Bradycardia, Renal Dysfunction, Atrioventricular Node Blockade, Shock, and Hyper...

연구 요약

Bradycardia, Renal Dysfunction, Atrioventricular Node Blockade, Shock, and Hyperkalemia (BRASH) Syndrome: Clinical Features, Outcomes, and Therapeutic Implications.

Cureus 학술지에 발표된 이 연구는 Esteves M, Bragança R, Morais S 외 연구팀이 수행하였습니다.

이 연구는 'Bradycardia, Renal Dysfunction, Atrioventricular Node Blockade, Shock, and Hyperkalemia (BRASH) Syndrome: Clinical Features, Outcomes, and Therapeutic Implications.'에 대한 과학적 분석을 제공합니다.

핵심 내용

INTRODUCTION: BRASH syndrome, characterized by the combination of bradycardia, renal dysfunction, atrioventricular node-blocking agent use, shock, and hyperkalemia, is an increasingly recognized but underdiagnosed clinical pattern, particularly in elderly patients with multiple comorbidities. Data regarding its clinical presentation, management, and short-term outcomes remain limited. METHODS: We conducted a single-center retrospective cohort study including patients admitted to the emergency department between 2019 and 2022. Patients met clinical criteria including bradycardia, hyperkalemia (K+≥5.0 mmol/L), acute kidney injury (KDIGO) or acute-on-CKD, AV-nodal blocker use, and evidence of shock. Demographic characteristics, comorbidities, precipitating factors, treatments, and short-term outcomes were analyzed. Subgroup analyses were exploratory. RESULTS: Fifty-one patients were included. The mean age was 79.8 years (SD 10.6; range 48-102), with a balanced sex distribution. Hypertension (90.2%), heart failure (68.6%), atrial fibrillation (52.9%), and chronic kidney disease (25.5%) were common. Most patients were receiving beta-blockers (82.4%), angiotensin-converting enzyme inhibitors (68.6%), calcium channel blockers (37.3%), or digoxin (31.4%). Frequent precipitating factors included nephrotoxic exposure (49.0%), infection or sepsis (43.1%), dose initiation or escalation of atrioventricular node-blocking agents (43.1%), and hypovolemia (33.3%). Admission hyperkalemia was generally mild to moderate, with a median potassium level of 6.5 mmol/L (IQR 5.8-7.2). Management included intravenous calcium (72.5%), insulin with dextrose (72.5%), beta-agonists (88.2%), vasopressor support (33.3%), renal replacement therapy (11.8%), and pacing support (9.8%). In-hospital mortality was 15.7%. Post-discharge mortality was 2.3% at 30 days and 7.0% at 90 days, and hospital readmission within 90 days occurred in 41.9%. CONCLUSIONS: Early recognition of BRASH syndrome is essential, as even moderate hyperkalemia may lead to significant hemodynamic compromise and organ support requirements in high-risk patients.

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