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  1. Article ; Online: Change in albuminuria as a surrogate endpoint for cardiovascular and renal outcomes in patients with diabetes.

    Palmer, Biff F

    Diabetes, obesity & metabolism

    2023  Volume 25, Issue 6, Page(s) 1434–1443

    Abstract: For the purpose of predicting clinical outcomes in patients with diabetes and chronic kidney disease, change in albuminuria is a good candidate to be a surrogate marker for future cardiovascular events and progression of kidney disease. Spot urine ... ...

    Abstract For the purpose of predicting clinical outcomes in patients with diabetes and chronic kidney disease, change in albuminuria is a good candidate to be a surrogate marker for future cardiovascular events and progression of kidney disease. Spot urine albumin/creatinine ratio is convenient and recognized as a viable alternative to 24-h albumin, with some limitations. Although there is sufficient evidence to validate its use in clinical trials as a surrogate endpoint for renal outcomes, this is not yet the case for cardiovascular outcomes. While change in albuminuria as a primary or secondary endpoint is trial-specific, its use should be encouraged, nonetheless.
    MeSH term(s) Humans ; Diabetes Mellitus, Type 2/complications ; Albuminuria/drug therapy ; Glomerular Filtration Rate ; Biomarkers ; Renal Insufficiency, Chronic/complications ; Renal Insufficiency, Chronic/epidemiology ; Diabetic Nephropathies/complications ; Diabetic Nephropathies/epidemiology ; Diabetic Nephropathies/drug therapy ; Cardiovascular Diseases/complications ; Cardiovascular Diseases/epidemiology
    Chemical Substances Biomarkers
    Language English
    Publishing date 2023-03-08
    Publishing country England
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 1454944-x
    ISSN 1463-1326 ; 1462-8902
    ISSN (online) 1463-1326
    ISSN 1462-8902
    DOI 10.1111/dom.15030
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 5442: Show issues Location:
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  2. Article ; Online: Non-steroidal mineralocorticoid antagonists and hyperkalemia monitoring in chronic kidney disease patients associated with type II diabetes: a narrative review.

    Morales, Javier / Palmer, Biff F

    Postgraduate medicine

    2024  Volume 136, Issue 2, Page(s) 111–119

    Abstract: Chronic kidney disease (CKD) is a prevalent complication of Type II diabetes (T2D). The coexistence of CKD with T2D is comparable to cardiovascular disease (CVD) when the estimated glomerular filtration rate declines below 60 ml/min/1.73 ... ...

    Abstract Chronic kidney disease (CKD) is a prevalent complication of Type II diabetes (T2D). The coexistence of CKD with T2D is comparable to cardiovascular disease (CVD) when the estimated glomerular filtration rate declines below 60 ml/min/1.73 m
    MeSH term(s) Humans ; Hyperkalemia/etiology ; Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/drug therapy ; Renal Insufficiency, Chronic/complications ; Renal Insufficiency, Chronic/drug therapy ; Mineralocorticoid Receptor Antagonists/therapeutic use ; Mineralocorticoid Receptor Antagonists/administration & dosage ; Sodium-Glucose Transporter 2 Inhibitors/therapeutic use ; Sodium-Glucose Transporter 2 Inhibitors/administration & dosage ; Naphthyridines/therapeutic use ; Naphthyridines/administration & dosage
    Chemical Substances Mineralocorticoid Receptor Antagonists ; Sodium-Glucose Transporter 2 Inhibitors ; Naphthyridines ; finerenone
    Language English
    Publishing date 2024-02-16
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 410138-8
    ISSN 1941-9260 ; 0032-5481
    ISSN (online) 1941-9260
    ISSN 0032-5481
    DOI 10.1080/00325481.2024.2316572
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Hyperkalemia treatment Standard.

    Palmer, Biff F / Clegg, Deborah J

    Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

    2024  

    Abstract: Hyperkalemia is a common electrolyte disturbance in both inpatient and outpatient clinical practice. The severity and associated risk depends on the underlying cause and rate of K+ increase. Acute hyperkalemia requires immediate attention due to ... ...

    Abstract Hyperkalemia is a common electrolyte disturbance in both inpatient and outpatient clinical practice. The severity and associated risk depends on the underlying cause and rate of K+ increase. Acute hyperkalemia requires immediate attention due to potentially life-threatening manifestations resulting from the rapid rise in plasma K+ concentration. Treatment is initially focused on stabilizing the cardiac membrane, followed by maneuvers to shift K+ into the cell, and ultimately initiating strategies to decrease total body K+ content. Chronic hyperkalemia develops over a more extended period of time and manifestations tend to be less severe. Nevertheless, the disorder is not benign since chronic hyperkalemia is associated with increased morbidity and mortality. The approach to patients with chronic hyperkalemia begins with a review of medications potentially responsible for the disorder, ensuring effective diuretic therapy, and correcting metabolic acidosis if present. The practice of restricting foods high in K+ potassium to manage hyperkalemia is being reassessed since the evidence supporting the effectiveness of this strategy is lacking. Rather, dietary restriction should be more nuanced focusing on reducing intake of non-plant sources of K+. Down titration and/or discontinuation of renin-angiotensin-aldosterone inhibitors should be discouraged since these drugs improve outcomes in patients with heart failure and proteinuric kidney disease. In addition to other conservative measures, K+ binding drugs and SGLT2 inhibitors can assist in maintaining use of these drugs.
    Language English
    Publishing date 2024-02-29
    Publishing country England
    Document type Journal Article
    ZDB-ID 90594-x
    ISSN 1460-2385 ; 0931-0509
    ISSN (online) 1460-2385
    ISSN 0931-0509
    DOI 10.1093/ndt/gfae056
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    Zs.A 2198: Show issues Location:
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    Zs.MO 329: Show issues

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  4. Article ; Online: Management of Hyperkalemia in Renin-Angiotensin-Aldosterone System Inhibitor: Strategies to Maintain Chronic Kidney Disease Patients with Type II Diabetes on Therapy.

    Mahmud, Humaira A / Palmer, Biff F

    Cardiorenal medicine

    2024  Volume 14, Issue 1, Page(s) 191–201

    Abstract: Background: According to the Centers for Disease Control and Prevention (CDC), diabetes affects approximately 37.3 million individuals in the USA, with another estimated 96 million people having a prediabetic state. Furthermore, one or two out of three ... ...

    Abstract Background: According to the Centers for Disease Control and Prevention (CDC), diabetes affects approximately 37.3 million individuals in the USA, with another estimated 96 million people having a prediabetic state. Furthermore, one or two out of three adult Americans exhibit metabolic syndrome or an insulin-resistant state, depending on their age group.
    Summary: Chronic kidney disease (CKD) represents a complication often associated with type II diabetes or the insulin-resistant condition, typically identifiable through proteinuria. Proteinuria serves as both a marker and a contributing factor to kidney damage, and it significantly heightens the risk of cardiovascular (CV) events, including atherosclerosis, heart attacks, and strokes. Renin-angiotensin-aldosterone system inhibitors (RAASis) have demonstrated clinical efficacy in lowering blood pressure, reducing proteinuria, and slowing CKD progression. However, hyperkalemia is a common and serious adverse effect associated with using RAASi.
    Key messages: It is imperative to establish personalized management strategies to enable patients to continue RAASi therapy while effectively addressing hyperkalemia risk. Healthcare professionals must be careful not to inadvertently create a low renal perfusion state, which can reduce distal nephron luminal flow or luminal sodium concentration while using RAASi. Nonsteroidal mineralocorticoid receptor antagonists (nsMRAs), such as finerenone, are demonstrated to delay CKD progression and reduce CV complications, all while mitigating the risk of hyperkalemia. Additionally, maintaining a routine monitoring regimen for serum potassium levels among at-risk patients, making dietary adjustments, and considering the adoption of newer potassium-binding agents hold promise for optimizing RAASi therapy and achieving more effective hyperkalemia management.
    MeSH term(s) Humans ; Hyperkalemia/chemically induced ; Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/drug therapy ; Renin-Angiotensin System/drug effects ; Renal Insufficiency, Chronic/complications ; Renal Insufficiency, Chronic/drug therapy ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Angiotensin-Converting Enzyme Inhibitors/adverse effects ; Mineralocorticoid Receptor Antagonists/therapeutic use ; Mineralocorticoid Receptor Antagonists/adverse effects ; Angiotensin Receptor Antagonists/therapeutic use ; Angiotensin Receptor Antagonists/adverse effects ; Naphthyridines
    Chemical Substances Angiotensin-Converting Enzyme Inhibitors ; Mineralocorticoid Receptor Antagonists ; Angiotensin Receptor Antagonists ; finerenone ; Naphthyridines
    Language English
    Publishing date 2024-03-21
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2595659-0
    ISSN 1664-5502 ; 1664-3828
    ISSN (online) 1664-5502
    ISSN 1664-3828
    DOI 10.1159/000538389
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  5. Article ; Online: SGLT2 Inhibition and Tubular Sodium Handling.

    Palmer, Biff F / Clegg, Deborah J

    Journal of the American Society of Nephrology : JASN

    2023  Volume 35, Issue 2, Page(s) 131–133

    MeSH term(s) Humans ; Sodium ; Sodium-Glucose Transporter 2 ; Glucose/pharmacology ; Sodium-Glucose Transporter 2 Inhibitors/pharmacology ; Sodium-Glucose Transporter 2 Inhibitors/therapeutic use ; Diabetes Mellitus, Type 2
    Chemical Substances Sodium (9NEZ333N27) ; Sodium-Glucose Transporter 2 ; Glucose (IY9XDZ35W2) ; Sodium-Glucose Transporter 2 Inhibitors
    Language English
    Publishing date 2023-12-22
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1085942-1
    ISSN 1533-3450 ; 1046-6673
    ISSN (online) 1533-3450
    ISSN 1046-6673
    DOI 10.1681/ASN.0000000000000280
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    Zs.A 3344: Show issues Location:
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  6. Article ; Online: Pathophysiology and clinical management of hyperkalemia in chronic kidney disease.

    Palmer, Biff F / Clegg, Deborah J

    Minerva medica

    2023  Volume 114, Issue 5, Page(s) 719–735

    Abstract: Adaptive increases in kidney and gastrointestinal excretion of ... ...

    Abstract Adaptive increases in kidney and gastrointestinal excretion of K
    MeSH term(s) Humans ; Aldosterone/physiology ; Hyperkalemia/drug therapy ; Hyperkalemia/etiology ; Kidney ; Potassium/metabolism ; Renal Insufficiency, Chronic/complications
    Chemical Substances Aldosterone (4964P6T9RB) ; Potassium (RWP5GA015D)
    Language English
    Publishing date 2023-03-13
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 123586-2
    ISSN 1827-1669 ; 0026-4806
    ISSN (online) 1827-1669
    ISSN 0026-4806
    DOI 10.23736/S0026-4806.23.08465-3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Ua VI Zs.132: Show issues Location:
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  7. Article ; Online: Respiratory Acidosis and Respiratory Alkalosis: Core Curriculum 2023.

    Palmer, Biff F / Clegg, Deborah J

    American journal of kidney diseases : the official journal of the National Kidney Foundation

    2023  Volume 82, Issue 3, Page(s) 347–359

    Abstract: The respiratory system plays an integral part in maintaining acid-base homeostasis. Normal ventilation participates in the maintenance of an open buffer system, allowing for excretion of ... ...

    Abstract The respiratory system plays an integral part in maintaining acid-base homeostasis. Normal ventilation participates in the maintenance of an open buffer system, allowing for excretion of CO
    MeSH term(s) Humans ; Acidosis, Respiratory ; Alkalosis, Respiratory/diagnosis ; Alkalosis, Respiratory/etiology ; Carbon Dioxide ; Hypocapnia ; Bicarbonates ; Alkalosis/etiology ; Alkalosis/complications ; Hydrogen-Ion Concentration ; Acid-Base Equilibrium
    Chemical Substances Carbon Dioxide (142M471B3J) ; Bicarbonates
    Language English
    Publishing date 2023-06-21
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 604539-x
    ISSN 1523-6838 ; 0272-6386
    ISSN (online) 1523-6838
    ISSN 0272-6386
    DOI 10.1053/j.ajkd.2023.02.004
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    Zs.A 1669: Show issues Location:
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    Zs.MO 468: Show issues

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  8. Article ; Online: SGLT2 Inhibition and Kidney Potassium Homeostasis.

    Palmer, Biff F / Clegg, Deborah J

    Clinical journal of the American Society of Nephrology : CJASN

    2023  Volume 19, Issue 3, Page(s) 399–405

    Abstract: Pharmacologic inhibition of the sodium-glucose transporter 2 (SGLT2) in the proximal tubule brings about physiologic changes predicted to both increase and decrease kidney K + excretion. Despite these effects, disorders of plasma K + concentration are an ...

    Abstract Pharmacologic inhibition of the sodium-glucose transporter 2 (SGLT2) in the proximal tubule brings about physiologic changes predicted to both increase and decrease kidney K + excretion. Despite these effects, disorders of plasma K + concentration are an uncommon occurrence. If anything, these drugs either cause no effect or a slight reduction in plasma K + concentration in patients with normal kidney function but seem to exert a protective effect against hyperkalemia in the setting of reduced kidney function or when given with drugs that block the renin-angiotensin-aldosterone axis. In this review, we discuss the changes in kidney physiology after the administration of SGLT2 inhibitors predicted to cause both hypokalemia and hyperkalemia. We conclude that these factors offset one another, explaining the uncommon occurrence of dyskalemias with these drugs. Careful human studies focusing on the determinants of kidney K + handling are needed to fully understand how these drugs attenuate the risk of hyperkalemia and yet rarely cause hypokalemia.
    MeSH term(s) Humans ; Hyperkalemia/etiology ; Sodium-Glucose Transporter 2 ; Hypokalemia/chemically induced ; Potassium ; Renin-Angiotensin System ; Angiotensin-Converting Enzyme Inhibitors ; Kidney ; Homeostasis
    Chemical Substances Sodium-Glucose Transporter 2 ; Potassium (RWP5GA015D) ; Angiotensin-Converting Enzyme Inhibitors
    Language English
    Publishing date 2023-08-28
    Publishing country United States
    Document type Review ; Journal Article
    ZDB-ID 2226665-3
    ISSN 1555-905X ; 1555-9041
    ISSN (online) 1555-905X
    ISSN 1555-9041
    DOI 10.2215/CJN.0000000000000300
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Extrarenal Effects of Aldosterone on Potassium Homeostasis.

    Palmer, Biff F / Clegg, Deborah J

    Kidney360

    2022  Volume 3, Issue 3, Page(s) 561–568

    Abstract: The role of aldosterone in regulating ... ...

    Abstract The role of aldosterone in regulating K
    MeSH term(s) Acid-Base Equilibrium ; Aldosterone/metabolism ; Homeostasis ; Kidney/metabolism ; Potassium/metabolism
    Chemical Substances Aldosterone (4964P6T9RB) ; Potassium (RWP5GA015D)
    Language English
    Publishing date 2022-01-14
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 2641-7650
    ISSN (online) 2641-7650
    DOI 10.34067/KID.0006762021
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  10. Article ; Online: Cerebral Salt Wasting Is a Real Cause of Hyponatremia: COMMENTARY.

    Palmer, Biff F / Clegg, Deborah J

    Kidney360

    2022  Volume 4, Issue 4, Page(s) e445–e447

    MeSH term(s) Humans ; Hyponatremia/etiology ; Hyponatremia/complications ; Inappropriate ADH Syndrome/diagnosis ; Inappropriate ADH Syndrome/etiology ; Sodium
    Chemical Substances Sodium (9NEZ333N27)
    Language English
    Publishing date 2022-06-02
    Publishing country United States
    Document type Journal Article ; Comment
    ISSN 2641-7650
    ISSN (online) 2641-7650
    DOI 10.34067/KID.0001452022
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