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| http://dx.doi.org/10.1136/bmj.312.7041.1289 | DOI Listing |
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Exploring Hyperkalemia Risk in Frail Older Patients Using RAAS Inhibitors.
Drugs Aging
January 2025
Department of Geriatric Medicine, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands.
Purpose: Renin-angiotensin-aldosterone system inhibitors (RAASi) are widely used in treatment of cardiovascular and renal disease. While effective, they pose a risk of hyperkalemia. In the general population, risk factors for hyperkalemia include chronic kidney disease, congestive heart failure, and use of medication affecting potassium balance.
View Article and Find Full Text PDFImpact of hyperkalaemia on renin-angiotensin-aldosterone (RAAS) inhibitor reduction or withdrawal following hospitalisation.
Clin Exp Med
December 2024
Department of Medicine, King's College Hospital NHS Foundation Trust, London, UK.
Background: Inhibitors of the renin-angiotensin-aldosterone system (RAAS), such as ACE inhibitors (ACEi), angiotensin-II receptor blockers and mineralocorticoid receptor antagonists, reduce morbidity and mortality in hypertension, congestive heart failure and chronic kidney disease. However, their use can lead to hyperkalaemia. We examined the proportions of RAAS inhibitor (RAASi) reduction or withdrawal, across GFR strata, following hospitalisation and the effect on patient mortality.
View Article and Find Full Text PDFOutcomes of Del Nido and hyperkalemic blood cardioplegia in adult cardiac surgery with prolonged aortic cross-clamp times★.
J Extra Corpor Technol
December 2024
College of Medicine and Public Health, Flinders University - Quality and Outcomes Unit, Cardiothoracic Surgical Unit, Division of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia.
Background: The utility and uptake of Del Nido cardioplegia in adult cardiac surgery is rapidly increasing. Cases with prolonged aortic cross-clamp times necessitate multi-dosing however an understanding of safe ischaemic times and definitive guidelines in this domain are lacking. Therefore, this study aimed to assess the safety and efficacy of our DNC strategy by comparing post-operative troponin profiles and clinical outcomes between Del Nido and hyperkalaemic cardioplegia for cases with aortic cross-clamp times of greater than 90 min.
View Article and Find Full Text PDFDetermining optimal pretreatment in cardiac surgery: an experimental study.
Gen Thorac Cardiovasc Surg
November 2024
Department of Cardiovascular Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo, Tokyo, 113-8603, Japan.
Objectives: Heart failure patients with reduced ejection fraction are currently treated with four drug combinations: angiotensin receptor/neprilysin inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors, resulting in improved survival outcomes. Herein, we examined whether myocardial protection by esaxerenone or sacubitril/valsartan may present a counter-effect to the harm caused by cardioplegic arrest.
Methods: Male Wistar rats fed a normal diet were orally administered esaxerenone (3 mg/kg; Esax) or sacubitril/valsartan (68 mg/kg; SaV) once a day for 2 weeks from 6 weeks of age.
Understanding renal tubular acidosis.
Br J Hosp Med (Lond)
October 2024
Monash Rural Health Mildura, Monash University, Melbourne, Australia.
Renal tubular acidosis is a group of disorders characterised by metabolic acidosis, hyperchloraemia, normal anion gap, and potassium imbalance. Genetic mutations, drugs or acquired disorders disrupt the function of various transport proteins and enzymes in the renal tubules, causing diminished bicarbonate reabsorption or inability to excrete hydrogen ions, leading to proximal (type 2) and distal (type 1) renal tubular acidosis, respectively. These conditions are typically associated with hypokalaemia, which, if severe, can cause muscle paralysis and dangerous cardiac arrhythmias.
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