ABSTRACT
BACKGROUND: We aimed to develop a model to estimate the risk of hyperkalaemia in patients treated for heart failure in a tertiary reference hospital and to identify precipitating factors. METHODS: 125 congestive heart failure (CHF) patients were studied retrospectively. Thirty of these patients developed episodes of hyperkalaemia (K>or=5.5 mmol/l). Both groups were compared for possible risk factors for hyperkalaemia (age, glomerular filtration rate (GFR), New York Heart Association (NYHA) class, diabetes mellitus (DM), ejection fraction and medication use (ACE inhibitors, angiotensin receptor blockers, aldosterone antagonists). RESULTS: On multivariate logistic regression analysis DM (OR 2.9, 95% CI=1.05 to 8.3, p=0.041), GFR<45 ml/min (OR 4.1, 95% CI=1.6 to 10.5. p=0.004) and NYHA class III-IV (OR 2.4, 95% CI=0.9 to 6.3, p=0.086) were independently associated with hyperkalaemia, whereas age, ejection fraction and medication sort and dose were not. Of the episodes of hyperkalaemia, 38% were precipitated by periods of dehydration (diarrhoea, fever) or change of medication. CONCLUSION: We identified kidney function, diabetes mellitus and heart failure class as independent risk factors of hyperkalaemia. The majority of the hyperkalaemic episodes develop without a precipitating factor. This implies that heart failure patients in a tertiary reference hospital should be very closely monitored to minimize the risk for hyperkalaemia.
Subject(s)
Heart Failure/complications , Hyperkalemia/etiology , Aged , Diabetes Complications/physiopathology , Episode of Care , Female , Heart Failure/physiopathology , Humans , Hyperkalemia/physiopathology , Kidney Diseases/complications , Kidney Diseases/physiopathology , Logistic Models , Male , Middle Aged , Retrospective Studies , Risk Assessment , Risk FactorsABSTRACT
The paper discusses conversion capacities of both anaerobic and aerobic wastewater treatment systems in relation to growth kinetics, hydrodynamics and biomass concentration. In the current modern anaerobic high-rate reactors the conversion potentials are optimally exploited. This is not yet true for aerobic systems since operation of aerobic systems under conditions of low biomass growth reduces the maximum applicable loading rates significantly. Both the concept of granulation and the introduction of fluidised bed systems have increased conversion capacities for both anaerobic and aerobic systems significantly. One of the latest development concerns the SBR with granular biomass. The grazing concept, in which ciliates convert aerobically grown dispersed cells, offers a possibility for significant improvement of aerobic systems. In the fields of psychrophilic and thermophilic anaerobic treatment, specific reactor development may contribute to further enhance volumetric conversion capacities. Due to reduced water usage, both COD and salt concentrations tend to increase for industrial effluents. As a consequence, there is a need for the development of anaerobic reactors retaining flocculant biomass. The membrane bioreactors offer a solution for certain niches in wastewater treatment. However the oxygen transfer economy is poor. There is a need for fundamental knowledge development to obtain a realistic image of this technology.
