosis; Beyhekim Research and Training Hospital, Konya, Turkey, and the Department of Chest Diseases and Tuberculosis, Konya City Hospital, Konya, Turkey.

Objectives: Patients who develop cytokine storm while they have coronavirus disease 2019 (COVID-19) experience more severe symptoms. This article aims to evaluate the effect of biochemical parameters on the clinical course of the disease in patients treated with tocilizumab (TCZ) due to cytokine storm.

Methods: Medical documents of patients with COVID-19 were searched retrospectively. Read More

Nephrol Dial Transplant 2022 Jul 1. Epub 2022 Jul 1.

Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy.

Acute kidney injury (AKI) is defined by a rapid increase in serum creatinine levels, reduced urine output, or both. Death may occur in 16%-49% of patients admitted to an intensive care unit with severe AKI. Complex arrhythmias are a potentially serious complication in AKI patients with pre-existing or AKI-induced heart damage and myocardial dysfunction, fluid overload, and especially electrolyte and acid-base disorders representing the pathogenetic mechanisms of arrhythmogenesis. Read More

J Pharmacokinet Pharmacodyn 2022 Jul 1. Epub 2022 Jul 1.

School of Chemical, Materials, and Biomedical Engineering, University of Georgia, Athens, GA, USA.

Plasma potassium regulation within a narrow range is vital for life. The risk for hyperkalemia increases when kidney function is impaired and with therapeutic interventions such as mineralocorticoid receptor antagonists (MRAs). The kidney maintains potassium homeostasis by matching potassium intake and excretion, in part through the action of aldosterone. Read More

Cureus 2022 May 29;14(5):e25444. Epub 2022 May 29.

Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Ehime, JPN.

We describe two cases in which the onset of bradycardia, renal failure, atrioventricular (AV) nodal blockade, shock, and hyperkalemia (BRASH) syndrome led to the diagnosis of transthyretin cardiac amyloidosis. In Case 1, BRASH syndrome developed shortly after a therapeutic dose of AV nodal blockers was prescribed for new-onset atrial flutter. BRASH syndrome improved with intravenous dopamine infusion and temporary cardiac pacing. Read More

HeartRhythm Case Rep 2022 Jun 6;8(6):453-457. Epub 2022 Apr 6.

Department of Medicine, Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota.

Clin Sci (Lond) 2022 Jun;136(12):1005-1017

Université de Lorraine, INSERM Centre d'Investigations Cliniques-Plurithématique 1433, UMR 1116, CHRU de Nancy, French-Clinical Research Infrastructure Network (F-CRIN) INI-CRCT, Nancy, France.

Despite strong preclinical data supporting the use of mineralocorticoid receptor antagonists (MRAs) to provide cardiorenal protection in rodent models of diabetes, the clinical evidence of their utility in treating chronic kidney disease (CKD) has been limited. Two major clinical trials (FIDELIO-DKD and FIGARO-DKD) including more than 13,000 patients with albuminuric CKD and Type 2 diabetes randomized to placebo or finerenone (MRA) have recently provided exciting results showing a significant risk reduction for kidney and cardiovascular outcomes. In this review, we will summarize the major findings of these trials, together with post-hoc and pooled analyses that have allowed evaluation of the efficacy and safety of finerenone across the spectrum of CKD, revealing significant protective effects of finerenone against kidney failure, new-onset atrial fibrillation or flutter, new-onset heart failure, cardiovascular death, and first and total heart-failure hospitalizations. Read More

J Med Case Rep 2022 Jun 28;16(1):252. Epub 2022 Jun 28.

Department of Oncology, Keck School of Medicine of USC, Los Angeles, CA, USA.

Background: Tumor lysis syndrome is an oncologic emergency that involves multiple metabolic abnormalities and clinical symptoms such as acute renal failure, cardiac arrhythmias, seizures, and multiorgan failure, and may be fatal if not promptly recognized. Tumor lysis syndrome occurs most often in patients with hematologic malignancies, and relatively few cases have been described in patients with sarcoma.

Case Presentation: A 64-year-old male of Asian heritage presented to his primary care physician with a right lower-extremity mass and was ultimately diagnosed with widely metastatic osteosarcoma. Read More

Emerg Med Australas 2022 Jun 27. Epub 2022 Jun 27.

Department of Internal Medicine, Second Faculty of Medicine, Charles University, Prague, Czech Republic.

Data Brief 2022 Aug 6;43:108357. Epub 2022 Jun 6.

Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.

The anion gap is a calculated parameter derived from the difference between the major plasma cations and anions in serum/plasma or whole blood, with a widely used simple equation utilizing concentrations of sodium, chloride, and bicarbonate. While there is extensive literature on the clinical significance and causes of elevated anion gaps, there is comparatively less data on low anion gaps. Occasionally, anion gap calculations result in a negative number (-1 or less). Read More

Adv Ther 2022 Jun 25. Epub 2022 Jun 25.

Department of Nephrology, Osaka Medical and Pharmaceutical University, Osaka, 569-8686, Japan.

Diabetic kidney disease (DKD) is one of the most important diabetic complications. DKD is also the most common cause of chronic kidney disease (CKD) and end-stage renal disease. This review focused on potential therapeutic drugs for which there is established evidence of treatment for DKD. Read More

ESC Heart Fail 2022 Jun 24. Epub 2022 Jun 24.

Heart Failure and Transplant Unit, Cardiology Service, Hospital Universitari i Politècnic La Fe, Valencia, Spain.

Aims: Hyperkalaemia (HK) is common in heart failure (HF) patients, related to renal dysfunction and medical treatment. It limits medical therapy optimization, which impacts prognosis. New potassium (K) binders help control HK, allowing better medical management of HF. Read More

Int J Mol Sci 2022 Jun 7;23(12). Epub 2022 Jun 7.

Silvio Borrelli Unit, Nephrology Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli" Piazza Miraglia, 80138 Naples, Italy.

Increasing potassium intake ameliorates blood pressure (BP) and cardiovascular (CV) prognoses in the general population; therefore the World Health Organization recommends a high-potassium diet (90-120 mEq/day). Hyperkalaemia is a rare condition in healthy individuals due to the ability of the kidneys to effectively excrete dietary potassium load in urine, while an increase in serum K is prevalent in patients with chronic kidney disease (CKD). Hyperkalaemia prevalence increases in more advanced CKD stages, and is associated with a poor prognosis. Read More

Cardiol Ther 2022 Jun 23. Epub 2022 Jun 23.

Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.

Overactivation of the renin-angiotensin-aldosterone system (RAAS) has been shown to be pathologic in heart failure and albuminuric chronic kidney disease (CKD), triggering pro-inflammatory and pro-fibrotic cellular pathways. The standard of care in these disease states includes treatment with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers. Mineralocorticoid receptor antagonists (MRAs) are also a mainstay in the treatment of heart failure with reduced ejection fraction; however, therapy is often limited by treatment-related hyperkalemia. Read More

ESC Heart Fail 2022 Jun 23. Epub 2022 Jun 23.

Montreal Heart Institute, Montreal, Canada.

Aims: The Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity (CHARM) programme consisted of three parallel, randomized, double-blind clinical trials comparing candesartan with placebo in patients with heart failure (HF) categorized according to left ventricular ejection fraction and tolerability to an angiotensin-converting enzyme inhibitor. We conducted a pharmacogenomic study of the CHARM trials with the objective of identifying genetic predictors of HF progression and of the efficacy and safety of treatment with candesartan.

Methods: We performed genome-wide association studies in 2727 patients of European ancestry from CHARM-Overall and stratified by CHARM study according to preserved and reduced ejection fraction and according to assignment to the interventional treatment with candesartan. Read More

Ned Tijdschr Geneeskd 2022 Jun 20;166. Epub 2022 Jun 20.

LUMC, afd. Interne Geneeskunde, Leiden.

Background: Hyperkalemia is an electrolyte disorder requiring medical attention because it can cause cardiac arrhythmias. Pseudohyperkalemia is the phenomenon of an elevated potassium concentration that is present in the blood sample but not in the patient. Pseudohyperkalemia can be caused by hemolysis, leukocytosis, thrombocytosis, seasonal pseudohyperkalemia, potassium release from muscle cells due to fist clenching during venipuncture, and contamination due to blood withdrawal from an intravenous line over which potassium was administered. Read More

Ned Tijdschr Geneeskd 2022 Jun 20;166. Epub 2022 Jun 20.

LUMC, Leiden. Afd. Interne Geneeskunde.

Background: The cause of hyperkalemia is frequently iatrogenic. Patient's prescriptions should therefore be checked in the analysis of the hyperkalemia. Low-molecular-weight heparin is not often suspected to cause this. Read More

Ned Tijdschr Geneeskd 2022 Jun 21;166. Epub 2022 Jun 21.

Amphia, afd. Interne Geneeskunde, Breda.

Background: Hyperkalemia is a common yet dangerous phenomenon in patients with chronic kidney disease (CKD). Patients suffering from CKD are therefore often treated with potassium-binding supplements such as calcium polystyrene sulfonate (CPS). Hypercalcemia is a known side effect of CPS. Read More

Ann Med Surg (Lond) 2022 Jun 19;78:103747. Epub 2022 May 19.

Department of Anaesthesia, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia.

Background: Hypoxemia is one of the feared critical events intraoperatively and postoperatively. Undetected postoperative oxygen hypoxemia may lead to pulmonary hypertension, hyperkalemia, respiratory and cardiac failure even brain ischemia, and lastly, it may end up with multiorgan failure. The main purpose of this study was to determine the incidence and associated factors for postoperative hypoxemia among elective surgical patients received anesthesia in Dessie Comprehensive Specialized Hospital. Read More

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2022 May;34(5):492-496

Department of Critical Care Medicine, Xinjiang People's Hospital, Urumqi 830001, Xinjiang Uygur Autonomous Region, China. Corresponding author: Hu Rui, Email:

Objective: To analyze the treatment process of a renal transplant patient infected with coronavirus disease 2019 (COVID-19), and discuss the management strategy for the immunocompromised hosts.

Methods: The diagnosis and treatment of a case of transplant patients with COVID-19 admitted to Horgos designated hospital of Xinjiang Uygur Autonomous Region in October 2021 were reviewed. The medical history and laboratory and imaging examination treatment and outcome of this case were analyzed. Read More

Curr Opin Nephrol Hypertens 2022 Jul;31(4):374-379

Division of Nephrology, Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, USA.

Purpose Of Review: The aim of this study was to present recent developments in pharmacotherapy of hypertension in patients with advanced chronic kidney disease (CKD).

Recent Findings: In the AMBER trial, compared with placebo, the potassium-binder patiromer mitigated the risk of hyperkalaemia and enabled more patients with uncontrolled resistant hypertension and stage 3b/4 CKD to tolerate and continue spironolactone treatment; add-on therapy with spironolactone provoked a clinically meaningful reduction of 11-12 mmHg in unattended automated office SBP over 12 weeks of follow-up. In the BLOCK-CKD trial, the investigational nonsteroidal mineralocorticoid-receptor-antagonist (MRA) KBP-5074 lowered office SBP by 7-10 mmHg relative to placebo at 84 days with a minimal risk of hyperkalaemia in patients with advanced CKD and uncontrolled hypertension. Read More

Hypertens Res 2022 Jun 20. Epub 2022 Jun 20.

Department of Internal Medicine, Division of Nephrology and Hypertension, International University of Health and Welfare School of Medicine, Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo, 108-8329, Japan.

Diabetes mellitus is the main cause of chronic kidney disease (CKD) in Japan and worldwide. Although angiotensin-converting enzyme (ACE) inhibitors and angiotensin II type 1 receptor blockers (ARBs) are basic drugs for the treatment of CKD with diabetes (diabetic kidney disease, DKD) with albuminuria and/or proteinuria, it has also become clear that the use of an ACE inhibitor or ARB alone is not fully sufficient. We have previously reported the clinical effects of mineralocorticoid receptor (MR) antagonists and recommended their use in addition to renin-angiotensin system inhibitors. Read More

Kidney360 2022 Apr 25;3(4):636-646. Epub 2022 Jan 25.

Division of Nephrology, Georgetown University/Medstar Washington Hospital Center, Washington, DC.

Background: Mortality of patients who are critically ill with AKI initiated on RRT is very high. Identifying modifiable and unmodifiable clinical variables at dialysis start that are associated with hospital survival can help, not only in prognostication, but also in clinical triaging.

Methods: A retrospective observational study was conducted on patients with AKI-D who were initiated on RRT in the medical and surgical intensive care units (ICUs) of a high-acuity academic medical center from January 2010 through December 2015. Read More

Kidney360 2022 Apr 9;3(4):615-626. Epub 2022 Feb 9.

Nova Scotia Health, Halifax, Canada.

Background: Hyperkalemia is common among patients on maintenance hemodialysis (HD) and is associated with mortality. We hypothesized that clinical characteristics available at time of paramedic assessment before emergency department (ED) ambulance transport (ambulance-ED) would associate with severe hyperkalemia (K≥6 mmol/L). Rapid identification of patients who are at risk for hyperkalemia and thereby hyperkalemia-associated complications may allow paramedics to intervene in a timely fashion, including directing emergency transport to dialysis-capable facilities. Read More

Kidney360 2022 Apr 3;3(4):608-614. Epub 2022 Feb 3.

Department of Medicine, Division of Hematology & Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Background: People with sickle cell disease (SCD) have an elevated estimated glomerular filtration rate (eGFR) compared with the general population, and this may alter the usual creatinine-based eGFR cutoffs for which physiologic evidence of kidney dysfunction is apparent. This study aimed to identify eGFR thresholds for hyperkalemia and metabolic acidosis in patients with SCD.

Methods: This was a cross-sectional analysis of 733 patients with severe (hemoglobin SS or S -thalassemia) SCD genotype, 238 patients with moderate (hemoglobin SC or S -thalassemia) SCD genotype, and 1333 age- and sex-matched African Americans from the National Health and Nutrition Examination Survey (NHANES). Read More

Eur Heart J 2022 Jun 17. Epub 2022 Jun 17.

Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, ON, Canada.

Despite existing treatments, patients with heart failure and chronic kidney disease (CKD) remain at high risk for adverse outcomes and progression to end-stage disease. Steroidal mineralocorticoid receptor antagonists (MRAs) such as spironolactone and eplerenone reduce mortality but remain under-prescribed due to the perceived risk of hyperkalaemia and hormonal side effects. The discovery of non-steroidal MRAs represents a major new dimension in cardiorenal disease therapy. Read More

Diabetes Obes Metab 2022 Jun 16. Epub 2022 Jun 16.

Department of Endocrinology and Metabolism, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, Liaoning Province, P.R.China.

Background: This study aimed to compare the efficacy of sodium-glucose cotransporter 2 (SGLT-2) inhibitors, non-steroidal mineralocorticoid receptor antagonist (MRA), selective aldosterone antagonist, and non-selective aldosterone antagonist on top of renin-angiotensin system (RAS) blockade in reducing kidney-specific composite events, cardiovascular outcomes, and other events of special interest in participants with type 2 diabetes (T2D) and chronic kidney disease (CKD).

Methods: PubMed, EMBASE, and CENTRAL were searched for studies published up to January 20, 2022. Randomized clinical trials enrolling participants with T2D and CKD were included, for which SGLT-2 inhibitors, non-steroidal MRA, selective aldosterone antagonist, and non-selsective aldosterone antagonists were compared with either each other, or placebo or no treatment. Read More

J Clin Nurs 2022 Jun 16. Epub 2022 Jun 16.

Department of Physiological Nursing, School of Nursing, UCSF, San Francisco, California, USA.

Aims And Objectives: This study examined the occurrence rate of specific types of premature ventricular complex (PVC) alarms and whether patient demographic and/or clinical characteristics were associated with PVC occurrences.

Background: Because PVCs can signal myocardial irritability, in-hospital electrocardiographic (ECG) monitors are typically configured to alert nurses when they occur. However, PVC alarms are common and can contribute to alarm fatigue. Read More

Curr Heart Fail Rep 2022 Jun 15. Epub 2022 Jun 15.

Institute of Medical and Biomedical Education, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.

Purpose Of Review: Heart failure (HF), in conjunction with common comorbidities such as chronic kidney disease and diabetes and medical therapies such as RAASi, predisposes to hyperkalaemia which may lead to hospitalisation and death. This paper aims to review the most current evidence surrounding the risks and management of hyperkalaemia in HF, with particular focus on recent research into RAASi including novel selective mineralocorticoid receptor blockers and novel potassium binders.

Recent Findings: The most recent evidence shows that even moderate hyperkalaemia may predispose to adverse outcomes such as hospitalisation and death. Read More

J Hypertens 2022 Jun;40(6):1239-1242

Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China.

Pseudohypoaldosteronism type II (PHA II) is a rare inherited disease characterized by hypertension, hyperkalemia and metabolic acidosis. With the development of gene sequencing technology, more genetic mutations underlying PHA II were reported and the understanding of its pathogenesis has gone deep into the molecular level. Here, we present a juvenile case of PHA II. Read More

Am J Transl Res 2022 15;14(5):3439-3447. Epub 2022 May 15.

Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400016, P. R. China.

To observe the effects and safety of Sacubitril/Valsartan (SV) on heart function and blood pressure in maintenance hemodialysis (MHD) patients with chronic heart failure (CHF). The clinical data and biochemical parameters of MHD patients were retrospectively analyzed. These MHD patients, who were collected from January 2020 to June 2021 in the Blood Purification Center of the First Affiliated Hospital of Chongqing Medical University, received SV treatment to control heart failure (HF). Read More