1,721,041 research outputs found
Pivotal clinical trials, meta-analyses and current guidelines in the treatment of hyperkalemia
No full textHyperkalemia (HK) is the most common electrolyte disturbance observed in patients with advanced stages of chronic kidney disease (CKD), is a potentially life-threatening clinical condition due to an increased risk of fatal arrhythmias, and strongly impacts the quality of life and prognosis of CKD patients. Moreover, while renin-angiotensin-aldosterone system inhibitors (RAASIs) represent the most cardio-nephro-protective drugs used in clinical practice, the treatment with these drugs per se increases serum potassium (sK) values, particularly when heart failure and diabetes mellitus coexist. In fact, the onset or recurrence of HK is frequently associated with not starting, down-titrating or withdrawing RAASIs, and is an indication to begin renal replacement treatment in end-stage renal disease. Current strategies aimed at preventing and treating chronic HK are still unsatisfactory, as evidenced by the relatively high prevalence of HK also in patients under stable nephrology care, and even in the ideal setting of randomized clinical trials. Indeed, dietary potassium restriction, the use of sodium bicarbonate or diuretics, the withdrawal or down-titration of RAASIs, or the administration of old potassium binders, namely sodium polystyrene sulphonate and calcium polystyrene sulphonate, have limited efficacy and are poorly tolerated; therefore, these strategies are not suitable for long-term control of sK. As such, there is an important unmet need for novel therapeutic options for the chronic management of patients at risk for HK. The development of new potassium binders may change the treatment landscape in the near future. This review summarizes the current evidence on the treatment of chronic HK in cardio-renal patients
Specific nutritional problems in acute kidney injury, treated with non-dialysis and dialytic modalities
No full textPatients who develop AKI, especially in the intensive care
unit (ICU), are at risk of protein–energy malnutrition,which
is a major negative prognostic factor in this clinical condition.
Despite the lack of evidence from controlled trials
of its effect on outcome, nutritional support by the enteral
(preferentially) and/or parenteral route appears clinically indicated
in most cases of ICU-acquired AKI, independently
of the actual nutritional status of the patient, in order to prevent
deterioration in the nutritional state with all its known
complications. Extrapolating from data in other conditions,
it seems intrinsically unlikely that starvation of a catabolic
patient is more beneficial than appropriate nutritional support
by an expert team with the skills to avoid the potential
complications of the enteral and parenteral nutrition
methodologies. By the same token, it is ethically impossible
to conduct a trial in which the control group undergoes
prolonged starvation. The primary goals of nutritional support
in AKI, which represents a well-known inflammatory
and pro-oxidative condition, are the same as those for other
critically ill patients with normal renal function, i.e. to ensure
the delivery of adequate nutrition, to prevent protein–
energy wasting with its attendant metabolic complications,
to promote wound healing and tissue repair, to support immune
system function, to accelerate recovery and to reduce
mortality. Patients with AKI on RRT should receive a basic
intake of at least 1.5 g/kg/day of protein with an additional
0.2 g/kg/day to compensate for amino acid/protein
loss during RRT, especially when daily treatments and/or
high efficiecy modalities are used. Energy intake should
consist of no more than 30 kcal non-protein calories or
1.3 × BEE (Basal Energy Expenditure) calculated by the
Harris–Benedict equation, with ∼30–35% from lipid, as
lipid emulsions. For nutritional support, the enteral route
is preferred, although it often needs to be supplemented
through the parenteral route in order to meet nutritional
requirement
Exercise in patients on chronic hemodialysis: Current evidence, knowledge gaps and future perspectives
No full textPurpose of reviewPhysical inactivity is common in hemodialysis patients, and is associated with disability and poor outcomes. We summarize the effects of aerobic, resistance or mixed exercise training on aerobic capacity, muscle mass and strength, dialysis efficiency, quality of life and cardiovascular adaptation according to clinical studies on this population, also focusing on knowledge gaps as topics for future research. Finally, we put evidence into clinical context deriving practical indications for exercise implementation in these patients.Recent findingsIn hemodialysis patients, aerobic or mixed exercise training increases predominantly aerobic capacity, whereas resistance training seems more effective in increasing muscle strength. Data concerning dialysis efficiency are equivocal, although phosphate and potassium clearances seem to be improved. There is also inconclusive evidence concerning changes in cardiovascular risk factors. All types of exercise improve patients' quality of life. However, there is a need for protocol standardization and selection of easily measurable endpoints. In clinical practice, it is advised that exercise implementation be performed gradually, and goals be tailored to individual pretraining fitness levels to maximize patient adherence and clinical benefits.SummaryThe overall evidence suggests that exercise training is beneficial and well tolerated in hemodialysis patients, although heterogeneity across studies hinders generalization of results. In any case, a gradual and individualized approach should be used to implement exercise in these patients
Can we trust ECG for diagnosing hyperkalemia? A challenging question for clinicians and bioengineers
No full textRecent insights into sodium and potassium handling by the aldosterone-sensitive distal nephron: a review of the relevant physiology
No full textIn recent years, our understanding of the physiology of the aldosterone-sensitive distal nephron (ASDN) has greatly advanced thanks to the discovery of the complex with-no-lysine kinase (WNK) signaling and the molecular characterization of the epithelial sodium channel (ENaC). A series of studies, initially focused on rare tubulopathies such as Gordon and Liddle syndromes, eventually led to a partial elucidation of the so-called “aldosterone paradox”, the traditional explanation of the physiology of such disparate conditions such as hyperkalemia and low effective arterial blood volume. The physiology of the ASDN is herein illustrated in light of the novel acquisitions in an easy-to-understand fashion, with the aim of giving the practicing nephrologist a solid “first glance” into this exciting but challenging field. Focus is on ion channels and transporters, their regulation by key hormones such as aldosterone and angiotensin II, and dietary implications
Efficacy and safety of long-term tolvaptan treatment in a patient with SCLC and SIADH
No full textHyponatremia frequently occurs in patients with cancer and is mostly due to a syndrome of inappropriate antidiuresis caused by ectopic secretion of antidiuretic hormone (SIADH). Small cell lung cancer presents with SIADH in approximately 11%-15% of cases. Recently, a new class of drugs, vasopressin V2-receptor antagonists (vaptans), emerged as a promising treatment for SIADH, but efficacy and safety data in cancer patients are lacking. We present a case of SIADH, heralding small cell lung cancer and persisting after apparent complete remission of primary tumor following chemotherapy/radiotherapy, in a patient who underwent long-term treatment with tolvaptan without any serious adverse effects
Myoplasmic Ca2+-force relationship studied with fura-2 during stimulation of rat aortic smooth muscle
No full text
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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