Management of Chronic Hyperkalemia in Patients With Chronic Kidney Disease: An Old Problem With News Options

Morales, Enrique; Cravedi, Paolo; Manrique, Joaquín

doi:10.3389/fmed.2021.653634

Cited by 21 publications

(19 citation statements)

References 85 publications

(80 reference statements)

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“…High serum uric acid levels are associated with high risk for advanced CKD and CKD progression [51,52], the prevalence of hyperuricemia was 30.9% in advanced CKD; advanced CKD had a 2.4-fold higher OR if a patient had hyperuricemia and 2.4-fold higher if a patient was on allopurinol; similar findings have been reported in other studies [23,53]. Hyperkalemia is common in patients with chronic CKD and its prevalence increases as the eGFR declines [54,55], approximately 8.8% patients with advanced CKD were found to have hyperkalemia; hyperkalemia had a 5.4-fold increased association with advanced CKD; similar findings have been reported in other studies [24,25]. Studies have shown that the incidence of cardiovascular events increases with worsening kidney function [56,57]; 22.7% patients with advanced CKD reported angina with a 2.5 times increased risk in advanced CKD, similar to other studies [56,58].…”

Section: Plos Onesupporting

confidence: 79%

Demographic and clinical profile of black patients with chronic kidney disease attending a tertiary hospital in Johannesburg, South Africa

et al. 2022

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Background The prevalence of chronic kidney disease (CKD) is increasing worldwide; black patients have an increased risk of developing CKD and end stage kidney disease (ESKD) at significantly higher rates than other races. Methods A cross sectional study was carried out on black patients with CKD attending the kidney outpatient clinic at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in South Africa, between September 2019 to March 2020. Demographic and clinical data were extracted from the ongoing kidney outpatient clinic records and interviews, and were filled in a questionnaire. Patients provided blood and urine for laboratory investigations as standard of care, and data were descriptively and inferentially entered into REDcap and analysed using STATA version 17. Multivariable logistic regression analysis was used to identify demographic and clinical variables associated with advanced CKD. Results A total of 312 black patients with CKD were enrolled in the study with a median age of 58 (IQR 46–67) years; 58% patients had advanced CKD, 31.5% of whom had grossly increased proteinuria, 96.7% had hypertension, 38.7% had diabetes mellitus and 38.1% had both hypertension and diabetes mellitus. In patients with advanced CKD, the median age was 61 (IQR 51–69) years, eGFR 33 (30–39) mL/min/1.73 m2, serum bicarbonate 22 (IQR 20–24), haemoglobin 12.9 (IQR 11.5–14.0) g/dl and serum uric acid 0.43 (IQR 0.37–0.53). The prevalence of metabolic acidosis was 62.4%, anemia 46.4% and gout 30.9% among those with advanced CKD, while the prevalence of metabolic acidosis and anaemia was 46.6% and 25.9% respectively in those with early CKD. Variables with higher odds for advanced CKD after multivariable logistic regression analysis were hypertension (OR 3.3, 95% CI 1.2–9.2, P = 0.020), diabetes mellitus (OR 1.8, 95% CI 1.1–3.3, P = 0.024), severe proteinuria (OR 3.5, 95% CI 1.9–6.5, P = 0.001), angina (OR 2.5, 95% CI 1.2–5.1, P = 0.008), anaemia (OR 2.9, 95% CI 1.7–4.9, P = 0.001), hyperuricemia (OR 2.4, 95% CI 1.4–4.1, P = 0.001), and metabolic acidosis (OR 2.0, 95% CI 1.2–3.1, P = 0.005). Other associations with advanced CKD were loss of spouse (widow/widower) (OR 3.2, 95% CI 1.4–7.4, P = 0.006), low transferrin (OR 2.4, 95% CI 1.1–5.1, P = 0.028), hyperkalemia (OR 5.4, 95% CI 1.2–24.1, P = 0.029), use of allopurinol (OR 2.4, 95% CI 1.4–4.3, P = 0.005) and doxazosin (OR 1.9, 95% CI 1.2–3.1, P = 0.006). Conclusion Hypertension and diabetes mellitus were strongly associated with advanced CKD, suggesting a need for primary and secondary population-based prevention measures. Metabolic acidosis, anemia with low transferrin levels, hyperuricemia and hyperkalemia were highly prevalent in our patients, including those with early CKD, and they were strongly associated with advanced CKD, requiring clinicians and dietitians to be proactive in supporting the needs of CKD patients in meeting their daily dietary requirements towards preventing and slowing the progression of CKD.

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Section: Plos Onesupporting

confidence: 79%

Demographic and clinical profile of black patients with chronic kidney disease attending a tertiary hospital in Johannesburg, South Africa

et al. 2022

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“…Hyperkalaemia was significantly associated with CKD progression on univariate analysis but this significance was lost on multivariate analysis. Studies have reported that high serum potassium levels are common in patients with chronic CKD and it is associated with decreased renal function and CKD progression; its prevalence increases as the eGFR declines (62, 63). Metabolic acidosis was not significantly associated with CKD progression in this study; studies from other settings reported that patients with low serum bicarbonate levels had higher rates of CKD progression and an accelerated reduction in eGFR with poor outcomes (64, 65).…”

Section: Discussionmentioning

confidence: 99%

Progression of chronic kidney disease among black patients attending a tertiary hospital in Johannesburg, South Africa

Meremo

Paget

Duarte

et al. 2022

Preprint

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Background: Chronic kidney disease (CKD) is a major public health issue worldwide and is an important contributor to the overall non-communicable disease burden. Chronic kidney disease is usually asymptomatic, and insidiously and silently progresses to advanced stages in resource limited settings. Methodology: A prospective longitudinal study was carried out on black patients with CKD attending the kidney outpatient clinic at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in South Africa, between September 2019 to March 2022. Demographic and clinical data were extracted from the ongoing continuous clinic records, as well as measurements of vital signs and interviews at baseline and at follow up. Patients provided urine and blood samples for laboratory investigations as standard of care at study entry (0) and at 24 months, and were followed up prospectively for two (2) years. Data were descriptively and inferentially entered into REDcap and analysed using STATA version 17, and multivariable logistic regression analysis was used to identify predictors of CKD progression. Results: A total of 312 patients were enrolled into the study, 297 (95.2%) patients completed the study, 10 (3.2%) patients were lost to follow and 5 (1.6%) patients died during the study period. The prevalence of CKD progression was 49.5%, while that of CKD remission was 33% and CKD regression was 17.5%. For patients with CKD progression the median age at baseline was 58 (46 - 67) years, the median eGFR was 37 (32 -51) mL/min/1.73 m2, median urine protein creatinine ratio (uPCR) was 0.038 (0.016 -0.82) g/mmol and the median haemoglobin (Hb) was 13.1 (11.7 – 14.4) g/dl; 95.2% had hypertension, 40.1% patients had diabetes mellitus and 39.5% had both hypertension and diabetes mellitus. Almost half (48.3%) of patients with CKD progression had severely increased proteinuria and 45.6% had anaemia. Variables associated with higher odds for CKD progression after multivariable logistic regression analysis were severely increased proteinuria (OR 32.3, 95 % CI 2.8 - 368.6, P = 0.005), moderately increased proteinuria (OR 23.3, 95% CI 2.6 - 230.1, P= 0.007), hypocalcaemia (OR 3.8, 95 % CI 1.0 - 14.8, P = 0.047), hyponatraemia (OR 4.5, 95% CI 0.8 - 23.6, P= 0.042), anaemia (OR 2.1, 95% CI 1.0 - 4.3, P= 0.048), diabetes mellitus (OR 1.8, 95 % CI 0.9 - 3.6, P = 0.047), elevated HbA1c (OR 1.8, 95 % CI 1.2 - 2.8, P = 0.007) and current smoking (OR 2.8, 95 % CI 0.9 - 8.6, P = 0.049). Conclusion: Our study identified a higher prevalence of progression of CKD in a prospective longitudinal study of black patients with CKD. Progression of CKD was associated with proteinuria, diabetes mellitus, elevated HbA1c, anaemia, hypocalcaemia, hyponatraemia and current smoking. This is a call for nephrologists and clinicians to be vigilant in identifying CKD patients at risk of CKD progression at early stages as this would allow risk stratification to improve kidney disease outcomes.

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“…Long-term use of SPS and CPS in treating chronic hyperkalemia may be limited due to lack of evidence and increasing reports of serious gastrointestinal side effects. 7 , 16 In a number of RCTs, patiromer has shown excellent efficacy and safety in treating hyperkalemia in CKD patients. 4 , 7 , 10 , 16 Future research is necessary to prospectively evaluate the comparative efficacy and safety of current treatment options in British Columbia, including SPS/CPS with newer treatment choices, for example, patiromer and sodium zirconium cyclosilicate.…”

Section: Discussionmentioning

confidence: 99%

“…However, its efficacy in treating chronic hyperkalemia among CKD patients is also not well established. 7 …”

Section: Introductionmentioning

confidence: 99%

Prescription Pattern of Cation Exchange Resins and Their Efficacy in Treating Chronic Hyperkalemia Among Patients With Chronic Kidney Diseases: Findings From a Population-Based Analysis in British Columbia, Canada

Atiquzzaman¹,

Birks

Bevilacqua

et al. 2022

Can J Kidney Health Dis

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Background: Little was known about how chronic hyperkalemia (cHK) in patients with chronic kidney disease (CKD) is managed in British Columbia, Canada. Objective: To investigate the trend in sodium polystyrene sulfonate (SPS) and calcium polystyrene sulfonate (CPS) utilization and their efficacy in treating cHK in CKD patients from British Columbia, Canada. Study Design: Retrospective cohort. Setting & Patients: CKD patients aged ≥18 years, followed in Kidney Care Clinic (KCC), who had at least 2 potassium values ≥5.0 mmol/L separated by no more than 91 days during the period of June 1, 2015, to July 31, 2021, were included. Index date was the first date of the 2 potassium values ≥5.0 mmol/L. Patients who received SPS or CPS within 90 days before index date were excluded. Patients who were on dialysis or received kidney transplantation on or before index date were also excluded. Exposure: Continuous exposure to SPS and CPS. Outcome: SPS/CPS prescription utilization trend was described by the proportion of patients ever treated with SPS/CPS, median time in days between cHK diagnosis and initiating treatment with SPS/CPS, total and median number of SPS/CPS prescriptions dispensed. Change in mean serum potassium concentration before and after a 90-day continuous treatment with SPS/CPS was estimated. Analytical Approach: Descriptive. Results: This study included 10 495 patients with cHK (median age 74 years, 60% were male). Median follow-up time was 625 days. Only 2864 (27%) patients were dispensed at least 1 prescription of either SPS or CPS. A total 7300 prescriptions were dispensed; median prescriptions dispensed per patients were 2 (interquartile range [IQR]: 1-3). Median time from index date to the first prescription dispensing date was 154 days (IQR: 36-455). Continuous 90-day treatment with SPS/CPS decreased the mean serum potassium concentration by 0.60 mmol/L, from 5.58 to 4.98 mmol/L. Limitations: Descriptive observational study without control group. Conclusions: In British Columbia, only 1 in 4 CKD patients with cHK were dispensed with SPS/CPS, mostly with higher degrees of hyperkalemia. These medications appeared to be moderately effective in reducing the serum potassium concentration. Future research is necessary to evaluate the comparative effectiveness of newer generation medications.

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Management of Chronic Hyperkalemia in Patients With Chronic Kidney Disease: An Old Problem With News Options

Cited by 21 publications

References 85 publications

Demographic and clinical profile of black patients with chronic kidney disease attending a tertiary hospital in Johannesburg, South Africa

Demographic and clinical profile of black patients with chronic kidney disease attending a tertiary hospital in Johannesburg, South Africa

Progression of chronic kidney disease among black patients attending a tertiary hospital in Johannesburg, South Africa

Prescription Pattern of Cation Exchange Resins and Their Efficacy in Treating Chronic Hyperkalemia Among Patients With Chronic Kidney Diseases: Findings From a Population-Based Analysis in British Columbia, Canada

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