Comprehensive Clinical Nephrology 5 th Edition Comprehensive Clinical
- Slides: 40
Νεφρική Διαχείριση του Κ+ Comprehensive Clinical Nephrology 5 th Edition
Φάρμακα που αυξάνουν τα επίπεδα Κ+ Comprehensive Clinical Nephrology 5 th Edition
Διπλός αποκλεισμός του ΣΡΑA VA-Nephron D Fried et al, NEJM 2013
Διπλός αποκλεισμός του ΣΡΑA VA-Nephron D Fried et al, NEJM 2013
Διπλός αποκλεισμός του ΣΡΑA VA-Nephron D Fried et al, NEJM 2013
Palmer et al, Lancet 2015
Palmer et al, Lancet 2015
Διπλός αποκλεισμός του ΣΡΑΑ MRAs Bolignano et al, Cochrane Database Syst Rev 2014
Διπλός αποκλεισμός του ΣΡΑΑ MRAs Bolignano et al, Cochrane Database Syst Rev 2014
Charg et al, Hypertension 2016
Charg et al, Hypertension 2016
s. K and Adverse outcomes: individual-level data meta-analysis of 1. 217. 986 patients Kovesdy et al, Eur Heart J 2018
ESC guidelines για το monitoring K+ μετά από έναρξη MRA σε ασθενείς με ΚΑ • • • Check renal function and electrolytes (particularly K+). Start with a low dose. Consider dose up-titration after 4 -8 weeks Check blood chemistry at 1 and 4 weeks after starting/increasing dose and at 8 and 12 weeks; 6, 9, and 12 months; 4 -monthly thereafter If K+ rises above 5. 5 mmol/L or creatinine rises to 221 μmol/L (2, 5 mg/dl)/e. GFR <30 ml/min/1, 73 m 2, halve dose and monitor blood chemistry closely If K+ rises to >6, 0 mmol/L or creatinine to >310 μmol (3, 5 mg/dl) e. GFR <20 ml/min/1, 73 m 2, stop MRA immediately and seek specialist advice Eur Heart J 2016; 37, 2129– 2200
Potassium binders
Patiromer
Sodium zirconium cyclosilicate
Lepage L. et al. Clin J Am Soc Nephrol 2015; 10: 2136 -42
l l l WARNINGS Colonic Necrosis: Cases of colonic necrosis and other serious gastrointestinal adverse events (bleeding, ischemic colitis, perforation) have been reported in association with KAYEXALATE use. The majority of these cases reported the concomitant use of sorbitol. Risk factors for gastrointestinal adverse events were present in many of the cases including l l l Prematurity history of intestinal disease or surgery Hypovolemia and renal insufficiency and failure. Concomitant administration of sorbitol is not recommended (see PRECAUTIONS, Drug Interactions)
Georgianos et al, Int Urol Nephrol 2017
AMETHYST-DN trial Bakris et al, JAMA 2015
AMETHYST-DN trial Bakris et al, JAMA 2015
AMETHYST-DN trial Bakris et al, JAMA 2015
Sodium Zirconium Cyclosilicate in Hyperkalemia Packham et al, N Engl J Med 2015
Sodium Zirconium Cyclosilicate in Hyperkalemia Packham et al, N Engl J Med 2015
Sodium Zirconium Cyclosilicate in Hyperkalemia Packham et al, N Engl J Med 2015
Ongoing AMBER trial design DBRCT: 311 sites, 16 countries Add-on spironolactone + Patiromer n = 145 Pts. w/ resistant HTN, CKD & s. K: 4, 3 -5, . 1 (n = 290) R Add-on spironolactone + Placebo n = 145 0 Primary Outcome: Between-group difference in the proportion of subjects remaining on spironolactone at Week 12 12 w
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