Kidney international
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Kidney international · Jan 1993
Clinical Trial Controlled Clinical TrialEffect of insulin-plus-glucose infusion with or without epinephrine on fasting hyperkalemia.
Extrarenal potassium disposal is an important defense against hyperkalemia in patients with end-stage renal disease. Both insulin and epinephrine are important modulators of this process. Hemodialysis patients are prone to developing hyperkalemia during fasting. ⋯ The plasma potassium increased by 0.58 +/- 0.13 mmol/liter (P = 0.002) after 18 hours of fasting. Administration of insulin with dextrose at a dose that doubled the plasma insulin levels within the physiologic range (9.3 +/- 1.1 vs. 20.2 +/- 2.3 mU/liter, P < 0.002), completely prevented the rise in plasma potassium (+0.06 +/- 0.13 mmol/liter, P = 0.64). Epinephrine did not significantly change the plasma potassium during fasting alone (+0.05 +/- 0.09 mmol/liter, P = 0.59), whereas it lowered the potassium significantly (-0.16 +/- 0.04 mmol/liter, P = 0.003) when the subjects were receiving insulin with glucose.(ABSTRACT TRUNCATED AT 250 WORDS)
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Kidney international · Apr 1991
Comparative Study Clinical Trial Controlled Clinical TrialEffect of dialysate and substitution fluid buffer on buffer flux in hemodiafiltration.
The effect of differing dialysate and substitution fluid buffer types and concentrations on acid-base balance have not been assessed in patients treated with hemodiafiltration for ESRD. To determine bicarbonate, acetate, lactate and total buffer flux, mass balance studies were performed in patients treated with hemodiafiltration using four different combinations of dialysate and substitution fluids. Driving force for bicarbonate flux was assessed in all treatments. ⋯ Overall buffer flux depended on the bicarbonate driving force, ultrafiltration rate, and varied with the type of substitution and dialysate buffer employed. The types and concentrations of buffer used in dialysate and substitution fluid have important effects on the acid-base balance of patients treated with hemodiafiltration. The long-term implications of different therapeutical choices in these patients is unknown.
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Kidney international · Nov 1990
Comparative Study Clinical Trial Controlled Clinical TrialAlbuterol and insulin for treatment of hyperkalemia in hemodialysis patients.
We evaluated in maintenance hemodialysis patients the potassium lowering effects of intravenous insulin with glucose, nebulized albuterol, and a regimen combining both modalities. There was a similar decrease in plasma potassium following either insulin with glucose (0.65 +/- 0.09 mmol/liter) or albuterol (0.66 +/- 0.12 mmol/liter), and a substantially greater fall with the combined regimen (1.21 +/- 0.19 mmol/liter, P less than 0.02 vs. either drug alone). Baseline plasma glucose concentrations were similar (about 4.8 mmol/liter) prior to all three treatments. ⋯ These observations suggest that albuterol and insulin with glucose are equally efficacious in lowering plasma potassium in uremic patients, and that the hypokalemic effects of the two drugs is additive. The hypoglycemic effect of insulin is attenuated by coadministration albuterol. Combined therapy with insulin, glucose and albuterol is efficacious and safe for the acute treatment of hyperkalemia in hemodialysis patients.