Review
Serum potassium concentrations: Importance of normokalaemia
Concentraciones séricas de potasio: importancia de la normopotasemia
Manuel Heras
, María José Fernández-Reyes
Corresponding author
Servicio de Nefrología, Hospital General de Segovia, Segovia, Spain
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Serum concentrations are much lower, its normal range being between 3.5 and 5<span class="elsevierStyleHsp" style=""></span>mEq/l.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">1</span></a> This implies that small variations in serum potassium concentrations may represent a significant decrease in intracellular potassium.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">2</span></a> It is known that variations in its concentrations, both hypokalaemia and hyperkalaemia, are associated with mortality.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In this review, we analyze the evidence that currently exists of the association of normal serum potassium concentrations with mortality, based on general population studies. In addition, this review includes brief considerations about serum potassium homeostasis in the elderly, given their special vulnerability, to increase concentrations in this population group.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Particularities of potassium in the elderly population</span><p id="par0015" class="elsevierStylePara elsevierViewall">Potassium body reserves are decreased in elderly patients, although plasma concentrations remain independent of age. However, there is a predisposition in these patients to develop hyperkalemia.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">4</span></a> Changes in age-related potassium homeostasis – a decrease in the glomerular filtration rate along with neurohormonal changes associated with the aging process (decreased renin and aldosterone) and the use of drugs with a tendency to retain potassium – are key factors in its occurrence, especially in the presence of cardiovascular or renal diseases.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">4</span></a><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the main mechanisms that contribute to the development of hyperkalaemia in the elderly.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Toxic hyperkalaemia</span><p id="par0020" class="elsevierStylePara elsevierViewall">Severe hyperkalaemia, defined as a serum potassium concentration<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>6.5<span class="elsevierStyleHsp" style=""></span>mEq/l, is considered a medical emergency because of its potential to cause electrophysiological variations that can compromise the patient's life.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">5</span></a> As previously mentioned, the elderly with renal insufficiency, diabetic patients and those with chronic heart failure would be among those with the highest risk of developing it.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">6</span></a> Phillips et al. performed a retrospective study to determine the prevalence of severe hyperkalaemia during a year, finding a low prevalence, 0.11%, which occurred in patients with chronic kidney disease (CKD) or acute renal failure and during the hospitalization period.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">7</span></a> In the study by Grodzinsky et al., the prevalence of hyperkalaemia was also analyzed in a cohort of more than 38,000 patients after having an acute myocardial infarction, finding that about 10% of them had serum potassium levels<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>5.5<span class="elsevierStyleHsp" style=""></span>mEq/l.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Regarding the causes that contribute to hyperkalaemia, the drug-induced cause represents the main one in routine practice: those drugs that alter the transmembrane potassium movement, those that modify renal excretion of potassium, such as agents that inhibit the renin–angiotensin–aldosterone system, or potassium-containing agents.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Normal range of serum potassium concentrations</span><p id="par0030" class="elsevierStylePara elsevierViewall">There is increasing evidence that even small variations in serum potassium concentrations, within the reference range of 3.5–5<span class="elsevierStyleHsp" style=""></span>mEq/l, could be related to an increase in mortality. In this review, we consider the existing studies of association of serum potassium concentrations – within normality – with mortality, based on studies performed in the general population, on different diseases: ischemic heart disease, heart failure, hypertension and CKD.</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">In ischemic heart disease</span><p id="par0035" class="elsevierStylePara elsevierViewall">Potassium plays a crucial role in myocardial function.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">9</span></a> Clinical guidelines recommend maintaining serum potassium levels >4<span class="elsevierStyleHsp" style=""></span>mEq/l, and even >4.5<span class="elsevierStyleHsp" style=""></span>mEq/l in patients with acute myocardial infarction.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">10</span></a> However, recent studies highlight that the reference range of serum potassium levels between >3.5 and <4.5<span class="elsevierStyleHsp" style=""></span>mEq/l are associated with a lower short- and long-term mortality. <a class="elsevierStyleCrossRef" href="#tbl0015">Table 2</a> summarizes the main association studies of serum potassium concentrations, in the normal range, with mortality.<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">9,11–17</span></a> Diuretics, often used to treat episodes of heart failure caused by acute myocardial infarction, may induce potassium deficiencies.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a> In the study by Krogager et al., the association between serum potassium concentrations and short-term mortality (90 days) was analyzed in a cohort of 2596 patients who had been treated with loop diuretics after the first episode of myocardial infarction, and found that potassium values outside the range of 3.9–4.5<span class="elsevierStyleHsp" style=""></span>mEq/l were associated with risk of death.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a></p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">In heart failure</span><p id="par0040" class="elsevierStylePara elsevierViewall">In heart failure and during the treatment of the same is frequent to find variations in normal concentrations of serum potassium (hypo or hyperkalaemia), as well as an increase of these during hospitalization.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">20</span></a> Compared with what has been mentioned on ischemic heart disease, in some heart failure studies, it seems safe and acceptable to maintain a serum potassium concentration within the normal-high range; in the Ahmed et al. study on patients with heart failure, the safety range of serum potassium concentrations between 5 and 5.5<span class="elsevierStyleHsp" style=""></span>mEq/l was evaluated, being relatively safe, with no association between mild hyperkalaemia and cardiovascular or heart failure mortality.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">21</span></a> In a more recent study by Hoss et al. on a cohort of 6073 patients with heart failure, 68% of them had serum potassium in the normal range (4–5<span class="elsevierStyleHsp" style=""></span>mEq/l) and survival was higher in those with serum potassium in the normal-high range (5–5.5<span class="elsevierStyleHsp" style=""></span>mEq/l).<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">22</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">In hypertension</span><p id="par0045" class="elsevierStylePara elsevierViewall">High blood pressure is a risk factor for morbidity and mortality, so its treatment has proven beneficial in reducing cardiovascular mortality.<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">23,24</span></a> However, various drugs that are used to treat it, mainly renin–angiotensin–aldosterone system blockers, diuretics and beta-blockers, frequently produce variations in serum potassium concentrations. To demonstrate the possible relationship between mortality (at 90 days) and serum potassium concentrations, Krogager et al. conducted a retrospective analysis of a large cohort of hypertensive patients from 1995 to 2012, stratifying the serum potassium concentrations in 7 ranges, and concluded that concentrations outside the range of 4.1–4.7<span class="elsevierStyleHsp" style=""></span>mEq/l were associated with an increased risk of mortality in hypertensive patients.<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">25</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">In chronic kidney disease</span><p id="par0050" class="elsevierStylePara elsevierViewall">As previously noted, variations in serum potassium concentrations are frequent in patients with CKD. Nakhoul et al. studied the association of these concentrations with mortality and progression of CKD to end stage renal disease in a cohort of more than 36,000 patients with estimated glomerular filtration rate <60<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>, finding a prevalence of 3 and 11% in the population with serum potassium <3.5 and >5<span class="elsevierStyleHsp" style=""></span>mEq/l, respectively.<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">26</span></a> In this work, after adjusting for confounding factors that included renal function, serum potassium concentrations <4 and >5<span class="elsevierStyleHsp" style=""></span>mEq/l were associated with a high mortality, but not with progression from CKD to end stage renal disease.<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">26</span></a></p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Strategies to treat chronic hyperkalaemia and achieve normokalaemia</span><p id="par0055" class="elsevierStylePara elsevierViewall">Hyperkalaemia is a limiting factor for the use of agents that inhibit the renin–angiotensin–aldosterone system in patients with a high cardiovascular risk. Current strategies for the treatment of chronic hyperkalaemia include: eating a low-potassium diet and/or supplements, as well as limiting or avoiding those drugs with a tendency to retain potassium,<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">27</span></a> particularly in patients with glomerular filtration rates <45<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> or that already had a baseline concentration of serum potassium >4.5<span class="elsevierStyleHsp" style=""></span>mEq/l, without using renin–angiotensin–aldosterone system blockers.<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">28</span></a> Also, cation exchange resins have been used since their discovery in the 1960s: calcium polystyrene sulfonate and sodium polystyrene sulfonate.<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">29,30</span></a> A recent randomized controlled trial demonstrated the efficacy and safety of these resins as a treatment of hyperkalaemia in patients with CKD without any side effects.<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">31</span></a> However, adverse effects such as colon perforation/necrosis associated with the use of these resins have been reported in the medical literature.<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">32,33</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Patiromer has recently been approved by the FDA as a treatment for chronic hyperkalaemia. It is a new non-absorbable cation exchange polymer that binds to potassium and is exchanged with calcium in the gastrointestinal tract.<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">34,35</span></a> Prior to its approval, clinical trials with patiromer have demonstrated its efficacy in normalizing potassium levels and maintaining them at follow-up (52 weeks) in patients with reduced ejection fraction, in diabetics (diabetic nephropathy), in hypertension and in those patients with CKD who are being treated with angiotensin converting enzyme inhibitors or aldosterone receptor antagonists.<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">36,37</span></a> Patiromer was well tolerated, with constipation being the most frequent side effect.</p><p id="par0065" class="elsevierStylePara elsevierViewall">In conclusion, in recent years, the number of studies suggesting that small variations within the normal potassium reference range are accompanied by an increase in mortality has grown, so it may be desirable to maintain serum potassium concentrations within a narrower normal range.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conclusions</span><p id="par0070" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0075" class="elsevierStylePara elsevierViewall">Only a small concentration of potassium is present in the extracellular space, with its normal range being between 3.5 and 5<span class="elsevierStyleHsp" style=""></span>mEq/l.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Variations in normality are frequent in patients with heart failure and its treatment, and lead to high morbidity and mortality.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0085" class="elsevierStylePara elsevierViewall">Increasing evidence points to the fact that small variations in the normal potassium reference range may be associated with mortality.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Strategies for treating chronic hyperkalaemia include following a low potassium food and supplements diet, limiting the use of potassium-retaining drugs, and using non-absorbable cation exchange resins/polymers, especially in patients where the use of renin–angiotensin–aldosterone system blockers is recommended due to their underlying disease.</p></li></ul></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflict of interests</span><p id="par0095" class="elsevierStylePara elsevierViewall">There is no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres860154" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec854253" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres860155" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec854254" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Particularities of potassium in the elderly population" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Toxic hyperkalaemia" ] 7 => array:3 [ "identificador" => "sec0020" "titulo" => "Normal range of serum potassium concentrations" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "In ischemic heart disease" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "In heart failure" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "In hypertension" ] 3 => array:2 [ "identificador" => "sec0040" "titulo" => "In chronic kidney disease" ] ] ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Strategies to treat chronic hyperkalaemia and achieve normokalaemia" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflict of interests" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-01-12" "fechaAceptado" => "2017-03-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec854253" "palabras" => array:4 [ 0 => "Serum potassium" 1 => "Normal potassium" 2 => "Mortality" 3 => "Cation exchange resins" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec854254" "palabras" => array:4 [ 0 => "Potasio sérico" 1 => "Normopotasemia" 2 => "Mortalidad" 3 => "Resinas de intercambio catiónico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Abnormalities in potassium concentrations are associated with morbidity and mortality. In recent years it has been considered that small variations in serum potassium concentrations within normal intervals may also be associated with mortality. Strategies for achieving normokalaemia include dietary measures, limiting the use of potassium retaining drugs, and use of conventional cation exchange resins (calcium/sodium polystyrene sulfonate) and/or the new non-absorbed cation exchange polymer (patiromer).</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Las anomalías en las concentraciones de potasio se asocian con morbimortalidad. En los últimos años se está considerando que pequeñas variaciones en las concentraciones séricas de potasio dentro del intervalo de la normalidad también pueden asociarse con mortalidad. Las estrategias para conseguir la normopotasemia incluyen medidas dietéticas, limitar el uso de fármacos que retienen potasio y emplear resinas de intercambio catiónico clásicas (poliestireno sulfonato cálcico/sódico) o el nuevo polímero no absorbible de intercambio catiónico (patiromer).</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Heras M, Fernández-Reyes MJ. Concentraciones séricas de potasio: importancia de la normopotasemia. Med Clin (Barc). 2017;148:562–565.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Renal changes</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Decreased glomerular filtration rate \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Decreased renal plasma flow \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Decreased function of the distal tubule \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Impaired ability to retain sodium in response to low salt intakes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Neurohumoral factors</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Decreased levels of renin and aldosterone \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Increased levels of atrial natriuretic factor \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Drugs</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Renin–angiotensin–aldosterone system inhibitors \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nonsteroidal anti-inflammatory drugs \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Beta-adrenergic antagonists \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cyclosporin and tacrolimus \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Digitalis toxicity \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1453834.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Main changes affecting potassium homeostasis and drugs predisposing to hyperkalaemia in the elderly.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">K: potassium; ST: ST segment.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Authors \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of study \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Objective \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Higher mortality \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Choi et al.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">9</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Serum K and long-term mortality \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1924 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">≥4.5 and <3.5<span class="elsevierStyleHsp" style=""></span>mEq/l \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Goyal et al.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">11</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retrospective (2000–2008) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Serum K and in-hospital mortality \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38,689 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.5–5 and 3.5<span class="elsevierStyleHsp" style=""></span>mEq/l \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Uluganyan et al.<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">12</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Serum K and in-hospital and long-term mortality \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">611 with high ST \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>4.5<span class="elsevierStyleHsp" style=""></span>Mmol/l \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Peng et al.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">13</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retrospective (2008–2012) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Serum K and long-term mortality \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2369 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>4.5 and <3.5<span class="elsevierStyleHsp" style=""></span>mEq/l \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ma et al.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">14</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">K serum and 30-day mortality \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6613 with high ST \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>4.5<span class="elsevierStyleHsp" style=""></span>Mmol/l \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patel et al.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">15</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Serum K, arrhythmias and cardiovascular mortality \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6515 without ST or unstable angina \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>4.5<span class="elsevierStyleHsp" style=""></span>Mmol/l \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Shlomani et al.<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">16</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prospective (2010–2013) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Serum K in normal range and prognosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1277 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.45–5.2<span class="elsevierStyleHsp" style=""></span>mEq/l \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Keskin et al.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">17</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Serum K and in-hospital and long-term mortality \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3760 with high ST \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">≥5 and <3.5<span class="elsevierStyleHsp" style=""></span>mEq/l \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1453835.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Association studies of serum potassium concentrations in the normal range with mortality in the general population.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:37 [ 0 => array:3 [ "identificador" => "bib0190" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Homeostasis del potasio" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.D. Rose" 1 => "T.W. Post" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Trastornos de los electrólitos y del equilibrio ácido-base" "paginaInicial" => "372" "paginaFinal" => "402" "serieFecha" => "2005" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0195" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical perspectives on the rationale for potassium supplementation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.R. Weir" 1 => "R. Espaillat" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/00325481.2015.1045814" "Revista" => array:6 [ "tituloSerie" => "Postgrad Med" "fecha" => "2015" "volumen" => "127" "paginaInicial" => "539" "paginaFinal" => "548" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25960118" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0200" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Serum potassium levels as an outcome determinat in acute medical admissions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. Conway" 1 => "D. Creagh" 2 => "D.G. Byrne" 3 => "D. O’Riordan" 4 => "B. Silke" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Med (Lond)" "fecha" => "2015" "volumen" => "15" "paginaInicial" => "239" "paginaFinal" => "243" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0205" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Potassium homoeostasis in the elderly" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K. Biswas" 1 => "E.C. Mulkerrin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Q J Med" "fecha" => "1997" "volumen" => "90" "paginaInicial" => "487" "paginaFinal" => "492" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0210" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of hyperkalemia: an update for the internist" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C.P. Kovesdy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjmed.2015.05.040" "Revista" => array:6 [ "tituloSerie" => "Am J Med" "fecha" => "2015" "volumen" => "128" "paginaInicial" => "1281" "paginaFinal" => "1287" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26093176" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0215" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The burden of hyperkalemia in patients with cardiovascular and renal disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.D. Dunn" 1 => "W.W. Benton" 2 => "E. Orozco-Torrentera" 3 => "R.T. Adamson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Am J Manag Care" "fecha" => "2015" "volumen" => "21" "numero" => "15 Suppl." "paginaInicial" => "s307" "paginaFinal" => "s315" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26788745" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0220" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Severe hyperkalaemia: demographics and outcome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.M. Phillips" 1 => "S. Milner" 2 => "S. Zouwail" 3 => "G. Roberts" 4 => "M. Cowan" 5 => "S.G. Riley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ckj/sft158" "Revista" => array:6 [ "tituloSerie" => "Clin Kidney J" "fecha" => "2014" "volumen" => "7" "paginaInicial" => "127" "paginaFinal" => "133" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25852860" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0225" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and prognosis of hyperkalemia in patients with acute myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Grodzinsky" 1 => "A. Goyal" 2 => "K. Gosch" 3 => "P.A. Mc Cullough" 4 => "G.C. Fanorow" 5 => "A. Mebazaa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjmed.2016.03.008" "Revista" => array:6 [ "tituloSerie" => "Am J Med" "fecha" => "2016" "volumen" => "129" "paginaInicial" => "858" "paginaFinal" => "865" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27060233" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0230" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relation of serum potassium level to long-term outcomes in patients with acute myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.S. Choi" 1 => "Y.A. Kim" 2 => "H.Y. Kim" 3 => "C.Y. Oak" 4 => "Y.U. Kang" 5 => "C.S. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjcard.2014.01.402" "Revista" => array:6 [ "tituloSerie" => "Am J Cardiol" "fecha" => "2014" "volumen" => "113" "paginaInicial" => "1285" "paginaFinal" => "1290" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24560065" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0235" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New guidelines for potassium replacement in clinical practice: a contemporary review by the National Council on Potassium in Clinical Practice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.N. Cohn" 1 => "P.R. Kowey" 2 => "P.K. Whelton" 3 => "L.M. Prisant" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Intern Med" "fecha" => "2000" "volumen" => "160" "paginaInicial" => "2429" "paginaFinal" => "2436" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10979053" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0240" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Serum potassium levels and mortality in acute myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Goyal" 1 => "J.A. Spertus" 2 => "K. Gosch" 3 => "L. Venkitachalam" 4 => "P.G. Jones" 5 => "G. van den Berghe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2011.1967" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2012" "volumen" => "307" "paginaInicial" => "157" "paginaFinal" => "164" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22235086" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0245" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Admission serum potassium level is associated with in-hospital and long-term mortality in ST-elevation myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Uluganyan" 1 => "A. Ekmekci" 2 => "A. Murat" 3 => "S. Avsar" 4 => "T.K. Ulutas" 5 => "H. Uyarel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5152/akd.2015.5706" "Revista" => array:6 [ "tituloSerie" => "Anatol J Cardiol" "fecha" => "2016" "volumen" => "16" "paginaInicial" => "10" "paginaFinal" => "15" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26467357" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0250" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relation between admission serum potassium levels and long-term mortality in acute coronary syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Peng" 1 => "F.Y. Huang" 2 => "W. Liu" 3 => "C. Zhang" 4 => "Z.G. Zhao" 5 => "B.T. Huang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11739-015-1253-1" "Revista" => array:6 [ "tituloSerie" => "Intern Emerg Med" "fecha" => "2015" "volumen" => "10" "paginaInicial" => "927" "paginaFinal" => "935" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25986480" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0255" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Serum potassium levels and short-term outcomes in patients with ST-segment elevation myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W. Ma" 1 => "Y. Liang" 2 => "J. Zhu" 3 => "Y. Yang" 4 => "H. Tan" 5 => "L. Yu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0003319715617074" "Revista" => array:6 [ "tituloSerie" => "Angiology" "fecha" => "2016" "volumen" => "67" "paginaInicial" => "729" "paginaFinal" => "736" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26626107" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0260" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Serum potassium levels, cardicac arrhythmias, and mortality following non-ST-elevation myocardial infarction or unstable angina: insights from MERLIN-TIMI 36" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "R.B. Patel" 1 => "S. Tannenbaum" 2 => "A. Viana-Tejedor" 3 => "J. Guo" 4 => "K. Im" 5 => "D.A. Morrow" 6 => "B.M. Scirica" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/2048872615624241" "Revista" => array:7 [ "tituloSerie" => "Eur Heart J Acute Cardiovasc Care" "fecha" => "2017" "volumen" => "6" "paginaInicial" => "18" "paginaFinal" => "25" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26714972" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0034935614000206" "estado" => "S300" "issn" => "00349356" ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0265" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The association between normal-range admission potassium levels in Israeli patients with acute coronary syndrome and early and late outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Shlomani" 1 => "A. Berkovitch" 2 => "S. Pinchevski-Kadir" 3 => "G. Bornstein" 4 => "A. Leibowitz" 5 => "I. Goldenberg" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Medicine (Baltimore)" "fecha" => "2016" "volumen" => "95" "paginaInicial" => "e3778" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0270" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of serum potassium level on in-hospital and long-term mortality in ST elevation myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Keskin" 1 => "A. Kaya" 2 => "M.A. Tatlisu" 3 => "M.I. Haylroglu" 4 => "O. Uzman" 5 => "E.B. Börklü" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2016.07.024" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2016" "volumen" => "221" "paginaInicial" => "505" "paginaFinal" => "510" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27414730" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0275" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Potassium/magnesium depletion in patients with cardiovascular disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T. Dyckner" 1 => "P.O. Wester" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Am J Med" "fecha" => "1987" "volumen" => "82" "numero" => "Suppl. 1" "paginaInicial" => "11" "paginaFinal" => "17" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3565422" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0280" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Short-term mortality risk of serum potassium levels in acute heart failure following myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.L. Krogager" 1 => "L. Eggers-Kaas" 2 => "K. Aasbjerg" 3 => "R.N. Mortensen" 4 => "L. Kober" 5 => "G. Gislason" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ehjcvp/pvv026" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J Cardiovasc Pharmacother" "fecha" => "2015" "volumen" => "1" "paginaInicial" => "245" "paginaFinal" => "251" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27418967" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0285" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Serum potassium levels and outcome in acute heart failure (data from the PROTECT and COACH trials)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Tromp" 1 => "J. Ter Maaten" 2 => "K. Damman" 3 => "C.M. O’Connor" 4 => "M. Metra" 5 => "H.C. Dittrich" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjcard.2016.09.038" "Revista" => array:6 [ "tituloSerie" => "Am J Cardiol" "fecha" => "2017" "volumen" => "119" "paginaInicial" => "290" "paginaFinal" => "296" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27823598" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0290" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mild hyperkalemia and outcomes in chronic heart failure: a propensity matched study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.I. Ahmed" 1 => "O.J. Ekundayo" 2 => "M. Mujib" 3 => "R.C. Campbell" 4 => "P.W. Sanders" 5 => "B. Pitt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2009.04.041" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2010" "volumen" => "144" "paginaInicial" => "383" "paginaFinal" => "388" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19500863" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0295" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Serum potassium levels and outcome in patients with chronic heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Hoss" 1 => "Y. Elizur" 2 => "D. Luria" 3 => "A. Keren" 4 => "C. Lotan" 5 => "I. Gotsman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjcard.2016.08.078" "Revista" => array:6 [ "tituloSerie" => "Am J Cardiol" "fecha" => "2016" "volumen" => "118" "paginaInicial" => "1868" "paginaFinal" => "1874" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27726855" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0300" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathogenesis of hypertension: interactions among sodium, potassium, and aldosterone" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Büssemaker" 1 => "U. Hillebrand" 2 => "M. Hausberg" 3 => "H. Pavenstädt" 4 => "H. Oberleithner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.ajkd.2009.12.022" "Revista" => array:6 [ "tituloSerie" => "Am J Kidney Dis" "fecha" => "2010" "volumen" => "55" "paginaInicial" => "1111" "paginaFinal" => "1120" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20223568" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0305" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypertension in the elderly: particularities and precautions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "O. Hanon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.lpm.2008.11.016" "Revista" => array:6 [ "tituloSerie" => "Presse Med" "fecha" => "2009" "volumen" => "38" "paginaInicial" => "614" "paginaFinal" => "620" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19264441" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0310" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Short-term mortality risk of serum potassium levels in hypertension: a retrospective analysis of nationwide registry data" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.L. Krogager" 1 => "C. Torp-Pedersen" 2 => "R.N. Mortensen" 3 => "L. Kober" 4 => "G. Gislason" 5 => "P. Sogaard" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehw129" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2017" "volumen" => "38" "paginaInicial" => "104" "paginaFinal" => "112" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28158516" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0315" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Serum potassium end-stage renal disease and mortality in chronic kidney disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.N. Nakhoul" 1 => "H. Huang" 2 => "S. Arrigain" 3 => "S.E. Jolly" 4 => "J.D. Schold" 5 => "J.V. Nally Jr." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000437151" "Revista" => array:6 [ "tituloSerie" => "Am J Nephrol" "fecha" => "2015" "volumen" => "41" "paginaInicial" => "456" "paginaFinal" => "463" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26228532" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0320" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "in press" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Updates in hyperkalemia: outcomes and therapeutic strategies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C.P. Kovesdy" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Rev Endocr Metab Disord" "fecha" => "2016" ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0325" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prediction and management of hyperkalemia across the spectrum of chronic kidney disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "I. Lazich" 1 => "G.L. Bakris" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.semnephrol.2014.04.008" "Revista" => array:6 [ "tituloSerie" => "Semin Nephrol" "fecha" => "2014" "volumen" => "34" "paginaInicial" => "333" "paginaFinal" => "339" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25016403" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0330" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of hyperkalemia with a calcium-resin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G.M. Berlyne" 1 => "K. Janabi" 2 => "A.B. Shaw" 3 => "A.G. Hocken" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "1966" "volumen" => "1" "paginaInicial" => "169" "paginaFinal" => "172" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11905655" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0335" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "[Treatment of hyperkalemia with polystyrene-sulfonate ion exchange resins] Czech" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Svejda" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Vnitr Lek" "fecha" => "1969" "volumen" => "15" "paginaInicial" => "804" "paginaFinal" => "806" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5810002" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0340" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of hyperkalemia in patients with chronic kidney disease: a comparison of calcium polystyrene sulphonate and sodium polystyrene sulphonate" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K. Nasir" 1 => "A. Ahmad" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Ayub Med Coll Abbottabad" "fecha" => "2014" "volumen" => "26" "paginaInicial" => "455" "paginaFinal" => "458" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25672163" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0345" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Colonic necrosis due to sodium polystyrene sulfate (Kayexalate)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.S. Bomback" 1 => "J.T. Woosley" 2 => "A.V. Kshirsagar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajem.2008.10.003" "Revista" => array:6 [ "tituloSerie" => "Am J Emerg Med" "fecha" => "2009" "volumen" => "27" "paginaInicial" => "753.e1" "paginaFinal" => "753.e2" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19751642" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0350" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cation exchange resins and colonic perforation. What surgeons need to know" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.R. Rodríguez-Luna" 1 => "E. Fernández-Rivera" 2 => "J.E. Guarneros-Zárate" 3 => "J. Tueme-Izaguirre" 4 => "J.R. Hernández-Méndez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijscr.2015.09.028" "Revista" => array:6 [ "tituloSerie" => "Int J Surg Case Rep" "fecha" => "2015" "volumen" => "16" "paginaInicial" => "102" "paginaFinal" => "105" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26439420" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0355" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patiromer: the first potassium binder approved in over 50 years" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B.N. Vu" 1 => "A.M. de Castro" 2 => "D. Shottland" 3 => "W.H. Frishman" 4 => "A. Cheng-Lai" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CRD.0000000000000123" "Revista" => array:6 [ "tituloSerie" => "Cardiol Rev" "fecha" => "2016" "volumen" => "24" "paginaInicial" => "316" "paginaFinal" => "323" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27548687" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0360" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patiromer: a significant advance in the management of hyperkalemia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.M. Paton" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Drugs Today (Barc)" "fecha" => "2015" "volumen" => "51" "paginaInicial" => "695" "paginaFinal" => "703" ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0365" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patiromer in patients with kidney disease and hyperkalemia receiving RAAS inhibitors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.R. Weir" 1 => "G.L. Bakris" 2 => "D.A. Bushinsky" 3 => "M.R. Mayo" 4 => "D. Garza" 5 => "Y. Stasiv" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1410853" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2015" "volumen" => "372" "paginaInicial" => "211" "paginaFinal" => "221" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25415805" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0370" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recent advances in pharmacological treatments of hyperkalemia: focus on patiromer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Epstein" 1 => "B. Pitt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/14656566.2016.1190333" "Revista" => array:6 [ "tituloSerie" => "Expert Opin Pharmacother" "fecha" => "2016" "volumen" => "17" "paginaInicial" => "1435" "paginaFinal" => "1448" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27180623" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000014800000012/v1_201707060050/S2387020617303625/v1_201707060050/en/main.assets" "Apartado" => array:4 [ "identificador" => "44147" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Review" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000014800000012/v1_201707060050/S2387020617303625/v1_201707060050/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020617303625?idApp=UINPBA00004N" ]
