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1. SGLT2i for evidence based cardiorenal protection in diabetic and non-diabetic chronic kidney disease: a comprehensive review by EURECA-m and ERBP working groups of ERA

Author

Mark, Patrick, Sarafidis, Pantelis, Ekart, Robert, Ferro, Charles, Balafa, Olga, Fernandez-Fernandez, Beatriz, Herrington, William, Rossignol, Patrick, del Vecchio, Lucia, Valdivielso, José M., Mallamaci, Francesca, Ortiz, Alberto, Nistor, Ionut, Cozzolino, Mario, University of Glasgow, Aristotle University of Thessaloniki, Hippokration Hospital, University medical centre Maribor (UKC Maribor), University Hospitals Birmingham [Birmingham, Royaume-Uni], University of Birmingham [Birmingham], University Hospital of Ioannina, Universidad Autónoma de Madrid (UAM), Fundación Jiménez Díaz, Fundacion Jimenez Diaz [Madrid] (FJD), Nuffield Department of Population Health [Oxford], University of Oxford, Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] (INI-CRCT), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], French-Clinical Research Infrastructure Network - F-CRIN [Paris] (Cardiovascular & Renal Clinical Trialists - CRCT ), Hôpital Princesse Grace [Monaco], ASST Lecco, University of Lleida-IRBLLEIDA-PCiTA, Vascular and Renal Translational Research Group and UDETMA, IRBLleida, CNR-IFC Clinical Epidemiology and Pathophysiology of Renal Diseases and Hpertension Unit, Reggio Calabria, Reggio Calabria c/o Ospedali Riuniti, University of Medicine and Pharmacy 'Grigore T.Popa' Iasi (UMF lasi), Università degli Studi di Milano = University of Milan (UNIMI), AO/BFF research is supported by FIS/Fondos FEDER (PI18/01366, PI19/00588, PI19/00815, PI21/00251, PI20/00744, ERA-PerMed-JTC2018 (KIDNEY ATTACK AC18/00064, ISCIII-RETIC REDinREN RD016/0009), Sociedad Española de Nefrología, Sociedad Madrileña de Nefrología (SOMANE), FRIAT, Comunidad de Madrid en Biomedicina B2017/BMD-3686 CIFRA2-CM. Instituto de Salud Carlos III (ISCIII) RICORS program to RICORS2040 (RD21/0005/0001) funded by European Union – NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia(MRR) and SPACKDc PMP21/00109, FEDER funds., European Project, and European Project: RD21/0005/000

Subjects
[SDV]Life Sciences [q-bio]
Abstract

International audience; Chronic kidney disease (CKD) is a major public health issue affecting an estimated 850 million people globally. The leading causes of CKD is diabetes and hypertension, which together account for more than 50% of patients with end-stage kidney disease. Progressive CKD leads to the requirement for kidney replacement therapy with transplantation or dialysis. In addition, CKD, is a risk factor for premature cardiovascular disease, particularly from structural heart disease and heart failure (HF). Until 2015, the mainstay of treatment to slow progression of both diabetic and many non-diabetic kidney diseases was blood pressure control and renin-angiotensin system inhibition; however, neither angiotensin converting enzyme inhibitors (ACEIs) nor angiotensin receptor blockers (ARBs) reduced cardiovascular events and mortality in major trials in CKD. The emergence of cardiovascular and renal benefits observed with sodium-glucose cotransporter-2 inhibitors (SGLT2i) from clinical trials of their use as antihyperglycaemic agents has led to a revolution in cardiorenal protection for patients with diabetes. Subsequent clinical trials, notably DAPA-HF, EMPEROR, CREDENCE, DAPA-CKD and EMPA-KIDNEY have demonstrated their benefits in reducing risk of HF and progression to kidney failure in patients with HF and/or CKD. The cardiorenal benefits - on a relative scale - appear similar in patients with or without diabetes. Specialty societies’ guidelines are continually adapting as trial data emerges to support increasingly wide use of SGLT2i. This consensus paper from EURECA-m and ERBP highlights the latest evidence and summarises the guidelines for use of SGLT2i for cardiorenal protection focusing on benefits observed relevant to people with CKD.

Published
2023

2. Systematic review and meta‐analysis: the incidence and prevalence of paediatric coeliac disease across Europe

Author

Osvaldo Borrelli, Christos Tzivinikos, Corina Pienar, Carmen Ribes-Koninckx, John Williams, Kym Thorne, Ilse Broekaert, Stephen E. Roberts, Javier Martín-de-Carpi, Ann John, Emmanuel Mas, Nikhil Thapar, Marc A. Benninga, Rut Anne Thomassen, Mike Thomson, Jernej Dolinsek, Sian Morrison-Rees, Erasmo Miele, Roberts, Stephen E, Morrison-Rees, Sian, Thapar, Nikhil, Benninga, Marc A, Borrelli, Osvaldo, Broekaert, Ilse, Dolinsek, Jernej, Martin-de-Carpi, Javier, Mas, Emmanuel, Miele, Erasmo, Pienar, Corina, Ribes-Koninckx, Carmen, Thomassen, Rut A, Thomson, Mike, Tzivinikos, Christo, Thorne, Kymberley, John, Ann, Williams, John G, Swansea University, Great Ormond Street Hospital for Children [London] (GOSH), University College of London [London] (UCL), Children’s Health Queensland [Brisbane] (CHQ), University of Amsterdam [Amsterdam] (UvA), University Hospital of Cologne [Cologne], University medical centre Maribor (UKC Maribor), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu [Barcelona, Spain], Institut de Recherche en Santé Digestive (IRSD ), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Ecole Nationale Vétérinaire de Toulouse (ENVT), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), 'Federico II' University of Naples Medical School, Victor Babeş University of Medicine and Pharmacy (UMFT), Hospital Universitari i Politècnic La Fe, Oslo University Hospital [Oslo], University of Sheffield [Sheffield], Al Jalila Children's Specialty Hospital, and European Society for Paediatric Gastroenterology Hepatology and Nutrition

Subjects
Pediatrics, medicine.medical_specialty, MEDLINE, Age at diagnosis, Cochrane Library, Asymptomatic, Coeliac disease, Serology, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, Prevalence, medicine, Humans, Pharmacology (medical), Child, Aged, Autoantibodies, [SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics, Hepatology, business.industry, Incidence, Incidence (epidemiology), Gastroenterology, Infant, medicine.disease, 3. Good health, Europe, Celiac Disease, Child, Preschool, Meta-analysis, 030211 gastroenterology & hepatology, medicine.symptom, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Background: Coeliac disease is one of the most prevalent immune-mediated gastrointestinal disorders in children. Aim: To review the incidence and prevalence of paediatric coeliac disease, and their trends, regionally across Europe, overall and according to age at diagnosis. Methods: Systematic review and meta-analysis from January 1, 1950 to December 31, 2019, based on PubMed, CINAHL and the Cochrane Library, searches of grey literature and websites and hand searching of reference lists. A total of 127 eligible studies were included. Results: The prevalence of previously undiagnosed coeliac disease from screening surveys (histology based) ranged from 0.10% to 3.03% (median = 0.70%), with a significantly increasing annual trend (P = 0.029). Prevalence since 2000 was significantly higher in northern Europe (1.60%) than in eastern (0.98%), southern (0.69%) and western (0.60%) Europe. Large increases in the incidence of diagnosed coeliac disease across Europe have reached 50 per 100 000 person-years in Scandinavia, Finland and Spain. The median age at diagnosis increased from 1.9 years before 1990 to 7.6 since 2000. Larger increases in incidence were found in older age groups than in infants and ages

Published
2021

3. Drugs in Focus: Octreotide Use in Children With Gastrointestinal Disorders

Author

Osvaldo Borrelli, Erasmo Miele, C Ribes Koninckx, Rut Ann Thomassen, J Martin de-Carpi, Marc A. Benninga, Ilse Broekaert, Jernej Dolinsek, Christo Tzivinikos, Corina Pienar, Emmanuel Mas, Mike Thomson, Institut de Recherche en Santé Digestive (IRSD ), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Ecole Nationale Vétérinaire de Toulouse (ENVT), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Great Ormond Street Hospital for Children [London] (GOSH), University Hospital of Cologne [Cologne], University medical centre Maribor (UKC Maribor), 'Federico II' University of Naples Medical School, Victor Babeş University of Medicine and Pharmacy (UMFT), University of Amsterdam [Amsterdam] (UvA), Vall d'Hebron University Hospital [Barcelona], Hospital Universitari i Politècnic La Fe, Oslo University Hospital [Oslo], Sheffield Children's NHS Foundation Trust, Al Jalila Children's Specialty Hospital, and VU University Medical Center [Amsterdam]

Subjects
medicine.medical_specialty, Gastrointestinal bleeding, Gastrointestinal Diseases, Octreotide, Lymphangiectasia, somatostatin, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Gastrointestinal Agents, children, Chylous ascites, Internal medicine, chylous ascites, medicine, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Humans, Child, business.industry, Chylothorax, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, medicine.disease, bleeding, 3. Good health, Clinical trial, diarrhoea, Pancreatitis, Pharmaceutical Preparations, ocreotide, 030220 oncology & carcinogenesis, [SDV.MHEP.PSM]Life Sciences [q-bio]/Human health and pathology/Psychiatrics and mental health, Acute Disease, Pediatrics, Perinatology and Child Health, Acute pancreatitis, 030211 gastroenterology & hepatology, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, medicine.drug
Abstract

International audience; Octreotide, a somatostatin analogue, has been used for more than 20 years in children with gastrointestinal bleeding, chylothorax or chylous ascites, intestinal lymphangiectasia, pancreatitis, intestinal dysmotility, and severe diarrhoea; however, until now, there is a lack of randomised clinical trials evaluating the efficacy of this compound in childhood. Hence, we aimed to review the literature in order to determine the evidence of its use and safety in children, using PubMed from 2000 to 2021 with the search terms "octreotide" and "children" and "bleeding or chylous ascites or chylothorax or acute pancreatitis or lymphangiectasia or diarrhoea or intestinal dysmotility".

Published
2021

4. An ESPGHAN Position Paper on the Use of Breath Testing in Paediatric Gastroenterology

Author

Rut Ann Thomassen, Jernej Dolinsek, Carmen Ribes-Koninckx, Erasmo Miele, Christos Tzivinikos, Corina Pienar, Javier Martín-de-Carpi, Emmanuel Mas, Marc A. Benninga, Osvaldo Borrelli, Ilse Broekaert, Mike Thomson, University Hospital of Cologne [Cologne], Great Ormond Street Hospital for Children [London] (GOSH), University medical centre Maribor (UKC Maribor), Hospital Sant Joan de Déu [Barcelona], Institut de Recherche en Santé Digestive (IRSD ), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Ecole Nationale Vétérinaire de Toulouse (ENVT), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), 'Federico II' University of Naples Medical School, Victor Babeş University of Medicine and Pharmacy (UMFT), Hospital Universitari i Politècnic La Fe = University and Polytechnic Hospital La Fe, Oslo University Hospital [Oslo], Sheffield Children's NHS Foundation Trust, Al Jalila Children's Specialty Hospital, VU University Medical Center [Amsterdam], SEGUIN, Nathalie, Broekaert, Ilse Julia, Borrelli, Osvaldo, Dolinsek, Jernej, Martin-de-Carpi, Javier, Mas, Emmanuel, Miele, Erasmo, Pienar, Corina, Ribes-Koninckx, Carmen, Thomassen, Rut, Thomson, Mike, Tzivinikos, Christo, Benninga, Marc, and Hospital Universitari i Politècnic La Fe

Subjects
medicine.medical_specialty, Malabsorption, Consensus, Carbohydrate malabsorption, 030309 nutrition & dietetics, MEDLINE, carbohydrate malabsorption, small intestinal bacterial overgrowth, Helicobacter pylori infection, Helicobacter Infections, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.PED] Life Sciences [q-bio]/Human health and pathology/Pediatrics, children, Internal medicine, Small intestinal bacterial overgrowth, medicine, breath testing, Humans, Intensive care medicine, Exocrine pancreatic insufficiency, Child, Children, 0303 health sciences, [SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, business.industry, Gastroenterology, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, Hepatology, medicine.disease, [SDV.MHEP.HEG] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, 3. Good health, Fat malabsorption, Breath testing, Systematic review, Breath Tests, Pediatrics, Perinatology and Child Health, Position paper, 030211 gastroenterology & hepatology, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Systematic Reviews as Topic
Abstract

International audience; Objectives: Given a lack of a systematic approach to the use of breath testing in paediatric patients, the aim of this position paper is to provide expert guidance regarding the indications for its use and practical considerations to optimise its utility and safety. Methods: Nine clinical questions regarding methodology, interpretation, and specific indications of breath testing and treatment of carbohydrate malabsorption were addressed by members of the Gastroenterology Committee (GIC) of the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN). A systematic literature search was performed from 1983 to 2020 using PubMed, the MEDLINE and Cochrane Database of Systematic Reviews. Grading of Recommendations, Assessment, Development, and Evaluation was applied to evaluate the outcomes. During a consensus meeting, all recommendations were discussed and finalised. In the absence of evidence from randomised controlled trials, recommendations reflect the expert opinion of the authors. Results: A total of 22 recommendations were voted on using the nominal voting technique. At first, recommendations on prerequisites and preparation for as well as on interpretation of breath tests are given. Then, recommendations on the usefulness of H2-lactose breath testing, H2-fructose breath testing as well as of breath tests for other types of carbohydrate malabsorption are provided. Furthermore, breath testing is recommended to diagnose small intestinal bacterial overgrowth (SIBO), to control for success of Helicobacter pylori eradication therapy and to diagnose and monitor therapy of exocrine pancreatic insufficiency, but not to estimate oro-caecal transit time (OCTT) or to diagnose and follow-up on celiac disease. Conclusions: Breath tests are frequently used in paediatric gastroenterology mainly assessing carbohydrate malabsorption, but also in the diagnosis of small intestinal overgrowth, fat malabsorption, H. pylori infection as well as for measuring gastrointestinal transit times. Interpretation of the results can be challenging and in addition, pertinent symptoms should be considered to evaluate clinical tolerance.

Published
2021

5. Diagnosis, Management, and Prevention of Button Battery Ingestion in Childhood: A European Society for Paediatric Gastroenterology Hepatology and Nutrition Position Paper

Author

Matjaž Homan, Nikhil Thapar, Mike Thomson, Christos Tzivinikos, Lissy de Ridder, Amani Mubarak, Emmanuel Mas, Marc A. Benninga, Ilse Broekaert, Corina Pienar, Jernej Dolinsek, Erasmo Miele, University Medical Center [Utrecht], Emma Children’s Hospital, University Hospital of Cologne [Cologne], University medical centre Maribor (UKC Maribor), Institut de Recherche en Santé Digestive (IRSD ), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Ecole Nationale Vétérinaire de Toulouse (ENVT), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), 'Federico II' University of Naples Medical School, Victor Babeş University of Medicine and Pharmacy (UMFT), Great Ormond Street Hospital for Children [London] (GOSH), Sheffield Children's NHS Foundation Trust, Al Jalila Children's Specialty Hospital, Eramus MC-Sophia Children’s Hospital, Partenaires INRAE, Nestle SA, Danone Nutricia, Mubarak, Amani, Benninga, Marc A, Broekaert, Ilse, Dolinsek, Jernej, Homan, Matjaž, Mas, Emmanuel, Miele, Erasmo, Pienar, Corina, Thapar, Nikhil, Thomson, Mike, Tzivinikos, Christo, de Ridder, Lissy, Paediatric Gastroenterology, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, ARD - Amsterdam Reproduction and Development, SEGUIN, Nathalie, and Pediatrics

Subjects
medicine.medical_specialty, MEDLINE, [SPI.MAT] Engineering Sciences [physics]/Materials, Asymptomatic, [SPI.MAT]Engineering Sciences [physics]/Materials, Eating, 03 medical and health sciences, [SDV.MHEP.PED] Life Sciences [q-bio]/Human health and pathology/Pediatrics, Electric Power Supplies, Esophagus, 0302 clinical medicine, SDG 3 - Good Health and Well-being, 030225 pediatrics, Internal medicine, medicine, Humans, endoscopy, Child, Intensive care medicine, [SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics, medicine.diagnostic_test, Impaction, business.industry, Gastroenterology, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, Guideline, Hepatology, Foreign Bodies, foreign body, esophageal perforation, [SDV.MHEP.HEG] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, 3. Good health, Endoscopy, caustic ingestion, [SDV.AEN] Life Sciences [q-bio]/Food and Nutrition, medicine.anatomical_structure, pediatric, Pediatrics, Perinatology and Child Health, Position paper, 030211 gastroenterology & hepatology, medicine.symptom, business, [SDV.AEN]Life Sciences [q-bio]/Food and Nutrition
Abstract

International audience; Button batteries (BB) remain a health hazard to children as ingestion might lead to life-threatening complications, especially if the battery is impacted in the esophagus. Worldwide initiatives have been set up in order to prevent and also timely diagnose and manage BB ingestions. A European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) task force for BB ingestions has been founded, which aimed to contribute to reducing the health risks related to this event. It is important to focus on the European setting, next to other worldwide initiatives, to develop and implement effective management strategies. As one of the first initiatives of the ESPGHAN task force, this ESPGHAN position paper has been written. The literature is summarized, and prevention strategies are discussed focusing on some controversial topics. An algorithm for the diagnosis and management of BB ingestions is presented and compared to previous guidelines (NASPGHAN, National Poison Center). In agreement with earlier guidelines, immediate localization of the BB is important and in case of esophageal impaction, the BB should be removed instantly (preferably 12 hours after ingestion or time point of removal >12 hours after ingestion) and esophageal impaction the guideline suggests to perform a CT scan in order to evaluate for vascular injury before removing the battery. In delayed diagnosis, even if the battery has passed the esophagus, endoscopy to screen for esophageal damage and a CT scan to rule out vascular injury should be considered even in asymptomatic children. In asymptomatic patients with early diagnosis (

Published
2021

6. Hyperkalemia in Chronic Kidney Disease in the New Era of Kidney Protection Therapies

Author

Pantelis Sarafidis, Alberto Ortiz, Charles J. Ferro, Francesca Mallamaci, Olga Balafa, Jose M. Valdivielso, Patrick Rossignol, Robert Ekart, Patrick B. Mark, Lucia Del Vecchio, Biomedical Research Institute of Lleida [Spain] (IRBLleida), Universitat de Lleida, University of Ioannina, University medical centre Maribor (UKC Maribor), University Hospitals Birmingham [Birmingham, Royaume-Uni], Ospedali Riuniti, Institute of Cardiovascular and Medical Sciences [Glasgow], University of Glasgow, Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] (INI-CRCT), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], French-Clinical Research Infrastructure Network - F-CRIN [Paris] (Cardiovascular & Renal Clinical Trialists - CRCT ), Aristotle University of Thessaloniki, Sant'Anna Hospital, Universidad Autónoma de Madrid (UAM), Española de Nefrología, FRIAT, and Comunidad de Madrid en Biomedicina B2017/BMD-3686 CIFRA2-CM. PR is supported by the RHU Fight-HF, a public grant overseen by the French National Research Agency (ANR) as part of the second 'Investissements d’Avenir' program (reference: ANR-15-RHUS-0004), by the French PIA project 'Lorraine Université d’Excellence' (reference: ANR-15-IDEX-04-LUE), the ANR FOCUS-MR (reference: ANR-15-CE14-0032-01), ERA-CVD EXPERT (reference: ANR-16-ECVD-0002-02), Contrat de Plan Etat Lorraine IT2MP and FEDER Lorraine., ANR-15-RHUS-0004,FIGHT-HF,Combattre l'insuffisance cardiaque(2015), ANR-15-IDEX-0004,LUE,Isite LUE(2015), ANR-15-CE14-0032,MR-focus,Régulation, Diagnostique et Thérapeutique ciblée du récepteur minéralocorticoïde dans le remodelage cardiaque(2015), ANR-16-ECVD-0002,EXPERT,Exploring new pathways in age-related heart diseases(2016), DE CARVALHO, Philippe, Combattre l'insuffisance cardiaque - - FIGHT-HF2015 - ANR-15-RHUS-0004 - RHUS - VALID, ISITE - Isite LUE - - LUE2015 - ANR-15-IDEX-0004 - IDEX - VALID, Régulation, Diagnostique et Thérapeutique ciblée du récepteur minéralocorticoïde dans le remodelage cardiaque - - MR-focus2015 - ANR-15-CE14-0032 - AAPG2015 - VALID, and Exploring new pathways in age-related heart diseases - - EXPERT2016 - ANR-16-ECVD-0002 - ERA-CVD - VALID

Subjects
Hyperkalemia, Polymers, [SDV]Life Sciences [q-bio], Disease, urologic and male genital diseases, Bioinformatics, Renin-Angiotensin System, chemistry.chemical_compound, Mineralocorticoid receptor, Pharmacotherapy, medicine, Humans, Pharmacology (medical), Renal Insufficiency, Chronic, Sodium-Glucose Transporter 2 Inhibitors, Mineralocorticoid Receptor Antagonists, Kidney, business.industry, Silicates, Patient Acuity, Metabolic acidosis, Patiromer, medicine.disease, [SDV] Life Sciences [q-bio], medicine.anatomical_structure, chemistry, medicine.symptom, business, Kidney disease
Abstract

International audience; Despite recent therapeutic advances, chronic kidney disease (CKD) is one of the fastest growing global causes of death. This illustrates limitations of current therapeutic approaches and, potentially, unidentified knowledge gaps. For decades, renin-angiotensin-aldosterone system (RAAS) blockers have been the mainstay of therapy for CKD. However, they favor the development of hyperkalemia, which is already common in CKD patients due to the CKD-associated decrease in urinary potassium (K+) excretion and metabolic acidosis. Hyperkalemia may itself be life-threatening as it may trigger potentially lethal arrhythmia, and additionally may limit the prescription of RAAS blockers and lead to low-K+ diets associated to low dietary fiber intake. Indeed, hyperkalemia is associated with adverse kidney, cardiovascular, and survival outcomes. Recently, novel kidney protective therapies, ranging from sodium/glucose cotransporter 2 (SGLT2) inhibitors to new mineralocorticoid receptor antagonists have shown efficacy in clinical trials. Herein, we review K+ pathophysiology and the clinical impact and management of hyperkalemia considering these developments and the availability of the novel K+ binders patiromer and sodium zirconium cyclosilicate, recent results from clinical trials targeting metabolic acidosis (sodium bicarbonate, veverimer), and an increasing understanding of the role of the gut microbiota in health and disease.

Published
2021

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