Search

This second article in a series of three on land reuse highlights brownfields redevelopment in the U.S., focusing on regulatory frameworks, public health, policy, and sustainable development. The main regulatory agency in the U.S. involved in brownfields is the U.S. Environmental Protection Agency (U.S. EPA). Many other state and federal agencies have brownfield or brownfield-supporting programs. Apart from the Agency for Toxic Substances and Disease Registry, few agencies have programs fully dedicated to public health protection related to brownfields. Sustainable development, defined in this article as development that minimizes use of nonrenewable resources, is recognized as a component of redevelopment and is generally promoted by U.S. EPA and through other sustainable development initiatives. A broader focus on sustainable development and public health improvement could reduce the inequity and health disparities typically seen in areas with distressed environments. Such a focus could be implemented globally to improve population health and the environment over the long term.

The first author currently listed as Lucia Bailon Alvarez should be Lucia Bailon.

Click on the link to view.

Aims: Hyperkalaemia risk precludes optimal renin–angiotensin–aldosterone system inhibitor use in patients with heart failure (HF), particularly those with chronic kidney disease (CKD). Patiromer is a sodium-free, non-absorbed potassium (K+)-binding polymer approved for the treatment of hyperkalaemia. In PEARL-HF, patiromer 25.2 g (fixed dose) prevented hyperkalaemia in HF patients with or without CKD initiating spironolactone. The current study evaluated the effectiveness of a lower starting dose of patiromer (16.4 g/day) followed by individualized titration in preventing hyperkalaemia and hypokalaemia when initiating spironolactone. Methods and results: This open-label 8-week study enrolled 63 patients with CKD, serum K+ 4.3–5.1 mEq/L, and chronic HF, who, based on investigator opinion, should receive spironolactone. Eligible patients started spironolactone 25 mg/day and patiromer 16.8 g/day (divided into two doses), with patiromer titrated to maintain serum K+ 4.0–5.1 mEq/L. Mean (standard deviation) serum K+ was 4.78 (0.51) mEq/L at baseline; weekly values were 4.48–4.70 mEq/L during treatment. Serum K+ of 3.5–5.5 mEq/L at the end of study treatment (primary endpoint) was achieved by 57 (90.5%) patients; 53 (84.1%) had serum K+ 4.0–5.1 mEq/L. One patient (1.6%) developed hypokalaemia, and two patients (3.2%) developed hypomagnesaemia. Spironolactone was increased to 50 mg/day in all patients; 43 (68%) patients required one or more patiromer dose titration. Adverse events (AEs) occurred in 36 (57.1%) patients, with a low rate of discontinuations [four (6.3%) patients]. The most common AE was mild to moderate abdominal discomfort [four (6.3%) patients]. Conclusions: In this open-label study, patiromer 16.8 g/day followed by individualized titration maintained serum K+ within the target range in the majority of patients with HF and CKD, all of whom were uptitrated to spironolactone 50 mg/day, patiromer was well tolerated, with a low incidence of hyperkalaemia, hypokalaemia, and hypomagnesaemia. © 2018 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.