New Agents May Improve Hyperkalemia Management in CKD

Hyperkalemia in patients with chronic kidney disease (CKD) remains a challenging condition to treat, but two new oral potassium-exchanging compounds may provide clinicians with more effective therapeutic options, according to researchers.

Importantly, the investigators noted, the new agents, patiromer and sodium zirconium cyclosilicate, could enable continued use of medications that inhibit the renin-angiotensin-aldosterone system (RAAS), which interfere with potassium homeostasis. One of the most complicated issues in CKD patient management is balancing the beneficial effects of RAAS inhibitors on the cardiovascular system and kidneys with the increased risk of hyperkalemia, a team led by George L. Bakris, MD, of the University of Chicago, wrote in Expert Opinion on Pharmacotherapy(2015;published online ahead of print).

Today, therapeutic options are limited to dietary potassium restriction, correction of metabolic acidosis using bicarbonate solutions, administration of cation exchange resins to bind potassium in the large intestines, and increasing the doses of loop diuretics to enhance potassium secretion by the kidneys.

The only currently available potassium binder in every-day clinical practice is sodium polystyrene sulfonate, a resin that exchanges 1 mEq of potassium to 1 or 2 mEq of sodium in the in the large intestines, Dr. Bakris' group observed. The authors noted that long-term administration of this compound is problematic and linked to serious adverse effects, especially involving the gastrointestinal (GI) tract.

In recent randomized clinical trials, patiromer and sodium zirconium cyclosilicate effectively normalized elevated serum potassium levels and maintained potassium homeostasis in hyperkalemic patients treated with RAAS inhibitors. The drugs were well tolerated and were not associated with serious adverse events.

These trials compared patiromer and sodium zirconium cyclosilicate with placebo and not sodium polystyrene sulfonate, so the comparative effectiveness of the new agents and existing potassium binders for managing hyperkalemia is not known, Dr. Bakris and his collaborators stated. They pointed out that sodium polystyrene sulfonate has been associated with an increased likelihood of colonic necrosis, which is a potentially life-threatening adverse event, and other GI complications, making the drug an unsuitable comparator due to serious safety issues.

The incidence of hyperkalemia in large-scaled outcome trials involving patients with stage 3 or higher CKD who were treated with RAAS inhibitor monotherapy generally is reported to be less than 3%, the authors stated. Initiation of RAAS inhibition in these studies was largely associated with a mean serum potassium rise of 0.4–0.6 mmol/L. They pointed out, however, that these data reflect hyperkalemia recorded in clinical trials, a setting with strict enrollment criteria and monitoring of patients during follow-up visits is very close. “Thus, these low rates of hyperkalemia could substantially underestimate the true frequency of hyperkalemia associated with the use of RAAS blockers in daily clinical practice, which has been reported to be as high as 10%.”

TOP 10 COMMON HABITS THAT DAMAGE YOUR KIDNEYS

Here are the top 10 common habits that damage your kidneys.

1. Not Emptying Your Bladder Timely

Maintaining a full bladder for a long time or delaying the urge to urinate is one of the main reasons behind kidney damage.

When urine remains in the bladder for a long time, it can cause the bacteria breeding in urine to multiply. In turn, these harmful bacteria can cause a urinary tract infection or kidney infection. Moreover, retaining urine increases pressure on the kidneys and can lead to renal failure and incontinence.

If you habitually delay responding to the call of nature, it’s time to rectify it for the benefit of your kidneys. No matter how busy you are, listen to the nature call signals and follow them.

2. Insufficient Water Intake

Not drinking an ample amount of water can also cause huge damage to your kidneys. The main function of the kidneys is to flush out metabolic waste from the body and regulate erythrocyte production.

When the body lacks sufficient water, there is less blood flow to the kidneys because the blood becomes concentrated. This hampers the kidneys’ ability to eliminate toxins from the body, and more toxins in the body means more health problems.

According to the National Kidney Foundation, a healthy adult must drink at least 10 to 12 glasses of fluid daily to keep the kidneys healthy and the body well hydrated. However, keep in mind that drinking too much water can also be hard on your kidneys. So, do not overdo it.

3. High Salt Consumption

Regularly eating too much salt can also cause huge damage to your kidneys as well as other health problems. The kidneys metabolize 95 percent of the sodium consumed through food.

When salt intake is high, the kidneys need to work harder to excrete the excess salt. This in turn can lead to decreased kidney functioning, causing water retention in the body. Water retention can cause a hike in blood pressure and increase the risk of developing kidney disease.

Studies have also shown that salt intake increases the amount of urinary protein, one of the major risk factors for developing kidney disease.

The recommended amount of salt is no more than 5 grams a day. More than this amount is harmful for your kidneys as well as your overall health. 1 teaspoon of salt is about 6 grams.

4. Regular Use of Analgesics

Many of us have the habit of taking analgesics (over-the-counter painkillers) to control pain and reduce fever and inflammation. But this can damage different body organs, including the kidneys.

Research shows that analgesics may reduce blood flow to the kidneys and deteriorate kidney functioning. Moreover, heavy or long-term use of over-the-counter analgesics can cause acute renal failure or chronic kidney disease known as chronic interstitial nephritis.

If you have decreased kidney function, do not take painkillers without asking your doctor. Even with normal kidney function, analgesics should be used as directed, at the lowest dose possible and for the shortest time.

5. High Protein Diet

Protein is good for your health, but excessive consumption of red meat and other protein-based foods can increase the risk of developing kidney disease.

One of the roles of the kidneys is to metabolize and excrete nitrogen by products from protein digestion. High protein intake increases the metabolic load of the kidneys by chronically increasing glomerular pressure and hyperfiltration. This in turn increases the risk of kidney problems.

So, limit your intake of red meat for the overall health of your kidneys. Moreover, those who have kidney problems must avoid eating red meat as it can worsen the condition.

6. Drinking Excessive Alcohol

Drinking in moderation is fine, but excessive drinking can cause significant damage to your kidneys. Alcohol is a toxin that puts a lot of stress on your kidneys and liver.

When you drink alcoholic beverages in high amounts, it causes uric acid to be deposited in renal tubules, leading to tubular obstruction. This in turn increases the risk of kidney failure. Moreover, alcohol causes dehydration and disrupts the normal functioning of the kidneys.

If you like to drink, then do it in moderation. A healthy amount is generally considered 2 drinks a day for men and 1 drink a day for women and older people.

7. Smoking Cigarettes

According to the Centers for Disease Control and Prevention, smoking is bad for almost every organ of the body, including the kidneys. Several studies have shown the connection between smoking and kidney disease.

In fact, smoking is a leading factor behind end stage renal disease (ESRD), according to the American Association of Kidney Patients (AAKP).

Smoking increases blood pressure and heart rate as well as reduces blood flow and narrows the blood vessels in the kidneys. It can even accelerate loss of kidney functions and worsen existing kidney diseases.

As smoking is not good for any part of your body, it is time to quit. Take help from friends, family members or professionals to help quit smoking.

8. Consuming Too Much Caffeine

Too much caffeine consumption can cause high blood pressure, which in turn will put a strain on your kidneys. Over time, this can damage your kidneys.

In fact, according to a 2002 study published in Kidney International, caffeine consumption has a strong connection with kidney stones. Caffeine can increase calcium excretion in urine.

Caffeine in moderate amounts will not cause health problems for most people. You can drink 1 to 2 cups of coffee, 3 cups of tea per day. Also, limit your intake of other sources of caffeine like soft drinks, energy drinks, chocolate, cocoa and some medications.

9. Ignoring Common Infections

Ignoring common infections like colds, the flu, coughs, pharyngitis, tonsillitis and others can also cause huge damage to your kidneys.

In fact, people who have kidney disease often have a history of not resting when they are sick. Moreover, people with kidney disease are more sensitive to weather changes and often get sick.

The bacteria or viruses that cause common infections can damage your kidneys if treatment is not carried out timely.

Next time you suffer from a common infection, get it treated quickly and properly. Take your antibiotics properly and rest your body until you feel better.

10. Lack of Sleep

Due to busy lifestyles, many people ignore the importance of sleep. Sound sleep of 6 to 8 hours daily is important for your overall health.

During the night when you sleep, renewal of organ tissues occurs. Therefore, when you do not get sound sleep, this interrupts the renewal process, resulting in damage to the kidneys and other organs.

Studies also suggest that sleepless nights may cause high blood pressure and more atherosclerosis (clogging of the arteries). This in turn increases your risk of kidney disease.

Try to adopt healthy sleeping habits and maintain a good balance between work and rest. This will greatly help protect your kidneys from health issues and allow you to live a healthy life.