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what is raasi therapy

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© 2020 MJH Life Sciences™ and HCPLive. Eur Heart J. However, there have recently been questions regarding its safety and efficacy based on reported cases of bowel necrosis.8, In October 2015, the FDA approved patiromer, the first new potassium binder for the treatment of hyperkalemia in decades.10 Patiromer binds with potassium in exchange for calcium in the colon, thereby decreasing the amount of potassium available for gastrointestinal absorption.11 To date, clinical studies have demonstrated the ability of patiromer to lower serum potassium levels and reduce RAASi discontinuation.11. 2015;doi:10.1056/NEJMoa1410853. 2. SPS was first approved by the FDA for the treatment of hyperkalemia in 1958 and has been used in the long-term management of hyperkalemia. Since the subgroup consisted of only 60 patients, additional studies in older patients with diabetic kidney disease are needed to further evaluate the cardiorenal protective effects and safety of these therapies that can enable the continuation of RASi therapy. These patients are also at risk for the development of hyperkalemia (HK), often leading to down-titration and/or discontinuation of RAASi therapy. Among these cohorts, we evaluated RAASi continuation and dose reductions within 1-, 3- and 6-month time frames. In an effort to make a dent in the fight against kidney disease, the US Federal Government recently issued an executive order that seeks to lower the number of new kidney failure cases by 25 percent by 2030. Jun M(1), Jardine MJ(1), Perkovic V(1), Pilard Q(1), Billot L(1), ... (RAASis) and its impact on subsequent RAASi treatment are limited. Hagan AE. She is credited as Raasi in Telugu, Kannada movies and Manthra in Tamil movies. RAASi therapies are life-saving medications for patients with heart failure and other chronic conditions. RAASi therapy benefit and challenges in cardio-renal patients Session: Enabling and optimising RAASi therapy for cardio-renal patients by controlling potassium levels Lisbon 2017 Dürrenmatt Hall 14. This original research developed a model to quantify the health and economic benefits of maintaining normokalaemia and enabling optimal RAASi therapy in patients with CKD. The value of maintaining normokalaemia and enabling RAASi therapy in chronic kidney disease. 1 Studies have shown that hyperkalaemia is associated with poor clinical outcomes in HF patients with hypertension who are being treated with hypertensive drugs including: 2,3 During the second part of the study, patients taking patiromer had no change in median potassium from baseline (0.00 mEq/L), whereas potassium levels significantly increased in the placebo group (0.72 mEq/L).12. He was a co-principal investigator on the NIH Clinical Research training grant for clinical research (K30) (1999-2004). In particular, data from the ESC HF registry reveal that RAASi were frequently underdosed because of persistent and consistent hyperkalemia and/or worsening renal function. 5. Recent clinical studies suggest that the newer K+ binders (patiromer sorbitex calcium and sodium zirconium cyclosilicate) may facilitate optimization of RAASi therapy. Close monitoring of glomerular filtration rate (GFR) and blood pressure can help provide earlier diagnosis in these high-risk patients. Desai A. Help us guide you to the right place. RAASI is listed in the World's largest and most authoritative dictionary database of abbreviations and acronyms. The use of such measures are especially important in those patients with the most to gain from RAASi therapy. Alongside collaborators from COHRDATA, UT-Southwestern and Relypsa, results from a retrospective study were reported that assessed RAASi utilization from a large, de-identified national health insurance claims database. Film career. Combined with RASi therapeutics, which inhibit potassium excretion by the kidneys, older patients with diabetic kidney disease are 50% more likely to develop hyperkalemia than the general population and should have their serum potassium levels closed monitored every two to four weeks. Across the Veltassa ® clinical trial program, over 99 percent of participants were also taking RAASi therapy. RAASi therapy benefit and challenges in cardio-renal patients. RAASi therapies are life-saving medications for patients with heart failure and other chronic conditions. All rights reserved. Primary care physicians will be the first line of defense in quickly identifying them based on their patient history and lab results, as well as be able to start them early on life-saving RAASi therapies. Diabetes, both type 1 and type 2, is the leading cause of chronic kidney disease (CKD) as well as end-stage renal disease (ESRD, or kidney failure). George Bakris, MD, outlines the difficulties clinicians face when treating diabetic kidney disease in an aging population. To achieve this ambitious goal, the order includes a proposed change in the way Medicare providers are paid to incentivize the prevention of disease progression to kidney failure. Patiromer is the first sodium-free, non-absorbed potassium (K+) … If left untreated, it can have potentially lethal consequences, including abnormal heart rhythms and sudden death. Patiromer and maintenance of RAASi therapy in hyperkalemic Medicare patients. In fact, diabetic kidney disease carries one of the highest risk for cardiovascular diseases, such as stroke, heart failure or myocardial infarction. Unfortunately, their use increases the risk for developing hyperkalemia, which can lead to underuse or discontinuation of RAASi therapy. Hyperkalaemia and subsequent suboptimal RAASi treatment is associated with increased morbidity and mortality. He has also served on many national guideline committees. *1. Edner M et al. 2015; www.ncbi.nlm.nih.gov/pubmed/26619183. With the elderly population in the United States estimated to double to 71 million by 2030, clinicians will begin caring for sicker patients living with age-related illnesses and multiple comorbidities, including diabetic kidney disease. The most common risk factors for hyperkalemia are reduced kidney function and treatment with renin-angiotensin-aldosterone system inhibitor (RAASi) therapy. The study, evaluating one of the potassium-binding polymers, patiromer, found that the medication significantly reduced and maintained serum potassium levels to ≤5.0 Eq/L in this difficult-to-manage patient population. 2015; www.ajmc.com/journals/supplement/2015/a577_nov15_hyperkalemia/a577_nov15_hyperkalemia. If a patient experiences a hyperkalemic event (serum potassium level >5.0 mEq/L), which occurs in up to 30% of cases, then the clinician is faced with the difficult decision of reducing or discontinuing RASi therapy to bring potassium levels back down to a safer range (4.6 to 5.0 mEq/L). Clin Nephrol. Due to this, it becomes imperative that these patients are diagnosed and provided aggressive intervention as early as possible to prevent or delay the progression of the disease and associated comorbidities, such as hypertension. Often overlooked and recurrent, hyperkalemia impacts approximately three million Americans — with most of them reporting no symptoms. Industry Discoveries organised by AstraZeneca × Am J Manag Care. More importantly, through the 52 weeks, the majority of these patients maintained RASi therapy. Rather than reduce or eliminate a patient’s RAASi therapy, one clinical alternative is to add a potassium‐binding polymer, such as sodium polystyrene sulfonate (SPS). Reinitiate RAASi therapy once any concurrent condition contributing to changes in K + is under control AND serum K + has decreased to <5.0 mEq/L or to within patient’s usual range (whichever is higher) Reintroduce RAASi agents one at a time with monitoring of kidney function and electrolytes: European Society of Cardiology 1: 4.5-5.0 b 2015; doi:10.1093/eurheartj/ehv268. RAASi therapy is being refined. After watching the videos on RAASi and hyperkalemia in cardiorenal disease, the learner should be able to: Explain the challenge of following guideline recommended (dose of) RAASi therapy in cardiorenal patients; Recall the association between serum potassium levels and outcomes; Describe determinants and prevalence of hyperkalemia in HF 10. Poster presented at: ASN Kidney Week; Oct. 27, 2018. Its use is strongly recommended in clinical guidelines for the treatment of HF with reduced ejection fraction, and CKD 1,2 . Physicians commonly use a renin-angiotensin-aldosterone system inhibitor (RAASi) to reduce the risk of death and to slow disease progression in patients with heart failure. Robert D. Toto (2019) Patiromer and maintenance of RAASi therapy in hyperkalemic medicare patients, Journal of Drug Assessment, 8:sup1, 2-2, DOI: 10.1080/21556660.2019.1658287 In 1958, the US Food and Drug Administration (FDA) approved a potassium-binding polymer, sodium polystyrene sulfonate (SPS), for the treatment of hyperkalemia in patients. Nihar Desai, MD, MPH, is assistant professor of medicine (cardiology) and in the Institution for Social and Policy Studies, Yale School of Medicine in New Haven, Connecticut. Large clinical trials have shown the critical value of RAASi therapy, demonstrating that risk of death was lowered with RAASi therapy, and discontinuing RAASi therapies or administering them at a suboptimal dose was associated with a higher death rate.4,5 Despite these benefits, RAASi therapies are closely linked to increased potassium concentrations, and ultimately to hyperkalemia, which is common in patients at risk for CKD and/or heart failure.6. Due to this significantly elevated risk, older patients with diabetic kidney disease can become challenging to treat for clinicians. Pitt B, et al. McCullough PA. Nephron 2018;doi:10.1159/000485645. All rights reserved. 4. In the PEARL-HF study of heart failure patients with previously documented hyperkalemia or CKD, patiromer significantly lowered serum potassium levels with a difference between groups of −0.45 mEq/L; a lower incidence of hyperkalemia (7.3% patiromer vs. 24.5% placebo); and a greater proportion of patients on spironolactone 50 mg/day (91% patiromer vs. 74% placebo). Additionally, he is an Associate Editor of the International Textbook of Cardiology. References: Epstein M et … Heart Assoc. Rastegar A, et al. HFrEF patients at higher risk of developing hyperkalemia present comorbidities such as CKD, diabetes, and use of dual or triple therapy including RAASi and concurrent HF therapy. While studies have shown that discontinuing or reducing RASi therapy may reduce the immediate risk of hyperkalemia and lower potassium levels, it may also put patients at greater risk for progression or exacerbation of their underlying disease, leading to poorer clinical outcomes, increased hospitalizations and associated health care costs, as well as a higher death rate. Older patients are particularly predisposed to developing hyperkalemia due to the combination of age-associated reductions in kidney function, poorly controlled diabetes, heart failure and high blood pressure, which can either impact their bodies’ ability to eliminate excess potassium or cause too much potassium to be released into the bloodstream. 14 Of note, a substantial proportion of patients receiving RAASi therapy have their therapy … Disclaimer: Some of Dr. Bakris’ research has been supported by Relypsa, Inc. Dr. Bakris is a tenured Professor of Medicine and Director of the Am. However, newer non-absorbable potassium binders have recently emerged for the long-term treatment and management of adults with hyperkalemia to enable concurrent RASi therapy. 6. Thus, a significant challenge for the optimal management of patients at high cardiovascular risk is that treatment with RAASi therapy may bring significant risk of hyperkalemia. In addition, diabetic kidney disease is infamous for being a disease multiplier, according to the National Institute of Diabetes and Digestive and Kidney Disease, with many of these patients having comorbidities that can increase their risk of mortality nearly 20 times. Data presented at the Kidney Week in 2018 further expand our understanding of the potential role of patiromer in patients on RAASi therapy. He is the Editor or Co-Editor of 21 books as well as the new 3rd edition of Hypertension: A Companion to Braunwald’s The Heart. Enabling and optimizing Renin-Angiotensin-Aldosterone-System inhibitors (RAASi) therapy in cardio-renal patients by controlling potassium levels session at Heart Failure 2017 - … Since RAASi therapy reduces mortality and morbidity in patients with cardiovascular disease steps should, when hyperkalaemia develops, be considered to lower K + level and enable patients to continue their RAASi therapy. 2011;doi:10.1093/eurheartj/ehq502. In turn, this may lead to a greater threat of heart failure and cardiovascular-related death. N Engl J Med. 2017;doi:10.15420/cfr.2017.2.1. He has published over 800 peer-reviewed articles and book chapters in the areas of diabetic kidney disease, hypertension and progression of nephropathy. What are the real-world factors that influence RAASi treatment decisions in patients with HF who have or are at risk for hyperkalemia? 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