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1.
Artigo em Chinês | MEDLINE | ID: mdl-34521171

RESUMO

Objective: To explore the influencing factors for serum potassium >4.4 mmol/L in the morning of parathyroidectomy in hemodialysis patients with secondary hyperparathyroidism (SHPT). Methods: The clinical data of 72 patients with SHPT who received regular hemodialysis and underwent parathyroidectomy in Guangdong Provincial People's Hospital from January 2012 to December 2018 were analyzed retrospectively. There were 37 males and 35 females, aged from 25 to 69 years, and the dialysis timespan was from 0.5 to 11 years. The levels of parathyroid hormone, serum potassium and serum calcium before hemodialysis were examined one day before operation, and hemodialysis time and dewatering volume after hemodialysis without heparin were recorded, and also the level of serum potassium in the morning of parathyroidectomy was detected. The occurrences of hyperkalemia during and after operation were studied. The factors related to hyperkalemia in the morning of parathyroidectomy were evaluated by Pearson or Spearman correlation analysis, and the cut-off values of risk factors were calculated by receiver operating characteristic (ROC) curve. Results: Serum potassium >4.4 mmol/L in the morning of parathyroidectomy existed in 23 of 72 patients. Correlation analysis showed that serum potassium one day before operation ((4.93±0.56)mmol/L, r=0.656, P<0.001) and dehydration volume ((2.37±0.75)L, r=0.261, P=0.027) were positively correlated with serum potassium in the morning of parathyroidectomy((4.16±0.54)mmol/L). Serum potassium before hemodialysis one day before operation was a main predictor for serum potassium in the morning of parathyroidectomy (AUC=0.791, P<0.001). The cut-off value of serum potassium before hemodialysis one day before operation was 5.0 mmol/L. Conclusion: Serum potassium before hemodialysis one day before operation in patients with SHPT can predict serum potassium in the morning of parathyroidectomy, offering imformation for the safety of operation.


Assuntos
Hiperpotassemia , Hiperparatireoidismo Secundário , Cálcio , Feminino , Humanos , Hiperpotassemia/etiologia , Hiperparatireoidismo Secundário/complicações , Hiperparatireoidismo Secundário/cirurgia , Masculino , Hormônio Paratireóideo , Paratireoidectomia , Diálise Renal , Estudos Retrospectivos
3.
Am J Case Rep ; 22: e932048, 2021 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-34234096

RESUMO

BACKGROUND Brugada syndrome is a rare ion channelopathy that can lead to sudden cardiac death and lethal arrhythmias in patients without a structural cardiac defect, the most common of which being the gain-of-function mutation of the SCN5a sodium ion channel involving phase 0 of the cardiac action potential. In 2012, BrS electrocardiogram findings were redefined and classified as either congenital Brugada syndrome (BrS) or Brugada phenocopies (BrP). Several etiologies of BrP have been reported, such as metabolic derangements, electrolyte abnormalities, cardiovascular diseases, and pulmonary embolism. CASE REPORT A 28-year-old man presented to the Emergency Department unresponsive. An initial ECG taken by Emergency Medical Services (EMS) was interpreted as a STEMI. An initial ECG in the ED showed a Brugada type I ECG pattern in leads V1-V2 and hyperacute T wave abnormalities, among other findings. Additionally, the patient had a serum potassium level of 9 mmol/L, glucose level of 1375 mmol/L, and peak cardiac troponin-I of 20.452 µg/L. All underlying medical conditions were stabilized, electrolyte and metabolic abnormalities were corrected, and subsequent normalization of electrocardiographic findings was achieved. CONCLUSIONS Distinguishing congenital Brugada syndrome from Brugada phenocopies can be difficult, especially when patients present to the ED with severe underlying conditions. Several factors can be used to direct clinical suspicion towards one or the other; however, confirmation may require EP studies and further tests. In this case, the following findings were suggestive of BrP: presence of an identifiable underlying abnormality, correction of the underlying condition resolves the ECG pattern, and the absence of family history of sudden cardiac death.


Assuntos
Intoxicação Alcoólica , Síndrome de Brugada , Cetoacidose Diabética , Hiperpotassemia , Adulto , Síndrome de Brugada/diagnóstico , Cetoacidose Diabética/complicações , Cetoacidose Diabética/diagnóstico , Eletrocardiografia , Humanos , Hiperpotassemia/diagnóstico , Hiperpotassemia/etiologia , Masculino
4.
Expert Rev Clin Pharmacol ; 14(9): 1055-1064, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34227913

RESUMO

INTRODUCTION: Hyperkalemia is a common finding in patients with advanced kidney disease for multiple reasons. Renin-Angiotensin-Aldosterone-System Inhibitors (RAASi) that are indicated for slowing down progression of kidney disease are often associated with hyperkalemia which becomes a limiting factor in their use and titration to the maximum dose. Having a safe, effective, tolerable, and affordable potassium binder can help optimize RAAS inhibition in the setting of kidney disease. AREAS COVERED: Although sodium polystyrene sulfonate has been a mainstay of acute management of hyperkalemia for decades, evidence regarding its efficacy is limited, and its chronic use is not routinely recommended for concerns regarding toxicity. The concern of gastrointestinal (GI) adverse effects with sodium polystyrene sulfonate has spurred the development of alternatives. Sodium zirconium cyclosilicate (SZC) is a promising agent that selectively binds potassium in the gut and eliminates it, while being safe for chronic use based on 1 year of data. Even though we do not have head-to-head studies among the three currently available binders, SZC stands out in rapidity of onset and efficacy. EXPERT OPINION: In this review, we summarize the general management of hyperkalemia, including new agents. We review the pre-clinical and clinical data relating to sodium zirconium cyclosilicate.


Assuntos
Hiperpotassemia/tratamento farmacológico , Insuficiência Renal Crônica/complicações , Silicatos/administração & dosagem , Doença Crônica , Progressão da Doença , Relação Dose-Resposta a Droga , Humanos , Hiperpotassemia/etiologia , Resinas de Troca Iônica/administração & dosagem , Resinas de Troca Iônica/efeitos adversos , Resinas de Troca Iônica/farmacologia , Insuficiência Renal Crônica/tratamento farmacológico , Sistema Renina-Angiotensina/efeitos dos fármacos , Silicatos/efeitos adversos , Silicatos/farmacologia
6.
Nutrients ; 13(6)2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34063969

RESUMO

Potassium (K), the main cation inside cells, plays roles in maintaining cellular osmolarity and acid-base equilibrium, as well as nerve stimulation transmission, and regulation of cardiac and muscle functions. It has also recently been shown that K has an antihypertensive effect by promoting sodium excretion, while it is also attracting attention as an important component that can suppress hypertension associated with excessive sodium intake. Since most ingested K is excreted through the kidneys, decreased renal function is a major factor in increased serum levels, and target values for its intake according to the degree of renal dysfunction have been established. In older individuals with impaired renal function, not only hyperkalemia but also hypokalemia due to anorexia, K loss by dialysis, and effects of various drugs are likely to develop. Thus, it is necessary to pay attention to K management tailored to individual conditions. Since abnormalities in K metabolism can also cause lethal arrhythmia or sudden cardiac death, it is extremely important to monitor patients with a high risk of hyper- or hypokalemia and attempt to provide early and appropriate intervention.


Assuntos
Estado Nutricional/fisiologia , Potássio/metabolismo , Insuficiência Renal Crônica/metabolismo , Adulto , Idoso , Pressão Sanguínea/efeitos dos fármacos , Feminino , Humanos , Hiperpotassemia/etiologia , Hiperpotassemia/metabolismo , Hipopotassemia/etiologia , Hipopotassemia/metabolismo , Rim/metabolismo , Masculino , Pessoa de Meia-Idade , Recomendações Nutricionais , Insuficiência Renal Crônica/complicações
10.
Int J Hematol ; 114(1): 102-108, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33782816

RESUMO

Pseudohyperkalemia, a false elevation of potassium level in vitro, can be observed in chronic lymphocytic leukemia (CLL) patients due to fragility of leukocytes along with a high leukocyte count. This retrospective, observational study included all patients diagnosed with CLL at our hospital who had at least one leukocyte count ≥ 50.0 × 109/L during the years 2008-2018. All hyperkalemic episodes (including when leukocyte count was below 50.0 × 109/L) during this period were assessed. Pseudohyperkalemia was defined as when a normal potassium level was measured in a repeated blood test or when known risk factors and ECG changes typical of hyperkalemia were absent. Of the 119 episodes of hyperkalemia observed, 41.2% were considered as pseudohyperkalemia. Pseudohyperkalemia episodes were characterized by significantly higher leukocyte counts as well as higher potassium and LDH levels compared to true hyperkalemia. Pseudohyperkalemia was documented in medical charts only in a minority of cases (n = 4, 8.1%). Treatment was administered in 17 of 49 (34.7%) cases and caused significant hypokalemia in 6 of those cases. The incidence of pseudohyperkalemia in this study was rather high, suggesting that physicians should be more aware of this phenomenon in patients with CLL.


Assuntos
Hiperpotassemia/diagnóstico , Hiperpotassemia/etiologia , Leucemia Linfocítica Crônica de Células B/complicações , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hiperpotassemia/sangue , Incidência , Leucemia Linfocítica Crônica de Células B/sangue , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Potássio/sangue , Estudos Retrospectivos , Fatores de Risco
11.
Am J Forensic Med Pathol ; 42(2): 174-177, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33590987

RESUMO

ABSTRACT: Acute myeloid leukemia can rarely cause sudden, unexpected death in children. Presentation may be non-specific and death may occur in children with no prior medical history. Herein we present the case of a previously healthy 2-year and 2 month-old White girl, who on autopsy, was found to have acute myeloid leukemia with KMT2A rearrangement extensively involving all major thoracic and abdominal organs. This case is presented to the forensic community to discuss the presentation and findings in sudden death caused by acute leukemia. The case highlights when acute leukemia should enter the differential as a potential cause of death, as well as potential resources available in the postmortem workup of acute leukemias.


Assuntos
Morte Súbita/etiologia , Leucemia Mieloide Aguda/diagnóstico , Acidose/etiologia , Anemia/etiologia , Pré-Escolar , Feminino , Rearranjo Gênico , Histona-Lisina N-Metiltransferase/genética , Humanos , Hiperpotassemia/etiologia , Hipoglicemia/etiologia , Ácido Láctico/sangue , Leucemia Mieloide Aguda/complicações , Leucocitose/etiologia , Proteína de Leucina Linfoide-Mieloide/genética , Trombocitopenia/etiologia
12.
Transfusion ; 61(4): 1093-1101, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33565635

RESUMO

BACKGROUND: Hyperkalemia is a rare life-threatening complication of red blood cell (RBC) transfusion. Stored RBCs leak intracellular potassium (K+) into the supernatant; irradiation potentiates the K+ leak. As the characteristics of patients and implicated RBCs have not been studied systematically, a multicenter study of transfusion-associated hyperkalemia (TAH) in the pediatric population was conducted through the AABB Pediatric Transfusion Medicine Subsection. STUDY DESIGN: The medical records of patients <18 years old were retrospectively queried for hyperkalemia occurrence during or ≤12 h after the completion of RBC transfusion in a 1-year period. Collected data included patient demographics, diagnosis, medical history, timing of hyperkalemia and transfusion, mortality, and RBC unit characteristics. RESULTS/FINDINGS: A total of 3777 patients received 19,649 RBC units during the study period in four facilities. TAH was found in 35 patients (0.93%) in 37 occurrences. The patient median age and weight were 1.28 years and 9.80 kg, respectively. All patients had multiple serious comorbidities. There were 79 RBC units transfused in the TAH events; 62% were irradiated, and the median age of the units was 10 days. The median total RBC volume transfused ≤12 h before TAH was 24% of patient estimated total blood volume, and the median infusion rate (IR) was19.6 ml/kg/h. Mortality rate within 1 day after the TAH event was 20%. CONCLUSIONS: The prevalence of TAH in children was low; however, the 1-day mortality rate was 20%. Patients with multiple comorbidities may be at higher risk for TAH. The IR was higher for patients who had TAH than the IR threshold for safe transfusion.


Assuntos
Transfusão de Eritrócitos/efeitos adversos , Hiperpotassemia/etiologia , Infusões Intravenosas/efeitos adversos , Potássio/efeitos da radiação , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Comorbidade , Feminino , Humanos , Hiperpotassemia/diagnóstico , Hiperpotassemia/epidemiologia , Hiperpotassemia/mortalidade , Lactente , Infusões Intravenosas/estatística & dados numéricos , Masculino , Mortalidade/tendências , Potássio/sangue , Prevalência , Estudos Retrospectivos , Fatores de Risco , Medicina Transfusional/estatística & dados numéricos
13.
Anaesthesia ; 76(5): 655-664, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33399225

RESUMO

Malignant hyperthermia is defined in the International Classification of Diseases as a progressive life-threatening hyperthermic reaction occurring during general anaesthesia. Malignant hyperthermia has an underlying genetic basis, and genetically susceptible individuals are at risk of developing malignant hyperthermia if they are exposed to any of the potent inhalational anaesthetics or suxamethonium. It can also be described as a malignant hypermetabolic syndrome. There are no specific clinical features of malignant hyperthermia and the condition may prove fatal unless it is recognised in its early stages and treatment is promptly and aggressively implemented. The Association of Anaesthetists has previously produced crisis management guidelines intended to be displayed in all anaesthetic rooms as an aide memoire should a malignant hyperthermia reaction occur. The last iteration was produced in 2011 and since then there have been some developments requiring an update. In these guidelines we will provide background information that has been used in updating the crisis management recommendations but will also provide more detailed guidance on the clinical diagnosis of malignant hyperthermia. The scope of these guidelines is extended to include practical guidance for anaesthetists dealing with a case of suspected malignant hyperthermia once the acute reaction has been reversed. This includes information on care and monitoring during and after the event; appropriate equipment and resuscitative measures within the operating theatre and ICU; the importance of communication and teamwork; guidance on counselling of the patient and their family; and how to make a referral of the patient for confirmation of the diagnosis. We also review which patients presenting for surgery may be at increased risk of developing malignant hyperthermia under anaesthesia and what precautions should be taken during the peri-operative management of the patients.


Assuntos
Dantroleno/uso terapêutico , Hipertermia Maligna/tratamento farmacológico , Relaxantes Musculares Centrais/uso terapêutico , Acidose/tratamento farmacológico , Acidose/etiologia , Temperatura Corporal , Cálcio/administração & dosagem , Dióxido de Carbono/análise , Síndromes Compartimentais/tratamento farmacológico , Síndromes Compartimentais/etiologia , Coagulação Intravascular Disseminada/etiologia , Coagulação Intravascular Disseminada/terapia , Frequência Cardíaca , Humanos , Hiperpotassemia/tratamento farmacológico , Hiperpotassemia/etiologia , Hipertermia Maligna/complicações , Hipertermia Maligna/diagnóstico , Mioglobinúria/tratamento farmacológico , Mioglobinúria/etiologia , Ventilação Pulmonar , Fatores de Risco , Bicarbonato de Sódio/administração & dosagem
14.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33495195

RESUMO

Takotsubo cardiomyopathy (TCMP) is an important, though under-recognised, syndrome which mimics acute coronary syndrome (ACS) presenting with similar clinical, biochemical and ECG features. A 68-year-old man was referred as ACS for emergency coronary angiography; however, a history of lethargy, weight loss and electrolyte abnormalities prompted further investigations. Angiography was postponed, adrenal insufficiency confirmed and steroid replacement commenced. Echocardiography demonstrated reduced left ventricular (LV) function (45%) with regional wall motion abnormalities, although angiography confirmed unobstructed arteries. Steroid replacement induced a rapid improvement in symptoms and LV function. Few cases of TCMP associated with adrenal insufficiency have been reported. This appears to be the first case describing TCMP precipitated by new-onset secondary adrenal insufficiency following long-term steroid use in a male patient, and highlights the importance of considering TCMP in patients presenting with suspected ACS. Here, prompt recognition and treatment of a serious underlying disorder prevented a potentially life-threatening Addisonian crisis.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Insuficiência Adrenal/diagnóstico , Cardiomiopatia de Takotsubo/diagnóstico , Testes de Função do Córtex Suprarrenal , Insuficiência Adrenal/induzido quimicamente , Insuficiência Adrenal/complicações , Insuficiência Adrenal/tratamento farmacológico , Idoso , Asma/tratamento farmacológico , Proteína C-Reativa/metabolismo , Diagnóstico Diferencial , Ecocardiografia , Eczema/tratamento farmacológico , Eletrocardiografia , Glucocorticoides/efeitos adversos , Terapia de Reposição Hormonal , Humanos , Hidrocortisona/uso terapêutico , Hiperpotassemia/etiologia , Hiponatremia/etiologia , Masculino , Pneumonia/complicações , Pneumonia/diagnóstico , Cardiomiopatia de Takotsubo/complicações
15.
J Pediatr ; 232: 294-298, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33493492

RESUMO

Pseudohyperkalemia and pseudohyponatremia are phenomena in which hematologic disorders with high cell counts result in factitious electrolyte measurements that can result in inappropriate treatment. We describe 2 children with leukemia presenting with both disturbances to highlight the importance of correlating electrolyte results from plasma with those from whole blood before intervening.


Assuntos
Hiperpotassemia/etiologia , Hiponatremia/etiologia , Leucemia-Linfoma Linfoblástico de Células T Precursoras/diagnóstico , Criança , Humanos , Hiperpotassemia/diagnóstico , Hiponatremia/diagnóstico , Lactente , Masculino , Leucemia-Linfoma Linfoblástico de Células T Precursoras/complicações
16.
Am J Med Sci ; 361(1): 106-110, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32709394

RESUMO

Potassium is the most important intracellular cation and the kidneys play a pivotal role in potassium homeostasis. Potassium disorder is a common electrolyte abnormality and it increases the risk of death from any cause, particularly cardiovascular events. Hyperkalemia is a common electrolyte abnormality encountered post organ transplantation. The etiology is multifactorial, and includes drugs such as calcineurin inhibitors. In certain regards, the clinical picture of post-transplantation hyperkalemia and hypertension resembles that of Gordon syndrome or familial hyperkalemic hypertension, a disorder characterized by over activity of thiazide-sensitive sodium chloride cotransporter. Effective and safe management of chronic hyperkalemia can be challenging in this special patient population. Despite the significant short-term and long-term side effects, fludrocortisone (a potent synthetic oral mineralocorticoid receptor agonist) has emerged as the default drug of choice for treatment of refractory hyperkalemia in many organ transplant recipients. However, the long-term efficacy and safety of fludrocortisone for management of hyperkalemia in organ transplant recipients remains unknown. This review discusses potassium homeostasis, including the role of the kidneys, and focuses on calcineurin inhibitor-induced hyperkalemia and on the under-appreciated role of thiazide-type diuretic use in management of hyperkalemia and hypertension. We present an illustrative case of post-transplantation hyperkalemia and hypertension with relevant literature.


Assuntos
Inibidores de Calcineurina/metabolismo , Diuréticos/uso terapêutico , Hiperpotassemia/terapia , Hipertensão/terapia , Potássio/fisiologia , Tiazidas/uso terapêutico , Transplantes/fisiopatologia , Homeostase , Hiperpotassemia/etiologia , Hipertensão/etiologia , Rim/fisiologia
17.
Nephrol Dial Transplant ; 36(4): 681-688, 2021 03 29.
Artigo em Inglês | MEDLINE | ID: mdl-33020805

RESUMO

BACKGROUND: Patients undergoing haemodialysis (HD) are often discouraged from eating fruits and vegetables because of fears of hyperkalaemia and undernutrition, yet evidence to support these claims is scarce. We here explore the association between adherence to a healthy plant-based diet with serum potassium, surrogates of nutritional status and attainment of energy/protein intake targets in HD patients. METHODS: We performed an observational single-centre study of stable patients undergoing HD with repeated dietary assessment every 3 months. Patients were provided with personalized nutritional counselling according to current guidelines. The diet was evaluated by 3-day food records and characterized by a healthy plant-based diet score (HPDS), which scores positively the intake of plant foods and negatively animal foods and sugar. The malnutrition inflammation score (MIS) and serum potassium were also assessed at each visit. We used mixed-effects models to evaluate the association of the HPDS with markers of nutritional status, serum potassium levels and attainment of energy/protein intake targets. RESULTS: After applying inclusion and exclusion criteria, a total of 150 patients contributing to 470 trimestral observations were included. Their mean age was 42 years [standard deviation (SD) 18] and 59% were women. In multivariable models, a higher HPDS was not associated with serum potassium levels or odds of hyperkalaemia {potassium >5.5 mEq/L; odds ratio [OR] 1.00 [95% confidence interval (CI) 0.94-1.07] per HPDS unit higher}. Patients with a higher HPDS did not differ in terms of energy intake [OR for consuming <30 kcal/kg day 1.05 (95% CI 0.97-1.13)] but were at risk of low protein intake [OR for consuming <1.1 g of protein/kg/day 1.11 (95% CI 1.04-1.19)]. A higher HPDS was associated with a lower MIS, indicating better nutritional status. CONCLUSIONS: In patients undergoing HD, adherence to a healthy plant-based diet was not associated with serum potassium, hyperkalaemia or differences in energy intake. Although these patients were less likely to reach daily protein intake targets, they appeared to associate with better nutritional status over time.


Assuntos
Dieta Vegetariana , Ingestão de Energia , Hiperpotassemia/dietoterapia , Desnutrição/prevenção & controle , Estado Nutricional , Diálise Renal/efeitos adversos , Adulto , Feminino , Humanos , Hiperpotassemia/etiologia , Hiperpotassemia/patologia , Estudos Longitudinais , Masculino , Desnutrição/etiologia , Desnutrição/patologia , Pessoa de Meia-Idade , Suécia/epidemiologia , Adulto Jovem
18.
Nephrol Dial Transplant ; 36(1): 137-150, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-32030422

RESUMO

BACKGROUND: Sodium zirconium cyclosilicate (SZC; formerly ZS-9) is a selective potassium (K+) binder for the treatment of adults with hyperkalaemia. This post hoc analysis of an open-label, single-arm trial (NCT02163499) compared SZC efficacy and safety >12 months among outpatients with hyperkalaemia and Stages 4 and 5 chronic kidney disease (CKD) versus those with Stages 1-3 CKD. METHODS: Adults with serum K+ ≥5.1 mmol/L (measured by point-of-care i-STAT device) received SZC 10 g three times daily for 24-72 h until normokalaemia (i-STAT K+ 3.5-5.0 mmol/L) was achieved [correction phase (CP)], followed by once daily SZC 5 g for ≤12 months [maintenance phase (MP)]. Here, patients were stratified by baseline estimated glomerular filtration rate (eGFR <30 or ≥30 mL/min/1.73 m2). Study endpoints included percent achieving normokalaemia during CP and MP, mean serum K+ and bicarbonate during MP, and adverse events (AEs). RESULTS: Of 751 patients enrolled, 289 (39%), 453 (60%) and 9 (1%) had baseline eGFR values of <30, ≥30 mL/min/1.73 m2 or missing, respectively. During the CP, 82% of patients achieved normokalaemia in both eGFR subgroups within 24 h, and 100 and 95% with baseline eGFR <30 and ≥30 mL/min/1.73 m2, respectively, within 72 h. Corresponding proportions with normokalaemia during the MP were 82 and 90% at Day 365, respectively. Mean serum K+ reduction from baseline during the CP was sustained throughout the MP and serum bicarbonate increased. AEs during the MP were more common in the eGFR <30 ≥30 mL/min/1.73 m2 subgroup. CONCLUSIONS: SZC corrects hyperkalaemia and maintains normokalaemia among outpatients regardless of the CKD stage.


Assuntos
Biomarcadores/sangue , Hiperpotassemia/tratamento farmacológico , Falência Renal Crônica/complicações , Potássio/sangue , Insuficiência Renal Crônica/complicações , Índice de Gravidade de Doença , Silicatos/uso terapêutico , Idoso , Feminino , Humanos , Hiperpotassemia/sangue , Hiperpotassemia/etiologia , Hiperpotassemia/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos
19.
Am J Kidney Dis ; 77(2): 287-296, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33075387

RESUMO

In recent years, a growing body of evidence has emerged on the benefits of plant-based diets for the prevention and treatment of lifestyle diseases. In parallel, data now exist regarding the treatment of chronic kidney disease and its most common complications with this dietary pattern. Improving the nutrient quality of foods consumed by patients by including a higher proportion of plant-based foods while reducing total and animal protein intake may reduce the need for or complement nephroprotective medications, improve kidney disease complications, and perhaps favorably affect disease progression and patient survival. In this In Practice article, we review the available evidence on plant-dominant fiber-rich diet as it relates to kidney disease prevention, chronic kidney disease incidence and progression, metabolic acidosis, hyperphosphatemia, hypertension, uremic toxins, need for kidney replacement therapy including dialysis, patient satisfaction and quality of life, and mortality. Further, concerns of hyperkalemia and protein inadequacy, which are often associated with plant-based diets, are also reviewed in the context of available evidence. It is likely that the risks for both issues may not have been as significant as previously thought, while the advantages are vast. In conclusion, the risk to benefit ratio of plant-based diets appears to be tilting in favor of their more prevalent use.


Assuntos
Dieta Vegetariana , Insuficiência Renal Crônica/dietoterapia , Insuficiência Renal Crônica/prevenção & controle , Acidose/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Fibras na Dieta , Proteínas na Dieta , Progressão da Doença , Humanos , Hiperpotassemia/epidemiologia , Hiperpotassemia/etiologia , Hiperfosfatemia/metabolismo , Hipertensão/fisiopatologia , Hipertensão Renal/fisiopatologia , Obesidade/metabolismo , Insuficiência Renal Crônica/metabolismo , Insuficiência Renal Crônica/fisiopatologia
20.
JAAPA ; 34(1): 10-13, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33315730

RESUMO

ABSTRACT: Tumor lysis syndrome (TLS) is one of the most common oncologic emergencies, occurring when tumor cell contents are rapidly released into the bloodstream. This release of cellular contents, including uric acid, phosphate, and potassium, can rapidly overwhelm the body's homeostasis mechanisms, leading to renal failure, seizures, cardiac dysrhythmias, or death. With an estimated 1.8 million new diagnoses of cancer projected in 2020 and an increase in the use of targeted agents for treatment, healthcare providers must be able to recognize, diagnose, and manage patients presenting with TLS.


Assuntos
Síndrome de Lise Tumoral/diagnóstico , Síndrome de Lise Tumoral/etiologia , Arritmias Cardíacas/etiologia , Emergências , Homeostase , Humanos , Hiperpotassemia/etiologia , Hiperfosfatemia/etiologia , Hiperuricemia/etiologia , Hipocalcemia/etiologia , Insuficiência Renal/etiologia , Convulsões/etiologia , Síndrome de Lise Tumoral/terapia
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