Role of fludrocortisone in the management of tacrolimus-induced hyperkalemia in a renal transplant recipient

Sivakumar, V.; Sriramnaveen, P; Krishna, C; Yadla, Manjusha; Reddy, Yanala Sandeep; Sridhar, N.; Srinivasan, S.

doi:10.4103/1319-2442.124539

Cited by 11 publications

(8 citation statements)

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“…82,83 This therapy has enjoyed some recent resurgence, with several reports demonstrating successful treatment of hyperkalemia due to a range of causes. [84][85][86] However, small randomized placebo-controlled trials using oral fludrocortisone in patients on hemodialysis with hyperkalemia have demonstrated poor efficacy 87 or modest efficacy 88 at lowering serum potassium. It is important to note that the doses used in these trials were relatively low (0.1 mg fludrocortisone daily), and older data indicate that patients with renal disease require much higher doses (up to 1.0 mg daily) to effectively reverse hyperkalemia.…”

Section: Treatment Of Hyperkalemiamentioning

confidence: 99%

How Dangerous Is Hyperkalemia?

Montford

Linas

2017

JASN

169

131

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Hyperkalemia is a potentially life-threatening electrolyte disorder appreciated with greater frequency in patients with renal disease, heart failure, and with use of certain medications such as renin angiotensin aldosterone inhibitors. The traditional views that hyperkalemia can be reliably diagnosed by electrocardiogram and that particular levels of hyperkalemia confer cardiotoxic risk have been challenged by several reports of patients with atypic presentations. Epidemiologic data demonstrate strong associations of morbidity and mortality in patients with hyperkalemia but these associations appear disconnected in certain patient populations and in differing clinical presentations. Physiologic adaptation, structural cardiac disease, medication use, and degree of concurrent illness might predispose certain patients presenting with hyperkalemia to a lower or higher threshold for toxicity. These factors are often overlooked; yet data suggest that the clinical context in which hyperkalemia develops is at least as important as the degree of hyperkalemia is in determining patient outcome. This review summarizes the clinical data linking hyperkalemia with poor outcomes and discusses how the efficacy of certain treatments might depend on the clinical presentation.

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Section: Treatment Of Hyperkalemiamentioning

confidence: 99%

How Dangerous Is Hyperkalemia?

Montford

Linas

2017

JASN

169

131

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“…Fludrocortisone, a corticosteroid with high glucocorticoid and potent mineralocorticoid activity, has been shown to be beneficial when used in adults with ESRD who are anuric, on haemodialysis, and hyperkalaemic . In managing CNI‐associated hyperkalaemia, adult literature reports a small number of cases with a beneficial response to fludrocortisone and emphasizes the benefits of fludrocortisone as a safe and effective treatment in reversing post‐transplant tubulopathies with normalization of electrolytes …”

Section: Introductionmentioning

confidence: 99%

“…7 In managing CNI-associated hyperkalaemia, adult literature reports a small number of cases with a beneficial response to fludrocortisone and emphasizes the benefits of fludrocortisone as a safe and effective treatment in reversing post-transplant tubulopathies with normalization of electrolytes. [8][9][10] Tubulopathy when occurring post-transplantation requires the initiation of electrolyte supplementation, particularly sodium bicarbonate and sodium chloride replacement, to aid amongst other factors, growth. However, this adds to the medication burden, potentially therefore affecting compliance.…”

Section: Introductionmentioning

confidence: 99%

Fludrocortisone—a treatment for tubulopathy post‐paediatric renal transplantation: A national paediatric nephrology unit experience

Ali

Shaheen

Young

et al. 2018

Pediatric Transplantation

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Calcineurin inhibitors post-renal transplantation are recognized to cause tubulopathies in the form of hyponatremia, hyperkalemia, and acidosis. Sodium supplementation may be required, increasing medication burden and potentially resulting in poor compliance. Fludrocortisone has been beneficial in addressing tubulopathies in adult studies, with limited paediatric data available. A retrospective review of data from an electronic renal database from December 2014 to January 2016 was carried out. Forty-seven post-transplant patients were reviewed with 23 (49%) patients on sodium chloride or bicarbonate. Nine patients, aged 8.3 years (range 4.9-16.4), commenced fludrocortisone 22 months (range 1-80) after transplant and were followed up for 9 months (range 2-20). All patients stopped sodium bicarbonate; all had a reduction or no increase in total daily doses of sodium chloride. Potassium levels were significantly lower on fludrocortisone, 5.2 vs 4.5 mmol/L, P = .04. No difference was noted in renal function (eGFR 77.8 vs 81.7 mL/min/1.73 m , P = .45) and no significant increase in systolic blood pressure (z-scores 0.99 vs 0.85, P = .92). No side effects secondary to treatment with fludrocortisone were reported. A significant proportion of renal transplant patients were on sodium supplementation and fludrocortisone reduced sodium supplementation without significant effects on renal function or blood pressure. Fludrocortisone appears to be safe and effective for tubulopathies in children post-transplantation.

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“…Thus, a question whether post‐transplant fludrocortisone therapy could be useful in treating CNI‐induced tubulopathy and ion homeostasis disturbances has arisen. A few adult case reports have suggested promising results in treating CNI‐associated hyperkalemia with fludrocortisone accompanied by only minor adverse effects . To date, only one study on pediatric fludrocortisone‐treated renal recipients has been performed and according to the results, on the one hand, significant reduction in sodium supplementation was achieved but, on the other hand, significant increase in blood pressure levels was observed …”

mentioning

confidence: 99%

“…A few adult case reports have suggested promising results in treating CNI-associated hyperkalemia with fludrocortisone accompanied by only minor adverse effects. 5,6 To date, only one study on pediatric fludrocortisone-treated renal recipients has been performed and according to the results, on the one hand, significant reduction in sodium supplementation was achieved but, on the other hand, significant increase in blood pressure levels was observed. 7 In this issue of Pediatric Transplantation, Ali et al 8 or non-compliance.…”

mentioning

confidence: 99%

Calcineurin inhibitor‐associated electrolyte disturbances after pediatric renal transplantation: Could fludrocortisone therapy have a role?

Tainio

2017

Pediatric Transplantation

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Role of fludrocortisone in the management of tacrolimus-induced hyperkalemia in a renal transplant recipient

Cited by 11 publications

References 0 publications

How Dangerous Is Hyperkalemia?

How Dangerous Is Hyperkalemia?

Fludrocortisone—a treatment for tubulopathy post‐paediatric renal transplantation: A national paediatric nephrology unit experience

Calcineurin inhibitor‐associated electrolyte disturbances after pediatric renal transplantation: Could fludrocortisone therapy have a role?

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