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Kildegaard H, Brabrand M, Forberg JL, Platonov P, Lassen AT, Ekelund U. Prevalence and prognostic value of electrocardiographic abnormalities in hypokalemia: A multicenter cohort study. J Intern Med 2024; 295:544-556. [PMID: 38098171 DOI: 10.1111/joim.13757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2024]
Abstract
BACKGROUND Hypokalemia is common in hospitalized patients and associated with ECG abnormalities. The prevalence and prognostic value of ECG abnormalities in hypokalemic patients are, however, not well established. METHODS The study was a multicentered cohort study, including all ault patients with an ECG and potassium level <4.4 mmol/L recorded at arrival to four emergency departments in Denmark and Sweden. Using computerized measurements from ECGs, we investigated the relationship between potassium levels and heart rate, QRS duration, corrected QT (QTc) interval, ST-segment depressions, T-wave flattening, and T-wave inversion using cubic splines. Within strata of potassium levels, we further estimated the hazard ratio (HR) for 7-day mortality, admission to the intensive care unit (ICU), and diagnosis of ventricular arrhythmia or cardiac arrest, comparing patients with and without specific ECG abnormalities matched 1:2 on propensity scores. RESULTS Among 79,599 included patients, decreasing potassium levels were associated with a concentration-dependent increase in all investigated ECG variables. ECG abnormalities were present in 40% of hypokalemic patients ([K+ ] <3.5 mmol/L), with T-wave flattening, ST-segment depression, and QTc prolongation occurring in 27%, 16%, and 14%. In patients with mild hypokalemia ([K+ ] 3.0-3.4 mmol/L), a heart rate >100 bpm, ST-depressions, and T-wave inversion were associated with increased HRs for 7-day mortality and ICU admission, whereas only a heart rate >100 bpm predicted both mortality and ICU admission among patients with [K+ ] <3.0 mmol/L. HR estimates were, however, similar to those in eukalemic patients. The low number of events with ventricular arrhythmia limited evaluation for this outcome. CONCLUSIONS ECG abnormalities were common in hypokalemic patients, but they are poor prognostic markers for short-term adverse events under the current standard of care.
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Affiliation(s)
- Helene Kildegaard
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Mikkel Brabrand
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jakob Lundager Forberg
- Department of Emergency Medicine, Helsingborg Hospital, Helsingborg, Sweden
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Pyotr Platonov
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | - Annmarie Touborg Lassen
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ulf Ekelund
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Emergency Medicine at Lund, Skåne University Hospital, Lund, Sweden
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Gruber S, Stasi E, Pion AB, Steiner R, Erlic Z, Bornstein SR, Sudano I, Reincke M, Beuschlein F. Unawareness of Primary Aldosteronism as a Common Cause of Hypokalemia - Insights from the IPAHK+ Trial (Incidence of Primary Aldosteronism in Patients with Hypokalemia). Horm Metab Res 2024; 56:300-307. [PMID: 37924818 DOI: 10.1055/a-2204-3163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
Hypokalemia plays an important role in the diagnosis and management of primary aldosteronism (PA). While the hypokalemic variant of the disease accounts for about one third of all cases, little is known about the incidence of PA in hypokalemic populations. The IPAHK+ study is an epidemiological, cross-sectional trial to provide evidence on the incidence of PA in hypokalemic patients from a university hospital outpatient population. Recruitment of outpatients with hypokalemia≤3 mmol/l is carried out on a continuous referral-basis through an automated data delivery system. Up to an interim data closure, 66 patients underwent the study protocol. The mean age of the participants was 52.9±1.5 years with an equal sex ratio of 1:1 women to men, a mean potassium value of 2.78±0.31 mmol/l [1.8;3.0] and a prevalence of arterial hypertension of 72.7%. PA was diagnosed in 46.6% of all participants, all of whom had a history of hypertension. Incidence of PA increased continuously with decreasing potassium levels with proportions of 26.7%, 50% and 57.1% in the subgroups of 3.0 mmol/l (n=15), 2.8-2.9 mmol/l (n=22) and≤2.7 mmol/l (n=21), respectively. Prior to testing, 59.1% of all patients presented at least with one plausible other cause of hypokalemia. The incidence of PA in the investigated outpatient population was more than 4 out of 10 and inversely correlated with baseline potassium levels. Moderate or severe hypokalemia, regardless of its cause, should therefore prompt evaluation for PA in hypertensive individuals. Normotensive hypokalemic PA was not observed in this cohort.
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Affiliation(s)
- Sven Gruber
- Department for Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
| | - Evangelia Stasi
- Department for Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
| | - Antonio Boan Pion
- Department for Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
| | - Regula Steiner
- Institute for Clinical Chemistry, University Hospital Zurich, Zurich, Switzerland
| | - Zoran Erlic
- Department for Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
| | - Stefan R Bornstein
- Department for Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
- Department of Medicine, Carl Gustav Carus, University of Dresden, Dresden, Germany
| | - Isabella Sudano
- University Heart Center, Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Martin Reincke
- Medizinische Klinik Innenstadt, Klinikum der Universität München, München, Germany
| | - Felix Beuschlein
- Department for Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
- Medizinische Klinik Innenstadt, Klinikum der Universität München, München, Germany
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Koneshamoorthy A, Epa DS, O'Neal DN, Lee MH, Santamaria JD, MacIsaac RJ. Outcomes associated with a variable rate insulin infusion diabetic ketoacidosis protocol. J Diabetes Complications 2024; 38:108702. [PMID: 38387103 DOI: 10.1016/j.jdiacomp.2024.108702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/30/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024]
Abstract
AIMS To relate adverse events with glucose correction rates in diabetic ketoacidosis (DKA) using variable rate intravenous insulin-infusions (VRIII). METHODS Retrospective, observational study in adults with DKA who received insulin infusions between 2012 and 2017 at St Vincent's Hospital, Melbourne. Early correction of hyperglycaemia (<10 mmol/L) was evaluated for association with hypoglycaemia (<4.0 mmol/L), hypokalaemia (potassium <3.3 mmol/L) and clinical outcomes via regression analysis. RESULTS The study involved 97 patients, with 93 % having type 1 diabetes. The mean age was 38 years, 47 % were women and 35 % were admitted to intensive care. Hypoglycaemia rates during 12 and 24 h of treatment were 6.2 % and 8.2 %, respectively with 58 % of patients recording their first BGL <10 mmol/L within 12 h and 88 % within 24 h. Ketone clearance time averaged at 15.6 h. Hyperglycaemia correction rates to <10 mmol/L were not different in those with/without hypoglycaemia at 12/24 h, in multivariate analysis including admission BGL. Hypokalaemia occurred in 40.2 % of patients and was associated with lower pH but not BGL correction rates. CONCLUSION The VRIII protocol achieved early hyperglycaemia correction and ketoacidosis reversal with low hypoglycaemia risk. However, high hypokalaemia rates suggest the need for aggressive potassium replacement, especially in markedly acidotic patients.
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Affiliation(s)
- Anojian Koneshamoorthy
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria 3065, Australia.
| | - Dilan Seneviratne Epa
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria 3065, Australia
| | - David N O'Neal
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria 3065, Australia; University of Melbourne, Department of Medicine, Fitzroy, Victoria 3065, Australia; Australian Centre for Accelerating Diabetes Innovations, University of Melbourne, Parkville, Victoria 3052, Australia
| | - Melissa H Lee
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria 3065, Australia
| | - John D Santamaria
- University of Melbourne, Department of Medicine, Fitzroy, Victoria 3065, Australia; Department of Critical Care Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria 3065, Australia
| | - Richard J MacIsaac
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria 3065, Australia; University of Melbourne, Department of Medicine, Fitzroy, Victoria 3065, Australia; Australian Centre for Accelerating Diabetes Innovations, University of Melbourne, Parkville, Victoria 3052, Australia
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Wu MZ, Teng THK, Tsang CTW, Chan YH, Lee CH, Ren QW, Huang JY, Cheang IF, Tse YK, Li XL, Xu X, Tse HF, Lam CSP, Yiu KH. Risk of hyperkalaemia in patients with type 2 diabetes mellitus prescribed with SGLT2 versus DPP-4 inhibitors. Eur Heart J Cardiovasc Pharmacother 2024; 10:45-52. [PMID: 37942588 DOI: 10.1093/ehjcvp/pvad081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/17/2023] [Accepted: 11/03/2023] [Indexed: 11/10/2023]
Abstract
AIMS To investigate the risk of hyperkalaemia in new users of sodium-glucose cotransporter 2 (SGLT2) inhibitors vs. dipeptidyl peptidase-4 (DPP-4) inhibitors among patients with type 2 diabetes mellitus (T2DM). METHODS AND RESULTS Patients with T2DM who commenced treatment with an SGLT2 or a DPP-4 inhibitor between 2015 and 2019 were collected. A multivariable Cox proportional hazards analysis was applied to compare the risk of central laboratory-determined severe hyperkalaemia, hyperkalaemia, hypokalaemia (serum potassium ≥6.0, ≥5.5, and <3.5 mmol/L, respectively), and initiation of a potassium binder in patients newly prescribed an SGLT2 or a DPP-4 inhibitor. A total of 28 599 patients (mean age 60 ± 11 years, 60.9% male) were included after 1:2 propensity score matching, of whom 10 586 were new users of SGLT2 inhibitors and 18 013 of DPP-4 inhibitors. During a 2-year follow-up, severe hyperkalaemia developed in 122 SGLT2 inhibitor users and 325 DPP-4 inhibitor users. Use of SGLT2 inhibitors was associated with a 29% reduction in incident severe hyperkalaemia [hazard ratio (HR) 0.71, 95% confidence interval (CI) 0.58-0.88] compared with DPP-4 inhibitors. Risk of hyperkalaemia (HR 0.81, 95% CI 0.71-0.92) and prescription of a potassium binder (HR 0.74, 95% CI 0.67-0.82) were likewise decreased with SGLT2 inhibitors compared with DPP-4 inhibitors. Occurrence of incident hypokalaemia was nonetheless similar between those prescribed an SGLT2 inhibitor and those prescribed a DPP-4 inhibitor (HR 0.90, 95% CI 0.81-1.01). CONCLUSION Our study provides real-world evidence that compared with DPP-4 inhibitors, SGLT2 inhibitors were associated with lower risk of hyperkalaemia and did not increase the incidence of hypokalaemia in patients with T2DM.
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Affiliation(s)
- Mei-Zhen Wu
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, 518000, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
| | - Tiew-Hwa Katherine Teng
- National Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, 169609, Singapore
- Duke-NUS Medical School, Cardiovascular Sciences Academic Clinical Programme, Singapore, 169857, Singapore
- School of Allied Health, University of Western Australia, Perth, 6009, Australia
| | - Christopher Tze-Wei Tsang
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
| | - Yap-Hang Chan
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
| | - Chi-Ho Lee
- Division of Endocrinology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
| | - Qing-Wen Ren
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
| | - Jia-Yi Huang
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
| | - Iok-Fai Cheang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu, 210029, China
| | - Yi-Kei Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
| | - Xin-Li Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu, 210029, China
| | - Xin Xu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, 518000, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
| | - Carolyn S P Lam
- National Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, 169609, Singapore
- Duke-NUS Medical School, Cardiovascular Sciences Academic Clinical Programme, Singapore, 169857, Singapore
- Department of Cardiology, University Medical Center Groningen, Groningen, 9713, The Netherlands
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, 518000, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
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Pan P, Zhang Z, Zhang X, Jiang Q, Xu Z. Postoperative Prevalence and Risk Factors for Serum Hypokalemia in Patients with Primary Total Joint Arthroplasty. Orthop Surg 2024; 16:72-77. [PMID: 38014456 PMCID: PMC10782241 DOI: 10.1111/os.13922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE Regular monitoring of serum potassium after a total joint arthroplasty (TJA) is a form of routine examination that can help detect abnormal serum potassium levels and reduce the incidences of adverse events that may occur on account of postoperative hypokalemia. Previous studies rarely discussed hypokalemia after joint replacement. In the present study, our primary goal was to investigate the incidence and possible risk factors of hypokalemia after a total hip and knee replacement procedure was performed. METHODS This study included patients who underwent a unilateral total knee or hip arthroplasty in our department between April 2017 and March 2018. Serum potassium levels pre and post operation were collected and retrospectively analyzed. The differences in age, gender, body mass index (BMI), history of diseases, red blood cell (RBC), hemoglobin, hematocrit, glomerular filtration rate, ejection fraction, blood glucose, urine creatinine, urea nitrogen, intraoperative blood loss, operation time, drainage, preoperative potassium, surgery type, were compared between those patients diagnosed with hypokalemia and their non-hypokalemia at different times post surgery. Thereafter, the risk factors of postoperative hypokalemia patients were analyzed using statistical procedure multiple logistic regression model. RESULTS The risk of hypokalemia after TJA was 53.1%, while, that on the first, third, and fifth day after operation was 12.5%, 40.7%, and 9.6% respectively. The serum potassium level on the first, third, and fifth postoperative days was 3.84 ± 0.32, 3.59 ± 0.34, and 3.80 ± 0.32 mmol/l, respectively. However, the level on the third day appeared to be the lowest (p = 0.015) of them all. The independent risk factors for hypokalemia after a total hip and knee replacement were the level of preoperative serum potassium concentration (p = 0.011), preoperative red blood cells counts (p = 0.027), and history of diabetes (p = 0.007). CONCLUSION Regular monitoring of serum potassium concentration should be performed post TJA. We need to pay more attention to the patient's preoperative potassium levels along with their red blood cell counts especially in patients diagnosed with type 2 diabetes mellitus.
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Affiliation(s)
- Pin Pan
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingPeople's Republic of China
- Department of orthopedics, The Second People's Hospital of HefeiHefei Hospital Affiliated to Anhui Medical UniversityHefeiChina
| | - Zitao Zhang
- Department of Orthopedics, Drum Tower Hospital, School of MedicineNanjing UniversityNanjing210008People's Republic of China
| | - Xiaofeng Zhang
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingPeople's Republic of China
- State Key Laboratory of Pharmaceutical BiotechnologyNanjing UniversityNanjingPeople's Republic of China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and RehabilitationPeople's Republic of China
| | - Qing Jiang
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingPeople's Republic of China
- State Key Laboratory of Pharmaceutical BiotechnologyNanjing UniversityNanjingPeople's Republic of China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and RehabilitationPeople's Republic of China
| | - Zhihong Xu
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingPeople's Republic of China
- State Key Laboratory of Pharmaceutical BiotechnologyNanjing UniversityNanjingPeople's Republic of China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and RehabilitationPeople's Republic of China
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Jønsson SS, Sørensen SA, Krøgh ST, Melgaard D, Søgaard P, Søndergaard MM, Leutscher P, Kragholm K, Aldahl M, Torp-Pedersen C, Krogager ML. Short-term prognosis of changes in plasma potassium following an episode of hyperkalaemia in patients with chronic heart failure. Eur J Intern Med 2023; 118:82-88. [PMID: 37517938 DOI: 10.1016/j.ejim.2023.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND/AIM There is an increasing prevalence of chronic heart failure (HF). It is well known that patients with HF and disturbances in the potassium level have an increased mortality risk. The aim of this study was to investigate the prognosis of a second plasma-potassium measurement after an episode with hyperkalaemia on short-term mortality in patients with chronic HF. METHODS AND RESULTS From Danish national registers, 2,339 patients with chronic HF and hyperkalaemia (>4.6 mmol/L) at first potassium measurement within 14-365 days from concomitant treatment were identified. To be included, a second measurement was required within 6-30 days subsequent to the first measurement and the 60-day mortality was observed. Based on the second measurement, the patients were divided into five groups: <3.5 mmol/L (n = 257), 3.5-4.0 mmol/L (n = 709), 4.1-4.6 mmol/L (n = 1,204, reference), 4.7-5.0 mmol/L (n = 89) and >5.0 mmol/L (n = 80). To assess all-cause and cardiovascular mortality, we used the Cox regression model. The multivariable analysis showed that patients with potassium concentrations <3.5 mmol/L (hazard ratio (HR): 3.03; 95% CI: 2.49-3.70) and 3.5-4.0 mmol/L (HR: 1.81; 95% CI: 1.54-2.14) had a worse prognosis compared to the reference. We observed similar results when calculating the risk of cardiovascular mortality. A restricted cubic spline curve showed a U-shaped relationship between plasma-potassium and all-cause mortality. CONCLUSION Patients with chronic HF and hyperkalaemia who became hypokalaemic after 6-30 days were associated with a higher 60-day all-cause and cardiovascular mortality compared to the reference. This also applied for patients with low normal potassium concentrations (3.5-4.0 mmol/L).
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Affiliation(s)
- Sofie Solhøj Jønsson
- Department of Health, Science, and Technology, Aalborg University, Aalborg, Denmark; Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark.
| | - Sofie Amalie Sørensen
- Department of Health, Science, and Technology, Aalborg University, Aalborg, Denmark; Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Sidse Thim Krøgh
- Department of Health, Science, and Technology, Aalborg University, Aalborg, Denmark; Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Dorte Melgaard
- North Denmark Regional Hospital, Hjoerring, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Peter Leutscher
- Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark; North Denmark Regional Hospital, Hjoerring, Denmark
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Mette Aldahl
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjaellands Hospital, Hillerød, Denmark; Department of Public Health, University of Copenhagen, Denmark
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Wu Y, Wu Z, Rao J, Hu H, Chen Z, Hu C, Peng Q, Li P. Sex modifies the predictive value of computed tomography combined with serum potassium for primary aldosteronism subtype diagnosis. Front Endocrinol (Lausanne) 2023; 14:1266961. [PMID: 38034006 PMCID: PMC10687468 DOI: 10.3389/fendo.2023.1266961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Objective We aimed to investigate the predictive value of the CT findings combined with serum potassium levels for primary aldosteronism (PA) subtype diagnosis, with a particular interest in sex differences. Methods In this retrospective study, we eventually included 482 PA patients who underwent successful adrenal venous sampling (AVS) and had available data. We diagnosed the subjects as having either unilateral (n = 289) or bilateral PA (n = 193) based on AVS. We analyzed the concordance rate between AVS and adrenal CT combined with serum potassium and performed a logistic regression analysis to assess the prevalence of unilateral PA on AVS. Results The total diagnostic concordance rate between CT findings and AVS was 51.5% (248/482). The prevalence of hypokalemia in men and women was 47.96% (129/269) and 40.85% (87/213), respectively. The occurrence of unilateral lesions on CT and hypokalemia was significantly associated with an increased prevalence of unilateral PA [odds ratio (OR) 1.537; 95% confidence interval (CI) 1.364-1.731; p < 0.001]. In male participants, G2 (bilateral lesion on CT and normokalemia), G3 (unilateral lesion on CT and normokalemia), G4 (bilateral normal on CT and hypokalemia), G5 (bilateral lesion on CT and hypokalemia), and G6 (unilateral lesion on CT and hypokalemia) were significantly increased for the prevalence of unilateral PA on AVS (G2: OR 4.620, 95% CI 1.408-15.153; G3: OR 6.275, 95% CI 2.490-15.814; G4: OR 3.793, 95% CI 1.191-12.082; G5: OR 16.476, 95% CI 4.531-59.905; G6: OR 20.101, 95% CI 7.481-54.009; all p < 0.05), compared with G1 (patients with bilateral normal on CT and normokalemia). However, among female participants, we found an increased likelihood for unilateral PA in patients with unilateral lesions on CT and hypokalemia alone (OR 10.266, 95% CI 3.602-29.259, p < 0.001), while no associations were found in other groups (all p > 0.05). Sex had a significant effect on modifying the relationship between unilateral PA and the combination of CT findings and serum potassium (p for interaction <0.001). Conclusion In conclusion, our results indicated that CT findings combined with serum potassium levels have a great value for predicting the subtype of PA and are stronger in men.
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Affiliation(s)
| | | | | | | | | | | | | | - Ping Li
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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de Rooij ENM, de Fijter JW, Le Cessie S, Hoorn EJ, Jager KJ, Chesnaye NC, Evans M, Windahl K, Caskey FJ, Torino C, Szymczak M, Drechsler C, Wanner C, Dekker FW, Hoogeveen EK. Serum Potassium and Risk of Death or Kidney Replacement Therapy in Older People With CKD Stages 4-5: Eight-Year Follow-up. Am J Kidney Dis 2023; 82:257-266.e1. [PMID: 37182596 DOI: 10.1053/j.ajkd.2023.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/02/2023] [Indexed: 05/16/2023]
Abstract
RATIONALE & OBJECTIVE Hypokalemia may accelerate kidney function decline. Both hypo- and hyperkalemia can cause sudden cardiac death. However, little is known about the relationship between serum potassium and death or the occurrence of kidney failure requiring replacement therapy (KRT). We investigated this relationship in older people with chronic kidney disease (CKD) stage 4-5. STUDY DESIGN Prospective observational cohort study. SETTING & PARTICIPANTS We followed 1,714 patients (≥65 years old) from the European Quality (EQUAL) study for 8 years from their first estimated glomerular filtration rate (eGFR)<20mL/min/1.73m2 measurement. EXPOSURE Serum potassium was measured every 3 to 6 months and categorized as≤3.5,>3.5-≤4.0,>4.0-≤4.5,>4.5-≤5.0 (reference),>5.0-≤5.5, >5.5-≤6.0, and>6.0mmol/L. OUTCOME The combined outcome death before KRT or start of KRT. ANALYTICAL APPROACH The association between categorical and continuous time-varying potassium and death or KRT start was examined using Cox proportional hazards and restricted cubic spline analyses, adjusted for age, sex, diabetes, cardiovascular disease, renin-angiotensin-aldosterone system (RAAS) inhibition, eGFR, and subjective global assessment (SGA). RESULTS At baseline, 66% of participants were men, 42% had diabetes, 47% cardiovascular disease, and 54% used RAAS inhibitors. Their mean age was 76±7 (SD) years, mean eGFR was 17±5 (SD) mL/min/1.73m2, and mean SGA was 6.0±1.0 (SD). Over 8 years, 414 (24%) died before starting KRT, and 595 (35%) started KRT. Adjusted hazard ratios for death or KRT according to the potassium categories were 1.6 (95% CI, 1.1-2.3), 1.4 (95% CI, 1.1-1.7), 1.1 (95% CI, 1.0-1.4), 1 (reference), 1.1 (95% CI, 0.9-1.4), 1.8 (95% CI, 1.4-2.3), and 2.2 (95% CI, 1.5-3.3). Hazard ratios were lowest at a potassium of about 4.9mmol/L. LIMITATIONS Shorter intervals between potassium measurements would have allowed for more precise estimations. CONCLUSIONS We observed a U-shaped relationship between serum potassium and death or KRT start among patients with incident CKD 4-5, with a nadir risk at a potassium level of 4.9mmol/L. These findings underscore the potential importance of preventing both high and low potassium in patients with CKD 4-5. PLAIN-LANGUAGE SUMMARY Abnormal potassium blood levels may increase the risk of death or kidney function decline, especially in older people with chronic kidney disease (CKD). We studied 1,714 patients aged≥65 years with advanced CKD from the European Quality (EQUAL) study and followed them for 8 years. We found that both low and high levels of potassium were associated with an increased risk of death or start of kidney replacement therapy, with the lowest risk observed at a potassium level of 4.9 mmol/L. In patients with CKD, the focus is often on preventing high blood potassium. However, this relatively high optimum potassium level stresses the potential importance of also preventing low potassium levels in older patients with advanced CKD.
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Affiliation(s)
- Esther N M de Rooij
- Department of Nephrology, Leiden University Medical Center, Leiden; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden.
| | | | - Saskia Le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden
| | - Ewout J Hoorn
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, Rotterdam
| | - Kitty J Jager
- European Renal Association (ERA) Registry, Amsterdam UMC, University of Amsterdam, Medical Informatics, Amsterdam; Amsterdam Public Health Research Institute, Quality of Care, Amsterdam
| | - Nicholas C Chesnaye
- European Renal Association (ERA) Registry, Amsterdam UMC, University of Amsterdam, Medical Informatics, Amsterdam; Amsterdam Public Health Research Institute, Quality of Care, Amsterdam
| | - Marie Evans
- Renal Unit, Department of Clinical Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Karin Windahl
- Renal Unit, Department of Clinical Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Fergus J Caskey
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Claudia Torino
- National Research Council, Institute of Clinical Physiology, Reggio Calabria, Italy
| | - Maciej Szymczak
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | | | - Christoph Wanner
- Division of Nephrology, University Hospital of Würzburg, Würzburg, Germany
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden
| | - Ellen K Hoogeveen
- Department of Nephrology, Leiden University Medical Center, Leiden; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden; Department of Nephrology, Jeroen Bosch Hospital, Den Bosch, the Netherlands
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Yang M, Li Q, Zhou Y, Zhu YQ, Cui YX, Chen Y, Zhou XK, He MF. Risk factors for hypokalemia and its association with postoperative recovery in patients scheduled for radical gastrectomy: a retrospective study. BMC Anesthesiol 2023; 23:285. [PMID: 37608299 PMCID: PMC10463583 DOI: 10.1186/s12871-023-02246-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/16/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Hypokalemia is common in patients of various operations, especially gastrointestinal surgery, which seriously affects the safety and enhanced recovery after surgery. Our study aims to explore the risk factors of preoperative hypokalemia of radical gastrectomy for gastric cancer and analyze its impact on postoperative recovery. METHODS A total of 122 patients scheduled for radical gastrectomy from September, 2022 to December, 2022 were retrospectively analyzed. According to the serum potassium level before skin incision, patients were divided into hypokalemia group (n = 64) and normokalemia group (n = 58). Factors including age, gender, BMI, ASA classification, glutamic pyruvic transaminase (ALT), glutamic oxaloacetic transaminase (AST), creatinine, blood urea nitrogen (BUN), albumin, hypertension history, whether taking calcium channel blockers, β-receptor blockers, angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor antagonist (ARB), thiazide diuretics and other drugs, anemia history, diabetes mellitus history, inability to eat or intestinal obstruction, vomiting, diarrhea, hypokalemia on admission and whether under cooperation with clinical nurse specialist were compared between groups. Univariate logistic regression analysis was used to determine risk factors for hypokalemia with p < 0.2 included as a cutoff. Multivariate logistic regression was used to analyze the influencing factors of preoperative hypokalemia for the indicators with differences. A receiver operating characteristic (ROC) curve was used to evaluate the efficacy of the regression model. Primary exhaust time and defecation time after surgery were compared between the two groups. RESULTS The use of ACEI or ARB [OR 0.08, 95% CI (0.01 to 0.58), p = 0.012] and thiazide diuretics [OR 8.31, 95% CI (1.31 to 52.68), p = 0.025], inability to eat for more than 3 days or intestinal obstruction [OR 17.96, 95% CI (2.16 to 149.43), p = 0.008], diarrhea for more than 48 h [OR 6.21, 95% CI (1.18 to 32.61), p = 0.031] and hypokalemia on admission [OR 8.97, 95% CI (1.05 to 77.04), p = 0.046] were independent influencing factors of hypokalemia before skin incision. Primary postoperative exhaust time and defecation time was significantly longer in the hypokalemia group than in the normokalemia group, no matter after laparoscopic radical gastrectomy (p = 0.044, p = 0.045, respectively) or open radical gastrectomy (p = 0.033, p = 0.019, respectively). CONCLUSION Early attention and management of serum potassium in patients undergoing radical gastrectomy can better reduce perioperative adverse reactions and promote recovery of gastrointestinal function.
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Affiliation(s)
- Min Yang
- Department of Anesthesiology and Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing Jiangsu, Jiangsu, 210029, China
| | - Qian Li
- The First Clinical Medical College, Nanjing Medical University, Nanjing Jiangsu, 210006, China
| | - Yan Zhou
- Department of Anesthesiology and Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing Jiangsu, Jiangsu, 210029, China
| | - Yun-Qing Zhu
- The First Clinical Medical College, Nanjing Medical University, Nanjing Jiangsu, 210006, China
| | - Yu-Xuan Cui
- The First Clinical Medical College, Nanjing Medical University, Nanjing Jiangsu, 210006, China
| | - Yu Chen
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Guangzhou Road 300, Nanjing Jiangsu, 210029, China
| | - Xiao-Kai Zhou
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Guangzhou Road 300, Nanjing Jiangsu, 210029, China.
| | - Ming-Feng He
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Guangzhou Road 300, Nanjing Jiangsu, 210029, China.
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10
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Wang XD, Wang Y, Liu J, Yao JW, Zhang J, Zhang YN. Prognosis of Older Adult Patients Suffering from Atrial Fibrillation and Hypokalemia. Clin Interv Aging 2023; 18:1363-1371. [PMID: 37609041 PMCID: PMC10441655 DOI: 10.2147/cia.s422801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023] Open
Abstract
Objective To examine the effects of hypokalemia on the prognosis of older adult patients with atrial fibrillation (AF). Methods We enrolled 794 older adult patients ≥ 75 years suffering from AF, and divided them into two groups according to the inclusion and exclusion criteria: Group 1, (hypokalemia group), 246 cases, serum K+<3.5 mmol/L; Group 2, (normal blood potassium group), 548 cases, 3.5mmol/L≤serum K+<5.5 mmol/L. The two groups of patients were followed for 70 months to observe the occurrence of clinical events. The primary endpoint was cardiovascular death and the secondary endpoint was all-cause death. Results The median follow-up time was 15.00 months. In terms of baseline profile characteristics, serum creatinine levels were significantly lower in Group 1 than in Group 2 patients (P=0.002). In terms of the relationship between hypokalemia and clinical outcomes, Kaplan-Meier survival analysis revealed that the incidence of clinical primary endpoint in Group 1 was significantly higher than that in Group 2 (P < 0.001), and the incidence of the secondary endpoint did not differ significantly between the two groups (P> 005). Based on multivariate Cox regression risk model analysis, coronary heart disease, hemoglobin content, serum uric acid and usage of anticoagulant drugs were the independent variables related to the primary endpoint of cardiovascular death (all P< 0.01). Conclusion The incidence of hypokalemia in older adult patients with AF was 30.98%. Hypokalemia was closely related to the cardiovascular death, and coronary heart disease, hemoglobin content, serum uric acid level, and usage of anticoagulant drugs were the independent risk factors for the primary endpoint event.
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Affiliation(s)
- Xue-Dong Wang
- Department of Cardiology, Beijing Hepingli Hospital, Beijing, People’s Republic of China
| | - Yu Wang
- Department of Cardiology, Beijing Hepingli Hospital, Beijing, People’s Republic of China
| | - Jing Liu
- Department of Cardiology, Beijing Hepingli Hospital, Beijing, People’s Republic of China
| | - Ji-Wen Yao
- Department of Cardiology, Beijing Hepingli Hospital, Beijing, People’s Republic of China
| | - Jing Zhang
- Department of Cardiology, Beijing Hepingli Hospital, Beijing, People’s Republic of China
| | - Yi-Nan Zhang
- Department of Cardiology, Beijing Hepingli Hospital, Beijing, People’s Republic of China
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11
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Ambati R, Kho LK, Prentice D, Thompson A. Osmotic demyelination syndrome: novel risk factors and proposed pathophysiology. Intern Med J 2023; 53:1154-1162. [PMID: 35717664 DOI: 10.1111/imj.15855] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 04/30/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Osmotic demyelination syndrome (ODS) is non-inflammatory demyelination in response to an osmotic challenge. It can be pontine or extrapontine in presentation. AIMS To retrospectively review cases involving ODS and define the spectrum of causes, risk factors, clinical and radiological presentations, and functional outcomes. RESULTS The study utilised data from 15 patients with a mean age of 53.6 years. Malnutrition (9; 60%) and chronic alcoholism (10; 66.7%) were the most common associated disorders. Two (13.3%) patients had severe hyponatraemia (<120 mmol/L). The average highest single-day change was 5.1 mmol/L. Radiologically, 14 (93.3%) had pontine and 6 (40%) had extra-pontine lesions. Hypokalaemia (14; 93.3%) and hypophosphataemia (9; 60%) were commonly associated. Common clinical manifestations include altered consciousness/encephalopathy (9; 60%), dysphagia (4; 26.7%) and limb weakness (4; 26.7%). At 3 months, two (14.3%) had died and six (40%) were functionally independent (modified Rankin scale 0-2). CONCLUSION We found that ODS occurred despite appropriate correction rates of hyponatraemia. Factors such as malnutrition, chronic alcoholism, hypokalaemia and hypophosphataemia are thought to play a role in its pathogenesis. Approximately half of the patients survived and became functionally independent.
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Affiliation(s)
- Ravi Ambati
- Department of Neurology, Royal Perth Hospital, Perth, Western Australia, Australia
- Department of Neurology, St. John of God Midland Hospital, Perth, Western Australia, Australia
| | - Lay K Kho
- Department of Neurology, Royal Perth Hospital, Perth, Western Australia, Australia
- Department of Neurology, St. John of God Midland Hospital, Perth, Western Australia, Australia
| | - David Prentice
- Department of Neurology, Royal Perth Hospital, Perth, Western Australia, Australia
- Department of Neurology, St. John of God Midland Hospital, Perth, Western Australia, Australia
| | - Andrew Thompson
- Neurological Intervention and Imaging Service of WA (NIISwa), Royal Perth and Sir Charles Gairdner Hospitals, Perth, Western Australia, Australia
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12
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Williams DM, Shaikh A, Williams E, Maroof A, Michael T, Boregowda K. The Prevalence of Primary Aldosteronism in Screening Populations: Is Hypokalaemia Important? Exp Clin Endocrinol Diabetes 2023; 131:375-376. [PMID: 37160152 DOI: 10.1055/a-2075-0735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- David M Williams
- Department of Diabetes and Endocrinology, Morriston Hospital, Swansea, SA6 6NL
| | - Ayesha Shaikh
- Department of Diabetes and Endocrinology, Morriston Hospital, Swansea, SA6 6NL
| | - Ellen Williams
- Department of Acute Medicine, Morriston Hospital, Swansea, SA6 6NL
| | - Aiman Maroof
- Department of Acute Medicine, Morriston Hospital, Swansea, SA6 6NL
| | - Therese Michael
- Department of Laboratory Medicine, Morriston Hospital, Swansea, SA6 6NL
| | - Kusuma Boregowda
- Department of Diabetes and Endocrinology, Morriston Hospital, Swansea, SA6 6NL
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Lin Z, Cheung BMY, Tang V, Tsoi MF. Incidence of severe hypokalaemia in patients taking indapamide. Intern Emerg Med 2023; 18:549-557. [PMID: 36715848 DOI: 10.1007/s11739-023-03209-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/18/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND Diuretics are commonly used for the treatment of hypertension. Yet, hypokalaemia is a well-recognised adverse effect. We conducted a retrospective study to evaluate the incidence of severe hypokalaemia, defined as requiring hospitalisation, among patients on indapamide. METHODS We searched a territory-wide database, Clinical Data Analysis and Reporting System of the Hong Kong Hospital Authority. We traced all hypertensive patients who had been prescribed indapamide in 2007-2016 and all admissions due to hypokalaemia in 2007-2018. Factors associated with hospitalisation were studied using multivariable logistic regression. RESULTS During the period studied, 62,881 patients were started on indapamide and 509 (0.8%) were hospitalised for hypokalaemia. 53% of these hospitalisations occurred within the first year of treatment, and half of those in the first year occurred during the first 16 weeks. Female sex (adjusted OR, 1.75; 95%CI, 1.45-2.12) and immediate-release formulation (adjusted OR, 1.41; 95%CI, 1.14-1.75) were associated with hospitalisation. In the multivariable model, advanced age was not a significant predictor. There were no deaths during hospitalisation and the median length of hospital stay was one day. CONCLUSIONS In this large population-based study with 147,319 person-years of follow-up, severe hypokalaemia requiring hospitalisation was uncommon among hypertensive patients on indapamide. The risk is higher in women and in the initial weeks and months after starting therapy. The use of the sustained-release formulation reduces the risk. We conclude that using indapamide to treat hypertension is safe, even in the elderly, especially if the sustained-release formulation is used and electrolytes are monitored periodically.
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Affiliation(s)
- Ziying Lin
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
| | - Bernard Man Yung Cheung
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China.
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, Hong Kong, China.
- Institute of Cardiovascular Science and Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China.
| | - Vicka Tang
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
| | - Man Fung Tsoi
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Huang N, Liu Y, Ai Z, Zhou Q, Mao H, Yang X, Xu Y, Yu X, Chen W. Mediation of serum albumin in the association of serum potassium with mortality in Chinese dialysis patients: a prospective cohort study. Chin Med J (Engl) 2023; 136:213-220. [PMID: 36805593 PMCID: PMC10106125 DOI: 10.1097/cm9.0000000000002588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND The clinical importance of hypokalemia is likely underrecognized in Chinese dialysis patients, and whether its clinical effect was mediated by serum albumin is not fully elucidated. This study aimed to explore the association between serum potassium and mortality in dialysis patients of a Chinese nationwide multicenter cohort, taking albumin as a consideration. METHODS This was a prospective nation-wide multicenter cohort study. Restricted cubic splines were used to test the linearity of serum potassium and relationships with all-cause (AC) and cardiovascular (CV) mortality and a subsequent two-line piecewise linear model was fitted to approach the nadir. A mediation analysis was performed to examine relations of albumin to potassium and mortalities. RESULTS A total of 10,027 patients were included, of whom 6605 were peritoneal dialysis and 3422 were hemodialysis patients. In the overall population, the mean age was 51.7 ± 14.8 years, 55.3%(5546/10,027) were male, and the median dialysis vintage was 13.60 (4.70, 39.70) months. Baseline serum potassium was 4.30 ± 0.88 mmol/L. After a median follow-up period of 26.87 (14.77, 41.50) months, a U-shape was found between potassium and mortality, and a marked increase in risk at lower potassium but a moderate elevation in risk at higher potassium were observed. The nadir for AC mortality risk was estimated from piecewise linear models to be a potassium concentration of 4.0 mmol/L. Interestingly, the significance of the association between potassium and mortality was attenuated when albumin was introduced into the extended adjusted model. A subsequent significant mediation by albumin for potassium and AC and CV mortalities were found ( P < 0.001 for both), indicating that hypokalemia led to higher mortality mediated by low serum albumin, which was a surrogate of poor nutritional status and inflammation. CONCLUSIONS Associations between potassium and mortalities were U-shaped in the overall population. The nadir for AC mortality risk was at a potassium of 4.0 mmol/L. Serum albumin mediated the association between potassium and AC and CV mortalities.
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Affiliation(s)
- Naya Huang
- Department of Nephrology, The First Affiliated Hospital, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Yuanying Liu
- Department of Nephrology, The First Affiliated Hospital, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Zhen Ai
- Department of Nephrology, The First Affiliated Hospital, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Qian Zhou
- Department of Medical Statistics, Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Haiping Mao
- Department of Nephrology, The First Affiliated Hospital, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Yuanwen Xu
- Department of Nephrology, The First Affiliated Hospital, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Xueqing Yu
- Department of Nephrology, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Wei Chen
- Department of Nephrology, The First Affiliated Hospital, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
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15
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Hundemer GL, Clarke A, Akbari A, Bugeja A, Massicotte-Azarniouch D, Knoll G, Myran DT, Tanuseputro P, Sood MM. Analysis of Electrolyte Abnormalities in Adolescents and Adults and Subsequent Diagnosis of an Eating Disorder. JAMA Netw Open 2022; 5:e2240809. [PMID: 36346630 PMCID: PMC9644262 DOI: 10.1001/jamanetworkopen.2022.40809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
IMPORTANCE Eating disorders lead to increased mortality and reduced quality of life. While the acute presentations of eating disorders frequently involve electrolyte abnormalities, it remains unknown whether electrolyte abnormalities may precede the future diagnosis of an eating disorder. OBJECTIVE To determine whether outpatient electrolyte abnormalities are associated with the future diagnosis of an eating disorder. DESIGN, SETTING, AND PARTICIPANTS This population-level case-control study used provincial administrative health data for residents of Ontario, Canada aged 13 years or older from 2008 to 2020. Individuals without an eating disorder (controls) were matched 4:1 to individuals diagnosed with an incident eating disorder (cases) based on age and sex. Both groups had outpatient electrolyte measurements between 3 years and 30 days prior to index. Index was defined as the date of an eating disorder diagnosis in any inpatient or outpatient clinical setting for cases. Controls were assigned a pseudo-index date according to the distribution of index dates in the case population. Individuals with any prior eating disorder diagnosis were excluded. The data analyzed was from January 1, 2008, through June 30, 2020. EXPOSURES Any electrolyte abnormality, defined as abnormal test results for a composite of hypokalemia, hyperkalemia, hyponatremia, hypernatremia, hypomagnesemia, hypophosphatemia, metabolic acidosis, or metabolic alkalosis. OUTCOMES AND MEASURES Eating disorder diagnosis including anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified. RESULTS A total 6970 eligible Ontario residents with an eating disorder (mean [SD] age, 28 (19) years; 6075 [87.2%] female, 895 [12.8%] male) were matched with 27 878 age- and sex-matched residents without an eating disorder diagnosis (mean [SD] age, 28 [19] years; 24 300 [87.2%] female, 3578 [12.8%] male). Overall, 18.4% of individuals with an eating disorder had a preceding electrolyte abnormality vs 7.5% of individuals without an eating disorder (adjusted odds ratio [aOR], 2.12; [95% CI, 1.86-2.41]). The median (IQR) time from the earliest electrolyte abnormality to eating disorder diagnosis was 386 (157-716) days. Specific electrolyte abnormalities associated with a higher risk of an eating disorder were: hypokalemia (aOR, 1.98; 95% CI, 1.70-2.32), hyperkalemia (aOR, 1.97; 95% CI, 1.48-2.62), hyponatremia (aOR, 5.26; 95% CI, 3.32-8.31), hypernatremia (aOR, 3.09; 95% CI, 1.01-9.51), hypophosphatemia (aOR, 2.83; 95% CI, 1.82-4.40), and metabolic alkalosis (aOR, 2.60; 95% CI, 1.63-4.15). CONCLUSIONS AND RELEVANCE In this case-control study, individuals with an eating disorder were associated with a preceding outpatient electrolyte abnormality compared with matched controls. Otherwise unexplained electrolyte abnormalities may serve to identify individuals who may benefit from screening for an underlying eating disorder.
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Affiliation(s)
- Gregory L. Hundemer
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- ICES (formerly Institute for Clinical Evaluative Sciences), Ottawa, Ontario, Canada
| | - Anna Clarke
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- ICES (formerly Institute for Clinical Evaluative Sciences), Ottawa, Ontario, Canada
| | - Ayub Akbari
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Ann Bugeja
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - David Massicotte-Azarniouch
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Greg Knoll
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel T. Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- ICES (formerly Institute for Clinical Evaluative Sciences), Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- ICES (formerly Institute for Clinical Evaluative Sciences), Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Manish M. Sood
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- ICES (formerly Institute for Clinical Evaluative Sciences), Ottawa, Ontario, Canada
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Miller TP, Getz KD, Li Y, Demissei BG, Adamson PC, Alonzo TA, Burrows E, Cao L, Castellino SM, Daves MH, Fisher BT, Gerbing R, Grundmeier RW, Krause EM, Lee J, Lupo PJ, Rabin KR, Ramos M, Scheurer ME, Wilkes JJ, Winestone LE, Hawkins DS, Gramatges MM, Aplenc R. Rates of laboratory adverse events by course in paediatric leukaemia ascertained with automated electronic health record extraction: a retrospective cohort study from the Children's Oncology Group. Lancet Haematol 2022; 9:e678-e688. [PMID: 35870472 PMCID: PMC9444944 DOI: 10.1016/s2352-3026(22)00168-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Adverse events are often misreported in clinical trials, leading to an incomplete understanding of toxicities. We aimed to test automated laboratory adverse event ascertainment and grading (via the ExtractEHR automated package) to assess its scalability and define adverse event rates for children with acute myeloid leukaemia and acute lymphoblastic leukaemia. METHODS For this retrospective cohort study from the Children's Oncology Group (COG), we included patients aged 0-22 years treated for acute myeloid leukaemia or acute lymphoblastic leukaemia at Children's Healthcare of Atlanta (Atlanta, GA, USA) from Jan 1, 2010, to Nov 1, 2018, at the Children's Hospital of Philadelphia (Philadelphia, PA, USA) from Jan 1, 2011, to Dec 31, 2014, and at the Texas Children's Hospital (Houston, TX, USA) from Jan 1, 2011, to Dec 31, 2014. The ExtractEHR automated package acquired, cleaned, and graded laboratory data as per Common Terminology Criteria for Adverse Events (CTCAE) version 5 for 22 commonly evaluated grade 3-4 adverse events (fatal events were not evaluated) with numerically based CTCAE definitions. Descriptive statistics tabulated adverse event frequencies. Adverse events ascertained by ExtractEHR were compared to manually reported adverse events for patients enrolled in two COG trials (AAML1031, NCT01371981; AALL0932, NCT02883049). Analyses were restricted to protocol-defined chemotherapy courses (induction I, induction II, intensification I, intensification II, and intensification III for acute myeloid leukaemia; induction, consolidation, interim maintenance, delayed intensification, and maintenance for acute lymphoblastic leukaemia). FINDINGS Laboratory adverse event data from 1077 patients (583 from Children's Healthcare of Atlanta, 200 from the Children's Hospital of Philadelphia, and 294 from the Texas Children's Hospital) who underwent 4611 courses (549 for acute myeloid leukaemia and 4062 for acute lymphoblastic leukaemia) were extracted, processed, and graded. Of the 166 patients with acute myeloid leukaemia, 86 (52%) were female, 80 (48%) were male, 96 (58%) were White, and 132 (80%) were non-Hispanic. Of the 911 patients with acute lymphoblastic leukaemia, 406 (45%) were female, 505 (55%) were male, 596 (65%) were White, and 641 (70%) were non-Hispanic. Patients with acute myeloid leukaemia had the most adverse events during induction I and intensification II. Hypokalaemia (one [17%] of six to 75 [48%] of 156 courses) and alanine aminotransferase (ALT) increased (13 [10%] of 134 to 27 [17%] of 156 courses) were the most prevalent non-haematological adverse events in patients with acute myeloid leukaemia, as identified by ExtractEHR. Patients with acute lymphoblastic leukaemia had the greatest number of adverse events during induction and maintenance (eight adverse events with prevalence ≥10%; induction and maintenance: anaemia, platelet count decreased, white blood cell count decreased, neutrophil count decreased, lymphocyte count decreased, ALT increased, and hypocalcaemia; induction: hypokalaemia; maintenance: aspartate aminotransferase [AST] increased and blood bilirubin increased), as identified by ExtractEHR. 187 (85%) of 220 total comparisons in 22 adverse events in four AAML1031 and six AALL0923 courses were substantially higher with ExtractEHR than COG-reported adverse event rates for adverse events with a prevalence of at least 2%. INTERPRETATION ExtractEHR is scalable and accurately defines laboratory adverse event rates for paediatric acute leukaemia; moreover, ExtractEHR seems to detect higher rates of laboratory adverse events than those reported in COG trials. These rates can be used for comparisons between therapies and to counsel patients treated on or off trials about the risks of chemotherapy. ExtractEHR-based adverse event ascertainment can improve reporting of laboratory adverse events in clinical trials. FUNDING US National Institutes of Health, St Baldrick's Foundation, and Alex's Lemonade Stand Foundation.
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Affiliation(s)
- Tamara P Miller
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Kelly D Getz
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Yimei Li
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Biniyam G Demissei
- Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Peter C Adamson
- Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Todd A Alonzo
- Department of Pediatrics, University of Southern California, Los Angeles, CA, USA
| | - Evanette Burrows
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lusha Cao
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sharon M Castellino
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Marla H Daves
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Brian T Fisher
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | | | - Robert W Grundmeier
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Edward M Krause
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Judy Lee
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Philip J Lupo
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Karen R Rabin
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Mark Ramos
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michael E Scheurer
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer J Wilkes
- Divisions of Hematology and Oncology, Seattle Children's Hospital, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Lena E Winestone
- Division of AIBMT, Department of Pediatrics, UCSF Benioff Children's Hospitals, San Francisco, CA, USA
| | - Douglas S Hawkins
- Divisions of Hematology and Oncology, Seattle Children's Hospital, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - M Monica Gramatges
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Richard Aplenc
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Yin J, Yuan N, Huang Z, Hu Z, Bao Q, Shao Z, Mei Q, Xu Y, Wang W, Liu D, Zhao L, Wan S. Assessment of hypokalemia and clinical prognosis in Patients with COVID-19 in Yangzhou, China. PLoS One 2022; 17:e0271132. [PMID: 35802669 PMCID: PMC9269409 DOI: 10.1371/journal.pone.0271132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/23/2022] [Indexed: 12/04/2022] Open
Abstract
Background Hypokalemia is a frequent electrolyte imbalance in patients with COVID-19. The aim of this study was to estimate the association between hypokalemia and clinical prognosis in patients with moderate COVID-19. Methods A single-center, retrospective, observational study was conducted on 81 non-ICU admitted patients with moderate COVID-19 according to the criteria issued by the Chinese Health Bureau in the Third People’s Hospital of Yangzhou (Northern Jiangsu People’s Hospital New District Branch) from 4th to 25th August 2021. The demographic, clinical, and laboratory data were reviewed and collected, then the correlation between hypokalemia and prognosis was determined. Results The level of serum potassium of patients ranged from 2.80 mmol/L to 4.70 mmol/L. Hypokalemia was detected in 39 out of the 81 included patients (48.15%) during hospitalization. Patients with hypokalemia had prolonged days of negative nucleic acid conversion and hospital stay. Correlation analysis showed that the level of serum potassium was negatively correlated with days of negative nucleic acid conversion and length of hospital stay. Bivariate logistic regression analysis proved that hypokalemia was a risk factor for prolonged hospital stay in patients with moderate COVID-19. Conclusion Hypokalemia was prevalent in patients with moderate COVID-19 in Yangzhou, China. Hypokalemia was associated with the prolonged hospital stay in patients with moderate COVID-19.
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Affiliation(s)
- Jiangtao Yin
- Department of Critical Care Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of China
- Institute of Digestive Diseases, Jiangsu University, Zhenjiang, People’s Republic of China
| | - Nana Yuan
- Department of Critical Care Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of China
| | - Ziqiang Huang
- Department of Infectious Diseases, The Third People’s Hospital of Yangzhou, Yangzhou, People’s Republic of China
| | - Zhenkui Hu
- Department of Critical Care Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of China
| | - Quanlei Bao
- Department of Infectious Diseases, Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of China
| | - Zhenli Shao
- Nursing Department, Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of China
| | - Qiong Mei
- Department of Critical Care Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of China
| | - Yong Xu
- Department of Infectious Diseases, The Third People’s Hospital of Yangzhou, Yangzhou, People’s Republic of China
| | - Wenli Wang
- Department of Critical Care Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of China
| | - Dadong Liu
- Department of Critical Care Medicine, Jinling Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Li Zhao
- Department of Endocrinology, Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of China
- * E-mail: (SW); (LZ)
| | - Shengxia Wan
- Department of Neurology, The Fourth Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of China
- * E-mail: (SW); (LZ)
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Abstract
IMPORTANCE Hyperkalemia is a common electrolyte disorder in hospitalized patients; however, the clinical usefulness of administering patiromer for reduction of serum potassium levels in this setting is unknown. OBJECTIVE To evaluate the outcomes associated with patiromer as monotherapy in patients with acute hyperkalemia in an acute care setting. DESIGN, SETTING, AND PARTICIPANTS This cohort study used electronic health record data from adult patients treated with patiromer for acute hyperkalemia in emergency departments, inpatient units, and intensive care units at an urban, academic medical center in the Bronx, New York, between January 30, 2018, and December 30, 2019. Data analysis was conducted between June 2020 and February 2021. EXPOSURES A single dose of oral patiromer (8.4 g, 16.8 g, or 25.2 g). MAIN OUTCOMES AND MEASURE The primary outcome was the mean absolute reduction in serum potassium level from baseline at 3 distinct time intervals after patiromer administration: 0 to 6 hours, greater than 6 to 12 hours, and greater than 12 to 24 hours. Key secondary outcomes were the incidence of hypokalemia and potassium reduction stratified by baseline potassium level and care setting. RESULTS Among 881 encounters of patiromer treatment, the mean (SD) age of patients was 67.4 (14.4) years; 463 encounters (52.6%) were for male patients, and most (338 [38.4%]) were for patients who identified as non-Hispanic Black. The mean (SD) baseline serum potassium level was 5.60 (0.35) mEq/L (to convert to mmol/L, multiply by 1.0), and within the first 6 hours after patiromer administration, the mean (SD) potassium reduction was 0.50 (0.56) mEq/L (P < .001). Both absolute and relative potassium reduction from baseline varied across baseline hyperkalemia severity but not by care setting. The lowest dose of patiromer (8.4 g) was used in 721 encounters (81.8%), and in 725 encounters (82.3%), no further doses of a potassium binder were required. Hypokalemia was noted in 2 encounters (0.2%) at 24 hours after patiromer administration. CONCLUSIONS AND RELEVANCE In this cohort study of patients with acute, non-life-threatening hyperkalemia, a single dose of patiromer was associated with a significant decrease in serum potassium levels and a low incidence of hypokalemia. These findings suggest that patiromer monotherapy may be useful in an institutional setting for managing elevated potassium levels and minimizing the risk of hypokalemia associated with other potassium control measures.
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Affiliation(s)
- Katherine E. Di Palo
- Center for Pharmacotherapy Research and Quality, Department of Pharmacy, Montefiore Medical Center, Bronx, New York
- Division of Hospital Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Mark J. Sinnett
- Center for Pharmacotherapy Research and Quality, Department of Pharmacy, Montefiore Medical Center, Bronx, New York
| | - Pavel Goriacko
- Center for Pharmacotherapy Research and Quality, Department of Pharmacy, Montefiore Medical Center, Bronx, New York
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
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Borchers J, Mäkitie O, Jääskeläinen J, Laakso S. Recurrent Hypokalemia and Adrenal Steroids in Patients With APECED. Front Endocrinol (Lausanne) 2022; 13:904507. [PMID: 35813662 PMCID: PMC9256963 DOI: 10.3389/fendo.2022.904507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/09/2022] [Indexed: 12/02/2022] Open
Abstract
CONTEXT Hypokalemia is a common finding in patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) but its exact cause often remains unknown. OBJECTIVE To explore the prevalence and etiology of hypokalemia and the role of adrenal steroids therein in a cohort of patients with APECED. METHODS We performed a cross-sectional assessment and retrospective data collection on 44 Finnish patients with APECED to identify subjects with episodes of hypokalemia. Also 68 healthy matched controls attended the cross-sectional evaluation. Factors associating with a tendency for hypokalemia were analyzed by reviewing medical records during 1960-2021 and performing a cross-sectional analysis of serum adrenal steroids. RESULTS In total 14 of the 44 APECED patients (32%) had episodes of hypokalemia; 2 presented with hypokalemia at cross-sectional evaluation and 12 had a history of hypokalemia before the cross-sectional evaluation. Hypokalemic episodes started at the median age of 14.1 years; 12/14 (86%) had primary adrenal insufficiency (PAI). The median number of hypokalemic periods per year was 0.3 (range 0.04-2.2); the frequency correlated positively with the number of clinical APECED manifestations at the time of cross-sectional evaluation (r=0.811, p<0.001). Etiologies of hypokalemia varied but episodes often occurred when new clinical manifestations developed and during hospitalizations. Three patients had kidney defects, also associated with electrolyte imbalances. Severity of hypokalemia varied (range 2.2-3.2 mmol/L), but no severe complications were observed. At cross-sectional evaluation, patients with PAI (n = 30) had significantly lower median plasma potassium and higher sodium concentration than controls, suggesting that fludrocortisone treatment contributed to hypokalemia. Detailed analysis of adrenal steroids provided no conclusive differences between patients with and without episodes of hypokalemia. CONCLUSIONS In APECED, hypokalemia is common and varies in terms of frequency, etiology, and severity. PAI and kidney disease predispose to hypokalemia. In addition, hypokalemic periods seem to be more common in patients with more severe phenotype of APECED.
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Affiliation(s)
- Joonatan Borchers
- Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- *Correspondence: Joonatan Borchers,
| | - Outi Mäkitie
- Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Jarmo Jääskeläinen
- Kuopio Pediatric Research Unit, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Saila Laakso
- Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Noori M, Nejadghaderi SA, Sullman MJM, Carson-Chahhoud K, Ardalan M, Kolahi AA, Safiri S. A Review on the Possible Pathophysiology of Potassium Abnormalities in COVID-19. Iran J Kidney Dis 2021; 15:397-407. [PMID: 34930851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/28/2021] [Indexed: 06/14/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is a catastrophic contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Electrolyte disturbances are common complications of COVID-19. The present article examined the potential mechanisms of hypokalemia and hyperkalemia in patients suffering from COVID-19, in order to raise awareness of potassium disorders in SARS-CoV-2 infections. PubMed, Scopus, and Google Scholar were searched with keywords, such as "COVID-19", "SARS-CoV-2", "2019-nCoV", "Hypokalemia", "Hyperkalemia", "Serum potassium", and "Etiology", "Pathophysiology" up to April 20, 2021 without any search filters. We included articles that proposed potential mechanisms for potassium abnormalities in COVID-19 patients. Furthermore, we used backward and forward citation searching. Potassium abnormalities are considered to be important electrolyte disturbances, with reported incidences ranging from < 5% to > 50% in patients affected by SARS-CoV-2. Therefore, understanding the etiologies of potassium abnormalities could help to improve disease outcome. Utilization of ACE2 by SARS-CoV-2 in the renal cells, viral-induced tubular injury, and gastrointestinal abnormalities, such as anorexia, diarrhea, and vomiting may predispose COVID-19 patients to developing hypokalemia. Furthermore, depleted magnesium levels make hypokalemia refractory to treatments. In addition, hyperkalemia may occur because of reduced urinary output, as a consequence of renal failure. Changes in blood pH and medication-induced side-effects are other possible reasons for the deviation of potassium levels from the normal range. The etiology of potassium abnormalities in COVID-19 patients is multifactorial. Therefore, the early detection and management of potassium disorders is vital and would improve the outcome of patients with COVID-19. DOI: 10.52547/ijkd.6552.
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Affiliation(s)
| | | | | | | | | | | | - Saeid Safiri
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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21
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Dashputre AA, Sumida K, Thomas F, Gatwood J, Akbilgic O, Potukuchi PK, Obi Y, Molnar MZ, Streja E, Kalantar Zadeh K, Kovesdy CP. Association of Dyskalemias with Ischemic Stroke in Advanced Chronic Kidney Disease Patients Transitioning to Dialysis. Am J Nephrol 2021; 52:539-547. [PMID: 34289468 DOI: 10.1159/000516902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/26/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Hypo- and hyperkalemia are associated with a higher risk of ischemic stroke. However, this association has not been examined in an advanced chronic kidney disease (CKD) population. METHODS From among 102,477 US veterans transitioning to dialysis between 2007 and 2015, 21,357 patients with 2 pre-dialysis outpatient estimated glomerular filtration rates <30 mL/min/1.73 m2 90-365 days apart and at least 1 potassium (K) each in the baseline and follow-up period were identified. We separately examined the association of both baseline time-averaged K (chronic exposure) and time-updated K (acute exposure) treated as categorized (hypokalemia [K <3.5 mEq/L] and hyperkalemia [K >5.5 mEq/L] vs. referent [3.5-5.5 mEq/L]) and continuous exposure with time to the first ischemic stroke event prior to dialysis initiation using multivariable-adjusted Cox regression models. RESULTS A total of 2,638 (12.4%) ischemic stroke events (crude event rate 41.9 per 1,000 patient years; 95% confidence interval [CI] 40.4-43.6) over a median (Q1-Q3) follow-up time of 2.56 (1.59-3.89) years were observed. The baseline time-averaged K category of hypokalemia (adjusted hazard ratio [aHR], 95% CI: 1.35, 1.01-1.81) was marginally associated with a significantly higher risk of ischemic stroke. However, time-updated hyperkalemia was associated with a significantly lower risk of ischemic stroke (aHR, 95% CI: 0.82, 0.68-0.98). The exposure-outcome relationship remained consistent when using continuous K levels for both the exposures. DISCUSSION/CONCLUSION In patients with advanced CKD, hypokalemia (chronic exposure) was associated with a higher risk of ischemic stroke, whereas hyperkalemia (acute exposure) was associated with a lower risk of ischemic stroke. Further studies in this population are needed to explore the mechanisms underlying these associations.
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Affiliation(s)
- Ankur A Dashputre
- Institute for Health Outcomes and Policy, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Keiichi Sumida
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Fridtjof Thomas
- Division of Biostatistics, Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Justin Gatwood
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Nashville, Tennessee, USA
| | - Oguz Akbilgic
- Department of Health Informatics and Data Science, Parkinson School of Health Sciences and Public Health, Loyola University, Chicago, Illinois, USA
| | - Praveen K Potukuchi
- Institute for Health Outcomes and Policy, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Yoshitsugu Obi
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Miklos Z Molnar
- Division of Nephrology & Hypertension, Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Elani Streja
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California-Irvine, Orange, California, USA
| | - Kamyar Kalantar Zadeh
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California-Irvine, Orange, California, USA
| | - Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Nephrology Section, Memphis VA Medical Center, Memphis, Tennessee, USA
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22
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Schernthaner-Reiter MH, Siess C, Micko A, Zauner C, Wolfsberger S, Scheuba C, Riss P, Knosp E, Kautzky-Willer A, Luger A, Vila G. Acute and Life-threatening Complications in Cushing Syndrome: Prevalence, Predictors, and Mortality. J Clin Endocrinol Metab 2021; 106:e2035-e2046. [PMID: 33517433 DOI: 10.1210/clinem/dgab058] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Indexed: 12/14/2022]
Abstract
CONTEXT Cushing syndrome (CS) results in significant morbidity and mortality. OBJECTIVE To study acute and life-threatening complications in patients with active CS. METHODS We performed a retrospective cohort study using inpatient and outpatient records of patients with CS in a tertiary center. A total of 242 patients with CS were included, including 213 with benign CS (pituitary n = 101, adrenal n = 99, ectopic n = 13), and 29 with malignant disease. We collected acute complications necessitating hospitalization, from appearance of first symptoms of hypercortisolism until 1 year after biochemical remission. Mortality data were obtained from the national registry. Baseline factors relating to and predicting acute complications were tested using uni- and multivariate analysis. RESULTS The prevalence of acute complications was 62% in patients with benign pituitary CS, 40% in patients with benign adrenal CS, and 100% in patients with ectopic CS. Complications observed in patients with benign CS included infections (25%), thromboembolic events (17%), hypokalemia (13%), hypertensive crises (9%), cardiac arrhythmias (5%), and acute coronary events (3%). Among these patients, 23% had already been hospitalized for acute complications before CS was suspected, and half of complications occurred after the first surgery. Glycated hemoglobin (HbA1c) and 24-hour urinary free cortisol positively correlated with the number of acute complications per patient. Patients with malignant disease had significantly higher rates of acute complications. Mortality during the observation period was 2.8% and 59% in benign and malignant CS, respectively. CONCLUSIONS This analysis highlights the whole spectrum of acute and life-threatening complications in CS, and their high prevalence even before disease diagnosis and after successful surgery.
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Affiliation(s)
- Marie Helene Schernthaner-Reiter
- Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Christina Siess
- Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Alexander Micko
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Christian Zauner
- Clinical Division of Gastroenterology and Hepatology, Intensive Care Unit, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, Vienna; Austria
| | - Stefan Wolfsberger
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Christian Scheuba
- Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Philipp Riss
- Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Engelbert Knosp
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Anton Luger
- Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Greisa Vila
- Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
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Usman A, Shaikh MF, Dujaili JA, Mustafa N, Gan SH. Re-visiting pH-adjusted potassium to avoid hypokalemic crisis during management of diabetic ketoacidosis: A conceptual framework. Diabetes Metab Syndr 2021; 15:573-580. [PMID: 33706189 DOI: 10.1016/j.dsx.2021.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/01/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Diabetic ketoacidosis (DKA) treatment guidelines recommend to initiate potassium-replacement when serum potassium (SK) drops within normal range, and to withhold insulin if SK is below normal. Despite strict recommendations, hypokalemia is frequently observed in DKA. METHODS Scientific literature was thoroughly searched to find 1) DKA treatment guidelines, 2) studies reporting hypokalemia in DKA, 3) and literature elaborating mechanisms involved in hypokalemia. RESULTS Acidosis affects SK and its regulators including insulin, catecholamines and aldosterone. Current conceptual framework is an argument to gauge the degree of hypokalemia before it strikes DKA patients utilizing SK level after adjusting it with pH. Suggested approach will reduce hypokalemia risk and its associated complications. The nomogram calculates pH-adjusted potassium and expected potassium loss. It also ranks hypokalemia associated risk, and proposes the potassium-replacement rate over given time period. The differences between current DKA treatment guidelines and proposed strategy are also discussed. Moreover, reasons and risk of hyperkalemia due to early initiation of potassium replacement and remedial actions are debated. CONCLUSION In light of proposed strategy, utilizing the nomogram ensures reduced incidence of hypokalemia in DKA resulting in improved clinical and patient outcomes. Pharmacoeconomic benefits can also be expected when avoiding hypokalemia ensures early discharge.
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Affiliation(s)
- Atif Usman
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.
| | - Mohd Farooq Shaikh
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | | | - Norlaila Mustafa
- Department of Endocrinology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
| | - Siew Hua Gan
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.
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Albasri A, Hattle M, Koshiaris C, Dunnigan A, Paxton B, Fox SE, Smith M, Archer L, Levis B, Payne RA, Riley RD, Roberts N, Snell KIE, Lay-Flurrie S, Usher-Smith J, Stevens R, Hobbs FDR, McManus RJ, Sheppard JP. Association between antihypertensive treatment and adverse events: systematic review and meta-analysis. BMJ 2021; 372:n189. [PMID: 33568342 PMCID: PMC7873715 DOI: 10.1136/bmj.n189] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine the association between antihypertensive treatment and specific adverse events. DESIGN Systematic review and meta-analysis. ELIGIBILITY CRITERIA Randomised controlled trials of adults receiving antihypertensives compared with placebo or no treatment, more antihypertensive drugs compared with fewer antihypertensive drugs, or higher blood pressure targets compared with lower targets. To avoid small early phase trials, studies were required to have at least 650 patient years of follow-up. INFORMATION SOURCES Searches were conducted in Embase, Medline, CENTRAL, and the Science Citation Index databases from inception until 14 April 2020. MAIN OUTCOME MEASURES The primary outcome was falls during trial follow-up. Secondary outcomes were acute kidney injury, fractures, gout, hyperkalaemia, hypokalaemia, hypotension, and syncope. Additional outcomes related to death and major cardiovascular events were extracted. Risk of bias was assessed using the Cochrane risk of bias tool, and random effects meta-analysis was used to pool rate ratios, odds ratios, and hazard ratios across studies, allowing for between study heterogeneity (τ2). RESULTS Of 15 023 articles screened for inclusion, 58 randomised controlled trials were identified, including 280 638 participants followed up for a median of 3 (interquartile range 2-4) years. Most of the trials (n=40, 69%) had a low risk of bias. Among seven trials reporting data for falls, no evidence was found of an association with antihypertensive treatment (summary risk ratio 1.05, 95% confidence interval 0.89 to 1.24, τ2=0.009). Antihypertensives were associated with an increased risk of acute kidney injury (1.18, 95% confidence interval 1.01 to 1.39, τ2=0.037, n=15), hyperkalaemia (1.89, 1.56 to 2.30, τ2=0.122, n=26), hypotension (1.97, 1.67 to 2.32, τ2=0.132, n=35), and syncope (1.28, 1.03 to 1.59, τ2=0.050, n=16). The heterogeneity between studies assessing acute kidney injury and hyperkalaemia events was reduced when focusing on drugs that affect the renin angiotensin-aldosterone system. Results were robust to sensitivity analyses focusing on adverse events leading to withdrawal from each trial. Antihypertensive treatment was associated with a reduced risk of all cause mortality, cardiovascular death, and stroke, but not of myocardial infarction. CONCLUSIONS This meta-analysis found no evidence to suggest that antihypertensive treatment is associated with falls but found evidence of an association with mild (hyperkalaemia, hypotension) and severe adverse events (acute kidney injury, syncope). These data could be used to inform shared decision making between doctors and patients about initiation and continuation of antihypertensive treatment, especially in patients at high risk of harm because of previous adverse events or poor renal function. REGISTRATION PROSPERO CRD42018116860.
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Affiliation(s)
- Ali Albasri
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, OX2 6GG, UK
| | | | - Constantinos Koshiaris
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, OX2 6GG, UK
| | - Anna Dunnigan
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ben Paxton
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sarah Emma Fox
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Margaret Smith
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, OX2 6GG, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | - Rupert A Payne
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | | | - Sarah Lay-Flurrie
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, OX2 6GG, UK
| | - Juliet Usher-Smith
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Richard Stevens
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, OX2 6GG, UK
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, OX2 6GG, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, OX2 6GG, UK
| | - James P Sheppard
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, OX2 6GG, UK
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25
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Alfano G, Ferrari A, Fontana F, Perrone R, Mori G, Ascione E, Magistroni R, Venturi G, Pederzoli S, Margiotta G, Romeo M, Piccinini F, Franceschi G, Volpi S, Faltoni M, Ciusa G, Bacca E, Tutone M, Raimondi A, Menozzi M, Franceschini E, Cuomo G, Orlando G, Santoro A, Di Gaetano M, Puzzolante C, Carli F, Bedini A, Milic J, Meschiari M, Mussini C, Cappelli G, Guaraldi G. Hypokalemia in Patients with COVID-19. Clin Exp Nephrol 2021; 25:401-409. [PMID: 33398605 PMCID: PMC7781399 DOI: 10.1007/s10157-020-01996-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/12/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Patients with COVID-19 experience multiple clinical conditions that may cause electrolyte imbalances. Hypokalemia is a concerning electrolyte disorder closely associated with severe complications. This study aimed to estimate prevalence, risk factors and outcome of hypokalemia in a cohort of patients with confirmed COVID-19. METHODS A retrospective analysis was conducted on 290 non-ICU admitted patients with COVID-19 at the tertiary teaching hospital of Modena, Italy, from February 16 to April 14, 2020. RESULTS Hypokalemia was detected in 119 out of 290 patients (41%) during hospitalization. Mean serum potassium was 3.1 ± 0.1 meq/L. The majority of patients (90.7%) patients experienced only a mild decrease in serum potassium level (3-3.4 mEq/L). Hypokalemia was associated with hypocalcemia, which was detected in 50% of subjects. Urine potassium-to-creatinine ratio, measured in a small number of patients (n = 45; 36.1%), revealed an increase of urinary potassium excretion in most cases (95.5%). Risk factors for hypokalemia were female sex (odds ratio (OR) 2.44; 95% CI 1.36-4.37; P 0.003) and diuretic therapy (OR 1.94, 95% CI 1.08-3.48; P 0.027). Hypokalemia, adjusted for sex, age and SOFA score, was not associated with ICU transfer (OR 0.52; 95% CI 0.228-1.212; P = 0.131), in-hospital mortality (OR, 0.47; 95% CI 0.170-1.324; P = 0.154) and composite outcome of ICU transfer or in-hospital mortality (OR 0.48; 95% CI 0.222-1.047; P = 0.065) in our cohort of patients. CONCLUSIONS Hypokalemia was a frequent disorder in subjects with COVID-19. Female sex and diuretic therapy were identified as risk factors for low serum potassium levels. Hypokalemia was unrelated to ICU transfer and death in this cohort of patients.
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Affiliation(s)
- Gaetano Alfano
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy.
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy.
- Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, Modena, Italy.
| | - Annachiara Ferrari
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy
| | - Francesco Fontana
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Rossella Perrone
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy
| | - Giacomo Mori
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Elisabetta Ascione
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Riccardo Magistroni
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Giulia Venturi
- Department of Biomedical, Metabolic and Neural Sciences, Section of Clinical Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Simone Pederzoli
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia,, Modena, Italy
| | - Gianluca Margiotta
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia,, Modena, Italy
| | - Marilina Romeo
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia,, Modena, Italy
| | - Francesca Piccinini
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia,, Modena, Italy
| | - Giacomo Franceschi
- Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - Sara Volpi
- Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - Matteo Faltoni
- Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - Giacomo Ciusa
- Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - Erica Bacca
- Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - Marco Tutone
- Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | | | - Marianna Menozzi
- Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - Erica Franceschini
- Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - Gianluca Cuomo
- Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - Gabriella Orlando
- Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - Antonella Santoro
- Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | | | - Cinzia Puzzolante
- Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - Federica Carli
- Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - Andrea Bedini
- Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - Jovana Milic
- Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, Modena, Italy
- Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - Marianna Meschiari
- Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - Cristina Mussini
- Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - Gianni Cappelli
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Giovanni Guaraldi
- Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy
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Chen Y, Chen X, Chen Q, Yu C. Non-Alcoholic Fatty Liver Disease and Hypokalemia in Primary Aldosteronism Among Chinese Population. Front Endocrinol (Lausanne) 2021; 12:565714. [PMID: 33967948 PMCID: PMC8101285 DOI: 10.3389/fendo.2021.565714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 03/29/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In recent years, evidence that aldosteronism is a risk factor for metabolic disorders has increased. This study was designed to investigate the role of nonalcoholic fatty liver disease (NAFLD) and hypokalemia in primary aldosteronism (PA). METHODS A total of 222 patients diagnosed with PA and 222 non-PA patients were included in our study. Demographic data, medical histories, clinical evaluations, complete blood counts, serum biochemical analyses, aldosterone and potassium levels were obtained. Data are presented as the means ± standard deviation (SD). To compare the parameters between cases and controls, Student's t-tests or Mann-Whitney U tests were used for continuous variables, and χ2 tests were used for categorical variables. Pearson correlation analysis was used to define relationships between pairs of parameters. A two-sided P < 0.05 was considered statistically significant. Multivariate logistic regression was performed to assess the independent effects of potassium and other metabolic variables on NAFLD in PA patients. RESULTS The diagnosis of NAFLD was more common in PA patients (n=222, 35.1%) than in non-PA subjects (29.7%). PA patients with and without NAFLD had similar metabolic imbalance characteristics. In PA patients with hypokalemia, relatively higher prevalences of NAFLD (44% vs. 27%, P < 0.05) and diabetes mellitus (19.8% vs. 9.9%, P < 0.05) were observed. Hypokalemic PA patients had a worse metabolic status than PA patients without hypokalemia, including higher body mass index (BMI) (25.4 ± 3.4 vs. 24.1 ± 3.9 kg/m2, P < 0.05), more severe dyslipidemia as well as insulin resistance, higher serum uric acid levels (354 ± 95 vs. 319 ± 87 μmol/L, P < 0.01) and aggravated inflammation. CONCLUSION The prevalence of NAFLD was higher in PA patients than in non-PA patients, although the patterns of obesity, dyslipidemia and insulin resistance were similar. Hypokalemic PA patients had a worse metabolic status than normokalemic PA patients. This study provides new insights that can inform further mechanistic studies about metabolic imbalance in patients with aldosteronism.
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27
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Schupp T, Behnes M, Zworowsky MV, Kim SH, Weidner K, Rusnak J, Kuche P, Müller J, Barth C, Reiser L, Taton G, Reichelt T, Ellguth D, Engelke N, Bollow A, Kittel M, Bertsch T, Mashayekhi K, Borggrefe M, Akin I. Hypokalemia but not Hyperkalemia is Associated with Recurrences of Ventricular Tachyarrhythmias in ICD Recipients. Clin Lab 2020; 66. [PMID: 32162892 DOI: 10.7754/clin.lab.2019.190645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Only few data evaluating the prognostic impact of blood-derived potassium levels (K) on arrhythmic endpoints in patients with implantable cardioverter-defibrillators (ICD) is available. Therefore, this study evaluates the prognostic impact of potassium levels on recurrences of ventricular tachyarrhythmias in consecutive ICD recipients. METHODS A large retrospective registry was used including all consecutive patients presenting with ventricular tachyarrhythmias on admission from 2002 to 2016 at one institution. Patients were divided into three subgroups: hypokalemia (i.e., K < 3.3 mmol/L), normokalemia (i.e., K 3.3 - 4.5 mmol/L), and hyperkalemia (i.e., K > 4.5 mmol/L). Kaplan-Meier and Cox regression analyses were applied for the evaluation of the primary endpoint of first recurrences of ventricular tachyarrhythmias at one year. Secondary endpoints comprised of first appropriate ICD therapy, first cardiac rehospitalization, and all-cause mortality at one year. RESULTS Five hundred and thirty ICD recipients with a median potassium level of 4.23 mmol/L were included (67%: normokalemia, 27%: hyperkalemia, and 6%: hypokalemia). Whereas hyperkalemia was not associated with increasing risk of recurrent ventricular tachyarrhythmias, hypokalemia was associated with decreasing freedom from recurrent ventricular tachyarrhythmias (HR = 2.135; 95% CI 1.158 - 3.937; p = 0.015), even after mul-tivariable adjustment (HR = 2.577; 95% CI 1.236 - 5.372; p = 0.012). Higher risk of recurrences was especially attributed to higher rates of electrical storm in the presence of hypokalemia (15% vs. 3 - 4%). Negative impact of hypokalemia was mainly attributed to secondary preventive ICD (HR = 2.637; 95% CI 1.325 - 5.248; p = 0.006). Moreover, hypokalemia was associated with increasing risk of appropriate ICD therapies (HR = 1.920; 95% CI 0.912 - 4.042; statistical trend: p = 0.086), which was still demonstrated after multivariable adjustment. In contrast, risk of first cardiac rehospitalization and all-cause mortality were not affected by potassium levels. CONCLUSIONS In consecutive ICD recipients with ventricular tachyarrhythmias at index, hypokalemia - but not hyperkalemia - was associated with increasing risk of recurrent ventricular tachyarrhythmias and appropriate ICD therapies.
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28
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Sun H, Weaver CM. Rise in Potassium Deficiency in the US Population Linked to Agriculture Practices and Dietary Potassium Deficits. J Agric Food Chem 2020; 68:11121-11127. [PMID: 32921052 DOI: 10.1021/acs.jafc.0c05139] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This paper, for the first time, provides evidence that current practices that lead to agricultural crop removal of potassium are unsustainable and likely contributed to the decline in dietary potassium intake and rise in hypokalemia prevalence in the US population. Potassium concentrations in beef, pork, turkey, fruit, vegetables, cereal crops, and so forth decreased between 1999 and 2015 based on the examination of potassium values of food items of USDA standard reference. Ratios of potassium input to removal by crops between 1987 and 2014, potassium in topsoil, and crop-available soil potassium in US farms all declined in recent years. Reported reductions in dietary potassium intake correspond to these decreases in the food supply and to increases in hypokalemia prevalence in the US population. Results of this paper provide new understanding on links between potassium management in agricultural practices and potassium intake deficits, which is needed for combating increasing hypokalemia prevalence in the US population.
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Affiliation(s)
- Hongbing Sun
- GEMS Department, Health Studies Institute, Rider University, 2083 Lawrenceville Road, Lawrenceville, New Jersey 08648, United States
| | - Connie M Weaver
- Weaver & Associates Consulting LLC, West Lafayette, Indiana 47906, United States
- Department of Nutrition Science, Purdue University, 700 W State Street, West Lafayette, Indiana 47907, United States
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29
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Laslett DB, Cooper JM, Greenberg RM, Yesenosky GA, Basil A, Gangireddy C, Whitman IR. Electrolyte Abnormalities in Patients Presenting With Ventricular Arrhythmia (from the LYTE-VT Study). Am J Cardiol 2020; 129:36-41. [PMID: 32565090 DOI: 10.1016/j.amjcard.2020.04.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/20/2020] [Accepted: 04/24/2020] [Indexed: 11/15/2022]
Abstract
Electrolyte abnormalities are a known trigger for ventricular arrhythmia, and patients with heart disease on diuretic therapy may be at higher risk for electrolyte depletion. Our aim was to determine the prevalence of electrolyte depletion in patients presenting to the hospital with sustained ventricular tachycardia or ventricular fibrillation (VT/VF) versus heart failure, and identify risk factors for electrolyte depletion. Consecutive admissions to a tertiary care hospital for VT/VF were identified between July 2016 and October 2018 using the electronic medical record and compared with an equal number of consecutive admissions for heart failure (CHF). The study included 280 patients (140 patients in each group; mean age 63, 60% male, 59% African American). Average EF in the VT/VF and CHF groups was 30% and 33%, respectively. Hypokalemia (K < 3.5 mmol/L) and severe hypokalemia (K < 3.0 mmol/L) were present in 35.7% and 13.6%, respectively, of patients with VT/VF, compared to 12.9% and 2.7% of patients with CHF (p < 0.001 and p = 0.001, respectively, between groups). Hypomagnesemia was found in 7.8% and 5.8% of VT/VF and CHF patients, respectively (p = 0.46). Gastrointestinal illness and recent increases in diuretic dose were strongly associated with severe hypokalemia in VT/VF patients (odds ratio: 11.1 and 21.9, respectively; p < 0.001). In conclusion, hypokalemia is extremely common in patients presenting with VT/VF, much more so than in patients with CHF alone. Preceding gastrointestinal illness and increase in diuretic dose were strongly associated with severe hypokalemia in the VT/VF population, revealing a potential opportunity for early intervention and arrhythmia risk reduction.
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Affiliation(s)
- David B Laslett
- Department of Medicine, Section of Cardiac Electrophysiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Joshua M Cooper
- Department of Medicine, Section of Cardiac Electrophysiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Richard M Greenberg
- Department of Medicine, Section of Cardiac Electrophysiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - George A Yesenosky
- Department of Medicine, Section of Cardiac Electrophysiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Anuj Basil
- Department of Medicine, Section of Cardiac Electrophysiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Chethan Gangireddy
- Department of Medicine, Section of Cardiac Electrophysiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Isaac R Whitman
- Department of Medicine, Section of Cardiac Electrophysiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.
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30
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Abensur Vuillaume L, Ferreira JP, Asseray N, Trombert-Paviot B, Montassier E, Legrand M, Girerd N, Boivin JM, Chouihed T, Rossignol P. Hypokalemia is frequent and has prognostic implications in stable patients attending the emergency department. PLoS One 2020; 15:e0236934. [PMID: 32750075 PMCID: PMC7402484 DOI: 10.1371/journal.pone.0236934] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 07/16/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Potassium disturbances are associated with adverse prognosis in patients with chronic conditions. Its prognostic implications in stable patients attending the emergency department (ED) is poorly described. AIMS This study aimed to assess the prevalence of dyskalemia, describe its predisposing factors and prognostic associations in a population presenting the ED without unstable medical illness. METHODS Post-hoc analysis of a prospective, cross-sectional, multicenter study in the ED of 11 French academic hospitals over a period of 8 weeks. All adults presenting to the ED during this period were included, except instances of self-drug poisoning, inability to complete self-medication questionnaire, presence of an unstable medical illness and decline to participate in the study. All-cause hospitalization or deaths were assessed. RESULTS A total of 1242 patients were included. The mean age was 57.2±22.3 years, 51% were female. The distribution according to potassium concentrations was: hypokalemia<4mmol/L(n = 620, 49.9%), normokalemia 4-5mmol/L(n = 549, 44.2%) and hyperkalemia >5mmol/L(n = 73, 0,6%). The proportion of patients with a kalemia<3.5mmol/L was 8% (n = 101). Renal insufficiency (OR [95% CI] = 3.56[1.94-6.52], p-value <0.001) and hemoglobin <12g/dl (OR [95% CI] = 2.62[1.50-4.60], p-value = 0.001) were associated with hyperkalemia. Female sex (OR [95% CI] = 1.31[1.03-1.66], p-value = 0.029), age <45years (OR [95% CI] = 1.69 [1.20-2.37], p-value = 0.002) and the use of thiazide diuretics (OR [95% CI] = 2.04 [1.28-3.32], p-value = 0.003), were associated with hypokalemia<4mmol/l. Two patients died in the ED and 629 (52.7%) were hospitalized. Hypokalemia <3.5mmol/L was independently associated with increased odds of hospitalization or death (OR [95% CI] = 1.47 [1.00-2.15], p-value = 0.048). CONCLUSIONS Hypokalemia is frequently found in the ED and was associated with worse outcomes in a low-risk ED population.
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Affiliation(s)
- Laure Abensur Vuillaume
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques- Plurithématique 1433, and Inserm U1116, CHRU, Nancy, France
- Emergency Departement, Regional Hospital Metz-Thionville, Metz, France
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France
| | - João Pedro Ferreira
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques- Plurithématique 1433, and Inserm U1116, CHRU, Nancy, France
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France
| | - Nathalie Asseray
- Infectious Diseases Department, Nantes University Hospital and CIC 1413, INSERM, Nantes, France
| | - Béatrice Trombert-Paviot
- Department of Public Health and Medical Informatics, University Hospital of Saint Etienne and Host Research Team SNA-EPIS, PRES Lyon, Jean Monnet University, Lyon, France
| | - Emmanuel Montassier
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France
- Department of Emergency Medicine, Nantes University Hospital; MiHAR lab, Université de Nantes, Nantes, France
| | - Matthieu Legrand
- APHP, Department of Anaesthesiology, Critical Care Medicine and Burn Unit, Saint Louis University Hospital, INSERM UMR-S942, INI-CRCT network and Univ Paris Diderot, Paris, France
| | - Nicolas Girerd
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques- Plurithématique 1433, and Inserm U1116, CHRU, Nancy, France
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France
| | - Jean-Marc Boivin
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques- Plurithématique 1433, and Inserm U1116, CHRU, Nancy, France
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France
| | - Tahar Chouihed
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques- Plurithématique 1433, and Inserm U1116, CHRU, Nancy, France
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France
- Emergency Departement, University Regional Hospital, Nancy, France
| | - Patrick Rossignol
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques- Plurithématique 1433, and Inserm U1116, CHRU, Nancy, France
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France
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Nyende L, Kalyesubula R, Sekasanvu E, Byakika-Kibwika P. Prevalence of renal dysfunction among HIV infected patients receiving Tenofovir at Mulago: a cross-sectional study. BMC Nephrol 2020; 21:232. [PMID: 32571236 PMCID: PMC7310064 DOI: 10.1186/s12882-020-01873-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 05/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an increasing burden of non-communicable disease globally. Tenofovir disoproxil fumarate (TDF) is the most commonly prescribed antiretroviral drug globally. Studies show that patients receiving TDF are more prone to renal dysfunction at some point in time during treatment. Evaluation of kidney function is not routinely done in most HIV public clinics. Identification of renal dysfunction is key in resource constrained settings because managing patients with end stage renal disease is costly. METHOD This was a cross-sectional study conducted at an outpatient clinic in 2018 involving patients on TDF for at least 6 months who were 18 years or older. Patients with documented kidney disease and pregnancy were excluded. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-Epi formula. Renal dysfunction was defined as any of the following; either eGFR< 60 mL/min/1.73m2,or proteinuria of ≥2+ on urine dipstick, glycosuria with normal blood glucose. Electrolyte abnormalities were also documented. RESULTS We enrolled 278 participants. One hundred sixty nine (60.8%) were females, majority 234(84.2%) were < 50 years old, 205 (73.74%) were in WHO stage 1, most participants 271(97.5%) in addition to TDF were receiving lamivudine/efavirenz. The median age was 37(IQR 29-45) years; median duration on ART was 36 (IQR 24-60) months. The prevalence of renal dysfunction was 2.52% (7/278). Most noted electrolyte abnormality was hypocalcaemia (15.44%). CONCLUSIONS The prevalence of renal dysfunction was low though some participants had hypocalcaemia. Screening for kidney disease should be done in symptomatic HIV infected patients on TDF.
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Affiliation(s)
- Louis Nyende
- KCCA- directorate of public health, P.O. Box 7010, Kampala, Uganda
| | - Robert Kalyesubula
- School of Medicine, Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Emmanuel Sekasanvu
- School of Medicine, Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Panorama medical centre, Kampala, Uganda
| | - Pauline Byakika-Kibwika
- School of Medicine, Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Abstract
Hypokalemia is closely linked with the pathophysiology of primary aldosteronism (PA). Although hypokalemic PA is less common than the normokalemic course of the disease, hypokalemia is of particular importance for the manifestation and development of comorbidities. Specifically, a growing body of evidence demonstrates that hypokalemia in PA patients is associated with a more severe disease course regarding cardiovascular and metabolic morbidity and mortality. It is also well appreciated that low potassium levels per se can promote or exacerbate hypertension. The spectrum of hypokalemia-related symptoms ranges from asymptomatic courses to life-threatening conditions. Hypokalemia is found in 9-37% of all cases of PA with a predominance in patients with aldosterone producing adenoma. Conversely, hypokalemia resolves in almost 100% of cases after both, specific medical or surgical treatment of the disease. However, to date, high-level evidence about the prevalence of primary aldosteronism in a hypokalemic population is missing. Epidemiological data are expected from the recently launched IPAHK+study ("Incidence of Primary Aldosteronism in Patients with Hypokalemia").
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Affiliation(s)
- Sven Gruber
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Felix Beuschlein
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, UniversitätsSpital Zürich, Zurich, Switzerland
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
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Chen D, Li X, Song Q, Hu C, Su F, Dai J, Ye Y, Huang J, Zhang X. Assessment of Hypokalemia and Clinical Characteristics in Patients With Coronavirus Disease 2019 in Wenzhou, China. JAMA Netw Open 2020; 3:e2011122. [PMID: 32525548 PMCID: PMC7290402 DOI: 10.1001/jamanetworkopen.2020.11122] [Citation(s) in RCA: 148] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Severe acute respiratory syndrome coronavirus 2 has caused a global outbreak of coronavirus disease 2019 (COVID-19). Severe acute respiratory syndrome coronavirus 2 binds angiotensin-converting enzyme 2 of the rennin-angiotensin system, resulting in hypokalemia. OBJECTIVE To investigate the prevalence, causes, and clinical implications of hypokalemia, including its possible association with treatment outcomes, among patients with COVID-19. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted at Wenzhou Central Hospital and Sixth People's Hospital of Wenzhou, Wenzhou, China, from January 11, 2020, to February 15, 2020. Participants included patients who received a diagnosis of COVID-19 according to the criteria issued by the Chinese Health Bureau and were admitted to the hospital. The patients were classified as having severe hypokalemia (plasma potassium <3 mmol/L), hypokalemia (plasma potassium 3-3.5 mmol/L), and normokalemia (plasma potassium >3.5 mmol/L). The clinical features, therapy, and outcomes were compared between the 3 groups. Data analysis was conducted in March 2020. INTERVENTIONS The patients were given general support and antiviral therapy. Their epidemiological and clinical features were collected. MAIN OUTCOMES AND MEASURES The prevalence of hypokalemia and response to treatment with potassium supplements were measured by analyzing plasma and urine potassium levels. RESULTS One hundred seventy-five patients (87 female patients [50%]; mean [SD] age, 45 [14] years) were classified as having severe hypokalemia (31 patients [18%]), hypokalemia (64 patients [37%]), and normokalemia (80 patients [46%]). Patients with severe hypokalemia had statistically significantly higher body temperature (mean [SD], 37.6 °C [0.9 °C]) than the patients with hypokalemia (mean [SD], 37.2 °C [0.7 °C]; difference, 0.4 °C; 95% CI, 0.2-0.6 °C; P = .02) and the patients with normokalemia (mean [SD], 37.1 °C [0.8 °C]; difference, 0.5 °C; 95% CI, 0.3-0.7 °C; P = .005). Patients with higher levels of hypokalemia also had higher creatine kinase levels (severe hypokalemia, mean [SD], 200 [257] U/L [median, 113 U/L; interquartile range {IQR}, 61-242 U/L]; hypokalemia, mean [SD], 97 [85] U/L; and normokalemia, mean [SD], 82 [57] U/L), higher creatine kinase-MB fraction (severe hypokalemia, mean [SD], 32 [39] U/L [median, 14 U/L; IQR, 11-36 U/L]; hypokalemia, mean [SD], 18 [15] U/L; and normokalemia, mean [SD], 15 [8] U/L), higher lactate dehydrogenase levels (mean [SD], severe hypokalemia, 256 [88] U/L; hypokalemia, 212 [59] U/L; and normokalemia, 199 [61] U/L), and higher C-reactive protein levels (severe hypokalemia, mean [SD], 29 [23] mg/L; hypokalemia, mean [SD], 18 [20] mg/L [median, 12, mg/L; IQR, 4-25 mg/L]; and normokalemia, mean [SD], 15 [18] mg/L [median, 6 U/L; IQR, 3-17 U/L]). Of 40 severely and critically ill patients, 34 (85%) had hypokalemia. Patients with severe hypokalemia were given potassium at a dose of 40 mEq per day, for a total mean (SD) of 453 (53) mEq potassium chloride, during the hospital stay. The patients responded well to potassium supplements as they recovered. CONCLUSIONS AND RELEVANCE The correction of hypokalemia is challenging because of continuous renal potassium loss resulting from the degradation of angiotensin-converting enzyme 2. The high prevalence of hypokalemia among patients with COVID-19 suggests the presence of disordered rennin-angiotensin system activity, which increases as a result of reduced counteractivity of angiotensin-converting enzyme 2, which is bound by severe acute respiratory syndrome coronavirus 2.
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Affiliation(s)
- Dong Chen
- Department of Infectious Diseases, The Ding Li Clinical College of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
- Department of Infectious Diseases, Sixth People’s Hospital of Wenzhou, Wenzhou, Zhejiang Province, China
| | - Xiaokun Li
- Virus Research Institute, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Qifa Song
- Department of Microbiology, Ningbo Municipal Centre for Disease Control and Prevention, Ningbo, Zhejiang Province, China
| | - Chenchan Hu
- Department of Infectious Diseases, The Ding Li Clinical College of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
- Department of Infectious Diseases, Sixth People’s Hospital of Wenzhou, Wenzhou, Zhejiang Province, China
| | - Feifei Su
- Department of Infectious Diseases, The Ding Li Clinical College of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
- Department of Infectious Diseases, Sixth People’s Hospital of Wenzhou, Wenzhou, Zhejiang Province, China
| | - Jianyi Dai
- Department of Infectious Diseases, The Ding Li Clinical College of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
- Department of Infectious Diseases, Sixth People’s Hospital of Wenzhou, Wenzhou, Zhejiang Province, China
| | - Yinghai Ye
- Department of Infectious Diseases, The Ding Li Clinical College of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
- Department of Infectious Diseases, Sixth People’s Hospital of Wenzhou, Wenzhou, Zhejiang Province, China
| | - Jianping Huang
- Department of Infectious Diseases, The Ding Li Clinical College of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
- Department of Infectious Diseases, Sixth People’s Hospital of Wenzhou, Wenzhou, Zhejiang Province, China
| | - Xiaoming Zhang
- Department of Microbiology, Wenzhou Municipal Centre for Disease Control and Prevention, Wenzhou, Zhejiang Province, China
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Ravn Jacobsen M, Jabbari R, Glinge C, Kjær Stampe N, Butt JH, Blanche P, Lønborg J, Wendelboe Nielsen O, Køber L, Torp‐Pedersen C, Pedersen F, Tfelt‐Hansen J, Engstrøm T. Potassium Disturbances and Risk of Ventricular Fibrillation Among Patients With ST-Segment-Elevation Myocardial Infarction. J Am Heart Assoc 2020; 9:e014160. [PMID: 32067598 PMCID: PMC7070188 DOI: 10.1161/jaha.119.014160] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Potassium disturbances per se increase the risk of ventricular fibrillation (VF). Whether potassium disturbances in the acute phase of ST-segment-elevation myocardial infarction (STEMI) are associated with VF before primary percutaneous coronary intervention (PPCI) is uncertain. Methods and Results All consecutive STEMI patients were identified in the Eastern Danish Heart Registry from 1999 to 2016. Comorbidities and medication use were assessed from Danish nationwide registries. Potassium levels were collected immediately before PPCI start. Multivariate logistic models were performed to determine the association between potassium and VF. The main analysis included 8624 STEMI patients of whom 822 (9.5%) had VF before PPCI. Compared with 6693 (77.6%) patients with normokalemia (3.5-5.0 mmol/L), 1797 (20.8%) patients with hypokalemia (<3.5 mmol/L) were often women with fewer comorbidities, whereas 134 (1.6%) patients with hyperkalemia (>5.0 mmol/L) were older with more comorbidities. After adjustment, patients with hypokalemia and hyperkalemia had a higher risk of VF before PPCI (odds ratio 1.90, 95% CI 1.57-2.30, P<0.001) and (odds ratio 3.36, 95% CI 1.95-5.77, P<0.001) compared with normokalemia, respectively. Since the association may reflect a post-resuscitation phenomenon, a sensitivity analysis was performed including 7929 STEMI patients without VF before PPCI of whom 127 (1.6%) had VF during PPCI. Compared with normokalemia, patients with hypokalemia had a significant association with VF during PPCI (odds ratio 1.68, 95% CI 1.01-2.77, P=0.045) after adjustment. Conclusions Hypokalemia and hyperkalemia are associated with increased risk of VF before PPCI during STEMI. For hypokalemia, the association may be independent of the measurement of potassium before or after VF.
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Affiliation(s)
- Mia Ravn Jacobsen
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Reza Jabbari
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Charlotte Glinge
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Niels Kjær Stampe
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Jawad Haider Butt
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Paul Blanche
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
- Department of BiostatisticsUniversity of CopenhagenDenmark
| | - Jacob Lønborg
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Olav Wendelboe Nielsen
- Department of CardiologyBispebjerg and Frederiksberg University HospitalCopenhagenDenmark
| | - Lars Køber
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | | | - Frants Pedersen
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Jacob Tfelt‐Hansen
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
- Department of Forensic MedicineFaculty of Medical ScienceUniversity of CopenhagenDenmark
| | - Thomas Engstrøm
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
- Department of CardiologyUniversity of LundSweden
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Formiga F, Chivite D, Corbella X, Conde-Martel A, Arévalo-Lorido JC, Trullàs JC, Silvestre JP, García SC, Manzano L, Montero-Pérez-Barquero M. Influence of potassium levels on one-year outcomes in elderly patients with acute heart failure. Eur J Intern Med 2019; 60:24-30. [PMID: 30722845 DOI: 10.1016/j.ejim.2018.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/15/2018] [Accepted: 10/18/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Abnormal serum potassium levels (K+) in patients with heart failure (HF) relate to worse prognosis. We evaluated whether admission K+ levels predict 1-year outcomes in elderly patients admitted for acute HF. METHODS We evaluated 2865 patients aged >74 years from the RICA Spanish Heart Failure Registry, classified according to admission serum K+ levels: hyperkalemia (>5.5 mmol/L), normokalemia (3.5-5.5 mmol/L) and hypokalemia (<3.5 mmol/L). We explored whether K+ levels were significantly associated with one-year all-cause mortality or hospital readmission and their combination. RESULTS Mean admission K+ value was 4.3 ± 0.6 mmol/L; 97 patients (3.38%) presented with hyperkalemia and 174 (6.06%) with hypokalemia. Overall, 43% of the patients died or were readmitted for HF during the follow-up period; the risk was higher for those with hyperkalemia (59% vs 41% in hypokalemic patients). The HR for one-year mortality was 1.43 (p = .073) and 1.67 for readmissions (p = .007) when K+ was >5.5 mmol/L and 1.08 (p = .618) and 0.90 (p = .533) respectively for K+ < 3.5 mmol/L. The HR for the combined outcome was 1.59 (1.19-2.13); p = .002 in hyperkalemic patients and 0.96 (0.75-1.23); p = .751in hypokalemic patients. Multivariate analysis showed a significant association of admission K+ values >5.5 mmol/L with the combined outcome of mortality and readmission (HR 1.15 [95% CI 1.04-1.27], p = .008). CONCLUSION In patients hospitalized for decompensated HF, admission hyperkalemia predicts a higher mid-term risk for HF readmission and mortality, probably related to the significant higher risk of readmission.
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Affiliation(s)
- Francesc Formiga
- Geriatric Unit, Internal Medicine Department, Hospital Universitari de Bellvitge-IDIBELL, L' Hospitalet de Llobregat, Barcelona, Spain.
| | - David Chivite
- Geriatric Unit, Internal Medicine Department, Hospital Universitari de Bellvitge-IDIBELL, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Corbella
- Geriatric Unit, Internal Medicine Department, Hospital Universitari de Bellvitge-IDIBELL, L' Hospitalet de Llobregat, Barcelona, Spain; Hestia Chair, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Alicia Conde-Martel
- Internal Medicine Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
| | | | - Joan Carles Trullàs
- Intenal Medicine Service, Hospital d'Olot i comarcal de la Garrtoxa, Olot, Girona, Spain and Medical Science Department, Universitat de Girona, Girona, Spain
| | - José Pérez Silvestre
- Internal Medicine Department, Hospital General Universitario de Valencia, Valencia, Spain
| | - Sara Carrascosa García
- Internal Medicine Department, Hospital General Universitario de Valencia, Valencia, Spain
| | - Luis Manzano
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá (IRYCIS), Madrid, Spain
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Jouini S, Aloui A, Slimani O, Hebaieb F, Kaddour RB, Manai H, Hedhli H. Profils épidémiologiques des acidocétoses diabètiques aux urgences. Pan Afr Med J 2019; 33:322. [PMID: 31692874 PMCID: PMC6815504 DOI: 10.11604/pamj.2019.33.322.17161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 05/19/2019] [Indexed: 11/14/2022] Open
Abstract
Introduction L'acidocétose diabétique (ACD) est une complication métabolique grave du diabète. Son incidence est en augmentation ces dernières années, cependant sa mortalité reste faible. L'objectif de cette étude a été de décrire les caractéristiques épidémiologiques, cliniques, thérapeutiques et pronostiques des patients admis aux urgences pour ACD sévère ou modérée. Méthodes Il s'agissait d'une étude prospective, descriptive qui a inclus les ACD modérées ou sévères. Standardisation du protocole de prise en charge thérapeutique. Nous avons étudié les caractéristiques épidémiologiques, cliniques, thérapeutiques et pronostiques chez ces patients. Résultats Nous avons inclus 185 patients avec ACD sévère ou modérée. L'âge moyen a été de 38 +/- 18 ans; le sexe ratio=0,94. Diabète connue= 159 patients (85%) dont 116 étaient des diabétiques type 1. Les facteurs de décompensation les plus fréquents étaient l'arrêt du traitement chez 42% et l'infection chez 32%. La glycémie moyenne a été de 32,7+/-12mmol/L, pH =7,14+/-0,13, HCO3- =7,2+/-3,56 mmol /L. La durée moyenne de l'insuline intraveineuse était de 17,3 +/- 16 heures. L'hypoglycémie a été observée chez 26 patients (14%), l'hypokaliémie chez 80 (43%). La mortalité au cours de l'hospitalisation a été de 2,1%. Conclusion L'acidocétose diabétique survient chez les sujets jeunes traités par insulinothérapie. Le traitement est à base d'insuline par voie intraveineuse en plus de la correction du déficit hydrique. Les complications sont essentiellement l'hypokaliémie et l'hypoglycémie; et la mortalité reste faible.
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Affiliation(s)
- Sarra Jouini
- Hôpital Charles Nicolle, Service des Urgences, Tunis, Tunisie
- Université Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisie
- Université Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisie
| | - Asma Aloui
- Hôpital Charles Nicolle, Service des Urgences, Tunis, Tunisie
- Université Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisie
| | - Olfa Slimani
- Université Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisie
- Hôpital Charles Nicolle, Service de Gynécologie Obstétrique, Tunis, Tunisie
| | - Fatma Hebaieb
- Hôpital Charles Nicolle, Service des Urgences, Tunis, Tunisie
- Université Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisie
| | - Rym Ben Kaddour
- Hôpital Charles Nicolle, Service des Urgences, Tunis, Tunisie
- Université Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisie
| | - Héla Manai
- Hôpital Charles Nicolle, Service des Urgences, Tunis, Tunisie
- Université Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisie
| | - Hana Hedhli
- Hôpital Charles Nicolle, Service des Urgences, Tunis, Tunisie
- Université Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisie
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Kaplan M, Ateş I, Gökcan H, Kayhan MA, Kaçar S, Akpınar MY, Gökbulut V, Kayaçetin E. Prognostic Utility of Hypokalemia in Cirrhotic Patients. Acta Gastroenterol Belg 2018; 81:398-403. [PMID: 30350528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND AIM We researched the relationships between serum potassium level and prognostic scores and complications of cirrhosis, and mortality. METHODS This study was performed retrospectively in Turkish High Specialty Training and Research Hospital between 2009 and 2015. Patients who had missing patient files and electrolyte disorder for another reason, showed complications at the time of application and were using diuretics were excluded from the study. RESULTS 218 patients were included in the study. During the follow-up period, 23.4% (n: 51) of the entire population passed away. Compared to the patients who survived, the patients who passed away had higher HCC and HES development rate, mean Child-Pugh and MELD score and lower mean blood potassium level. The stepwise multivariable Cox regression model which included significant independent predictors showed that ChildPugh score (HR: 1.29; p <0.001), MELD score (HR:1.13; p= 0.006), and potassium level (HR: 0.18; p< 0.001) were independent predictors of mortality. The cut off value for potassium level in predicting mortality was found to be ≤ 3.4 mmol/L with 80.4% sensitivity and 100% specificity. Compared to the patients with a potassium level > 3.4 mmol/L, the patients with a potassium level ≤ 3.4 mmol/L had higher mortality rate, HCC and HES development rate, mean Child-Pugh and mean MELD scores. CONCLUSION Hypokalemia is an important prognostic factor in cirrhotic patients.
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Affiliation(s)
- M Kaplan
- Turkey Yuksek Ihtisas Training and Research Hospital, Department of Gastroenterology, Ankara, Turkey
| | - I Ateş
- Ankara Numune Training and Research Hospital, Department of Internal Medicine, Ankara, Turkey
| | - H Gökcan
- Turkey Yuksek Ihtisas Training and Research Hospital, Department of Gastroenterology, Ankara, Turkey
| | - M A Kayhan
- Turkey Yuksek Ihtisas Training and Research Hospital, Department of Gastroenterology, Ankara, Turkey
| | - S Kaçar
- Turkey Yuksek Ihtisas Training and Research Hospital, Department of Gastroenterology, Ankara, Turkey
| | - M Y Akpınar
- Turkey Yuksek Ihtisas Training and Research Hospital, Department of Gastroenterology, Ankara, Turkey
| | - V Gökbulut
- Turkey Yuksek Ihtisas Training and Research Hospital, Department of Gastroenterology, Ankara, Turkey
| | - E Kayaçetin
- Turkey Yuksek Ihtisas Training and Research Hospital, Department of Gastroenterology, Ankara, Turkey
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38
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Turakhia MP, Blankestijn PJ, Carrero JJ, Clase CM, Deo R, Herzog CA, Kasner SE, Passman RS, Pecoits-Filho R, Reinecke H, Shroff GR, Zareba W, Cheung M, Wheeler DC, Winkelmayer WC, Wanner C. Chronic kidney disease and arrhythmias: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Eur Heart J 2018; 39:2314-2325. [PMID: 29522134 PMCID: PMC6012907 DOI: 10.1093/eurheartj/ehy060] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/18/2017] [Accepted: 01/27/2018] [Indexed: 12/15/2022] Open
MESH Headings
- Arrhythmias, Cardiac/epidemiology
- Arrhythmias, Cardiac/therapy
- Atrial Fibrillation/complications
- Atrial Fibrillation/drug therapy
- Atrial Fibrillation/epidemiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Humans
- Hyperkalemia/epidemiology
- Hyperkalemia/metabolism
- Hypokalemia/epidemiology
- Hypokalemia/metabolism
- Inflammation
- Kidney Failure, Chronic/epidemiology
- Kidney Failure, Chronic/metabolism
- Kidney Failure, Chronic/therapy
- Oxidative Stress
- Potassium/metabolism
- Renal Dialysis
- Renal Insufficiency, Chronic/epidemiology
- Renal Insufficiency, Chronic/metabolism
- Renal Insufficiency, Chronic/therapy
- Risk Factors
- Stroke/etiology
- Stroke/prevention & control
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Affiliation(s)
- Mintu P Turakhia
- Stanford University School of Medicine, Veterans Affairs Palo Alto Health Care System, Miranda Ave, Palo Alto, CA, USA
| | - Peter J Blankestijn
- Department of Nephrology, room F03.220, University Medical Center, Utrecht, The Netherlands
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Stockholm, Sweden
| | - Catherine M Clase
- Department of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, St. Joseph’s Healthcare, Marian Wing, 3rd Floor, M333, 50 Charlton Ave. E, Hamilton, Ontario, Canada
| | - Rajat Deo
- Section of Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, 9 Founders Cardiology, Philadelphia, PA, USA
| | - Charles A Herzog
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota and Chronic Disease Research Group, Minneapolis Medical Research Foundation, 914 S. 8th Street, S4.100, Minneapolis, MN, USA
| | - Scott E Kasner
- Department of Neurology, 3W Gates Bldg. Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, USA
| | - Rod S Passman
- Northwestern University Feinberg School of Medicine and the Bluhm Cardiovascular Institute, 201 E. Huron St. Chicago, IL, USA
| | - Roberto Pecoits-Filho
- School of Medicine, Pontificia Universidade Catolica do Paraná, Rua Imaculada Conceição Curitiba PR, Brazil
| | - Holger Reinecke
- Department für Kardiologie und Angiologie Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, Muenster, Germany
| | - Gautam R Shroff
- Division of Cardiology, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN, USA
| | - Wojciech Zareba
- Heart Research Follow-up Program, Cardiology Division, University of Rochester Medical Center, Saunders Research Building, 265 Crittenden Blvd. CU, Rochester, NY, USA
| | | | - David C Wheeler
- Centre for Nephrology, University College London, Rowland Hill Street, London, UK
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, ABBR R705, MS: 395, Houston, TX, USA
| | - Christoph Wanner
- Division of Nephrology, Department of Medicine, University Hospital of Würzburg, Oberduerrbacherstr. 6 Würzburg, Germany
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Kovesdy CP, Matsushita K, Sang Y, Brunskill NJ, Carrero JJ, Chodick G, Hasegawa T, Heerspink HL, Hirayama A, Landman GWD, Levin A, Nitsch D, Wheeler DC, Coresh J, Hallan SI, Shalev V, Grams ME. Serum potassium and adverse outcomes across the range of kidney function: a CKD Prognosis Consortium meta-analysis. Eur Heart J 2018; 39:1535-1542. [PMID: 29554312 PMCID: PMC5930249 DOI: 10.1093/eurheartj/ehy100] [Citation(s) in RCA: 184] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/22/2017] [Accepted: 02/14/2018] [Indexed: 12/20/2022] Open
Abstract
Aims Both hypo- and hyperkalaemia can have immediate deleterious physiological effects, and less is known about long-term risks. The objective was to determine the risks of all-cause mortality, cardiovascular mortality, and end-stage renal disease associated with potassium levels across the range of kidney function and evaluate for consistency across cohorts in a global consortium. Methods and results We performed an individual-level data meta-analysis of 27 international cohorts [10 general population, 7 high cardiovascular risk, and 10 chronic kidney disease (CKD)] in the CKD Prognosis Consortium. We used Cox regression followed by random-effects meta-analysis to assess the relationship between baseline potassium and adverse outcomes, adjusted for demographic and clinical characteristics, overall and across strata of estimated glomerular filtration rate (eGFR) and albuminuria. We included 1 217 986 participants followed up for a mean of 6.9 years. The average age was 55 ± 16 years, average eGFR was 83 ± 23 mL/min/1.73 m2, and 17% had moderate- to-severe increased albuminuria levels. The mean baseline potassium was 4.2 ± 0.4 mmol/L. The risk of serum potassium of >5.5 mmol/L was related to lower eGFR and higher albuminuria. The risk relationship between potassium levels and adverse outcomes was U-shaped, with the lowest risk at serum potassium of 4-4.5 mmol/L. Compared with a reference of 4.2 mmol/L, the adjusted hazard ratio for all-cause mortality was 1.22 [95% confidence interval (CI) 1.15-1.29] at 5.5 mmol/L and 1.49 (95% CI 1.26-1.76) at 3.0 mmol/L. Risks were similar by eGFR, albuminuria, renin-angiotensin-aldosterone system inhibitor use, and across cohorts. Conclusions Outpatient potassium levels both above and below the normal range are consistently associated with adverse outcomes, with similar risk relationships across eGFR and albuminuria.
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Affiliation(s)
- Csaba P Kovesdy
- University of Tennessee Health Science Center, Memphis, TN, USA
- Memphis Veterans Affairs Medical Center, Memphis, TN, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, USA
| | - Yingying Sang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, USA
| | - Nigel J Brunskill
- Department of Infection Immunity and Inflammation, University of Leicester, Leicester, UK
- John Walls Renal Unit, University Hospitals of Leicester, Leicester, UK
| | - Juan J Carrero
- Department of Medical Epidemiology and Biosatistics (MEB), Karolinska Institutet, Stockholm, Sweden
| | - Gabriel Chodick
- Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Takeshi Hasegawa
- Showa University, Office for Promoting Medical Research, Tokyo, Japan
- Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Public Health, Kyoto, Japan
| | - Hiddo L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Atsushi Hirayama
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | | | - Adeera Levin
- BC Provincial Renal Agency, Vancouver, BC, Canada
- University of British Columbia, Vancouver, BC, Canada
| | - Dorothea Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - David C Wheeler
- Centre for Nephrology, University College London, London, UK
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, USA
| | - Stein I Hallan
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science Technology, Trondheim, Norway
- Division of Nephrology, Department of Medicine, St Olav University Hospital, Trondheim, Norway
| | - Varda Shalev
- Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Morgan E Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, USA
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Hortencio TDR, Golucci APBS, Marson FAL, Ribeiro AF, Nogueira RJ. Mineral Disorders in Adult Inpatients Receiving Parenteral Nutrition. Is Older Age a Contributory Factor? J Nutr Health Aging 2018; 22:811-818. [PMID: 30080225 DOI: 10.1007/s12603-018-1035-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Parenteral nutrition (PN)-dependent adults and elderly individuals who are admitted to hospital treatment are potentially susceptible to mineral disorder complications due to depleted physiological reserves, loss of lean body mass, and increased fat mass, thus worsening inflammation. AIM The purpose of this study is to evaluate the prevalence of hypophosphatemia, hypokalemia, and hypomagnesaemia prior and within the first 7 days of PN infusion. Furthermore, whether malnutrition and old age are associated with these disorders was also investigated. METHODS This study included a historical cohort of adult patients, and 1,040 patients whose information was prospectively entered in the database were evaluated. RESULTS Of the 781 patients, 27.3% were ≥65 years, 80.9% had undergone surgical treatment, 74.3% were in the intensive care unit, and 17.9% died during the hospitalization period. About 17.1% patients were malnourished. Protein energy malnutrition (PEM) was observed in 31.9% of the elderly patients and 27.1% of adults in general. Hypophosphatemia, hypokalemia, and hypomagnesemia were more prevalent before the start of PN infusion (D0: 214 [18.4%]), and new events were more common during the first 2 days of PN infusion (D1: 283 [23.1%]; D2: 243 [20.1%]. Elderly patients were more susceptible to developing hypophosphatemia (odds ratio [OR]: 1.69; 95% confidence interval [CI]: 1.29-2.19; p<0.001). Patients with PEM were also more susceptible to hypophosphatemia (OR: 3.75; 95% CI: 1.13-12.47; p=0.036). CONCLUSION Hypophosphatemia, hypokalemia, and hypomagnesemia were frequently observed in hospitalized adults and elderly patients before and particularly during the first 2 days of PN infusion. Elderly patients and patients with PEM are more susceptible to developing hypophosphatemia.
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Affiliation(s)
- T D R Hortencio
- Tais Daiene Russo Hortencio, Universidade Estadual de Campinas, Campinas, Sao Paulo, Brazil,
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Rao SSC, Summers RW, Rao GRS, Ramana S, Devi U, Zimmerman B, Pratap BCV. Oral Rehydration for Viral Gastroenteritis in Adults: A Randomized, Controlled Trial of 3 Solutions. JPEN J Parenter Enteral Nutr 2017; 30:433-9. [PMID: 16931613 DOI: 10.1177/0148607106030005433] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pedialyte and Gatorade are advocated for the treatment of dehydration in viral gastroenteritis, but there is limited evidence to support their use. We examine the efficacy, safety, and palatability of Pedialyte, Gatorade, and a New Oral Rehydration Solution (N-ORS). This was a randomized double-blind trial conducted in an inpatient, community hospital. Seventy-five consecutive adult patients (male, 42; female, 33) admitted with viral gastroenteritis were randomized to receive Gatorade, Pedialyte, or N-ORS for 48 hours. A yogurt/rice diet was allowed ad libitum. Stool and urine output, electrolytes, fluid intake, body weight, hematocrit, and palatability of solutions were measured. RESULTS Sixty completed the study. Stool frequency, consistency, and body weight improved (p < .001) in all 3 groups, but there was no difference between groups. Likewise, urine output, hematocrit, and correlations between fluid ingested, stool weight, or urine output were similar. At admission and 24 and 48 hours later, hypokalemia was observed in 7, 10, and 8 patients with Gatorade; 3, 2, and 1 with N-ORS; and 2, 2, and 1 with Pedialyte, respectively. Similarly, hyponatremia was observed in 6, 9, and 3 patients with Gatorade; 5, 3, and 4 with N-ORS; and 4, 5, and 4 with Pedialyte. Tastewise, Gatorade and N-ORS were rated higher (p < .05) than Pedialyte. Limitations were a smaller sample size and higher dropout (20%). CONCLUSIONS Gatorade and N-ORS seem to be as effective as Pedialyte in correcting dehydration and in improving bowel symptoms. All 3 solutions were safe. Unlike other groups, hypokalemia persisted in the Gatorade group. Gatorade and N-ORS may be effective in the treatment of dehydration associated with mild viral gastroenteritis.
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Affiliation(s)
- S S C Rao
- Department of Internal Medicine, University of Iowa, Iowa City, 52242-1009, USA.
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Lieu CH, Hidalgo M, Berlin JD, Ko AH, Cervantes A, LoRusso P, Gerber DE, Eder JP, Eckhardt SG, Kapp AV, Tsuhako A, McCall B, Pirzkall A, Uyei A, Tabernero J. A Phase Ib Dose-Escalation Study of the Safety, Tolerability, and Pharmacokinetics of Cobimetinib and Duligotuzumab in Patients with Previously Treated Locally Advanced or Metastatic Cancers with Mutant KRAS. Oncologist 2017; 22:1024-e89. [PMID: 28592615 PMCID: PMC5599193 DOI: 10.1634/theoncologist.2017-0175] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 04/13/2017] [Indexed: 11/19/2022] Open
Abstract
Lessons Learned. Cobimetinib and duligotuzumab were well tolerated as single agents and in combination with other agents. The cobimetinib and duligotuzumab combination was associated with increased toxicity, most notably gastrointestinal, and limited efficacy in the patient population tested.
Background. KRAS‐mutant tumors possess abnormal mitogen‐activated protein kinases (MAPK) pathway signaling, leading to dysregulated cell proliferation. Cobimetinib blocks MAPK signaling. The dual‐action antibody duligotuzumab (MEHD7945A) inhibits ligand binding to both epidermal growth factor receptor (EGFR) and human epidermal growth factor receptor 3 (HER3). Blockade of EGFR/HER3 and inhibition of mitogen‐activated protein kinase (MEK) in KRAS‐mutant tumors may provide additive benefit. Methods. Patients with KRAS‐mutant solid tumors were eligible for this phase Ib dose‐escalation study with a planned expansion phase. Duligotuzumab was given intravenously (IV) at 1,100 mg every 2 weeks (q2w), while cobimetinib was given orally in a standard 3 + 3 design to identify the recommended phase II dose (RP2D). The primary objective was to evaluate the safety and tolerability of this combination. Results. Twenty‐three patients were enrolled. Dose‐limiting toxicities (DLTs) included grade 4 hypokalemia and grade 3 mucosal inflammation, asthenia, and dermatitis acneiform. Seventy percent of patients experienced grade 3 or worse adverse events (AEs). Five (22%) and 12 (52%) patients missed at least 1 dose of duligotuzumab and cobimetinib, respectively, and 9 (39%) patients required a cobimetinib dose reduction. Three (13%) patients discontinued due to an AE. Best response was limited to 9 patients with stable disease and 13 patients with progressive disease. Conclusion. Given the limited tolerability and efficacy of this combination, the study did not proceed to expansion stage and closed for enrollment.
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Affiliation(s)
- Christopher H Lieu
- Division of Medical Oncology, University of Colorado Health Sciences Center, Aurora, Colorado, USA
| | - Manuel Hidalgo
- START Madrid, Centro Integral Oncologico Clara Campal (CIOCC), Madrid, Spain
| | | | - Andrew H Ko
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
| | - Andres Cervantes
- Department of Medical Oncology, Biomedical Research Institute INCLIVA, CIBERONC, University of Valencia, Valencia, Spain
| | | | - David E Gerber
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - J Paul Eder
- Yale Smilow Cancer Center, New Haven, Connecticut, USA
| | - S Gail Eckhardt
- Division of Medical Oncology, University of Colorado Health Sciences Center, Aurora, Colorado, USA
| | - Amy V Kapp
- Genentech, Inc., South San Francisco, California, USA
| | - Amy Tsuhako
- Genentech, Inc., South San Francisco, California, USA
| | - Bruce McCall
- Genentech, Inc., South San Francisco, California, USA
| | | | - Anne Uyei
- Genentech, Inc., South San Francisco, California, USA
| | - Josep Tabernero
- Vall d'Hebron University Hospital and Institute of Oncology, CIBERONC, Universitat Autònoma de Barcelona, Barcelona, Spain
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Bilal A, Sadiq MA, Haider N. Frequency of hyponatraemia and hypokalaemia in malnourished children with acute diarrhoea. J PAK MED ASSOC 2016; 66:1077-1080. [PMID: 27654723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To determine the frequency of hyponatraemia and hypokalaemia in malnourished children with acute diarrhoea. METHODS This cross-sectional study was carried out at the Military Hospital, Rawalpindi, Pakistan, from September 2013 to March 2014, and comprised acute diarrhoea patients whose ages ranged from six months to five years. Blood samples for serum sodium and potassium were examined at the Armed Forces Institute of Pathology. Patients were labelled as having hyponatraemia, hypokalaemia, both or having normal serum sodium and potassium levels. RESULTS Of the 80 patients, 49(61.3%) were boys and 31(38.7%) were girls with an overall mean age of 1.9±1.4 years. Besides, 41(51.3%) were aged below one year. The mean duration of diarrhoea was 3.2±1.7 days, with 53(66%) patients having the illness for 1-3 days. Hyponatraemia was observed in 26(32.5%) patients and hypokalaemia in 44(55%), whereas 10(12.5%) had no electrolyte imbalance. None of the participants had hypernatraemia or hyperkalaemia. CONCLUSIONS Electrolyte disturbances among malnourished children may not be clinically evident, but diarrhoeal illness aggravated these imbalances.
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Affiliation(s)
- Asma Bilal
- FCPS Trainee at Military Hospital, Rawalpindi, Pakistan
| | | | - Nighat Haider
- Pediatrician, Frontier Corps Hospital, Quetta, Pakistan
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Kang MY. Blood electrolyte disturbances during severe hypoglycemia in Korean patients with type 2 diabetes. Korean J Intern Med 2015; 30:648-56. [PMID: 26354059 PMCID: PMC4578021 DOI: 10.3904/kjim.2015.30.5.648] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 12/26/2014] [Accepted: 04/05/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS To investigate abnormalities in blood electrolyte levels during severe hypoglycemia in Korean patients with type 2 diabetes mellitus (T2DM) in a clinical setting. METHODS Blood electrolyte levels in adult T2DM patients during severe hypoglycemia were collected from January 1, 2008 to December 31, 2012. Patients who maintained normal serum creatinine and blood urea nitrogen levels were utilized in the study. Severe hypoglycemia was defined as a condition requiring medical assistance, such as administering carbohydrates when serum glucose levels less than 70 mg/dL were observed, in conjunction with other symptoms of hypoglycemia. RESULTS A total of 1,068 patients who visited the emergency room with severe hypoglycemia were screened, of which 219 patients were included in this study. The incidence of abnormal levels for any electrolyte was 47%. Hypokalemia (< 3.5 mmol/L) was the most common type of electrolyte disturbance observed at 21.9%. A decrease in serum potassium levels was associated with decreases in blood glucose levels (r = 0.151, p = 0.025). During severe hypoglycemia, median blood glucose levels, incidence of tachycardia (> 100 beats per minute) and severe hypertension (≥ 180/120 mmHg) were 30 mg/dL (range, 14 to 62) and 35 mg/dL (range, 10 to 69; p = 0.04), 18.8% and 7.2% (p = 0.02), and 20.8% and 10.2% (p = 0.05) in the hypokalemia and normokalemia groups, respectively. CONCLUSIONS During severe hypoglycemia, hypokalemia occurred in 21.9% of T2DM patients and was associated with tachycardia and severe hypertension. Therefore, the results suggest that severe hypoglycemia may increase cardiovascular events in T2DM.
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Affiliation(s)
- Mi Yeon Kang
- Correspondence to Mi Yeon Kang, M.D. Department of Internal Medicine, Saint Carollo Hospital, 221 Sungwang-ro, Suncheon 57931, Korea Tel: +82-61-720-2428 Fax: +82-61-720-6000 E-mail:
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Nakhoul GN, Huang H, Arrigain S, Jolly SE, Schold JD, Nally JV, Navaneethan SD. Serum Potassium, End-Stage Renal Disease and Mortality in Chronic Kidney Disease. Am J Nephrol 2015; 41:456-63. [PMID: 26228532 DOI: 10.1159/000437151] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 06/18/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND/AIMS Hypokalemia and hyperkalemia are often noted in chronic kidney disease (CKD) patients, but their impact on mortality and end-stage renal disease (ESRD) is less well understood. We aimed at studying the associations between potassium disorders, and mortality and progression to ESRD in a CKD population. METHODS Using our electronic health record-based CKD registry, 36,359 patients with eGFR <60 ml/min/1.73 m(2) and potassium levels measured from January 1, 2005 to September 15, 2009 were identified. We examined factors associated with hypokalemia (<3.5 mmol/l) and hyperkalemia (>5.0 mmol/l) using logistic regression models and associations between serum potassium levels (both as continuous and categorical variables) and all-cause mortality or ESRD using Cox-proportional hazards models. RESULTS Serum potassium <3.5 mmol/l was noted among 3% and >5.0 mmol/l among 11% of the study population. In the multivariable logistic regression analysis, lower eGFR, diabetes and use of ACE inhibitors or Angiotensin-Receptor Blockers were associated with higher odds of having hyperkalemia. Heart failure and African American race were factors associated with higher odds of hypokalemia. After adjustment for covariates including kidney function, serum potassium <4.0 and >5.0 mmol/l were significantly associated with increased mortality risk, but there was no increased risk for progression to ESRD. Time-dependent repeated measures analysis confirmed these findings. When potassium was examined as a continuous variable, there was a U-shaped association between serum potassium levels and mortality. CONCLUSION In patients with stage 3-4 CKD, serum potassium levels <4.0 and >5.0 mmol/l are associated with higher mortality but not with ESRD.
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Affiliation(s)
- Georges N Nakhoul
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Kapelios CJ, Kaldara E, Ntalianis A, Sousonis V, Repasos E, Sfakianaki T, Vakrou S, Pantsios C, Nanas JN, Terrovitis JV. High furosemide dose has detrimental effects on survival of patients with stable heart failure. Hellenic J Cardiol 2015; 56:154-159. [PMID: 25854445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION High doses of furosemide for heart failure (HF) have been correlated with an increased mortality, though whether they are a marker of disease severity or an independent predictor is unknown. We hypothesized that, in patients presenting with stable HF, the likelihood of long-term major adverse clinical events is increased by higher furosemide doses. METHODS We retrospectively recorded the doses of furosemide prescribed to 173 consecutive, clinically stable patients during a first ambulatory HF department visit. The low-dose group included 103 patients treated with 80 mg and the high-dose group included 70 patients treated with >80 mg of furosemide daily. Proportional hazard regression analyses were performed with single and multiple variables in search of correlates of long-term adverse clinical events. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated. RESULTS The baseline characteristics of the 2 groups were similar, except for estimated glomerular filtration rate, which was higher in the low- than the high-dose group (72.9 ± 19.4 vs. 60.8 ± 22.0 mL/min/ m2, p<0.001). The 3-year survival free from the composite endpoint was significantly higher in the lowdose group than in the high-dose group (93.1% vs. 60.0%, p<0.001). By multiple variable analysis, highdose furosemide was an independent predictor of an adverse outcome at 3 years (adjusted HR: 15.25; 95% CI:1.06-219.39, p=0.045). The incidence of deterioration of renal function and episodes of hypokalemia during follow up was also higher in the high furosemide dose (73.2% vs. 48.3, p=0.003, and 43.1% vs. 6.5%, p<0.001, respectively). CONCLUSIONS High doses of furosemide administered in order to stabilize HF patients and continued thereafter are associated with an adverse clinical outcome.
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Affiliation(s)
- Chris J Kapelios
- Third Department of Cardiology, University of Athens School of Medicine, Athens, Greece
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Eliacik E, Yildirim T, Sahin U, Kizilarslanoglu C, Tapan U, Aybal-Kutlugun A, Hascelik G, Arici M. Potassium abnormalities in current clinical practice: frequency, causes, severity and management. Med Princ Pract 2015; 24:271-5. [PMID: 25766276 PMCID: PMC5588203 DOI: 10.1159/000376580] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 01/29/2015] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE We aimed to investigate the prevalence and etiology of potassium abnormalities (hypokalemia and hyperkalemia) and management approaches for hospitalized patients. SUBJECTS AND METHODS Over a 4-month period, all hospitalized patients at Hacettepe University Medical Faculty Hospitals who underwent at least one measurement of serum potassium during hospitalization were included. Data on serum levels of electrolytes, demographic characteristics, cause(s) of hospitalization, medications, etiology of potassium abnormality and treatment approaches were obtained from the hospital records. RESULTS Of the 9,045 hospitalized patients, 1,265 (14.0%) had a serum potassium abnormality; 604 (6.7%) patients had hypokalemia and 661 (7.30%) had hyperkalemia. In the hypokalemic patients, the most important reasons were gastrointestinal losses in 555 (91.8%) patients and renal losses in 252 (41.7%) patients. The most frequent treatment strategies were correcting the underlying cause and replacing the potassium deficit. Of the 604 hypokalemic patients, 319 (52.8%) were normokalemic at hospital discharge. The most common reason for hyperkalemia was treatment with renin-angiotensin-aldosterone system blockers in 228 (34.4%) patients, followed by renal failure in 191 (28.8%). Two hundred and ninety-eight (45.0%) patients were followed without any specific treatment. Of the 661 hyperkalemic patients, 324 (49.0%) were normokalemic at hospital discharge. CONCLUSION This study showed a high prevalence of potassium imbalance among hospitalized patients. Although most of the potassium abnormalities were mild/moderate, approximately half of the patients treated for hypokalemia or hyperkalemia were discharged from the hospital with ongoing dyskalemia.
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Affiliation(s)
- Eylem Eliacik
- Department of Internal Medicine, Hacettepe University, Ankara, Turkey
- *Eylem Eliacik, MD, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, TR-06100 Sihhiye, Ankara (Turkey), E-Mail
| | - Tolga Yildirim
- Department of Nephrology, Hacettepe University, Ankara, Turkey
| | - Ugur Sahin
- Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | | | - Umit Tapan
- Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | | | - Gulsen Hascelik
- Department of Biochemistry, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mustafa Arici
- Department of Nephrology, Hacettepe University, Ankara, Turkey
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Mamushet Y, Zenebe G, Addissie A. MEDICAL AND NEUROLOGICAL COMPLICATIONS AMONG STROKE PATIENTS ADMITTED FOR INPATIENT CARE IN ADDIS ABABA, ETHIOPIA. Ethiop Med J 2015; 53:9-17. [PMID: 26591287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND PURPOSE Medical and neurologic complications of acute stroke adversely impact patient outcome and in some cases can be preventable. There is scarcity of data in the African medical setup and none to date in our country to our knowledge. The current study aims to describe types and frequencies of neuro-medical complications occurring in hospitalized patients after an acute stroke and to identify risk factors for development of these complications and the role of these factors on mortality. METHODS A total of 71 patients with acute stroke (excluding Sub-arachnoid Hemorrhage) who were admitted to three hospitals in Addis Ababa from June 2008 to March 2009 were included in the study. These patients were prospectively followed until their discharge or death to look for the nature and frequency of neuro-medical complications. Basic demographic data, stroke related medical information, pre-existing medical conditions, admission laboratory and imaging findings were recorded. All events were documented for each patient using pre-defined medical complication using a data collection format. Descriptive and analytic statistical tests were performed to measure associations between risk and outcome factors. RESULTS Stroke-complications were detected in 71.8% (51/71) of the study participants and the most frequent complication was aspiration pneumonia which occurred in 33.8% (24/71). Miscellaneous complications such as sepsis, hypokalemia exposure keratitis were detected in 25% (17/71) of stroke patients. Complications were more common in patients with severe neurologic deficit as measured by Glasgow coma scale (GSC) and old age. GCS < 12 and age > 40 years were both significantly associated with developments of complications after stroke (p < 0.05). A total of 17 (23%) patients died during their in-patient stay. GCS < 12 was significantly associated with mortality related to stroke in the admitted patients (p = 0.0002) while there was no association between old age and mortality. CONCLUSIONS Complications after stroke are common and are major factors contributing to mortality. Being aware of the types of common complications and associated risk factors helps the clinical team involved in the care of stroke patients to make preparations and plans for the best possible care and to take preventive measures that will save a lot of lives with best possible use of meager resources available such as educating the population to avoid oral feeding for patients with altered mental state and physicians to evaluate gag reflex bedside swallowing test and proper positioning of patients to avoid aspiration pneumonia. GSC measurement at admission is an important predictor of complications and death following stroke.
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Guerra-Hernández N, Matos-Martínez M, Ordaz-López KV, Camargo-Muñiz MD, Medeiros M, Escobar-Pérez L. Clinical and biochemical findings in Mexican patients with distal renal tubular acidosis. Rev Invest Clin 2014; 66:386-392. [PMID: 25695380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 06/27/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Renal tubular acidosis (RTA) is a rare disease characterized by a normal serum anion gap, sustained metabolic acidosis, low concentration of plasma bicarbonate, variable hyperchloremia and hypokalemia and conserved glomerular filtration rate. RTA is developed during the first year of life and produces failure to thrive and anorexia. Primary distal RTA (type 1) is a renal syndrome with a reduced ability to excrete the acid load through the collecting ducts and impairment to concentrate the urine causing polyuria and dehydration. OBJECTIVE Evaluate the current health status and describe the clinical findings and progress of Mexican patients with distal RTA. Demonstrate the distal urinary acidification defect by measuring the urinary pCO2 tension in alkaline urines. MATERIAL AND METHODS We looked for infants in tertiary care hospitals with a clinical history of normal serum anion gap, metabolic acidosis, hypokalemia, hyperchloremia, nephrocalcinosis, sensorineural hearing loss and inability for urine acidification under systemic metabolic acidosis. Biochemical analysis were performed periodically. Alkali medication was not suspended in one patient to assess urinary acidification with oral administration of sodium bicarbonate (2 mEq/Kg) and acetazolamide (500 mg/1.73 m2 body surface). Urinary pCO2 levels were determined at 60 and 90 min. RESULTS Three children, one adolescent and one adult with distal RTA were found. They had an infant history of dehydration, failure to thrive, anorexia, vomiting, muscle paralysis, hypercalciuria, urinary infections, polyuria, polydipsia and polyhidramnios during pregnancy. Severe nephrocalcinosis was detected in all patients whereas sensorineural hearing loss was developed in four cases. Under the alkali medication all cases but one were normocalciuric. A patient developed kidney failure. The urinary acidification test confirmed the innability to eliminate the acid load. CONCLUSION Early diagnosis in infancy and continuos alkali medication were of great benefit for most of the patients. Urinary pCO2 levels in alkaline urine provided an index for collecting duct hydrogen-ion secretion. To our knowledge this is the first report of mexican patients with distal RTA.
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Affiliation(s)
| | | | | | | | | | - Laura Escobar-Pérez
- Departamento de Fisiología. Facultad de Medicina. Universidad Nacional Autónoma de México
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Zilio M, Barbot M, Ceccato F, Camozzi V, Bilora F, Casonato A, Frigo AC, Albiger N, Daidone V, Mazzai L, Mantero F, Scaroni C. Diagnosis and complications of Cushing's disease: gender-related differences. Clin Endocrinol (Oxf) 2014; 80:403-10. [PMID: 23889360 DOI: 10.1111/cen.12299] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 05/10/2013] [Accepted: 07/22/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Cushing's disease (CD) presents a remarkable preponderance in female gender, with a female-to-male ratio of 3-8:1. The aim of this study was to evaluate gender-related differences in the presentation of CD, as regards: biochemical indices of hypercortisolism; sensitivity of diagnostic tests; clinical features and complications of disease. METHODS We retrospectively studied 84 adult patients with CD, 67 women and 17 men, evaluated at diagnosis. We compared the features of the disease between the sexes and analysed the effect of gender on CD complications, adjusted for potential confounders (age, gonadal status, BMI, urinary free cortisol values). RESULTS We observed no differences between males and females as regards age at diagnosis, disease duration and BMI. Men, compared with women, presented higher urinary free cortisol values (P < 0·001) and ACTH values (P < 0·05). As regards diagnostic tests, men presented a lower ACTH response to DDAVP stimulation (P < 0·05). The pituitary tumour itself was less easily visualized by pituitary MRI in males compared with females (P < 0·05). Furthermore, some complications of disease were more frequent or more severe in men, in particular hypokalaemia (P < 0·05), hypercoagulable state and osteoporosis at lumbar spine (P < 0·01), with consequent higher risk of vertebral fractures. Male gender was found to be an independent risk factor for dyslipidaemia, severity of hypertension, lumbar osteoporosis and fractures. CONCLUSIONS Although CD is less frequent in male patients, in this gender, it presents with more florid clinical manifestations and may imply more diagnostic difficulties.
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Affiliation(s)
- Marialuisa Zilio
- Endocrinology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
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