BACKGROUND AND OBJECTIVE:Hyperkalaemia is common in patients with chronic kidney disease (CKD) treated with renin-angiotensin-aldosterone system inhibitors (RAASi) and mineralocorticoid receptor antagonists (MRAs). Although new potassium binders have demonstrated efficacy in clinical trials, evidence from real-world clinical practice remains limited. MATERIALS AND METHODS:We present a retrospective, observational, multicentre, non-interventional study aimed at evaluating the use of patiromer in patients with hyperkalaemia under routine clinical conditions in the Valencian Community. Patients who received patiromer for at least 3 months due to hyperkalaemia were included. The primary objective was to assess the evolution of serum potassium at 1, 3, 6, and 12 months after initiation of treatment. Secondary objectives included describing baseline patient characteristics, changes in RAASi and MRA therapy, and patiromer-related adverse events. RESULTS:A total of 59 patients were included. The baseline serum potassium level was 5.72 mmol/L, showing significant reductions at 1, 3, 6, and 12 months (5.02, 5.17, 5.11, and 5.01 mmol/L, respectively; all P < .001). Patiromer treatment enabled continuation of RAASi in 94.9% of patients and MRAs in 98.3%. The most frequent adverse events were gastrointestinal. Patiromer was discontinued in 8 patients (13.5%), with adverse effects accounting for half of these cases. CONCLUSIONS:Our study provides real-world evidence on the effectiveness, safety, and RAASi/MRA maintenance potential of patiromer in patients with CKD and hyperkalaemia under routine care. In this setting, patiromer proved effective and well tolerated for managing hyperkalaemia and preserving RAASi/MRA therapy.
We present the case of a woman with metastatic BRAF-mutated melanoma and a history of type 1 diabetes mellitus, who developed ocular toxicity secondary to Binimetinib treatment. She was initially treated with Vemurafenib and Cobimetinib, achieving complete remission. However, due to cumulative toxicities, therapy was switched to Encorafenib and Binimetinib in February 2023. After three months, she developed cystoid macular edema (CME), confirmed by optical coherence tomography (OCT). Management included Binimetinib dose reduction and topical ketorolac, resulting in initial improvement, although the CME recurred several months later. The rapid progression of metastatic melanoma in January 2024, with peritoneal carcinomatosis, massive ascites, and a left adrenal metastasis, limited further treatment options such as intravitreal anti-VEGF or dexamethasone. The patient ultimately began immunotherapy with Nivolumab and Ipilimumab, but died in February 2024 due to refractory abdominal septic shock. This case highlights the importance of early ophthalmologic monitoring and interdisciplinary collaboration in patients receiving MEK inhibitors.
Optimal glycemic control is essential to prevent complications in diabetes, and insulin administration practices play a key role. This study assessed insulin injection behaviors and related glycemic outcomes among individuals using multiple daily injections in Spain. A cross-sectional online survey was conducted via an independent patient platform (Canal Diabetes). Adults (18–65 years) with type 1, type 2, or other forms of diabetes (e.g., maturity-onset diabetes of the young (MODY) or secondary diabetes) requiring daily insulin injections were included. Demographic, clinical, and behavioral data were analyzed using SPSS Statistics, version 23 (IBM Corp., Armonk, NY, USA). Among 288 participants (mean age: 43.7 ± 14.7 years; 28.8
Presentamos el caso de un varón de 10 años remitido por episodios visuales transitorios compatibles con síndrome de Alicia en el País de las Maravillas, descritos como sensación de alejamiento de los objetos. La exploración oftalmológica mostró una agudeza visual conservada y un segmento anterior normal, pero una papila izquierda sobreelevada, lo que obligó a descartar papiledema verdadero. La OCT macular fue normal, mientras que la OCT de papila evidenció asimetría estructural compatible con seudopapiledema. La resonancia magnética mostró dilatación aislada de las vainas de ambos nervios ópticos y discreta sobreelevación papilar izquierda, sin otros hallazgos sugestivos de hipertensión intracraneal. La ecografía orbitaria identificó un foco ecogénico sugestivo de drusas papilares. La evolución clínica y estructural estable apoyó el diagnóstico de seudopapiledema unilateral por drusas, probablemente independiente de los síntomas perceptivos.
Presentamos el primer caso pediátrico con un diagnóstico molecular dual de albinismo oculocutáneo tipo 1 relacionado con TYR y síndrome de Marfan asociado a FBN1. El paciente mostraba un fenotipo ocular mixto que combinaba miopía magna, coroidopatía miópica difusa e hipoplasia foveal bilateral, junto con evidencia electrofisiológica de desrute quiasmático. La evaluación sistémica reveló talla alta, escoliosis leve y rasgos marfanoides y se confirmó la presencia de variantes patogénicas en TYR y FBN1. La coexistencia de 2entidades tradicionalmente consideradas independientes amplía el espectro fenotípico de albinismo oculocutáneo tipo 1 y del síndrome de Marfan y señala posibles interacciones entre vías de melanogénesis y matriz extracelular. Este caso subraya la importancia de una evaluación multidisciplinar y del estudio genético integral en pacientes con presentaciones oculares atípicas, así como la necesidad de considerar diagnósticos duales cuando un único gen no explica adecuadamente el cuadro clínico.
