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Prediction of clinically relevant hyperkalemia in patients treated with peptide receptor radionuclide therapy.

Abstract：

BACKGROUND:Peptide receptor radionuclide therapy (PRRT) is applied in patients with advanced neuroendocrine tumors. Co-infused amino acids (AA) should prevent nephrotoxicity. The aims of this study were to correlate the incidence of AA-induced hyperkalemia (HK) (≥5.0 mmol/l) and to identify predictors of AA-induced severe HK (>6.0). METHODS:In 38 patients, standard activity of (177)Lu-labelled somatostatin analogs was administered. Pre-therapeutic kidney function was assessed by renal scintigraphy and laboratory tests. For kidney protection, AA was co-infused. Biochemical parameters (potassium, glomerular filtration rate, creatinine, blood urea nitrogen (BUN), sodium, phosphate, chloride, and lactate dehydrogenase (LDH)) were obtained prior to 4 and 24 h after the AA infusion. Incidence of HK (≥5.0) was correlated with pre-therapeutic kidney function and serum parameters. Formulas for the prediction of severe hyperkalemia (>6.0) were computed and prospectively validated. RESULTS:At 4 h, HK (≥5.0) was present in 94.7% with severe HK (>6.0) in 36.1%. Values normalized after 24 h in 84.2%. Pre-therapeutic kidney function did not correlate with the incidence of severe HK. Increases in K(+) were significantly correlated with decreases in phosphate (r = -0.444, p < 0.005) and increases in BUN (r = 0.313, p = 0.056). A baseline BUN of >28 mg/dl had a sensitivity of 84.6% and a specificity of 60.0% (AUC = 0.75) in predicting severe HK of >6.0 (phosphate, AUC = 0.37). Computing of five standard serum parameters (potassium, BUN, sodium, phosphate, LDH) resulted in a sensitivity of 88.9% and a specificity of 79.3% for the prediction of severe HK >6.0 (accuracy = 81.6%). CONCLUSIONS:A combination of serum parameters predicted prospectively the occurrence of relevant HK with an accuracy of 81.6% underlining its potential utility for identifying 'high-risk' patients prone to PRRT.

journal_name

EJNMMI Res

journal_title

EJNMMI research

authors

Lapa C,Werner RA,Bluemel C,Lueckerath K,Muegge DO,Strate A,Haenscheid H,Schirbel A,Allen-Auerbach MS,Bundschuh RA,Buck AK,Herrmann K

doi

10.1186/s13550-014-0074-y

subject

Has Abstract

pub_date

2014-12-24 00:00:00

pages

issn

2191-219X

pii

s13550-014-0074-y

journal_volume

pub_type

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Prediction of clinically relevant hyperkalemia in patients treated with peptide receptor radionuclide therapy.