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hyperkalemia guidelines

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https://www.readbyqxmd.com/read/29180023/effect-of-patiromer-on-hyperkalemia-recurrence-in-older-chronic-kidney-disease-patients-on-renin-angiotensin-aldosterone-system-inhibitors
#1
Matthew R Weir, David A Bushinsky, Wade W Benton, Steven D Woods, Martha R Mayo, Susan P Arthur, Bertram Pitt, George L Bakris
BACKGROUND: Older people are predisposed to hyperkalemia because of impaired renal function, comorbid conditions, and polypharmacy. Renin-angiotensin-aldosterone system inhibitors (RAASi), guideline-recommended for the treatment of chronic kidney disease and heart failure, further augment the risk. Patiromer, a nonabsorbed potassium binder, was shown in a phase 3 study (OPAL-HK) to decrease serum potassium in patients with chronic kidney disease on RAASi. We studied the efficacy and safety of patiromer in a prespecified subgroup of patients aged ≥65 years from OPAL-HK...
November 24, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/29174200/group-2-adrenal-insufficiency-screening-methods-and-confirmation-of-diagnosis
#2
Philippe Chanson, Laurence Guignat, Bernard Goichot, Olivier Chabre, Dinane Samara Boustani, Rachel Reynaud, Dominique Simon, Antoine Tabarin, Damien Gruson, Yves Reznik, Marie-Laure Raffin Sanson
A diagnosis of adrenal insufficiency should be suspected in the presence of a number of non-specific symptoms (fatigue, anorexia, weight loss, hypotension, hyponatremia and hyperkalemia amongst adrenal causes of insufficiency). The diagnosis should be considered in case of pituitary disease or a state of shock. Treatment should be commenced immediately without waiting for confirmation from biochemical tests, which rely on cortisol level at 8am (expected to be low) and on ACTH level (expected to be high in the case of primary adrenal insufficiency)...
November 22, 2017: Annales D'endocrinologie
https://www.readbyqxmd.com/read/28978211/managing-hyperkalemia-in-high-risk-patients-in-long-term-care
#3
Rajeev Kumar, Leo Kanev, Steven D Woods, Melanie Brenner, Bernie Smith
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...
February 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28844335/sacubitril-valsartan-an-important-piece-in-the-therapeutic-puzzle-of-heart-failure
#4
REVIEW
Pedro Marques da Silva, Carlos Aguiar
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...
September 2017: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
https://www.readbyqxmd.com/read/28794651/hypertension-in-pediatric-patients-with-chronic-kidney-disease-management-challenges
#5
REVIEW
Claire M Gallibois, Natasha A Jawa, Damien G Noone
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...
2017: International Journal of Nephrology and Renovascular Disease
https://www.readbyqxmd.com/read/28724651/hyperkalemia-after-initiating-renin-angiotensin-system-blockade-the-stockholm-creatinine-measurements-scream-project
#6
Ghassan Bandak, Yingying Sang, Alessandro Gasparini, Alex R Chang, Shoshana H Ballew, Marie Evans, Johan Arnlov, Lars H Lund, Lesley A Inker, Josef Coresh, Juan-Jesus Carrero, Morgan E Grams
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...
July 19, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28717776/a-retrospective-study-of-emergency-department-potassium-disturbances-severity-treatment-and-outcomes
#7
Adam J Singer, Henry C Thode, W Frank Peacock
OBJECTIVE: Disturbances in potassium (K) levels are relatively common and may be associated with significant morbidity and mortality; however, treatments vary. Our purpose was to determine the incidence, treatments, and outcomes associated with hyperkalemia and hypokalemia in emergency department (ED) patients. METHODS: We performed a structured, retrospective review of electronic medical records of consecutive adult ED patients with K measured while in the ED. Demographic, clinical, and laboratory data as well as treatments, disposition, and in-hospital complications were collected...
June 2017: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/28707341/impact-of-hyperkalemia-and-worsening-renal-function-on-the-use-of-renin-angiotensin-aldosterone-system-inhibitors-in-chronic-heart-failure-with-reduced-ejection-fraction
#8
B Pitt, P Rossignol
Patients with heart failure (HF) and reduced ejection fraction (HFREF) are at increased risk of death and hospitalizations for HF. Numerous registries have reported a large and persistent gap between real-life practice in the use of life-saving evidence-based therapies, such as renin angiotensin system inhibitors, beta blockers, mineralocorticoid receptor antagonists (MRAs), and recommended practices in international guidelines. The fears of inducing hyperkalemia and/or worsening renal function are the main triggers of this underuse...
September 2017: Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28497085/evaluation-of-water-and-electrolytes-disorders-in-severe-acute-diarrhea-patients-treated-by-who-protocol-in-eight-large-hospitals-in-tehran-a-nephrology-viewpoint
#9
Alireza Soleimani, Fatemeh Foroozanfard, Mohammad Reza Tamadon
Introduction: The most common cause of death from diarrhea is the shock caused by dehydration, electrolytes and acid-base disorders. Objectives: The aim of this study was to evaluate water and electrolytes disorders in diarrhea patients after treating severe acute diarrhea. Patients and Methods: In this study we used a historical cohort and studied patients who were hospitalized due to acute diarrhea and were similarly treated for dehydration and water and electrolyte disorders as recommended by the World Health Organization (WHO) guideline...
2017: Journal of Renal Injury Prevention
https://www.readbyqxmd.com/read/28485203/expert-panel-recommendations-for-the-identification-and-management-of-hyperkalemia-and-role-of-patiromer-in-patients-with-chronic-kidney-disease-and-heart-failure
#10
Zubaid Rafique, Matthew R Weir, Macaulay Onuigbo, Bertram Pitt, Richard Lafayette, Javed Butler, Maria Lopes, Carolyn Farnum, W Frank Peacock
Virtual panel meetings were conducted among 7 physicians, all of whom are independent experts, including 3 nephrologists, 2 cardiologists, and 2 emergency medicine physicians (the panel). The panel met with the purpose of discussing the current treatment landscape, treatment challenges, economic impact, and gaps in care for patients with hyperkalemia that is associated with heart failure and chronic kidney disease. The stated goal of the panel discussion was to develop practical solutions in the identification and management of hyperkalemia in this patient population...
April 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28395912/dobutamine-stress-echocardiography-impact-of-abnormal-blood-potassium-levels-on-cardiac-arrhythmias
#11
Jared G Bird, Robert B McCully, Patricia A Pellikka, Garvan C Kane
BACKGROUND: Guidelines suggest that an abnormal blood potassium level is a relative contraindication to performing dobutamine stress echocardiography (DSE). However, this has not been previously studied. METHODS: We reviewed a consecutive series of patients who had potassium testing within 48 hours of undergoing DSE for the evaluation of myocardial ischemia over a 10-year period (N = 13,198). Normal potassium range in our laboratory is 3.6-5.2 mmol/L. Hemolyzed samples were not included...
June 2017: Journal of the American Society of Echocardiography
https://www.readbyqxmd.com/read/28290795/-a-breakthrough-in-the-treatment-of-patients-with-heart-failure-with-reduced-ejection-fraction-the-clinical-significance-of-the-paradigm-hf-trial
#12
Zh D Kobalava, S V Villevalde, O I Lukina
The implementation into clinical practice of new therapeutic strategies that could improve the prognosis of patients with heart failure (HF) with reduced ejection fraction (HFrEF) remains relevant. Innovative approach is to restore imbalances of neurohumoral systems by inhibiting angiotensin II receptor and neprilysin. The review presents the role of the natriuretic peptides system in the HFrEF pathophysiology, historical approaches to neurohormonal modulation, clinical pharmacology of the first in the class of angiotensin receptor and neprilysin inhibitor sakubitril/valsartan...
February 2017: Kardiologiia
https://www.readbyqxmd.com/read/28073850/characterization-of-mineralocorticoid-receptor-antagonist-therapy-initiation-in-high-risk-patients-with-heart-failure
#13
Lauren B Cooper, Bradley G Hammill, Eric D Peterson, Bertram Pitt, Matthew L Maciejewski, Lesley H Curtis, Adrian F Hernandez
BACKGROUND: Heart failure guidelines recommend routine monitoring of serum potassium, and renal function in patients treated with a mineralocorticoid receptor antagonist (MRA). How these recommendations are implemented in high-risk patients or according to setting of drug initiation is poorly characterized. METHODS AND RESULTS: We conducted a retrospective cohort study of Medicare beneficiaries linked to laboratory data in 10 states with prevalent heart failure as of July 1, 2011, and incident MRA use between May 1 and September 30, 2011...
January 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28004291/sacubitril-valsartan-lcz696-in-heart-failure
#14
REVIEW
Yasser Khder, Victor Shi, John J V McMurray, Martin P Lefkowitz
It has been known since the 1990s that long-term morbidity and mortality is improved in patients with heart failure with reduced ejection fraction (HFrEF) by treatments that target the renin-angiotensin-aldosterone system (RAAS). It has also long been thought that enhancement of the activity of natriuretic peptides (NPs) could potentially benefit patients with HFrEF, but multiple attempts to realize this benefit had failed over the years - until 2014, when a large, phase III, randomized, controlled clinical trial (PARADIGM-HF) was completed comparing sacubitril/valsartan with enalapril, a well-established treatment for HFrEF...
2017: Handbook of Experimental Pharmacology
https://www.readbyqxmd.com/read/27857927/a-fatal-adverse-effect-of-barbiturate-coma-therapy-dyskalemia
#15
Hyun Mook Kwon, Jin Wook Baek, Sang Pyung Lee, Jae Ik Cho
The management guideline for traumatic brain injury (TBI) recommends high-dose barbiturate therapy to control increased intracranial pressure refractory to other therapeutic options. High-dose barbiturate therapy, however, may cause many severe side effects; the commonly recognized ones include hypotension, immunosuppression, hepatic dysfunction, renal dysfunction, and prolonged decrease of cortical activity. Meanwhile, dyskalemia remains relatively uncommon. In this study, we report the case of a hypokalemic patient with severe rebound hyperkalemia, which occurred as a result of barbiturate coma therapy administered for TBI treatment...
October 2016: Korean Journal of Neurotrauma
https://www.readbyqxmd.com/read/27754188/sp-05-1-should-the-target-for-blood-pressure-reduction-be-lower-in-adults-with-hypertension-and-a-history-of-cardiovascular-disease
#16
Paul Whelton
BACKGROUND: Choice of the optimal target for blood pressure (BP) reduction during treatment of patients with hypertension, including those with underlying co-morbid conditions, is an important challenge in clinical practice. The Systolic Blood Pressure Intervention Trial (SPRINT) was designed to provide guidance in selection of a Systolic BP target during treatment of hypertension. METHODS: Adults ≥50 years old with hypertension and at least one additional risk factor for cardiovascular disease (CVD), but excluding persons with diabetes mellitus, prior stroke, or advanced chronic kidney disease (CKD) were randomly assigned to intensive therapy (intensive), targeting a systolic BP (SBP) <120 mmHg, or standard therapy (standard), targeting a SBP <140 mmHg...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27693804/emergency-management-of-severe-hyperkalemia-guideline-for-best-practice-and-opportunities-for-the-future
#17
REVIEW
Patrick Rossignol, Matthieu Legrand, Mikhail Kosiborod, Steven M Hollenberg, W Frank Peacock, Michael Emmett, Murray Epstein, Csaba P Kovesdy, Mehmet Birhan Yilmaz, Wendy Gattis Stough, Etienne Gayat, Bertram Pitt, Faiez Zannad, Alexandre Mebazaa
Hyperkalemia is a common electrolyte disorder, especially in chronic kidney disease, diabetes mellitus, or heart failure. Hyperkalemia can lead to potentially fatal cardiac dysrhythmias, and it is associated with increased mortality. Determining whether emergency therapy is warranted is largely based on subjective clinical judgment. The Investigator Network Initiative Cardiovascular and Renal Clinical Trialists (INI-CRCT) aimed to evaluate the current knowledge pertaining to the emergency treatment of hyperkalemia...
November 2016: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
https://www.readbyqxmd.com/read/27502849/long-term-changes-of-renal-function-in-relation-to-ace-inhibitor-angiotensin-receptor-blocker-dosing-in-patients-with-heart-failure-and-chronic-kidney-disease
#18
Hanna Fröhlich, Christoph Nelges, Tobias Täger, Vedat Schwenger, Rita Cebola, Johannes Schnorbach, Kevin M Goode, Syed Kazmi, Hugo A Katus, John G F Cleland, Andrew L Clark, Lutz Frankenstein
BACKGROUND: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have become cornerstones of therapy for chronic heart failure (CHF). Guidelines advise high target doses for ACEIs/ARBs, but fear of worsening renal function may limit dose titration in patients with concomitant chronic kidney disease (CKD). METHODS: In this retrospective observational study, we identified 722 consecutive patients with systolic CHF, stable CKD stage III/IV (estimated glomerular filtration rate [eGFR] 15-60 mL min(-1) 1...
August 2016: American Heart Journal
https://www.readbyqxmd.com/read/27269276/lisinopril-induced-alopecia-a-case-report
#19
Vivek Kataria, Hueyyoung Wang, Joyce W Wald, Yvonne L Phan
The American College of Cardiology Foundation/American Heart Association (ACCF/AHA) guidelines consider angiotensin-converting enzyme (ACE) inhibitors as one of the mainstay therapies in the management of heart failure. The widespread use of ACE inhibitors has been associated with several notable adverse effects such as hyperkalemia and an increased serum creatinine. There are no previous reports of alopecia associated with lisinopril use; however, a few previous cases of alopecia associated with other ACE inhibitors exist...
June 6, 2016: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/27254901/heart-failure-with-reduced-ejection-fraction-hyperkalemia-and-worsening-renal-function-as-challenges-to-implementation-guidelines-vs-real-world
#20
Patrick Rossignol
No abstract text is available yet for this article.
April 2016: Nephrology News & Issues
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