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Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and objective: Hyperkalemia (HK) is an electrolyte disturbance in the concentration of potassium ions (K+), whose risk increases in patients with chronic kidney disease (CKD) or heart failure (HF) and/or in patients being treated with renin–angiotensin–aldosterone system inhibitors (RAASi). The new oral K+ chelators offer a safe and effective treatment to maintain normokalemia in these patients. The objective of the analysis is to estimate the cost-effectiveness of sodium zirconium cyclosilicate (SZC) for the treatment of chronic HK in patients with CKD or HF versus standard treatment (calcium polystyrene sulfonate and lifestyle modifications) from the perspective of the Spanish National Health System. Materials and methods: Two microsimulation models reflecting the natural history of CKD and HF were used. In both models, K+ levels were simulated individually. Based on efficacy (reduction of K+ levels), quality of life of patients (utilities according to health states, and disutilities of events derived from each pathology and adverse events [AEs] of treatment) and costs considered (cost of treatment for HK, of RAASi treatment and its modification, health states, management of events derived from each pathology, HK episodes, and AEs treatment) (, 2022), clinical benefit (quality-adjusted life years [QALYs]) and cost results were obtained. A time horizon of the patient’s lifetime was used and a discount rate of 3% was applied for costs and outcomes. Results: SZC is a more effective option in both pathologies, with a difference in QALYs of 0.476 in CKD and 0.978 in HF compared to standard treatment, and it represents an incremental cost of 3,616 and 14,749, respectively, obtaining an incremental cost-utility ratio of 7,605/QALY in CKD and 15,078/QALY in HF. Conclusions: SZC is a cost-effective alternative for the treatment of HK in patients with CKD or HF, taking into account the reference efficiency values commonly used in Spain. Resumen: Antecedentes y objetivo: La hiperpotasemia (HK) es una alteración electrolítica en la concentración de iones potasio (K+), cuyo riesgo aumenta en pacientes con enfermedad renal crónica (ERC) o insuficiencia cardiaca (IC) y/o en pacientes en tratamiento con inhibidores del sistema renina-angiotensina-aldosterona (iSRAA). Los nuevos quelantes orales de K+ ofrecen un tratamiento seguro y eficaz para mantener la normopotasemia en estos pacientes. El objetivo del análisis es estimar el coste-efectividad del ciclosilicato de sodio y zirconio (CSZ) para el tratamiento de la HK crónica en pacientes con ERC o IC frente al tratamiento estándar (poliestireno sulfonato cálcico y modificaciones del estilo de vida) desde la perspectiva del Sistema Nacional de Salud (SNS) español. Materiales y métodos: Se utilizaron dos modelos de microsimulación que reflejan la historia natural de la ERC y de la IC. En ambos modelos se realizó una simulación de forma individual de los niveles de K+. En base a la eficacia (reducción de los niveles de K+), la calidad de vida de los pacientes (utilidades según estado de salud, y disutilidades de los eventos derivados de cada patología y los eventos adversos [EA] del tratamiento) y a los costes contemplados (coste del tratamiento para la HK, del tratamiento con iSRAA y su modificación, de los estados de salud, del manejo de los eventos derivados de cada patología, de los episodios de HK, y de los EA del tratamiento) (, 2022), se obtuvieron resultados de beneficio clínico (años de vida ajustados por calidad [AVAC]) y costes. Se empleó un horizonte temporal de toda la vida del paciente y se aplicó una tasa de descuento del 3% para costes y resultados. Resultados: El CSZ resulta una opción más efectiva en ambas patologías, con una diferencia de AVAC de 0,476 en ERC, y de 0,978 en IC frente al tratamiento estándar, y supone un coste incremental de 3.616 y 14.749 , respectivamente, obteniéndose un ratio coste-utilidad incremental (RCUI) de 7.605 /AVAC en ERC y 15.078 /AVAC en IC. Conclusiones: El CSZ es una alternativa con una buena relación coste-efectividad para el tratamiento de la HK en pacientes con ERC o IC, teniendo en cuenta los valores de eficiencia de referencia empleados habitualmente en España.

Introduction: Chronic hyperkalemia has negative consequences in the medium and long term, and determines the suspension of nephro and cardioprotective drugs, such as renin–angiotensin–aldosterone system inhibitors (RAASi). There is an alternative to the suspension or dose reduction of these treatments: the administration of potassium chelators. The aim of this study is to estimate the economic impact of the use of patiromer in patients with chronic kidney disease (CKD) or heart failure (HF) and hyperkalemia in Spain. Materials and method: The annual economic impact of the use of patiromer has been estimated from the perspective of the Spanish society. Two scenarios were compared: patients with CKD or HF and hyperkalemia treated with and without patiromer. The costs have been updated to 2020 euros, using the Health Consumer Price Index. Direct healthcare costs related to the use of resources (treatment with RAASi, CKD progression, cardiovascular events and hospitalization due to hyperkalemia), direct non-healthcare costs (informal care: costs derived from time dedicated by patient’s relatives), the indirect costs (productivity loss), as well as an intangible cost (due to premature mortality) were considered. A deterministic sensitivity analysis was performed to validate the robustness of the study results. Results: The mean annual cost per patient in the scenario without patiromer is €9,834.09 and €10,739.37 in CKD and HF, respectively. The use of patiromer would lead to cost savings of over 30% in both diseases. The greatest savings in CKD come from the delay in the progression of CKD. While in the case of HF, 80.1% of these savings come from premature mortality reduction. The sensitivity analyses carried out show the robustness of the results, obtaining savings in all cases. Conclusions: The incorporation of patiromer allows better control of hyperkalemia and, as a consequence, maintain treatment with RAASi in patients with CKD or HF. This would generate a 32% of annual savings in Spain (€3,127 in CKD; €3,466 in HF). The results support the positive contribution of patiromer to health cost in patients with only CKD or in patients with only HF. Resumen: Introducción: La hiperpotasemia crónica tiene consecuencias negativas a medio y largo plazo, condicionando generalmente la suspensión de fármacos nefro y cardioprotectores, en pacientes con enfermedad renal crónica (ERC) e insuficiencia cardíaca (IC), como son los inhibidores del sistema renina-angiotensina-aldosterona. Existe una alternativa a la suspensión o reducción de dosis de estos tratamientos y es la administración de quelantes del potasio. El objetivo de este estudio es estimar el impacto económico que supondría el uso de patiromer en pacientes con ERC o IC e hiperpotasemia en España. Material y métodos: Se ha estimado el impacto económico anual del uso de patiromer desde la perspectiva de la sociedad española, comparando 2 escenarios: pacientes con ERC o IC e hiperpotasemia tratada con patiromer y sin patiromer. Los costes se han actualizado a euros de 2020, utilizando el índice de precios de consumo de Sanidad. Se han considerado los costes directos sanitarios relacionados con el uso de recursos (el tratamiento con inhibidores del sistema renina-angiotensina-aldosterona, la progresión de la ERC, los eventos cardiovasculares y la hospitalización por hiperpotasemia), los costes directos no sanitarios (cuidados informales: costes derivados del tiempo de dedicación por parte de los familiares del paciente), los costes indirectos (pérdidas de productividad laboral), así como un coste intangible (por mortalidad prematura). Se realizó un análisis de sensibilidad determinístico para validar la consistencia de los resultados del estudio. Resultados: El coste medio anual por paciente en el escenario sin patiromer es de 9.834,09 y 10.739,37 € en ERC e IC, respectivamente. El uso de patiromer supondría un ahorro de costes superior al 30% en ambas enfermedades. En el caso de la ERC, el mayor ahorro procede del retraso de la progresión de la ERC. Mientras que en IC el 80,1% de estos ahorros provienen de la reducción de la mortalidad prematura. Los análisis de sensibilidad realizados muestran la consistencia de los resultados, obteniendo ahorros en todos los casos. Conclusiones: La incorporación de patiromer permite controlar la hiperpotasemia y, como consecuencia, mantener el tratamiento con inhibidores del sistema renina-angiotensina-aldosterona en los pacientes con ERC o IC, generando unos ahorros anuales en España del 32% (3.127 € en ERC; 3.466 € en IC). Estos resultados apoyan la contribución positiva que patiromer puede tener tanto en los pacientes con ERC como en aquellos que solo tienen IC.

Hyperkalaemia is a common electrolyte imbalance with potentially serious short-, medium- and long-term consequences on morbidity and mortality rates and the use of national health service resources. The fact that different medical specialities can manage hyperkalaemia makes it important to have a unified approach, and the recent availability of new specific drug treatments means that the approach needs to be updated. This consensus document from the scientific societies most directly involved in the management of hyperkalaemia (Sociedad Española de Cardiología [Spanish Society of Cardiology], Sociedad Española de Endocrinología y Nutrición [Spanish Society of Endocrinology and Nutrition], Sociedad Española de Medicina Interna [Spanish Society of Internal Medicine], Sociedad Española de Medicina de Urgencias y Emergencias [Spanish Society of Accident and Emergency Medicine] and Sociedad Española de Nefrología [Spanish Society of Nephrology]) first of all reviews basic aspects of potassium balance and blood potassium. Then it goes on to focus on the concept, epidemiology, pathophysiology and diagnostic and therapeutic approaches to hyperkalaemia. The available evidence and the main published studies have been reviewed with the aim of providing a useful tool in the multidisciplinary approach to patients with hyperkalaemia. Resumen: La hiperpotasemia es una alteración electrolítica frecuente con consecuencias potencialmente graves a corto, medio y largo plazo, tanto en términos de morbilidad y mortalidad como de consumo de recursos del Sistema Nacional de Salud. El abordaje de la hiperpotasemia por diversas especialidades médicas y la reciente disponibilidad de nuevos tratamientos farmacológicos específicos hace necesaria una acción unificada y actualizada. El presente documento de consenso entre las sociedades científicas más directamente implicadas en el abordaje de la hiperpotasemia (Sociedad Española de Cardiología, Sociedad Española de Endocrinología y Nutrición, Sociedad Española de Medicina Interna, Sociedad Española de Medicina de Urgencias y Emergencias y Sociedad Española de Nefrología) repasa, en primer lugar, aspectos básicos del balance de potasio y de la potasemia, centrándose posteriormente en el concepto, epidemiología, fisiopatología, y abordaje diagnóstico y terapéutico de la hiperpotasemia. Se han revisado las evidencias y los principales estudios publicados con el objetivo de que sea una herramienta útil en el abordaje multidisciplinar del paciente con hiperpotasemia.

Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Potassium is an essential cation for multiple physiological processes and potassium disorders, also known as dyskalemias, imply an increased risk of cardiovascular and neurological complications. The present review aims to outline the main strategies for the management of patients with potassium disorders in the hospital setting. For the management of hyperkalemia, we propose that the therapeutic approach should include etiologic evaluation, evidence-based pharmacologic management, monitoring of therapeutic response, and timely decision on initiation of dialysis. For hypokalemia, we suggest initial assessment of severity, pharmacologic management, and monitoring of response to therapy. Despite the limitations of the primary evidence for the management of potassium disorders, the present recommendations emphasize practices based on the best available evidence. [ABSTRACT FROM AUTHOR]

Introduction and Objective: To determine the clinical characteristics and evolution of patients with hyperkalemia due to chronic prescription of angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACE inhibition/ARBs), plus spironolactone, documented in Internal Medicine-Nephrology outpatient service, inter-consultation, or recent hospitalization discharge report. Materials and Methods: Patients over 18 years of age were included, in whom serum potassium levels over 5.5 mEq/l were documented, associated with combined treatment of an ACE inhibitors or ARBs plus spironolactone. In addition, patients were grouped due to base diseases, predisposing factors, and previous medications related to the risk of hyperkalemia. The serum potassium and creatinine laboratory variables were included at the entrance and follow-up at 30 days. Additionally, the type of outpatient and hospitable management patients received, and interventions practiced were recorded. The statistical analysis was conducted with the SPSS 25.0V statistical program in Spanish licensed for the University of Caldas. Results: The study spanned 13 years. Seventy-two patients were identified, of whom 41 met the inclusion criteria, 3.15 patients per year: 22 women (54%), with a mean age of 74. The main reason for the combination prescription was difficult to manage arterial hypertension, followed by heart failure. Regarding medications, 54% were ACE inhibitors, enalapril the most common, with an average dose of 27.75 mg/d, ARBs losartan 105.5 mg/d, and spironolactone 35.37 mg/d. Other prescribed medications associated with hyperkalemia were Beta-blockers, NSAIDs, heparin, and no use of trimethoprim sulfa. The main precipitating for which hyperkalemia was triggered was decompensated heart failure (low cardiac output) and acute renal failure of various origins. None in 13 outpatients (32%), required further hospitalization, improving just with treatment discontinuation. In hospitalized patients, hemodialysis was required in five patients (12.2%), with an average of 2.4, performed every 24 hours. No patient died. Creatinine significantly declined over 30 days, changing GFR from a baseline average value of 27.82 mL/minute to 46.16 mL/minute at 30 days. In hospitalized patients, various interventions were chosen suspension of the causal medication, intravenous furosemide, B2 agonists, ion exchange resins, calcium gluconate, glucoseinsulin infusion, and intravenous bicarbonate. Conclusions: Severe hyperkalemia associated with combined ACE inhibitors/ARBs + spironolactone therapy is a pathology that continues to occur. Therefore, hydration status, renal function, and serum potassium should be monitored in frequent recipients. Elderly individuals with heart failure and renal failure are the highest-risk population. Henceforward, if possible, do not try to escalate to very high doses of medications when prescribing this combination. [ABSTRACT FROM AUTHOR]

Introduction: Patients with advanced chronic kidney disease (ACKD) have a high prevalence of malnutrition. The dietary restrictions that we usually apply in terms of macro and micronutrients force our patients to follow dietary guidelines that deviate from healthy patterns. Objetives: To determine if a personalized nutritional intervention program, minimizing the usual restrictions would be justified in case it improved the evolution of kidney disease compared to standard treatment. Secundary objetives: To determine changes in nutrient intakes and in anthropometric and biochemical parameters, as well as quantify episodes of hyperkalemia. Material and methods: A single-center, randomized and controlled educational intervention clinical trial was conduct in patients from the ERCA outpatients clinic at the Complejo Hospitalario Universitario de Albacete. 75 patients were included, assigning 35 to a Control group and 40 to the Intervention group with 1-year follow-up. The nutritional status was determined using anthropometric data, body composition by Bioimpedance, blood and urine biochemical parameters and a 24-h recall questionnaire. The nutritional intervention was carried out in three different ways: individual, collective and telephone recall. Results: At the beginning of the study, the BMI showed a situation of weight excess with a mean of 28.83 kg/m2 (5.4) in men and 26.96 kg/m2 (4.09) in women. 70% of our patients had overweight. The abdominal circumference was 105.3 cm (10.2) and 92.3 cm (13.7) for men and women respectively without significant changes throughout the study. The percentage of fat mass (FM) was high in both groups for men and women throughout the study. We did not find biochemical parameters of malnutrition and only significant differences were observed in glomerular filtration rate (GFR), which increased in the intervention group. No patient presented any episodes of hyperkalemia during the study. The energy intake in both groups showed an inadequate distribution of macronutrients with a poor intake of carbohydrates (CH) that was supplemented with an excess of fat. In the case of micronutrients, we did observe an increase in potassium and fiber intakes with a decrease in sodium and phosphorus in the intervention group. Conclusions: Malnutrition is not exclusively an intake defficit and encompasses both the problems derived from a deficit and an excess of nutrients intake. Un to 70% of our patients showed weight excess and a fat mass higher than desirable. The implementation of an individualized nutritional education program, including a vegetables and fiber rich diet, less atherogenic, not only did not cause electrolyte alterations but also slowed the progression of kidney disease. Resumen: Introducción: El paciente con enfermedad renal crónica avanzada (ERCA) presenta una elevada prevalencia de malnutrición. Las restricciones dietéticas que aplicamos habitualmente en cuanto a macro y micronutrientes obligan a nuestros pacientes a seguir pautas dietéticas alejadas de los patrones saludables. Objetivo: Determinar si un programa de intervención nutricional personalizado minimizando las restricciones habituales estaría justificado si mejorase la evolución de la enfermedad renal comparado con el tratamiento estándar. Objetivos secundarios: Determinar los cambios en las ingestas de nutrientes y en los parámetros antropométricos y bioquímicos así como los episodios de hiperpotasemia. Material y métodos: Se realizó un ensayo clínico de intervención educativa, unicéntrico, randomizado y controlado en los pacientes de la consulta ERCA del Complejo Hospitalario Universitario de Albacete. Se incluyeron 75 pacientes asignando 35 en un grupo control y 40 en el grupo de intervención con seguimiento a 1 año. La situación nutricional se determinó mediante datos antropométricos, composición corporal por Bioimpedancia, parámetros bioquímicos en sangre y orina y cuestionario de recuerdo de 24 horas. La intervención nutricional se realizó de 3 formas: individual, colectiva y recuerdo telefónico. Resultados: Al inicio del estudio el IMC mostró una situación de exceso de peso con una media en hombres de 28,83 kg/m2 (5,4) y de 26,96 kg/m2 (4,09) en mujeres. El 70% de nuestros pacientes mostraron exceso de peso. La circunferencia abdominal fue de 105,3 cm (10,2) y 92,3 cm (13,7) para hombres y mujeres respectivamente sin cambios significativos a lo largo del estudio. El porcentaje de masa grasa (MG) fue elevado tanto hombres como en mujeres durante todo el estudio. Los parámetros bioquímicos no mostraron una situación de malnutrición y solo se observaron diferencias significativas en el filtrado glomerular (FG) que aumentó en el grupo intervención. Ningún paciente presentó episodios de hiperpotasemia durante el estudio. La ingesta energética mostró en ambos grupos una inadecuada distribución de macronutrientes con una pobre ingesta de hidratos de carbono (HC) que se suple con un exceso de grasa. Para los micronutrientes sí observamos en el grupo intervención un aumento en las ingestas de potasio y fibra con una disminución de las de sodio y fósforo. Conclusiones: Malnutrición no es sinónimo exclusivamente de desnutrición y engloba tanto los problemas derivados del déficit como del exceso de ingesta de nutrientes. El 70% de nuestros pacientes mostraron exceso de peso y un porcentaje de masa grasa mayor del deseable. La aplicación de un programa de educación nutricional individualizado realizando una dieta rica en vegetales y fibra, menos aterogénica, no provocó alteraciones electrolíticas y supuso un enlentecimiento en la progresión de la enfermedad renal.

Two types of early childhood hyperkalemia had been recognized, according to the presence or absence of urinary salt wasting. This condition was attributed to a maturation disorder of aldosterone receptors and is characterized by sustained hyperkalemia, hyperchloremic metabolic acidosis (MA) due to reduced ammonium urinary excretion and bicarbonate loss, and normal creatinine with growth delay. We present 3 patients of the type without salt wasting, which we will call transient early-childhood hyperkalemia (TECHH) without salt wasting, and discuss its physiopathology according to new insights into sodium and potassium handling by the aldosterone in distal nephron. In 3 children from 30 to 120-day-old admitted with bronchiolitis and growth delay hyperkalemia was found in routine laboratory. Further studies revealed a normal creatinine with inappropriately normal or low fractional excretion (FE) of potassium, accompanied by inadequately normal serum aldosterone and plasma renin activity for their higher plasma potassium levels, but without urine salt wasting. They also presented hyperchloremic MA with FE of bicarbonate 0.58%–2.2%, positive urinary anion gap during MA and normal ability to acidify the urine. Based on these findings a diagnosis of TECHH without salt wasting was made and they were treated sodium bicarbonate and hydrochlorothiazide with favorable response. The condition was transient in all cases leading to treatment discontinuation. Given that TECCH without salt wasting is a tubular disorder of transient nature with mild symptoms; it must be keep in mind in the differential diagnosis of hyperkalemia in young children. Resumen: Se reconocen dos variedades de hiperpotasemia temprana de la infancia (del inglés Early childhood hyperkalemia) según la presencia o no de pérdida salina urinaria. Se trata de una entidad atribuida a un desorden madurativo en los receptores de aldosterona caracterizada por hiperpotasemia, acidosis metabólica (AM) hiperclorémica por diminución de la eliminación de amonio y bicarbonaturia, y creatinina normal con retraso de crecimiento. Presentamos 3 pacientes de la forma con ausencia de pérdida salina, a la que denominaremos hiperpotasemia transitoria del lactante (HTL) sin pérdida salina, y discutimos su fisiopatología en relación a los nuevos conocimientos en el manejo tubular del sodio y el potasio por la aldosterona. En 3 pacientes de entre 30 y 120 días de edad con bronquiolitis y retraso de crecimiento se encontró hiperpotasemia en laboratorio de rutina. Presentaban creatinina normal, excreción fraccionada (EF) de potasio disminuida o inapropiadamente normal junto a niveles de aldosterona y renina plasmática inadecuadamente normales para el estado de hiperpotasemia, pero sin pérdida salina. También cursaban con AM hiperclorémica con bicarbonaturia (EF bicarbonato 0,58%–2,2%), anión restante urinario positivo durante AM y capacidad normal para acidificar la orina. En base a estos hallazgos se diagnosticó HTL sin pérdida salina y se trataron con bicarbonato de sodio e hidroclorotiazida con buena respuesta. El cuadro fue transitorio permitiendo la suspensión del tratamiento. Dado que el HTL sin pérdida salina es un desorden tubular transitorio con síntomas leves debe tenerse presente en el diagnóstico diferencial de hiperpotasemia en niños pequeños.

Background and Objective: Hyperkalemia (HK) is an electrolyte disturbance in the concentration of potassium ions (K + ), whose risk increases in patients with chronic kidney disease (CKD) or heart failure (HF) and/or in patients being treated with renin-angiotensin-aldosterone system inhibitors (RAASi). The new oral K + chelators offer a safe and effective treatment to maintain normokalemia in these patients. The objective of the analysis is to estimate the cost-effectiveness of sodium zirconium cyclosilicate (SZC) for the treatment of chronic HK in patients with CKD or HF versus standard treatment (calcium polystyrene sulfonate and lifestyle modifications) from the perspective of the Spanish National Health System., Materials and Methods: Two microsimulation models reflecting the natural history of CKD and HF were used. In both models, K + levels were simulated individually. Based on efficacy (reduction of K + levels), quality of life of patients (utilities according to health states, and disutilities of events derived from each pathology and adverse events [AEs] of treatment) and costs considered (cost of treatment for HK, of RAASi treatment and its modification, health states, management of events derived from each pathology, HK episodes, and AEs treatment) (, 2022), clinical benefit (quality-adjusted life years [QALYs]) and cost results were obtained. A time horizon of the patient's lifetime was used and a discount rate of 3% was applied for costs and outcomes., Results: SZC is a more effective option in both pathologies, with a difference in QALYs of 0.476 in CKD and 0.978 in HF compared to standard treatment, and it represents an incremental cost of 3,616 and 14,749, respectively, obtaining an incremental cost-utility ratio of 7,605/QALY in CKD and 15,078/QALY in HF., Conclusions: SZC is a cost-effective alternative for the treatment of HK in patients with CKD or HF, taking into account the reference efficiency values commonly used in Spain., (Copyright © 2024. Published by Elsevier España, S.L.U.)

Descripción del caso: Paciente que ingresa por anemia y deterioro de la función renal. Se diagnostica neoplasia de recto infiltrante tras realización de colonoscopia e inicia tratamiento renal sustitutivo tras colocación de catéter temporal. Previamente a la realización de la ileostomía se somete a radioterapia neoadyuvante. Tres meses después presenta hiperpotasemia severa persistente. Encontramos pocos casos descritos en la literatura al respecto, pero parece estar relacionado con la interrupción del tránsito intestinal. Descripción-evaluación del plan de cuidados: Se hace refuerzo dietético, se modifican los parámetros de la hemodiálisis (HD) y se inicia tratamiento con resinas, pero no se normaliza el potasio hasta el cierre de la ileostomía. Resolver la hiperpotasemia fue el objetivo imperioso del plan de cuidados, además del manejo de la ansiedad y el apoyo al paciente en el autocuidado de su estoma. Parece ser que la alteración de la homeostasia se debió al déficit de secreción intestinal de potasio en el colon. Se aceleró el proceso de restauración de la continuidad intestinal con el cierre de la ileostomía, confirmándose la sospecha. Conclusiones: La hiperpotasemia en los pacientes en tratamiento en hemodiálisis puede estar relacionada con la cirugía de colon. Nuestro caso demuestra la importancia de la secreción de potasio en el tracto intestinal para mantener la homeostasis en los pacientes con insuficiencia renal crónica terminal.

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The Tumor Lysis Syndrome is an oncological emergency, caused by destruction of the tumor cell, spontaneously or secondary to chemotherapy, generating release of the intracellular content into the bloodstream. Producing hyperuricemia, hyperphosphatemia, hypocalcemia and hyperkalemia. For its diagnosis, a high degree of suspicion and the Cairo-Bishop and Howard criteria must be applied. A case of a 35-year-old patient is presented with a history of stage IIC retroperitoneal non-gonadal seminoma. He was admitted from an outpatient clinic due to intolerance to the oral route, dehydration and paresthesia in the lower limbs, hyperkalemia, hypocalcemia and hyperuricemia, in addition, elevated serum creatinine. It was considered a diagnosis of tumor lysis syndrome; it was treated with aggressive fluid therapy at a dose of 2-3 L/m2/day of normal saline solution. In addition, rasburicase it was indicated and electrolyte disturbances were corrected. Once renal function was above 60 mL/min/1,73 m3, cytoreductive treatment with cisplatin, etoposide, and bleomycin it was started. The importance of having a diagnostic suspicion in cancer patients concluded, even in low-risk neoplasms, in addition, it is highlighted that, in the literature reviews, its incidence is subject to case reports. [ABSTRACT FROM AUTHOR]

BRASH syndrome results as a consequence of a chain of pathophysiological events that generally occurs in elderly patients, with underlying cardiac disease, treated with beta-blockers or calcium channel blockers, and who present hyperkalemia. This combination of events potentiates the adverse effects of these drugs, thus, bradycardia, hypoperfusion and shock may develop. We present the case of a 78-year-old male patient with a history of high blood pressure, diabetes mellitus and stage II chronic kidney disease, who was being treated with carvedilol and who attended the emergency department presenting the clinical features that characterize the syndrome. Despite the implantation of a temporary transvenous pacemaker, he died a few hours later. In this report is highlighted the importance of recognizing the factors that lead to the appearance of this syndrome, and the multimodal treatment that these patients need as part of the therapeutic protocol. [ABSTRACT FROM AUTHOR]

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Autoimmune polyglandular syndromes are rare conditions distinguished by the coexistence of at least two autoimmune glandular diseases. Autoimmune polyendocrine syndrome type II, also known as Schmidt syndrome is characterized by Addison's disease, autoimmune thyroid disease, or type 1 diabetes mellitus that can be associated with other autoimmune disorders. We present the case of 26 year-old male that was admitted by asthenia and palpitations and who had a new hyperpigmentation on his lips and forehead.

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Copyright of Hospital a Domicilio is the property of Centro Internacional Virtual de Investigacion en Nutricion and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

El suero salino normal (SSN) ha sido clásicamente el fluido de resucitación elegido en el periodo perioperatorio del trasplante renal frente a aquellas soluciones balanceadas con potasio. Sin embargo, los problemas derivados de la hipercloremia desencadenada por la infusión de SSN han llevado a la realización de estudios que comparaban esta solución con los fluidos equilibrados. Mediante la presente revisión narrativa se deduce que el uso de cristaloides balanceados con contenido de potasio en su formulación, en el perioperatorio de trasplante renal, puede considerarse seguro. Estas soluciones no provocan una alteración del potasio sérico mayor que la provocada por el SSN y mantienen mejor el equilibrio ácido-base en estos enfermos.

Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introducción: Con el fin de prevenir una posible hiperpotasemia, los enfermos renales crónicos, especialmente en fases avanzadas, deben seguir una dieta baja en potasio. Para ello, las guías alimentarias para la enfermedad renal crónica recomiendan limitar el consumo de muchas verduras, así como aplicar laboriosas técnicas culinarias para reducir al máximo la cantidad de potasio. Objetivos: El objetivo de este trabajo es analizar el contenido de potasio de varios productos vegetales (frescos, congelados y en conserva), así como comprobar y comparar la efectividad en la reducción de potasio de distintos procesos culinarios, algunos de ellos recomendados en las guías alimentarias, como son el remojo o la doble cocción. Métodos: Se analizó el contenido de potasio de las muestras por triplicado mediante espectrometría de emisión atómica de llama. Resultados: Los resultados mostraron reducciones significativas en el contenido de potasio en todos los procesos culinarios estudiados. El grado de disminución varió según el tipo de verdura y el procesado al que fue sometida. En los productos congelados se alcanzaron mayores reducciones que en los frescos, y en algunos casos se lograron pérdidas de potasio superiores al 90%. Además, se observó como en muchos casos la simple aplicación de una cocción normal dio lugar a reducciones de potasio hasta niveles aceptables para la inclusión en la dieta del enfermo renal. Conclusión: Los resultados mostrados en este estudio son muy positivos, ya que aportan herramientas a los profesionales que tratan con este tipo de pacientes, lo que les permite adaptarse más fácilmente a las necesidades y preferencias de sus pacientes, así como incrementar la variedad en su dieta.

Introduction: Chronic hyperkalemia has negative consequences in the medium and long term, and determines the suspension of nephro and cardioprotective drugs, such as renin-angiotensin-aldosterone system inhibitors (RAASi). There is an alternative to the suspension or dose reduction of these treatments: the administration of potassium chelators. The aim of this study is to estimate the economic impact of the use of patiromer in patients with chronic kidney disease (CKD) or heart failure (HF) and hyperkalemia in Spain., Materials and Method: The annual economic impact of the use of patiromer has been estimated from the perspective of the Spanish society. Two scenarios were compared: patients with CKD or HF and hyperkalemia treated with and without patiromer. The costs have been updated to 2020 euros, using the Health Consumer Price Index. Direct healthcare costs related to the use of resources (treatment with RAASi, CKD progression, cardiovascular events and hospitalization due to hyperkalemia), direct non-healthcare costs (informal care: costs derived from time dedicated by patient's relatives), the indirect costs (productivity loss), as well as an intangible cost (due to premature mortality) were considered. A deterministic sensitivity analysis was performed to validate the robustness of the study results., Results: The mean annual cost per patient in the scenario without patiromer is €9,834.09 and €10,739.37 in CKD and HF, respectively. The use of patiromer would lead to cost savings of over 30% in both diseases. The greatest savings in CKD come from the delay in the progression of CKD. While in the case of HF, 80.1% of these savings come from premature mortality reduction. The sensitivity analyses carried out show the robustness of the results, obtaining savings in all cases., Conclusions: The incorporation of patiromer allows better control of hyperkalemia and, as a consequence, maintain treatment with RAASi in patients with CKD or HF. This would generate a 32% of annual savings in Spain (€3,127 in CKD; €3,466 in HF). The results support the positive contribution of patiromer to health cost in patients with only CKD or in patients with only HF., (Copyright © 2022 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)

Hyperkalaemia is a common electrolyte imbalance with potentially serious short-, medium- and long-term consequences on morbidity and mortality rates and the use of national health service resources. The fact that different medical specialities can manage hyperkalaemia makes it important to have a unified approach, and the recent availability of new specific drug treatments means that the approach needs to be updated. This consensus document from the scientific societies most directly involved in the management of hyperkalaemia (Sociedad Española de Cardiología [Spanish Society of Cardiology], Sociedad Española de Endocrinología y Nutrición [Spanish Society of Endocrinology and Nutrition], Sociedad Española de Medicina Interna [Spanish Society of Internal Medicine], Sociedad Española de Medicina de Urgencias y Emergencias [Spanish Society of Accident and Emergency Medicine] and Sociedad Española de Nefrología [Spanish Society of Nephrology]) first of all reviews basic aspects of potassium balance and blood potassium. Then it goes on to focus on the concept, epidemiology, pathophysiology and diagnostic and therapeutic approaches to hyperkalaemia. The available evidence and the main published studies have been reviewed with the aim of providing a useful tool in the multidisciplinary approach to patients with hyperkalaemia., (Copyright © 2023 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)

Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Medica Colombiana is the property of Acta Medica Colombiana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of West Indian Medical Journal is the property of West Indian Medical Journal (WIMJ) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

En situaciones de urgencia, la hemodiálisis es la técnica más empleada en pacientes portadores de Insuficiencia Renal Crónica, Insuficiencia Renal Crónica Agudizada y en Insuficiencia Renal Aguda Se realizó un estudio observacional descriptivo de corte transversal. Fueron estudiados todos los pacientes que requirieron hemodiálisis de urgencia en la Unidad de Terapia Intensiva del Instituto de Nefrología Dr. Abelardo Buch, en el período del 1ro. de marzo al 30 de septiembre del 2010, para determinar las causas y para comportamiento de las mismas fueron revisadas todas las historias clínicas y los registros de Enfermería. Se utilizó la técnica estadística de análisis de distribución de frecuencias; absolutas y relativas. De un total de 44 pacientes, predominó el sexo femenino con 54,5%, la edad mayor de 40 años, 95,5%, entre 60-69 años, y mayores de 69 años con 25% respectivamente; la enfermedad de base más frecuente fue la hipertensión arterial. Las causas de indicación de hemodiálisis de urgencia que prevalecieron fueron la hipervolemia (52,2%) y la hiperazoemia (27,3%). El 92,9% de los hemodializados de urgencia no presentaron ninguna complicación durante el proceder. Los resultados expuestos demuestran la experiencia acumulada y calidad de los cuidados que se brindan a estos pacientes en la realización de hemodiálisis de urgencia en nuestro Centro.All the patients who received urgent hemodialysis at the intensive care unit of the Nephrology Institute «Dr Abelardo Buch» in the period of March 1st to September 30th 2010 were studied through out an observational descriptive method of transversal cut. Every medical history and nursing register related to these urgent hemodialysis were carefully studied in order to determine the causes that provoked them and their ulterior behavior. It was used the statistical technique of analysis of frequency distributions and the absolute and relative frequencies were calculated. This technique came to show that of 44 patients most of them were female of white race with an age between 40 and 69 years. The most frequent base illness was hypertension. Hypervolemia and Hyperazoemia were the most suggesting causes for urgent hemodialysis. There were not significant complications.

La hiperpotasemia inducida por el trimetoprim- sulfametoxasol es un efecto secundario relativamente común pero poco reconocido, independientemente de la dosis utilizada. Descrita inicialmente en 1983, se presenta en diversos tipos de pacientes; no obstante, existen condiciones que aumentan el riesgo de presentarla, entre las que se encuentra la insuficiencia suprarrenal. Reportamos el caso de un paciente con insuficiencia suprarrenal primaria que, posterior al uso de trimetoprim-sulfametoxazol, presentó hiperpotasemia e hiponatremia. Generalmente, la suspensión del fármaco es suficiente para normalizar los niveles séricos; en nuestro paciente, también se aumentó temporalmente la dosis de esteroides, con lo cual se logró una excelente respuesta clínica.Hyperkalemia induced by trimethoprim therapy is a frequent, yet less thought-off complication associated with its use. Initially described in 1983, it has been reported in several different patient populations; nonetheless, some groups of patients have a higher risk of presenting it, amongst them patients with adrenal insufficiency. We describe a patient with primary adrenal insufficiency who developed hyperkalemia and hyponatremia after trimethoprimsulfamethoxazole therapy. Generally, drug suspension is all that is required to return potassium to normal levels; in our patient, a temporary increase in the steroid dose was also used, achieving an excellent clinical response.

Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Colombian Journal of Anesthesiology is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Hyperkalemia is the most common ion disorder in patients with chronic kidney disease, the comparative assays between existing treatment strategies are scarce, especially in adults. Objective: To evaluate the efficiency of hiperK-cocktail in the management of hyperkalemia, compared to the standard strategy of insulin-dextrose. Material and method: A randomized clinical trial was done in two groups with relation 2:1 in favor of the innovative proposal; group A received insuline-dextrose; group B received hiperK-cocktail (1,000 mL of 10% dextrose + sodium bicarbonate [44.6 mEq] + 20 units of regular insulin). Adults with chronic kidney disease and serum potassium between 6.0-8.6 mEq/L were included, excluding cases who received renal function replacement therapy. Results: In total, 50 patients were included, with 45.9 years old as average age. The overall mean of potassium at enrollment was 6.7 mEq/L (6.01-8.2 range), similar between both groups. Both strategies decreased the serum potassium significantly (p=0.000) regarding the basal mean of the same group, but without statistical difference in the intergroup comparative at 30 minutes (6.18 vs 6.19), 60 minutes (6.30 vs 5.96) neither 4 hours (6.07 vs 5.64). The hiperK-cocktail group obtained a lower overall mean of potassium (5.97 vs 6.2, p=0.001), and higher number of complete remissions since the 60 minutes (63.3% vs 35%, p=0.046). Conclusions: Our results agree with other studies and indicate that hiperK-cocktail is as effective as standard therapy, obtaining greater number of complete remissions of hyperkalemia, especially after one hour of administration. [ABSTRACT FROM AUTHOR]

Rapid transfusion of blood products and the presence of ionic changes as Hypocalcaemia and HyperKalaemia are common in liver transplantation. The objective of this paper is to give the reader a clear and practical description of the etiological factors, biochemical mechanisms, diagnosis and treatment of the calcium and potassium plasmatic disorders associated with massive transfusion. The peculiarities that arise in the clinical setting of liver transplant surgery and citrate intoxication are highlighted. A non- systematic review of literature was conducted in MEDLINE, OVID and Cochrane databases. Correct and early anesthetic management of calcium and potassium disorders prevents serious complications in intraoperative bleeding risk surgeries such as liver transplantation. [ABSTRACT FROM AUTHOR]

Copyright of Colombian Journal of Anesthesiology is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Patients with advanced chronic kidney disease (ACKD) have a high prevalence of malnutrition. The dietary restrictions that we usually apply in terms of macro and micronutrients force our patients to follow dietary guidelines that deviate from healthy patterns., Objetives: To determine if a personalized nutritional intervention program, minimizing the usual restrictions would be justified in case it improved the evolution of kidney disease compared to standard treatment., Secundary Objetives: To determine changes in nutrient intakes and in anthropometric and biochemical parameters, as well as quantify episodes of hyperkalemia., Material and Methods: A single-center, randomized and controlled educational intervention clinical trial was conduct in patients from the ERCA outpatients clinic at the Complejo Hospitalario Universitario de Albacete. 75 patients were included, assigning 35 to a Control group and 40 to the Intervention group with 1-year follow-up. The nutritional status was determined using anthropometric data, body composition by Bioimpedance, blood and urine biochemical parameters and a 24-h recall questionnaire. The nutritional intervention was carried out in three different ways: individual, collective and telephone recall., Results: At the beginning of the study, the BMI showed a situation of weight excess with a mean of 28.83 kg/m 2 (5.4) in men and 26.96 kg/m 2 (4.09) in women. 70% of our patients had overweight. The abdominal circumference was 105.3 cm (10.2) and 92.3 cm (13.7) for men and women respectively without significant changes throughout the study. The percentage of fat mass (FM) was high in both groups for men and women throughout the study. We did not find biochemical parameters of malnutrition and only significant differences were observed in glomerular filtration rate (GFR), which increased in the intervention group. No patient presented any episodes of hyperkalemia during the study. The energy intake in both groups showed an inadequate distribution of macronutrients with a poor intake of carbohydrates (CH) that was supplemented with an excess of fat. In the case of micronutrients, we did observe an increase in potassium and fiber intakes with a decrease in sodium and phosphorus in the intervention group., Conclusions: Malnutrition is not exclusively an intake defficit and encompasses both the problems derived from a deficit and an excess of nutrients intake. Un to 70% of our patients showed weight excess and a fat mass higher than desirable. The implementation of an individualized nutritional education program, including a vegetables and fiber rich diet, less atherogenic, not only did not cause electrolyte alterations but also slowed the progression of kidney disease., (Copyright © 2021 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)