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Lapa C, Werner RA, Bluemel C, et al. Prediction of clinically relevant hyperkalemia in patients treated with peptide receptor radionuclide therapy. EJNMMI Res. 2014;4:74doi: 10.1186/s13550-014-0074-y.
Lapa, C., Werner, R. A., Bluemel, C., Lueckerath, K., Muegge, D. O., Strate, A., Haenscheid, H., Schirbel, A., Allen-Auerbach, M. S., Bundschuh, R. A., Buck, A. K., & Herrmann, K. (2014). Prediction of clinically relevant hyperkalemia in patients treated with peptide receptor radionuclide therapy. EJNMMI research, 474. https://doi.org/10.1186/s13550-014-0074-y
Lapa, Constantin, et al. "Prediction of clinically relevant hyperkalemia in patients treated with peptide receptor radionuclide therapy." EJNMMI research vol. 4 (2014): 74. doi: https://doi.org/10.1186/s13550-014-0074-y
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. Prediction of clinically relevant hyperkalemia in patients treated with peptide receptor radionuclide therapy. EJNMMI Res. 2014 Dec 24;4:74. doi: 10.1186/s13550-014-0074-y. eCollection 2014. PMID: 25977880; PMCID: PMC4412196.
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EJNMMI Res. 2014 Dec 24;4:74. doi: 10.1186/s13550-014-0074-y. eCollection 2014.

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

EJNMMI research

Constantin Lapa, Rudolf A Werner, Christina Bluemel, Katharina Lueckerath, Dirk O Muegge, Alexander Strate, Heribert Haenscheid, Andreas Schirbel, Martin S Allen-Auerbach, Ralph A Bundschuh, Andreas K Buck, Ken Herrmann

Affiliations

  1. Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, Würzburg 97080, Germany.
  2. Institute of Psychology, University of Innsbruck, Innsbruck, Austria.
  3. Institute of Clinical Chemistry, University Hospital Würzburg, Oberdürrbacher Str. 6, Würzburg 97080, Germany.
  4. Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles 90095, CA, USA.
  5. Department of Nuclear Medicine, University Hospital Bonn, Sigmund-Freud-Straße 25, Bonn 53127, Germany.

PMID: 25977880 PMCID: PMC4412196 DOI: 10.1186/s13550-014-0074-y

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.

Keywords: Amino acids; Hyperkalemia; Kidney function; MAG3; NET; PRRT

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