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Evaluation of Drug Combinations’ Effectiveness in Hyperkalemia Management of Chronic Kidney Disease Patients


Affiliations
1 Department of Pharmacy, Faculty of Medicine, Universitas Brawijaya, Malang,, Indonesia
2 Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang,, Indonesia
     

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Objective: This study aims to compare the effectiveness of hyperkalemia drug combinations in reducing potassium levels in chronic kidney disease (CKD) patients. Methods: This is an observational study on medical records of CKD patients with hyperkalemia at Dr. Saiful Anwar and Lavalette Hospitals, Malang, Indonesia. From 2017 to 2019, 78 hyperkalemia correction data were obtained from 47 patients’ medical records. The hypothesis test used in this study was the one-way ANOVA test. Results: Drug combinations of calcium gluconate, Actrapid® HM, and D40% (Δp = 0.62 mmol/L); calcium gluconate, Actrapid® HM, D40%, and Ventolin® Nebules (Δp = 0.72 mmol/L); and calcium gluconate, NovoRapid®, and D40%® (Δp = 1.03 mmol/L) were able to significantly reduce serum potassium levels (p < 0.05). A drug combination of calcium gluconate, Humulin® R, and D40% (Δp = 0.84 mmol/L) was also able to reduce serum potassium levels but not statistically significant (p > 0.05). The comparison test results of the four groups of drug combinations showed that no combination of drugs was superior to others in lowering potassium levels (p > 0.05). Conclusions: The four groups of hyperkalemia drug combinations can reduce the patient’s serum potassium level and have the same effectiveness.

Keywords

Chronic kidney disease, Drug combination, Effectiveness, Hyperkalemia, Potassium level.
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  • Mohammmed GF, Sultan SM, Sadullah YQ. The Relationship Between Creatinine and Patients With Renal Failure Associated With Anemia. Research Journal of Pharmacy and Technology. 2020; 13(4): 1633-1635. doi:10.5958/0974-360X.2020.00296.6.

  • Eknoyan G, Lameire N, Eckardt K-U, Kasiske BL, Wheeler DC. KDIGO 2012 Clinical Practice Guideline for The Evaluation and Management of Chronic Kidney Disease. Kidney International Supplements. 2013; 3(1): 1-150. doi:10.3182/20140824-6-za-1003.01333.

  • Radhika CK, Raj A. Uremic Hypoglycemia. Asian Journal of Nursing Education and Research. 2017; 7(3): 445-448. doi:10.5958/2349-2996.2017.00087.8.

  • Pothen C, Baby B, Ashokan A, Chacko C, Shenoy P, Nandakumar N. Drug Usage Pattern in Chronic Kidney Disease Patients Undergoing Maintenance Hemodialysis. Research Journal of Pharmacy and Technology. 2019; 12(10): 5024-5028. doi:10.5958/0974-360X.2019.00872.2.

  • Hill NR, Fatoba ST, Oke JL, Hirst JA, O'Callaghan A, Lasserson DS, et al. Global Prevalence of Chronic Kidney Disease-A Systematic Review and Meta-Analysis. PLoS One. 2016; 11(7): 1-18. doi: 10.1371/journal.pone.0158765.

  • Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA. Global, Regional, and National Life Expectancy, All-Cause Mortality, and Cause-Specific Mortality for 249 Causes of Death, 1980-2015: A Systematic Analysis for The Global Burden of Disease Study 2015. Lancet. 2016; 388:1459-1544.doi:10.1016/S0140-6736(16)31012-1.

  • NKF. Clinical Update on Hyperkalemia. National Kidney Foundation Inc., New York. 2014.

  • Kovesdy CP. Updates in Hyperkalemia: Outcomes and Therapeutic Strategies. Reviews in Endocrine and Metabolic Disorders. 2017; 18(1): 41-47. doi: 10.1007/s11154-016-9384-x.

  • Mukaddas A, Faustine I, Sudiasih P. Effect of Combination ACEI (Angiotensin Converting Enzyme Inhibitor) and Diuretics on Potassium Levels of Congestive Heart Failure Patients. Research Journal of Pharmacy and Technology. 2020; 13(2): 747-750. doi:10.5958/0974-360X.2020.00141.9.

  • Bedelbayeva G, Nurmakhanova Z, Almukhambetov M, Zarubekova N, Nuftieva A. Factors of The Complicated Course of The Myocardial Infarction in Men and Women. Research Journal of Pharmacy and Technology. 2018; 11(5): 1737-1744. doi:10.5958/0974-360X.2018.00323.2.

  • Sathyanarayanan G, Shanmugasundaram P, Geetha P. A Prospective Observational Study on Microalbuminuria as Risk Factor of Chronic Renal Failure in Patients With Type 2 Diabetes. Research Journal of Pharmacy and Technology. 2017; 10(9): 3085-3088. doi:10.5958/0974-360X.2017.00547.9.

  • NKF. Best Practices in Managing Hyperkalemia in Chronic Kidney Disease. National Kidney Foundation Inc., New York. 2016.

  • Turgutalp K, Bardak S, Helvacı I, Isguzar G, Payas E, Demir S, et al. Community-Acquired Hyperkalemia in Elderly Patients: Risk Factors and Clinical Outcomes. Renal Failure. 2016; 38(9): 1405-1412. doi:10.1080/0886022X.2016.1216714.

  • Senthilkumar S, Dhivya K. Prognostic Potential of Serum Biomarkers as Predictors for Cardiovascular Complications and Disease Progression in Chronic Kidney Disease Patients. Research Journal of Pharmacy and Technology. 2016; 9(3): 227-234. doi:10.5958/0974-360X.2016.00041.X.

  • Siddiq A, Bharathi D, Raj R, Benny J, Saji S, Lakshmi S. A Study on Insulin Use, Prescription Pattern and Its Regimens in A Tertiary Care Hospital. Research Journal of Pharmacy and Technology. 2019; 12(5): 2079-2082. doi:10.5958/0974-360X.2019.00344.5.

  • Viera AJ, Wouk N. Potassium Disorders: Hypokalemia and Hyperkalemia. American Family Physician. 2015; 92(6): 487-495.

  • Lederer E, Alsauskas ZC, Mackelaite L, Nayak V. Hyperkalemia. Medscape. https://emedicine.medscape.com/article/240903. Published 2020. Accessed July 16, 2020.

  • Weiss JN, Qu Z, Shivkumar K. The Electrophysiology of Hypo- and Hyperkalemia. Circulation: Arrhythmia and Electrophysiology. 2017; 10: 1-10. doi:10.1161/CIRCEP.116.004667.

  • Mohsen H, Shaden H, Faiza AQ, Taghrid H. Correlation of Serum Leptin Levels With Insulin Resistance in Syrian Obese Patients With Type 2 Diabetes Mellitus. Research Journal of Pharmacy and Technology. 2013;6(10): 1149-1151.

  • Shingarev R, Allon M. A Physiologic-Based Approach to The Treatment of Acute Hyperkalemia. American Journal of Kidney Diseases. 2010; 56(3): 578-584. doi:10.1053/j.ajkd.2010.03.014.

  • Dhapake PR, Chauriya CB, Umredkar RC. Painless Insulin Drug Delivery Systems-A Review. Asian Journal of Research Pharmaceutical Sciences. 2017; 7(1): 01-07. doi:10.5958/2231-5659.2017.00001.7.

  • Ho K. A Critically Swift Response: Insulin-Stimulated Potassium and Glucose Transport in Skeletal Muscle. Clinical Journal of The American Society of Nephrology. 2011; 6: 1513-1516. doi:10.2215/CJN.04540511.

  • Palmer BF. Regulation of Potassium Homeostasis. Clinical Journal of The American Society of Nephrology. 2015; 10: 1050-1060. doi:10.2215/CJN.08580813.

  • Al-Ogaidi SO, Abdulsattar SA, Al-Dulaimi HMJ. The Impact of Serum Leptin, Leptin Receptor and Insulin on Maternal Obesity. Research Journal of Pharmacy and Technology. 2019; 12(7): 3569-3574. doi:10.5958/0974-360X.2019.00609.7.

  • Li T, Vijayan A. Insulin for The Treatment of Hyperkalemia: A Double-Edged Sword? Clinical Kidney Journal. 2014; 7: 239-241. doi:10.1093/ckj/sfu049.

  • Farina N, Anderson C. Impact of Dextrose Dose on Hypoglycemia Development Following Treatment of Hyperkalemia. Therapeutic Advances in Drug Safety. 2018; 9(6): 323-329. doi:10.1177/2042098618768725.

  • Schafers S, Naunheim R, Vijayan A, Tobin G. Incidence of Hypoglycemia Following Insulin-Based Acute Stabilization of Hyperkalemia Treatment. Journal of Hospital Medicine. 2012; 7(3): 239-242.

  • Apel J, Reutrakul S, Baldwin D. Hypoglycemia in The Treatment of Hyperkalemia With Insulin in Patients With End-Stage Renal Disease. Clinical Kidney Journal. 2014; 7: 248-250. doi:10.1093/ckj/sfu026.

  • Pirkmajer S, Chibalin AV. Na, K-ATPase Regulation in Skeletal Muscle. American Journal of Physiology-Endocrinology and Metabolism. 2016; 311:E1-E31. doi:10.1152/ajpendo.00539.2015.

  • Dresser R, Frader J. Off-Label Prescribing: A Call for Heightened Professional and Government Oversight. The Journal of Law, Medicine & Ethics. 2009; 37(3): 476-496. doi:10.1111/j.1748-720X.2009.00408.x.

  • BPOM. Insulin. Badan Pengawas Obat dan Makanan. http://pionas.pom.go.id/monografi/insulin. Published 2015. Accessed July 16, 2020.

  • ASHP. AHFS Drug Information 2017. American Society of Health System Pharmacists, Bethesda. 2019; 3rd ed.

  • ISMP. Wrong-Route Incident Involving Insulin and Dextrose Prescribed for Hyperkalemia. ISMP Canada Safety Bulletin. 2015; 15(2): 1-4.

  • Gahart BL, Nazareno AR, Ortega MQ. Gahart’s 2021 Intravenous Medications A Handbook for Nurses and Health Professionals. Elsevier Inc., United States of America. 2021; 37th ed: p. 774.

  • Elliott MJ, Ronksley PE, Clase CM, Ahmed SB, Hemmelgarn BR. Management of Patients With Acute Hyperkalemia. Canadian Medical Association Journal. 2010; 182(15): 1631-1635. doi:10.1503/cmaj.100461.

  • Peacock WF, Rafique Z, Clark CL, Singer AJ, Turner S, Miller J, et al. Real World Evidence for Treatment of Hyperkalemia in The Emergency Department (Reveal-Ed): A Multicenter, Prospective, Observational Study. The Journal of Emergency Medicine. 2018; 55(6): 741-750. doi:10.1016/j.jemermed.2018.09.007.


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  • Evaluation of Drug Combinations’ Effectiveness in Hyperkalemia Management of Chronic Kidney Disease Patients

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Authors

Ema Pristi Yunita
Department of Pharmacy, Faculty of Medicine, Universitas Brawijaya, Malang,, Indonesia
Ni Luh Putu Gita Asriyanti
Department of Pharmacy, Faculty of Medicine, Universitas Brawijaya, Malang,, Indonesia
Atma Gunawan
Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang,, Indonesia

Abstract


Objective: This study aims to compare the effectiveness of hyperkalemia drug combinations in reducing potassium levels in chronic kidney disease (CKD) patients. Methods: This is an observational study on medical records of CKD patients with hyperkalemia at Dr. Saiful Anwar and Lavalette Hospitals, Malang, Indonesia. From 2017 to 2019, 78 hyperkalemia correction data were obtained from 47 patients’ medical records. The hypothesis test used in this study was the one-way ANOVA test. Results: Drug combinations of calcium gluconate, Actrapid® HM, and D40% (Δp = 0.62 mmol/L); calcium gluconate, Actrapid® HM, D40%, and Ventolin® Nebules (Δp = 0.72 mmol/L); and calcium gluconate, NovoRapid®, and D40%® (Δp = 1.03 mmol/L) were able to significantly reduce serum potassium levels (p < 0.05). A drug combination of calcium gluconate, Humulin® R, and D40% (Δp = 0.84 mmol/L) was also able to reduce serum potassium levels but not statistically significant (p > 0.05). The comparison test results of the four groups of drug combinations showed that no combination of drugs was superior to others in lowering potassium levels (p > 0.05). Conclusions: The four groups of hyperkalemia drug combinations can reduce the patient’s serum potassium level and have the same effectiveness.

Keywords


Chronic kidney disease, Drug combination, Effectiveness, Hyperkalemia, Potassium level.

References