Browsing by Subject "Potassium"
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Item Adiposity has unique influence on the renin-aldosterone axis and blood pressure in black children(Elsevier, 2013-11) Yu, Zhangsheng; Eckert, George; Liu, Hai; Pratt, J. Howard; Tu, Wanzhu; Medicine, School of MedicineOBJECTIVE: To comparatively examine the effects of adiposity on the levels of plasma renin activity (PRA), plasma aldosterone concentration (PAC), and aldosterone-renin ratio (ARR) in young black and white children. STUDY DESIGN: We prospectively assessed 248 black and 345 white children and adolescents. A novel analytical technique was used to assess the concurrent influences of age and body mass index (BMI) on PRA, PAC, and ARR. The estimated effects were depicted by colored contour plots. RESULTS: In contrast to whites, blacks had lower PRA (2.76 vs 3.36 ng/mL/h; P < .001) and lower PAC (9.01 vs 14.59 ng/dL; P < .001). In blacks, BMI was negatively associated with PRA (P = .001), consistent with an association with a more expanded plasma volume; there was no association with PAC. In whites, BMI was positively associated with PAC (P = .005); we did not detect a BMI-PRA association. The effects of BMI on ARR were directionally similar in the two race groups but more pronounced in blacks. Mean systolic blood pressure was greater in blacks with lower PRA (P < .01), higher PAC (P = .015), and higher ARR (P = .49). CONCLUSIONS: An increase in adiposity was associated with a suppressed PRA in blacks and an increase in PAC in whites. The unique relationship between adiposity and renin-aldosterone axis in blacks suggests the possible existence of a population-specific mechanism characterized by volume expansion, which could in turn enhance the influences of adiposity on blood pressure in black children and adolescents.Item Clinical investigations with marihuana and alcohol(1970) Manno, Joseph E.Item Comparative Effects of Sodium-Glucose Cotransporter 2 Inhibitors on Serum Electrolyte Levels in Patients with Type 2 Diabetes: A Pairwise and Network Meta-Analysis of Randomized Controlled Trials(Wolters Kluwer, 2022-01-19) Zhang, Jingjing; Huan, Yonghong; Leibensperger, Mark; Seo, Bojung; Song, Yiqing; Epidemiology, School of Public HealthBackground: Previous studies have reported that sodium-glucose co-transporter 2 (SGLT2) inhibitors (SGLT2is) affect levels of serum electrolytes, especially magnesium. This study aimed to integrate direct and indirect trial evidence to maximize statistical power to clarify their overall and comparative effects in patients with type 2 diabetes (T2D). Methods: We systematically searched PubMed, EMBASE, CENTRAL, and ClinicalTrials.gov up to January 2021 to identify eligible randomized controlled trials (RCTs) of SGLT2is that reported mean changes in serum electrolytes, including magnesium, sodium, potassium, phosphate, and calcium. We performed both random-effects pairwise and network meta-analyses to calculate the weighted mean difference (WMD) and 95% confidence intervals (CI). Results: In total, we included 25 RCTs involving 28,269 patients with T2D and 6 SGLT2is. Compared with placebo, SGLT2is were significantly associated with elevations in serum magnesium by 0.07 mmol/L (95% CI, 0.06 to 0.08 mmol/L) and serum phosphate by 0.03 mmol/L (95% CI, 0.02 to 0.04 mmol/L). Our network meta-analysis showed no evidence of significantly superior efficacy of any specific SGLT2 inhibitor over the others, although dapagliflozin was associated with a larger increment in serum magnesium (WMD=0.16 mmol/L) compared with other SGLT2is. Similarly, no statistically detectable differences among the effects of SGLT2is on serum levels of other electrolytes were detected. Conclusions: SGLT2is significantly increased serum magnesium and phosphate levels, consistent with a class effect of SGLT2 inhibition. However, further investigations of long-term efficacy and safety in patients with T2D with different clinical phenotypes are needed.Item Consideration of Kinase Inhibitors for the Treatment of Hydrocephalus(MDPI, 2023-04-03) Blazer-Yost, Bonnie L.; Biology, School of ScienceHydrocephalus is a devastating condition characterized by excess cerebrospinal fluid (CSF) in the brain. Currently, the only effective treatment is surgical intervention, usually involving shunt placement, a procedure prone to malfunction, blockage, and infection that requires additional, often repetitive, surgeries. There are no long-term pharmaceutical treatments for hydrocephalus. To initiate an intelligent drug design, it is necessary to understand the biochemical changes underlying the pathology of this chronic condition. One potential commonality in the various forms of hydrocephalus is an imbalance in fluid-electrolyte homeostasis. The choroid plexus, a complex tissue found in the brain ventricles, is one of the most secretory tissues in the body, producing approximately 500 mL of CSF per day in an adult human. In this manuscript, two key transport proteins of the choroid plexus epithelial cells, transient receptor potential vanilloid 4 and sodium, potassium, 2 chloride co-transporter 1, will be considered. Both appear to play key roles in CSF production, and their inhibition or genetic manipulation has been shown to affect CSF volume. As with most transporters, these proteins are regulated by kinases. Therefore, specific kinase inhibitors are also potential targets for the development of pharmaceuticals to treat hydrocephalus.Item Dietary Electrolytes and their Influences on Plasma Aldosterone Concentration(2019-06) Ye, Xiaohan; Tu, Wanzhu; Katz, Barry P.; Bakoyannis, Giorgos; Yiannoutsos, Constantin T.Excessive sodium retention is thought to be the main culprit for hypertension. The modern American diet provides an excess of sodium and not sufficient amount of sodium. In this research, we examined the relations among urinary sodium and potassium excretion, and plasma levels of aldosterone, a mineralocorticoid hormone that has been linked to incidence hypertension, in a cohort of healthy children and young adults. We found that higher plasma aldosterone level was associated with lower sodium excretion in the urine, in blacks and whites, suggesting that aldosterone plays a critical role in retaining the sodium from dietary sources. The study highlights the importance of dietary sodium restriction.Item Electrochemical Tape-and-Paper-Based Sensor for the Quantification of Potassium(2023-08) Zhang, Tommy; Deiss, Frédérique; Webb, IanPotassium levels in serum are used in the diagnosis of diseases involving cardiac arrhythmias, neuromuscular weakness, and chronic kidney diseases. These illnesses are becoming more prevalent, therefore, developing new potassium quantification methods would aid in advancing preventative care. Current methods of quantifying potassium mainly rely on the use of glass ion-selective electrodes which are costly, fragile, and requires frequent maintenance and recalibration. For faster and more accessible quantification of potassium, we are developing low cost, portable, and easy to fabricate electrochemical tape-and-paper-based devices. Our sensor bypasses the inconveniences of ion-selective electrodes and could ultimately serve as a point-of-care device to allow for regular monitoring or even home-use. Our sensing method relies on Prussian blue immobilized on the surface of electrodes as a potassium recognition element. Potassium ions intercalate into the Prussian blue lattice and subsequently changes the electrochemical characteristics of Prussian blue such as the redox peak potentials. These devices are highly robust, feature a limit of detection of 1.3 mM potassium and the response is linear to at least 100 mM, which contains the clinically relevant ranges required for diagnostics. Quantification was developed using cyclic voltammetry, demonstrated in Chapter 3. We observed changes in Prussian blue redox peak potentials at different concentrations of potassium and followed the expected Nernstian response. We investigated multiple methods of immobilizing Prussian blue onto the electrode surfaces to investigate stability and reproducibility in Chapter 4. Adsorption, in-situ synthesis, and carbon paste incorporation of Prussian blue was tested. Prussian blue-carbon paste devices had reproducibility issues and featured broad reduction peaks. In-situ synthesis of Prussian blue directly onto the surface of the electrodes also featured broad reduction peaks but the Prussian blue response was reproducible. The issue with in-situ synthesis was the stability of the Prussian blue layer, which was susceptible to degradation after repeated use of the device, which is required for evaluating the performance of the device. Although adsorption using Prussian blue in water had some reproducibility issues as well, this method led to the most stable Prussian blue layer, had distinct reduction peaks, and was simple to perform. Various solvents were used to dissolve Prussian blue in Chapter 5 to investigate methods of increasing device reproducibility when using adsorption. A few organic solvents were able to dissolve Prussian blue to form a stable solution with the goal of forming a more uniform Prussian blue layer and potentially improving consistency of the layer immobilization. While these alternative solvents were able to dissolve Prussian blue, they also damaged the graphite electrodes on the devices, which altered the electrochemical responses of the devices to the point where potassium quantification was no longer possible. Due to incompatibility between these alternative solvents and the devices, adsorption of Prussian blue in water continued to be used. Different modes of adsorption were explored and was optimized in Chapter 6. By altering the adsorption setup and allowing the Prussian blue particles to settle evenly onto a level electrode surface, device reproductivity increased substantially. To understand the applicability of the devices in real samples, interferent studies were performed in Chapter 7. Other cations such as Na+, Li+, Ca2+, Mg2+, and Ba2+ were not observed to enter the Prussian blue lattice in the cyclic voltammograms. Monovalent cations that share the same charge as K+ but have smaller ionic radius, Na+ and Li+, were able to decrease K+ sensitivity. Divalent cations that had a smaller ionic radius than K+ did not alter sensitivity. The exception was Ba2+, which also decreased K+ sensitivity. These results suggested that both ionic radius and charge of a species were important factors in impacting K+ intercalation into the Prussian blue lattice. Other interferents such as sulfates, phosphates, carbonates, urea, and lactic found in serum and sweat samples were tested. The presence of these interferents decreased the current intensity of the reduction peak of Prussian blue, which resulted in less definition in the peaks. For the future of this project, the effects of interferents found in serum and sweat must be investigated further. Additionally, reproducibility of the devices could be improved further if less harsh organic solvents are tested for adsorption, square wave voltammetry could be used for quantification to evaluate the viability of alternative voltametric techniques, and Prussian blue analogues could be implemented into the devices for quantification of other cations.Item Hyperkalemia and Metabolic Acidosis Occur at a Higher eGFR in Sickle Cell Disease(Wolters Kluwer, 2022-02-03) Saraf, Santosh L.; Derebail, Vimal K.; Zhang, Xu; Machado, Roberto F.; Gordeuk, Victor R.; Lash, James P.; Little, Jane; Medicine, School of MedicineBackground: People with sickle cell disease (SCD) have an elevated estimated glomerular filtration rate (eGFR) compared with the general population, and this may alter the usual creatinine-based eGFR cutoffs for which physiologic evidence of kidney dysfunction is apparent. This study aimed to identify eGFR thresholds for hyperkalemia and metabolic acidosis in patients with SCD. Methods: This was a cross-sectional analysis of 733 patients with severe (hemoglobin SS or Sβ0-thalassemia) SCD genotype, 238 patients with moderate (hemoglobin SC or Sβ+-thalassemia) SCD genotype, and 1333 age- and sex-matched African Americans from the National Health and Nutrition Examination Survey (NHANES). The prevalence rates of hyperkalemia and metabolic acidosis were compared by eGFR category. Cutoffs for hyperkalemia and metabolic acidosis were determined using generalized additive models. Results: Hyperkalemia and metabolic acidosis were more common in those with severe SCD genotype (13% and 21%, respectively) compared with the NHANES (0.3% and 5%, respectively); the prevalence rates in the moderate SCD genotype were intermediate for hyperkalemia (3%) and metabolic acidosis (11%). The proportion of patients with hyperkalemia and metabolic acidosis progressively increased with lower eGFR category in both SCD genotype groups. The eGFR thresholds for hyperkalemia and metabolic acidosis were higher in the severe (85 and 91 ml/min per 1.73 m2, respectively) and moderate (52 and 102 ml/min per 1.73 m2, respectively) SCD genotypes compared with the NHANES (34 and 46 ml/min per 1.73 m2). Conclusions: We demonstrate that hyperkalemia and metabolic acidosis are more common and occur at higher eGFR values in patients with SCD compared with age- and sex-matched African Americans, including in eGFR ranges considered to be normal. Future studies using redefined creatinine-based eGFR thresholds for abnormal kidney function may identify high-risk patients for earlier intervention strategies and referral for specialized renal care in SCD.Item Management of hypertension in advanced kidney disease(Wolters Kluwer, 2022) Georgianos, Panagiotis I.; Agarwal, Rajiv; Medicine, School of MedicinePurpose of review: The aim of this study was to present recent developments in pharmacotherapy of hypertension in patients with advanced chronic kidney disease (CKD). Recent findings: In the AMBER trial, compared with placebo, the potassium-binder patiromer mitigated the risk of hyperkalaemia and enabled more patients with uncontrolled resistant hypertension and stage 3b/4 CKD to tolerate and continue spironolactone treatment; add-on therapy with spironolactone provoked a clinically meaningful reduction of 11-12 mmHg in unattended automated office SBP over 12 weeks of follow-up. In the BLOCK-CKD trial, the investigational nonsteroidal mineralocorticoid-receptor-antagonist (MRA) KBP-5074 lowered office SBP by 7-10 mmHg relative to placebo at 84 days with a minimal risk of hyperkalaemia in patients with advanced CKD and uncontrolled hypertension. The CLICK trial showed that the thiazide-like diuretic chlorthalidone provoked a placebo-subtracted reduction of 10.5 mmHg in 24-h ambulatory SBP at 12 weeks in patients with stage 4 CKD and poorly controlled hypertension. Summary: Enablement of more persistent spironolactone use with newer potassium-binding agents, the clinical development of novel nonsteroidal MRAs with a more favourable benefit-risk profile and the recently proven blood pressure lowering action of chlorthalidone are three therapeutic opportunities for more effective management of hypertension in high-risk patients with advanced CKD.Item Mineral Content of Water From Public Fountains Along the Monon Trail in Central Indiana(2024) Bakhaider, Renad Fahad; Lippert, Frank; E. Soto Rojas, Armando; Capin, OrianaBackground: The Monon trail is one of the most popular trails located in central Indiana that the public uses for various physical activities, such as cycling, jogging, and walking. Physical activity, especially in the summer, causes the body to dehydrate and lose some of its electrolytes via sweating (e.g., calcium, magnesium, potassium, and sodium). These minerals are considered important in regulating some of the body’s chemical and biological reactions. Therefore, water fountains are located along the trail. However, no study has thus far investigated the mineral composition of water provided along the Monon trail and how it compares with commonly used bottled water. Fluoride is added to tap water in many communities in the US for the prevention of dental caries (community water fluoridation). However, whether water provided by these fountains meets the recommended fluoride level by the CDC for caries prevention has not been established. Therefore, this study aimed to determine the fluoride, calcium, magnesium, potassium, and sodium contents from water samples collected from all water fountains along the Monon trail and to compare their mineral concentrations to commercially available bottled waters. As an exploratory objective, we also assessed the utilization of theses fountains by the users of the Monon trail. Objectives: The primary aim of this study was to evaluate the fluoride, calcium, magnesium, potassium, and sodium contents of water from public drinking water fountains along the Monon trail in central Indiana. The secondary aim was to compare the nutritional value of the collected water samples to that of commercially available bottled waters. An exploratory objective will be to study the utilization of these fountains by users of the Monon trail. Methodology: Two 50-ml samples of water from each fountain along the Monon Trail were collected. The fluoride concentration was determined using a fluoride ion-specific electrode (Orion #96-909-00). The calcium, magnesium, sodium, and potassium contents were determined by atomic absorption spectrometer, equipped with deuterium and cathode lamps at wave lengths of 422.7 nm, 285.2 nm, 589.0 nm, and 766.5 nm, respectively. Data collected from water samples were compared to those of bottled water available in Indianapolis, Indiana, using data from a recently conducted study. Mineral data of water samples were compared to recommended dietary allowances (calcium and magnesium) or adequate intakes (potassium and sodium) as established by the Institutes of Medicine. The utilization of those fountains by cyclists, runners/joggers, and walkers was also investigated by conducting an observational study at each water fountain during a one-hour period in mid- to late afternoon during a weekday and weekend. Data collection was taken twice, one month apart. The statistical analyses of the study were carried out using two-sided two sample t-tests at 5-% significance level. Results: The author identified seven water fountains along the Monon trail during the study period. Fluoride concentration was generally high (mean 1.01 parts per million [ppm]). Calcium concentration ranged from 45 ppm to 81 ppm (mean, 60.9 ppm) which was greater than those of magnesium (range, 4.8 ppm to 13.7 ppm; mean 8.4 ppm), sodium (range, 14.7 ppm to 78.1 ppm; mean 40.5 ppm), and potassium (range, 1.2 ppm to 2.2 ppm; mean 1.6 ppm). Overall, water fountains provided meaningful contributions to adequate intake of fluoride. However, the contributions to adequate intake of sodium and potassium, or to the recommended dietary allowances for calcium and magnesium were lower. Moreover, water from fountains was found to contain higher mineral concentrations than most bottled waters. Conclusion: Within the limitations of this study, it was found that water fountains are a valuable source of rehydration and essential mineral replenishment during and after physical activity, as they provide greater nutritious values than most bottled waters. Furthermore, it was found that F concentration in water fountains satisfies the standards needed to prevent dental caries.