The History Of The ankyrin
As recently summarized in NDT by Azizi [58], inhibition of aldosterone synthase (CYP11B2) lowered BP in an initial randomized double blind study of patients with primary hypertension [59]; in a second study it also caused significant reduction of 24 h blood pressure��although less compared selleck chemicals with eplerenone (Amar, J.Hypertension in press). How to cope with the risk of hyperkalaemia ? To assess and reduce the risk of hyperkalaemia, one must not only avoid food items with a high potassium content, but one must also consider that a number of drugs tend to increase serum K+: obviously K+-sparing diuretics, but also K+ salts or supplements, non-steroidal anti-inflammatory drugs, pentamidin, trimethoprim, heparin, penicillin G, tolvaptan, cyclosporine and tacrolimus. To identify patients at a high risk for hyperkalaemia, a number of tests have been proposed, none of which are very reliable. Follow-up monitoring was required in the RALES dose-finding study in the subgroup of patients with reduced kidney function. Serum K+ increased from baseline in the first 8 weeks of spironolactone treatment GSK-3 inhibitor [44], but in patients on RAS blockade the risk of hyperkalaemia persisted throughout the treatment, mainly because of changes in dietary habits [60]. Mineralocorticoid receptor blockers reduce sodium and water reabsorption, but as a downside of this action the potassium excretion is reduced causing hyperkalaemia. The classical management of hyperkalaemia in patients receiving mineralocorticoid receptor antagonists has been recently summarized by Roscioni et al. [61]. The risk of hyperkalaemia��a novel approach Against the background of hyperkalaemia as the limiting factor in the use of mineralocorticoid receptor blockade, it is of interest to the nephrologist that the polymeric potassium binder RLY5016 has recently become available which opens up new possibilities [62, 63]: RLY5016 is a non-absorbed polymer in the form of 100 ?m beads. In the colon, RLY5016 binds preferentially to K+, the concentration of which is much higher than the concentration of other cations. One important issue is the potential scavenging of coadministered drugs. This has so far been documented for valsartan and rosiglitazone, ankyrin but this issue requires further studies. The efficacy and safety in cardiac patients have recently been assessed in a double-blind placebo-controlled study in patients with chronic heart failure, the PEARL-HF trial [62]. One hundred and five patients on spironolactone with chronic heart failure and a history of hyperkalaemia were treated for 4 weeks with 30 g/day RLY5016 or placebo. Thirty-two of the patients had an eGFR of
