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which can produce bradycardia&#44; ventricular fibrillation and ultimately death&#46;<span class="elsevierStyleSup">4&#46;5 </span>Therefore&#44; we must use various methods in order to control it&#46; A low potassium diet is one of the first steps to implement by explaining to the patient the need to moderate the intake of fruits and raw vegetables&#44; chocolate or nuts&#44; and also by recommending the double boiling of vegetables and legumes&#46;</p><p class="elsevierStylePara">If the trend to hyperkalaemia persists&#44; it is suitable to prescribe ion exchange oral resins&#44; which act as potassium &#8220;binding agents&#8221;&#46;<span class="elsevierStyleSup">6 </span>The most widely used in our setting is calcium polystyrene sulfonate &#40;CPS&#41;&#44; although there are others such as sodium polystyrene sulfonate&#46;<span class="elsevierStyleSup">7 </span></p><p class="elsevierStylePara">The most common adverse effects of CPS are hypokalaemia&#44; in patients compliant with the restrictive diet&#44; and severe constipation&#44; which can sometimes result in intestinal occlusions&#46;<span class="elsevierStyleSup">8&#46;9 </span>CPS owes its binding power to its calcium content&#44; since it exchanges a calcium ion for two potassium ions in the gastrointestinal tract&#46; A certain amount of this calcium can be absorbed&#44; which is not a problem for patients with more advanced stages of kidney disease&#44; who tend to present hypocalcaemia&#46; Nonetheless&#44; in earlier stages the level of serum calcium may mildly increase&#44; consequently decreasing the levels of serum intact PTH &#40;iPTH&#41;&#46; Resincalcio<span class="elsevierStyleSup">&#174; </span>and Sorbisterit<span class="elsevierStyleSup">&#174; </span>are the two CPS preparations available in Spain&#46; Their technical data sheets indicate hypercalcaemia as a possible adverse effect&#46;<span class="elsevierStyleSup">10 </span>The Spanish Society of Nephrology&#8217;s guidelines for the management of bone mineral metabolism mentions the importance of remembering the calcium content of the ion exchange resins&#46;<span class="elsevierStyleSup">11 </span>It is estimated that one gram of CSP contains 2&#46;1 mmol of pure calcium element&#44;<span class="elsevierStyleSup">12 </span>so that a 15 grams pack of Resincalcio<span class="elsevierStyleSup">&#174; </span>adds 31&#46;7 mmol of pure calcium element&#46; A Mexican study makes a brief reference to increases of calcium absorption due to use of these drugs&#44; though it is not statistically significant&#46;<span class="elsevierStyleSup">13 </span>There are no other data described in the literature concerning this possible adverse effect&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">MATERIAL AND METHOD </span></p><p class="elsevierStylePara">In 2011&#44; we identified a patient with mild hypercalcaemia in the Nephrology Department of the Gregorio Mara&#241;&#243;n General University Hospital&#44; receiving outpatient services at the time&#46; Other known causes of hypercalcaemia were ruled out&#44; including contributions of exogenous calcium or vitamin D&#44; and concomitant bone disease&#46; There was a possibility of hypercalcaemia being related to the treatment with resins &#40;Resincalcio<span class="elsevierStyleSup">&#174;</span>&#41; and as a result we proceeded to withdrawal&#46; Hypercalcaemia correction was observed and it was reported as an adverse effect&#46;</p><p class="elsevierStylePara">Subsequently&#44; for the next 3 months we collected all patients on follow-up by our Clinical Nephrology Unit &#40;which excludes advanced CKD with glomerular filtratation rate &#60;20mL&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span>&#41;&#44; who showed elevations of serum calcium with no attributable secondary causes other than the contributions of potassium binders&#46; In these patients&#44; we discontinued CPS treatment or reduced doses&#46; We collected data relative to renal function&#44; calcaemia and serum iPTH levels&#44; prior to the introduction of the binder&#44; during treatment and after withdrawal&#46;</p><p class="elsevierStylePara">For the literature review&#44; we carried out a search in the <span class="elsevierStyleItalic">Pubmed-Medline </span>database with the MeSH &#40;<span class="elsevierStyleItalic">Medical Subject Heading</span>&#41; terms &#171;polystyrene sulfonic acid&#187; and &#171;calcium polystyrene sulfonate&#187;&#59; both independently and in combination with other MeSH terms&#58; &#8220;Hyperkalaemia&#8221;&#44; &#8220;hypercalcaemia&#8221; and &#8220;chronic kidney disease&#8221;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS </span></p><p class="elsevierStylePara">Seven patients were found to meet the criteria described above&#46; Six men and a woman&#44; between the ages of 50 and 89 years &#40;mean&#58; 66 years&#41;&#46; Three patients &#40;43&#37;&#41; are diabetics&#59; two &#40;28&#46;5&#37;&#41; have chronic interstitial nephropathy&#59; one &#40;14&#46;3&#37;&#41; has systemic lupus erythematous&#44; and the other one&#44; chronic glomerulonephritis&#46; The average glomerular filtration rate estimated with the CKD-EPI formula is 41&#46;29&#177;10&#46;83mL&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span>&#46; Four patients were classified in stage 3A&#44; two in stage 3B and one in stage 4 of the K&#47;DOQI classification guidelines&#46; 85&#37; &#40;6 patients&#41; were treated with renin-angiotensin system blockers for the control of arterial hypertension or proteinuria&#46; The serum potassium level prior to treatment was 5&#46;9&#177;0&#46;46mmol&#47;L&#46; The average dose of Resincalcio<span class="elsevierStyleSup">&#174; </span>was 8&#46;93&#177;3&#46;49g&#47;day&#46;</p><p class="elsevierStylePara">Serum calcium rose on average 0&#46;91&#177;0&#46;46mg&#47;dL over the baseline levels&#46; Besides&#44; there was a parallel decrease in the levels of iPTH of 49&#46;29&#177;52&#46;24ng&#47;dL&#44; equivalent to an average decrease of 38&#46;83&#37; over baseline levels&#46;</p><p class="elsevierStylePara">Treatment with CPS was interrupted or dose was reduced at the nephrologist&#39;s criterium&#46; In the subsequent follow-up&#44; calcium and iPTH levels returned to baseline levels in most patients &#40;Figure 1&#44; Table 1&#41;&#46;</p><p class="elsevierStylePara">Given that this adverse effect is not clearly described in the literature&#44; those cases with overt biochemical hypercalcaemia were reported to the Drug-monitoring Centre of Madrid&#44; through the Spontaneous Reporting of Adverse Drug Reactions Programme &#40;&#8220;Yellow Card&#8221;&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION </span></p><p class="elsevierStylePara">Hypercalcaemia associated to treatment with ion-exchange calcium resins is not frequent in the clinical setting&#44; probably because potassium binders are only used in advanced stages of CKD&#46; In these stages we find hyperkalaemia with tendency to hypocalcaemia and secondary hyperparathyroidism&#44; each effect counteracting the other with a final benefit for the patient&#46;</p><p class="elsevierStylePara">Occasionally&#44; we find patients with a tendency to hyperkalaemia despite being on early stages of renal dysfunction&#46; This is due to the existence of certain pathologies that produce hyperkalaemia through hyporeninemic hypoaldosteronism&#44; such as diabetes or chronic interstitial nephritis&#46; We usually need to prescribe various hyperkalaemia-inducing drugs&#44; such as beta blockers or renin&#173;angiotensin-aldosterone system blockers&#44; often at full doses&#44; so it is possible to see patients with mild or moderate renal dysfunction and hyperkalaemia that require therapeutic actions&#46;</p><p class="elsevierStylePara">In these situations&#44; patients have normal levels of serum calcium&#46; Therefore&#44; we must take into account the potentially hypercalcaemic effect of CPS&#44; and include it in the differential diagnosis&#46; In our study&#44; all patients presented glomerular filtration rate greater than 25mL&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span>&#44; and four of them reached biochemical hypercalcaemia&#46; In one case&#44; this hypercalcaemia persisted because it was considered necessary to maintain the treatment with CPS&#46;</p><p class="elsevierStylePara">With the rise of blood calcium levels we observed a decrease of iPTH&#46; Under normal conditions&#44; with normal or slightly elevated iPTH levels&#44; this effect is trivial or even beneficial&#46; Nonetheless&#44; as shown in Figure 1&#44; two patients had iPTH values &#60;20ng&#47;dL&#46; In this situation&#44; a stronger inhibition of the parathyroid gland may turn into a clinical problem&#46; These variations of iPTH also are reversible with the withdrawal of CPS&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CONCLUSION </span></p><p class="elsevierStylePara">In patients with moderate chronic kidney disease&#44; treatment of hyperkalaemia with ion-exchange calcium resins &#40;CPS&#41; can produce mild hypercalcaemia&#44; which must be taken into account in the differential diagnosis&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest </span></p><p class="elsevierStylePara">The authors declare that they have no potential conflicts of interest related to the contents of this article&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><a href="grande&#47;11500&#95;16025&#95;35207&#95;en&#95;t1&#95;11500&#46;jpg" class="elsevierStyleCrossRefs"><img src="11500_16025_35207_en_t1_11500.jpg" alt="Mean of serum calcium and parathormone before&#44; during and after treatment with Resincalcio&#174;"></img></a></p><p class="elsevierStylePara">Table 1&#46; Mean of serum calcium and parathormone before&#44; during and after treatment with Resincalcio&#174;</p><p class="elsevierStylePara"><a href="grande&#47;11500&#95;16025&#95;35208&#95;en&#95;f1&#95;11500&#46;jpg" class="elsevierStyleCrossRefs"><img src="11500_16025_35208_en_f1_11500.jpg" alt="Evolution of serum calcium &#40;A&#41; and parathormone &#40;B&#41; levels before the prescription of calcium polystyrene sulfonate&#44; during treatment and after withdrawal"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Evolution of serum calcium &#40;A&#41; and parathormone &#40;B&#41; levels before the prescription of calcium polystyrene sulfonate&#44; during treatment and after withdrawal</p>"
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        "resumen" => "<p class="elsevierStylePara">La hipercalcemia es un efecto adverso potencial de las resinas c&#225;lcicas de intercambio i&#243;nico&#44; de uso frecuente en el tratamiento y la prevenci&#243;n de la hiperpotasemia en la enfermedad renal cr&#243;nica &#40;ERC&#41;&#46; Describimos una serie de siete pacientes con ERC moderada de la consulta de Nefrolog&#237;a Cl&#237;nica &#40;filtrado glomerular medio estimado por CKD-EPI&#58; 41&#44;29 &#177; 10&#44;83 ml&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup"><span class="elsevierStyleSup">2</span></span>&#41;&#44; que presentan hipercalcemia leve en relaci&#243;n con el tratamiento con poliestireno sulfonato c&#225;lcico&#46; El calcio s&#233;rico se elev&#243; de media 0&#44;91 &#177; 0&#44;46 mg&#47;dl&#44; con un descenso paralelo de los niveles de hormona paratiroidea intacta &#40;iPTH&#41; de 49&#44;29 &#177; 52&#44;24 ng&#47;dl de media&#46; Tras la retirada o la reducci&#243;n de la dosis&#44; se objetiv&#243; una recuperaci&#243;n de las cifras de calcio e iPTH s&#233;ricos&#46; Los quelantes c&#225;lcicos de potasio se deben incluir en el diagn&#243;stico diferencial de la hipercalcemia en pacientes con ERC no avanzada&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara">Hypercalcaemia is a potential adverse effect of calcium-containing ion exchange resins&#44; often used in the treatment and prevention of hyperkalaemia in chronic kidney disease &#40;CKD&#41;&#46; We describe a series of seven outpatients with moderate CKD &#40;mean glomerular filtration rate estimated with the CKD-EPI formula&#58; 41&#46;29&#177;10&#46;83mL&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span>&#41;&#44; presenting mild hypercalcaemia in relation to the treatment with calcium polystyrene sulfonate&#46; Serum calcium increased a mean of 0&#46;91&#177;0&#46;46mg&#47;dL&#44; with a mean concomitant decrease of serum intact parathormone &#40;iPTH&#41; of 52&#46;24&#177;49&#46;29ng&#47;dL&#46; After treatment withdrawal or dose reduction&#44; we observed a recovery of serum calcium and iPTH values&#46; Treatment with calcium-based potassium binders should be included in the differential diagnosis of hypercalcaemia in patients with moderate CKD&#46;</p>"
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Hypercalcaemia as a side effect of potassium binding agents
Hipercalcemia como efecto secundario de los quelantes de potasio
David Arroyoa, Nayara Panizoa, Soledad García de Vinuesaa, Marian Goicoecheaa, Úrsula Verdallesa, José Luñoa
a Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid,
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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION </span></p><p class="elsevierStylePara">Hyperkalaemia is one of the most frequent electrolyte abnormalities in chronic kidney disease &#40;CKD&#41; patients&#46; It affects approximately 2&#46;5&#37; of CKD patients older than 65<span class="elsevierStyleSup">1 </span>and it becomes symptomatical with a prevalence of 1&#46;5&#37; in the hospitalised population&#46;<span class="elsevierStyleSup">2 </span>The main cause of hyperkalaemia in CKD is the decrease of glomerular filtration rate&#44; but there often are other contributing factors&#44; such as the use of hyperkalaemia-inducing drugs &#40;renin-angiotensin-aldosterone system blockers&#44; non&#173;steroidal anti-inflammatory drugs&#44; etc&#46;&#41;&#46; In addition&#44; some causes of CKD&#44; such as diabetic nephropathy or tubulointerstitial nephritis&#44; can convey hyporeninemic hypoaldosteronism that favours the occurrence of hyperkalaemia with moderately decreased glomerular filtration rates&#46;<span class="elsevierStyleSup">3 </span></p><p class="elsevierStylePara">Severe hyperkalaemia is a proarrhythmogenic condition&#44; which can produce bradycardia&#44; ventricular fibrillation and ultimately death&#46;<span class="elsevierStyleSup">4&#46;5 </span>Therefore&#44; we must use various methods in order to control it&#46; A low potassium diet is one of the first steps to implement by explaining to the patient the need to moderate the intake of fruits and raw vegetables&#44; chocolate or nuts&#44; and also by recommending the double boiling of vegetables and legumes&#46;</p><p class="elsevierStylePara">If the trend to hyperkalaemia persists&#44; it is suitable to prescribe ion exchange oral resins&#44; which act as potassium &#8220;binding agents&#8221;&#46;<span class="elsevierStyleSup">6 </span>The most widely used in our setting is calcium polystyrene sulfonate &#40;CPS&#41;&#44; although there are others such as sodium polystyrene sulfonate&#46;<span class="elsevierStyleSup">7 </span></p><p class="elsevierStylePara">The most common adverse effects of CPS are hypokalaemia&#44; in patients compliant with the restrictive diet&#44; and severe constipation&#44; which can sometimes result in intestinal occlusions&#46;<span class="elsevierStyleSup">8&#46;9 </span>CPS owes its binding power to its calcium content&#44; since it exchanges a calcium ion for two potassium ions in the gastrointestinal tract&#46; A certain amount of this calcium can be absorbed&#44; which is not a problem for patients with more advanced stages of kidney disease&#44; who tend to present hypocalcaemia&#46; Nonetheless&#44; in earlier stages the level of serum calcium may mildly increase&#44; consequently decreasing the levels of serum intact PTH &#40;iPTH&#41;&#46; Resincalcio<span class="elsevierStyleSup">&#174; </span>and Sorbisterit<span class="elsevierStyleSup">&#174; </span>are the two CPS preparations available in Spain&#46; Their technical data sheets indicate hypercalcaemia as a possible adverse effect&#46;<span class="elsevierStyleSup">10 </span>The Spanish Society of Nephrology&#8217;s guidelines for the management of bone mineral metabolism mentions the importance of remembering the calcium content of the ion exchange resins&#46;<span class="elsevierStyleSup">11 </span>It is estimated that one gram of CSP contains 2&#46;1 mmol of pure calcium element&#44;<span class="elsevierStyleSup">12 </span>so that a 15 grams pack of Resincalcio<span class="elsevierStyleSup">&#174; </span>adds 31&#46;7 mmol of pure calcium element&#46; A Mexican study makes a brief reference to increases of calcium absorption due to use of these drugs&#44; though it is not statistically significant&#46;<span class="elsevierStyleSup">13 </span>There are no other data described in the literature concerning this possible adverse effect&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">MATERIAL AND METHOD </span></p><p class="elsevierStylePara">In 2011&#44; we identified a patient with mild hypercalcaemia in the Nephrology Department of the Gregorio Mara&#241;&#243;n General University Hospital&#44; receiving outpatient services at the time&#46; Other known causes of hypercalcaemia were ruled out&#44; including contributions of exogenous calcium or vitamin D&#44; and concomitant bone disease&#46; There was a possibility of hypercalcaemia being related to the treatment with resins &#40;Resincalcio<span class="elsevierStyleSup">&#174;</span>&#41; and as a result we proceeded to withdrawal&#46; Hypercalcaemia correction was observed and it was reported as an adverse effect&#46;</p><p class="elsevierStylePara">Subsequently&#44; for the next 3 months we collected all patients on follow-up by our Clinical Nephrology Unit &#40;which excludes advanced CKD with glomerular filtratation rate &#60;20mL&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span>&#41;&#44; who showed elevations of serum calcium with no attributable secondary causes other than the contributions of potassium binders&#46; In these patients&#44; we discontinued CPS treatment or reduced doses&#46; We collected data relative to renal function&#44; calcaemia and serum iPTH levels&#44; prior to the introduction of the binder&#44; during treatment and after withdrawal&#46;</p><p class="elsevierStylePara">For the literature review&#44; we carried out a search in the <span class="elsevierStyleItalic">Pubmed-Medline </span>database with the MeSH &#40;<span class="elsevierStyleItalic">Medical Subject Heading</span>&#41; terms &#171;polystyrene sulfonic acid&#187; and &#171;calcium polystyrene sulfonate&#187;&#59; both independently and in combination with other MeSH terms&#58; &#8220;Hyperkalaemia&#8221;&#44; &#8220;hypercalcaemia&#8221; and &#8220;chronic kidney disease&#8221;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS </span></p><p class="elsevierStylePara">Seven patients were found to meet the criteria described above&#46; Six men and a woman&#44; between the ages of 50 and 89 years &#40;mean&#58; 66 years&#41;&#46; Three patients &#40;43&#37;&#41; are diabetics&#59; two &#40;28&#46;5&#37;&#41; have chronic interstitial nephropathy&#59; one &#40;14&#46;3&#37;&#41; has systemic lupus erythematous&#44; and the other one&#44; chronic glomerulonephritis&#46; The average glomerular filtration rate estimated with the CKD-EPI formula is 41&#46;29&#177;10&#46;83mL&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span>&#46; Four patients were classified in stage 3A&#44; two in stage 3B and one in stage 4 of the K&#47;DOQI classification guidelines&#46; 85&#37; &#40;6 patients&#41; were treated with renin-angiotensin system blockers for the control of arterial hypertension or proteinuria&#46; The serum potassium level prior to treatment was 5&#46;9&#177;0&#46;46mmol&#47;L&#46; The average dose of Resincalcio<span class="elsevierStyleSup">&#174; </span>was 8&#46;93&#177;3&#46;49g&#47;day&#46;</p><p class="elsevierStylePara">Serum calcium rose on average 0&#46;91&#177;0&#46;46mg&#47;dL over the baseline levels&#46; Besides&#44; there was a parallel decrease in the levels of iPTH of 49&#46;29&#177;52&#46;24ng&#47;dL&#44; equivalent to an average decrease of 38&#46;83&#37; over baseline levels&#46;</p><p class="elsevierStylePara">Treatment with CPS was interrupted or dose was reduced at the nephrologist&#39;s criterium&#46; In the subsequent follow-up&#44; calcium and iPTH levels returned to baseline levels in most patients &#40;Figure 1&#44; Table 1&#41;&#46;</p><p class="elsevierStylePara">Given that this adverse effect is not clearly described in the literature&#44; those cases with overt biochemical hypercalcaemia were reported to the Drug-monitoring Centre of Madrid&#44; through the Spontaneous Reporting of Adverse Drug Reactions Programme &#40;&#8220;Yellow Card&#8221;&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION </span></p><p class="elsevierStylePara">Hypercalcaemia associated to treatment with ion-exchange calcium resins is not frequent in the clinical setting&#44; probably because potassium binders are only used in advanced stages of CKD&#46; In these stages we find hyperkalaemia with tendency to hypocalcaemia and secondary hyperparathyroidism&#44; each effect counteracting the other with a final benefit for the patient&#46;</p><p class="elsevierStylePara">Occasionally&#44; we find patients with a tendency to hyperkalaemia despite being on early stages of renal dysfunction&#46; This is due to the existence of certain pathologies that produce hyperkalaemia through hyporeninemic hypoaldosteronism&#44; such as diabetes or chronic interstitial nephritis&#46; We usually need to prescribe various hyperkalaemia-inducing drugs&#44; such as beta blockers or renin&#173;angiotensin-aldosterone system blockers&#44; often at full doses&#44; so it is possible to see patients with mild or moderate renal dysfunction and hyperkalaemia that require therapeutic actions&#46;</p><p class="elsevierStylePara">In these situations&#44; patients have normal levels of serum calcium&#46; Therefore&#44; we must take into account the potentially hypercalcaemic effect of CPS&#44; and include it in the differential diagnosis&#46; In our study&#44; all patients presented glomerular filtration rate greater than 25mL&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span>&#44; and four of them reached biochemical hypercalcaemia&#46; In one case&#44; this hypercalcaemia persisted because it was considered necessary to maintain the treatment with CPS&#46;</p><p class="elsevierStylePara">With the rise of blood calcium levels we observed a decrease of iPTH&#46; Under normal conditions&#44; with normal or slightly elevated iPTH levels&#44; this effect is trivial or even beneficial&#46; Nonetheless&#44; as shown in Figure 1&#44; two patients had iPTH values &#60;20ng&#47;dL&#46; In this situation&#44; a stronger inhibition of the parathyroid gland may turn into a clinical problem&#46; These variations of iPTH also are reversible with the withdrawal of CPS&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CONCLUSION </span></p><p class="elsevierStylePara">In patients with moderate chronic kidney disease&#44; treatment of hyperkalaemia with ion-exchange calcium resins &#40;CPS&#41; can produce mild hypercalcaemia&#44; which must be taken into account in the differential diagnosis&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest </span></p><p class="elsevierStylePara">The authors declare that they have no potential conflicts of interest related to the contents of this article&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><a href="grande&#47;11500&#95;16025&#95;35207&#95;en&#95;t1&#95;11500&#46;jpg" class="elsevierStyleCrossRefs"><img src="11500_16025_35207_en_t1_11500.jpg" alt="Mean of serum calcium and parathormone before&#44; during and after treatment with Resincalcio&#174;"></img></a></p><p class="elsevierStylePara">Table 1&#46; Mean of serum calcium and parathormone before&#44; during and after treatment with Resincalcio&#174;</p><p class="elsevierStylePara"><a href="grande&#47;11500&#95;16025&#95;35208&#95;en&#95;f1&#95;11500&#46;jpg" class="elsevierStyleCrossRefs"><img src="11500_16025_35208_en_f1_11500.jpg" alt="Evolution of serum calcium &#40;A&#41; and parathormone &#40;B&#41; levels before the prescription of calcium polystyrene sulfonate&#44; during treatment and after withdrawal"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Evolution of serum calcium &#40;A&#41; and parathormone &#40;B&#41; levels before the prescription of calcium polystyrene sulfonate&#44; during treatment and after withdrawal</p>"
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        "resumen" => "<p class="elsevierStylePara">La hipercalcemia es un efecto adverso potencial de las resinas c&#225;lcicas de intercambio i&#243;nico&#44; de uso frecuente en el tratamiento y la prevenci&#243;n de la hiperpotasemia en la enfermedad renal cr&#243;nica &#40;ERC&#41;&#46; Describimos una serie de siete pacientes con ERC moderada de la consulta de Nefrolog&#237;a Cl&#237;nica &#40;filtrado glomerular medio estimado por CKD-EPI&#58; 41&#44;29 &#177; 10&#44;83 ml&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup"><span class="elsevierStyleSup">2</span></span>&#41;&#44; que presentan hipercalcemia leve en relaci&#243;n con el tratamiento con poliestireno sulfonato c&#225;lcico&#46; El calcio s&#233;rico se elev&#243; de media 0&#44;91 &#177; 0&#44;46 mg&#47;dl&#44; con un descenso paralelo de los niveles de hormona paratiroidea intacta &#40;iPTH&#41; de 49&#44;29 &#177; 52&#44;24 ng&#47;dl de media&#46; Tras la retirada o la reducci&#243;n de la dosis&#44; se objetiv&#243; una recuperaci&#243;n de las cifras de calcio e iPTH s&#233;ricos&#46; Los quelantes c&#225;lcicos de potasio se deben incluir en el diagn&#243;stico diferencial de la hipercalcemia en pacientes con ERC no avanzada&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara">Hypercalcaemia is a potential adverse effect of calcium-containing ion exchange resins&#44; often used in the treatment and prevention of hyperkalaemia in chronic kidney disease &#40;CKD&#41;&#46; We describe a series of seven outpatients with moderate CKD &#40;mean glomerular filtration rate estimated with the CKD-EPI formula&#58; 41&#46;29&#177;10&#46;83mL&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span>&#41;&#44; presenting mild hypercalcaemia in relation to the treatment with calcium polystyrene sulfonate&#46; Serum calcium increased a mean of 0&#46;91&#177;0&#46;46mg&#47;dL&#44; with a mean concomitant decrease of serum intact parathormone &#40;iPTH&#41; of 52&#46;24&#177;49&#46;29ng&#47;dL&#46; After treatment withdrawal or dose reduction&#44; we observed a recovery of serum calcium and iPTH values&#46; Treatment with calcium-based potassium binders should be included in the differential diagnosis of hypercalcaemia in patients with moderate CKD&#46;</p>"
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Article information
ISSN: 20132514
Original language: English
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Idiomas
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