Journal of European Internal Medicine Professionals

A Systematic Review of Sodium Zirconium Cyclosilicate for Hyperkalemia Management in Heart Failure and Chronic Kidney Disease

2026-01-06T17:15:21+03:00

Background: Hyperkalemia is common in chronic kidney disease (CKD) and heart failure (HF) and often limits the initiation, continuation, or up-titration of renin-angiotensin-aldosterone system inhibitors (RAASi). Sodium zirconium cyclosilicate (SZC) is a non-absorbed, selective potassium binder used for both acute correction and maintenance therapy.

Methods: We systematically searched PubMed/MEDLINE) to identify randomized and real-world clinical studies evaluating SZC for hyperkalemia in adult CKD and/or HF populations; Embase and Cochrane Library were not searched, and no language restrictions were applied. Reporting was guided by the PRISMA 2020 statement, and study selection is summarized in a PRISMA flow diagram. Evidence was synthesized narratively due to heterogeneity in study designs and outcome reporting.

Results: Across randomized trials, SZC lowered serum potassium rapidly, with onset within 1 hour and clinically meaningful reductions within 24-48 hours. Maintenance-phase trials demonstrated sustained normokalemia during continued SZC dosing. In CKD with concomitant metabolic acidosis, SZC was associated with higher rates of normokalemia maintenance at 4 weeks and modest increases in serum bicarbonate. In HF with reduced ejection fraction during spironolactone optimization, SZC improved maintenance of normokalemia on guideline-directed mineralocorticoid receptor antagonist therapy. Based on observational real-world evidence, studies reported fewer urgent hyperkalemia interventions and improved RAASi persistence; edema related to sodium load and occasional hypokalemia were the most clinically relevant safety considerations.

Conclusion: SZC provides rapid and durable potassium control in CKD and HF and may facilitate continuation of guideline-directed RAASi therapy. Monitoring for sodium-related fluid retention and electrolyte overcorrection is warranted, and the lowest effective dose should be used in volume-sensitive patients. Reported clinical outcome benefits remain hypothesis-generating and require confirmation in prospective trials.

Impact of SGLT-2 Inhibitors on Aggregate Index of Systemic Inflammation in Patients with Stage 3-4 Chronic Kidney Disease: A Retrospective Cohort Study

2025-10-18T12:00:11+03:00

Background: Chronic kidney disease (CKD) is characterized by systemic inflammation that contributes to cardiovascular morbidity. The Aggregate Index of Systemic Inflammation (AISI), calculated as (neutrophils × platelets × monocytes)/lymphocytes, has emerged as a prognostic biomarker. SGLT-2 inhibitors demonstrate anti-inflammatory properties in CKD, yet their impact on AISI remains unexplored. We aim to evaluate the impact of SGLT-2 inhibitor therapy on AISI values in patients with stage 3-4 CKD and type 2 diabetes mellitus.
Methods: This retrospective cohort study included 148 patients with stage 3-4 CKD and type 2 diabetes mellitus who initiated SGLT-2 inhibitor therapy at Gazi University Nephrology Clinic between September 2024 and September 2025. AISI was calculated from complete blood counts at baseline and follow-up (mean 48.0 ± 12.2 days). The primary outcome was change in AISI values. Paired t-test was used for statistical analysis.
Results: Mean age was 67.15 ± 9.20 years, 54.7% were male, and baseline eGFR was 38.9 ± 12.1 mL/min/1.73m². Patients received empagliflozin (n=74) or dapagliflozin (n=74). AISI showed no significant change from baseline to follow-up indicating no significant difference (519.89 ± 319.52 vs. 503.15 ± 442.39, p=0.535).
Conclusions: SGLT-2 inhibitor therapy does not significantly alter AISI values in stage 3-4 CKD patients with diabetes over short-term follow-up. The established cardiovascular and renal benefits of SGLT-2 inhibitors appear to operate through mechanisms not reflected in this composite inflammatory marker.

Comparison of Dapagliflozin and Empagliflozin in Patients with Type 2 Diabetes and/or Chronic Kidney Disease: A Real-World Observational Study

2026-01-03T10:04:01+03:00

Background: Sodium-glucose cotransporter-2 (SGLT2) inhibitors provide renal protection in patients with diabetes mellitus (DM) and chronic kidney disease (CKD), but comparative real-world data on dapagliflozin and empagliflozin across different renal diagnoses are limited.

Method: In this retrospective observational study, 328 adults with DM and/or CKD, including diabetic nephropathy, glomerulonephritis, and heart failure, who received dapagliflozin or empagliflozin for at least 12 months were evaluated. Demographic, clinical, and laboratory data, including estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio, were recorded at baseline and 12 months. The primary outcome was ≥50% reduction in albuminuria, and a >50% decline in eGFR was analyzed as a safety endpoint.

Results: Of 328 patients (mean age 60.4 ± 11.1 years, 43.3% female), 165 received dapagliflozin and 163 received empagliflozin. Among 298 patients with DM, 61.4% achieved ≥50% reduction in albuminuria at 12 months, while 86.7% of 30 non-diabetic patients reached this target. High response rates were observed in patients with isolated DM, DM+CKD, and non-diabetic CKD, including those with glomerulonephritis. Only one patient (with DM and CKD in the empagliflozin group) experienced a >50% decline in eGFR; no such decline occurred in other subgroups. There were no significant differences between dapagliflozin and empagliflozin in albuminuria reduction or eGFR decline across diagnostic categories.

Conclusion: In this real-world cohort, dapagliflozin and empagliflozin were similarly effective in substantially reducing albuminuria and preserving eGFR in patients with DM, CKD, glomerulonephritis, and heart failure. These findings support the use of SGLT2 inhibitors as renoprotective therapy across diverse high-risk populations.

Renal Impairment at Multiple Myeloma Diagnosis: Clinical Characteristics, Contributing Factors in a Retrospective Cohort

2025-12-15T16:30:10+03:00

Background: This study aimed to examine the frequency and clinical characteristics of kidney dysfunction at the time of multiple myeloma (MM) diagnosis, focusing on factors associated with MM-related nephropathy, to identify factors associated with renal recovery among patients presenting with impaired kidney function.

Methods: This retrospective single-center study included patients diagnosed with MM between 1999 and 2009. Of 204 screened patients, 136 were eligible for analysis after exclusion of cases with incomplete laboratory or imaging data. Kidney dysfunction was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m² at diagnosis. Demographic characteristics, myeloma subtype, International Staging System (ISS) stage and risk category, laboratory parameters, renal ultrasonography findings, and nephrotoxic exposures were evaluated. Renal recovery was assessed in patients with kidney dysfunction at baseline.

Results: Kidney dysfunction was present in 24 patients (17.6%) at diagnosis. Compared with those with preserved renal function, these patients had higher rates of light chain myeloma, and higher β2-microglobulin and CRP levels, and greater proteinuria (all p ≤ 0.05). Moreover, patients with kidney dysfunction were more likely to have higher ISS Stage and high-risk ISS classification (p<0.001). Renal ultrasonography abnormalities—including increased cortical echogenicity and reduced kidney size—were significantly more common in the kidney dysfunction group (p < 0.001). Among patients with kidney dysfunction, renal recovery occurred in 9 of 24 (37.5%). Lower baseline creatinine and absence of hemodialysis requirement at diagnosis were associated with higher recovery likelihood, whereas increased cortical echogenicity or reduced kidney size predicted persistent dysfunction.

Conclusion: Kidney dysfunction at diagnosis in MM patients is associated with advanced disease stage, and unfavorable laboratory and clinical features. While β2-microglobulin remains a useful prognostic marker, its interpretation in patients with kidney dysfunction should be approached cautiously due to impaired renal clearance. These findings underscore the importance of early recognition and appropriate management of renal impairment in MM.

SGLT2 Inhibitors in Heart Failure: A Meta-Analysis of Randomized Trials and Observational Studies

2026-01-18T10:12:48+03:00

Background: Heart failure (HF) remains a leading cause of morbidity and mortality worldwide. Sodium–glucose cotransporter-2 (SGLT2) inhibitors have demonstrated cardiovascular benefits in HF beyond glucose lowering, yet uncertainties remain regarding consistency across the ejection fraction spectrum, individual agents, and real-world populations. We conducted a comprehensive meta-analysis of randomized controlled trials (RCTs) and observational studies to evaluate the efficacy and safety of SGLT2 inhibitors across HF phenotypes.
Methods: MEDLINE, Embase, the Cochrane Library, and ClinicalTrials.gov were systematically searched from inception through November 2025 for RCTs and observational cohort studies evaluating empagliflozin, dapagliflozin, canagliflozin, ertugliflozin, or sotagliflozin in HF patients. Studies compared SGLT2 inhibitors with placebo or standard care. To account for differing bias structures, RCTs and observational studies were analyzed separately using random-effects models. The primary outcome was the composite of cardiovascular (CV) death or hospitalization for heart failure (HHF). Secondary outcomes included HHF alone, CV death, all-cause mortality, and safety endpoints. Heterogeneity was assessed using the I² statistic, publication bias with funnel plots and Egger’s test, and reporting followed PRISMA guidelines.
Results: Seventeen RCTs, including 20,749 patients and 21 observational studies comprising more than 300,000 patients, were analyzed, spanning HFrEF, HFmrEF, and HFpEF populations. In pooled RCT analyses, SGLT2 inhibitors reduced CV death or HHF by approximately 25% compared with placebo (hazard ratio [HR] 0.73, 95% CI 0.68–0.78), corresponding to absolute risk reductions of 4–5% over a median follow-up of ~1.5 years. This benefit was largely driven by a ~30% reduction in HHF, while CV death declined by ~15–18%. All-cause mortality was reduced by ~17% (HR ~0.83). Treatment effects were consistent across agents, diabetes status, renal function, age, sex, and body mass index, and across the full ejection fraction spectrum. In HFpEF, CV death or HHF was reduced by ~17%, with a ~25% reduction in HHF alone, while numerically greater effects were observed in HFrEF. Observational data supported these findings, showing substantial reductions in HHF and all-cause mortality. Heterogeneity for primary RCT outcomes was low (I² <25%). SGLT2 inhibitors were well tolerated, with no excess risk of serious adverse events or major safety concerns.
Conclusions: SGLT2 inhibitors provide consistent and clinically meaningful benefits in HF, significantly reducing HF hospitalizations and improving survival across HF phenotypes, with a favorable safety profile.

Severe Hypernatremia Associated with Intravenous Fosfomycin: A Preventable Adverse Effect in the Intensive Care Setting

2025-12-23T10:36:52+03:00

Letter to Editor - No Abstract

Response to the Letter to the Editor Entitled “What’s Missing in Diabetes Treatment? A Novel Agent, Finerenone?”

2025-12-13T00:38:39+03:00

Letter to Editor - No Abstract

Shocking Cause of Kidney Failure: Antiphospholipid Antibody Syndrome

2026-01-25T23:07:40+03:00

Letter to Editor - No Abstract