{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T00:37:21Z","timestamp":1760834241091,"version":"build-2065373602"},"reference-count":26,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2021,10,22]],"date-time":"2021-10-22T00:00:00Z","timestamp":1634860800000},"content-version":"unspecified","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,10,6]]},"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To determine if liver cirrhosis is associated with reduced efficacy of insulin-glucose treatment in moderate to severe hyperkalaemia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Retrospective, cohort study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Two secondary and one tertiary care hospital at a large metropolitan healthcare network in Melbourne, Australia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>This study included 463 adults with a mean age of 68.7\u00b115.8 years, comprising 79 patients with cirrhosis and 384 without cirrhosis as controls, who received standard insulin-glucose treatment for a serum potassium \u22656.0\u2009mmol\/L from October 2016 to March 2020. Patients were excluded if they received an insulin infusion, or if there was inadequate follow-up data for at least 6\u2009hours after IDT due to death, lost to follow-up or inadequate biochemistry monitoring. The mean Model for End-stage Liver Disease score in patients with cirrhosis was 22.2\u00b17.5, and the distribution of the Child-Pugh score for cirrhosis was: class A (24%), class B (46%), class C (30%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Outcome measures<\/jats:title>\n                  <jats:p>The primary outcome was the degree of potassium lowering and the secondary outcome was the proportion of patients who achieved normokalaemia, within 6\u2009hours of treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The mean pretreatment potassium for the cohort was 6.57\u00b10.52\u2009mmol\/L. After insulin-glucose treatment, mean potassium lowering was 0.84\u00b10.58\u2009mmol\/L in patients with cirrhosis compared with 1.33\u00b10.75\u2009mmol\/L for controls (p&lt;0.001). The proportion of patients achieving normokalaemia was 33% for patients with cirrhosis, compared with 53% for controls (p=0.001). By multivariable regression, on average, liver cirrhosis was associated with a reduced potassium lowering effect of 0.42\u2009mmol\/L (95%\u2009CI 0.22 to 0.63\u2009mmol\/L, p&lt;0.001) from insulin-glucose treatment, after adjusting for age, serum creatinine, cancer, pretreatment potassium level, \u03b2-blocker use and cotreatments (sodium polystyrene sulfonate, salbutamol, sodium bicarbonate).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Our observational data suggest reduced efficacy of insulin-glucose treatment for hyperkalaemia in patients with cirrhosis.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-051201","type":"journal-article","created":{"date-parts":[[2021,10,22]],"date-time":"2021-10-22T11:01:07Z","timestamp":1634900467000},"page":"e051201","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Observational study of the relative efficacy of insulin-glucose treatment for hyperkalaemia in patients with liver cirrhosis"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7816-4724","authenticated-orcid":false,"given":"Andy K H","family":"Lim","sequence":"first","affiliation":[{"name":"Department of Medicine, Monash University School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia"},{"name":"General Medicine, Monash Health, Clayton, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ljiljana","family":"Crnobrnja","sequence":"additional","affiliation":[{"name":"General Medicine, Monash Health, Clayton, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manogna","family":"Metlapalli","sequence":"additional","affiliation":[{"name":"General Medicine, Monash Health, Clayton, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cathy","family":"Jiang","sequence":"additional","affiliation":[{"name":"General Medicine, Monash Health, Clayton, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rene S H","family":"Wang","sequence":"additional","affiliation":[{"name":"General Medicine, Monash Health, Clayton, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeanette H","family":"Pham","sequence":"additional","affiliation":[{"name":"General Medicine, Monash Health, Clayton, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua H","family":"Abasszade","sequence":"additional","affiliation":[{"name":"General Medicine, Monash Health, Clayton, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,10,22]]},"reference":[{"key":"2025101810470225000_11.10.e051201.1","doi-asserted-by":"crossref","unstructured":"Batterink J , Cessford TA , Taylor RAI , et al . Pharmacological interventions for the acute management of hyperkalaemia in adults. Cochrane Database Syst Rev 2015;35.doi:10.1002\/14651858.CD010344.pub2","DOI":"10.1002\/14651858.CD010344.pub2"},{"key":"2025101810470225000_11.10.e051201.2","article-title":"Efficacy and safety of the pharmacotherapy used in the management of hyperkalemia: a systematic review","volume":"17","author":"Varallo","year":"2019","journal-title":"Pharm Pract"},{"key":"2025101810470225000_11.10.e051201.3","doi-asserted-by":"crossref","first-page":"27","DOI":"10.3390\/epidemiologia2010003","article-title":"The effect of patient factors and Cotreatments on the magnitude of potassium lowering with Insulin\u2013Glucose treatment in patients with hyperkalemia","volume":"2","author":"Lim","year":"2021","journal-title":"Epidemiologia"},{"key":"2025101810470225000_11.10.e051201.4","first-page":"237","article-title":"Insulin resistance in euglycemic cirrhosis","volume":"27","author":"Goswami","year":"2014","journal-title":"Ann Gastroenterol"},{"key":"2025101810470225000_11.10.e051201.5","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1631\/jzus.B1100001","article-title":"Effects of GLUT4 expression on insulin resistance in patients with advanced liver cirrhosis","volume":"12","author":"Shan","year":"2011","journal-title":"J Zhejiang Univ Sci B"},{"key":"2025101810470225000_11.10.e051201.6","first-page":"309","article-title":"Insulin resistance in liver cirrhosis","volume":"57","author":"Goral","year":"2010","journal-title":"Hepatogastroenterology"},{"key":"2025101810470225000_11.10.e051201.7","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1111\/jgh.13243","article-title":"Prevalence and prognostic significance of hyperkalemia in hospitalized patients with cirrhosis","volume":"31","author":"Maiwall","year":"2016","journal-title":"J Gastroenterol Hepatol"},{"key":"2025101810470225000_11.10.e051201.8","doi-asserted-by":"crossref","first-page":"358","DOI":"10.3109\/00365521.2012.743583","article-title":"Moderate hyperkalemia in hospitalized patients with cirrhotic ascites indicates a poor prognosis","volume":"48","author":"Wallerstedt","year":"2013","journal-title":"Scand J Gastroenterol"},{"key":"2025101810470225000_11.10.e051201.9","first-page":"1","article-title":"Characteristics, risk factors, and adverse outcomes of hyperkalemia in acute-on-chronic liver failure patients","volume":"2019","author":"Cai","year":"2019","journal-title":"Biomed Res Int"},{"key":"2025101810470225000_11.10.e051201.10","doi-asserted-by":"crossref","first-page":"2255","DOI":"10.1093\/ckj\/sfab033","article-title":"Impact of insulin adsorption in various containers during hyperkalaemia treatment","volume":"14","author":"Robert","year":"2021","journal-title":"Clin Kidney J"},{"key":"2025101810470225000_11.10.e051201.11","doi-asserted-by":"publisher","DOI":"10.1038\/kisup.2012.1"},{"key":"2025101810470225000_11.10.e051201.12","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.10821011"},{"key":"2025101810470225000_11.10.e051201.13","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0287"},{"key":"2025101810470225000_11.10.e051201.14","doi-asserted-by":"publisher","DOI":"10.1079\/BJN20041258"},{"key":"2025101810470225000_11.10.e051201.15","unstructured":"MELD calculator: organ procurement and transplantation network. Available: https:\/\/optn.transplant.hrsa.gov\/resources\/allocation-calculators\/meld-calculator [Accessed 20 Feb 2021]."},{"key":"2025101810470225000_11.10.e051201.16","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800600817"},{"key":"2025101810470225000_11.10.e051201.17","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.28.5.1245"},{"key":"2025101810470225000_11.10.e051201.18","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(92)90329-W"},{"key":"2025101810470225000_11.10.e051201.19","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.00389.2011"},{"key":"2025101810470225000_11.10.e051201.20","doi-asserted-by":"publisher","DOI":"10.1172\/JCI111873"},{"key":"2025101810470225000_11.10.e051201.21","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1007\/s11255-015-1001-5","article-title":"A relationship between serum potassium concentration and insulin resistance in patients with type 2 diabetes mellitus","volume":"47","author":"Kim","year":"2015","journal-title":"Int Urol Nephrol"},{"key":"2025101810470225000_11.10.e051201.22","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.00750111"},{"key":"2025101810470225000_11.10.e051201.23","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-73-3-564"},{"key":"2025101810470225000_11.10.e051201.24","doi-asserted-by":"publisher","DOI":"10.1002\/lt.500020607"},{"key":"2025101810470225000_11.10.e051201.25","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-789X.2006.00276.x"},{"key":"2025101810470225000_11.10.e051201.26","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1988.00380030053012"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-051201","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T17:47:09Z","timestamp":1760809629000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-051201"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10]]},"references-count":26,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,10,22]]},"published-print":{"date-parts":[[2021,10]]}},"alternative-id":["10.1136\/bmjopen-2021-051201"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-051201","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2021,10]]}}}