***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Ten patients with acute and 60 with chronic renal failure ( both groups having hyperkalaemia ) , were managed at Kenyatta National Hospital in the medical wards and Renal Unit between August , 1995 and January , 1996 . They were divided into seven different treatment groups , each consisting of ten patients . Treatment A glucose 25 g i.v . with insulin 10 units i.v . , treatment B 50 mmol of 8.4 % sodium bicarbonate infusion , treatment C 0.5 mg of salbutamol i.v . in 50mls 5 % dextrose , treatment D was a combination of treatments A and B , treatment E was a combination of treatment B and C , treatment F was a combination of treatments A and C while treatment G was a combination of treatments A and B and C.  Serum potassium was measured , 30 minutes , 1 hour , 2 hours , 4 hours and 8 hours after treatment . Plasma glucose concentration was measured before treatment was given and 1 hour after in all patients . Electrocardiography was done before treatment on all patients and repeated 30 minutes and 1 hour after treatment for the patients with hyperkalaemic changes on the initial recording . All treatment modalities had satisfactory potassium lowering effects . Of the single therapeutic approaches , treatment A and C were equieffective , but better than treatment B ( P < 0.001 ) . Amongst the two regimen combinations , treatment D and F were more efficacious than treatment E and all the single therapeutic approaches ( P < 0.001 ) . Treatment G was the most efficacious in lowering serum potassium in this study . All treatment modalities had maximum serum potassium lowering effect at 1 - 2 hours . A fall in plasma glucose concentration was a notable feature of treatments A and D , but significant hypoglycaemia occurred in 20 % of patients receiving treatment A and in none on treatment D. The ECG changes of hyperkalaemia did not correlate with serum potassium levels . The normalisation of hyperkalaemic ECG alteration occurred within the first 30 minutes after treatment . In conclusion , combination therapies for hyperkalaemia appear to be more efficacious than single therapeutic approaches . Inclusion of salbutamol seems to protect against insulin induced hypoglycaemia . The maximum potassium lowering effect is observed 1 - 2 hours of administration of either agents . The potassium reducing effect remains significant compared to baseline values even after 8 hours . If dialysis can not be instituted early enough it seems reasonable to repeat treatment every 4 - 6 hours to sustain the effect . Repeated administration of glucose with insulin may not be safe because of the hypoglycaemic effect . Other single and combination therapies can theoretically be repeated regularly until dialysis is initiated although this requires further clinical evaluation Three groups of patients with acute or chronic renal failure ( GFR less than 5 ml/min ) and hyperkalaemia ( K+ greater than or equal to 6 mEq/l ) , similar in age , serum creatinine and pretreatment K+ . Group A ( n = 24 ) received salbutamol 0.5 mg i.v . in 15 min , group B ( n = 10 ) received glucose 40 g i.v . plus 10 units insulin i.v . in 15 min , and group C ( n = 10 ) received salbutamol 0.5 mg i.v . , glucose 40 g i.v . and insulin 10 units i.v . over a 15-min period . Serum potassium was measured at 30 , 60 , 180 and 360 min after administration of treatment . All treatments reduced serum potassium , maximal at 30 or 60 min , and ranging from -0.5 + /- 0.1 to -1.5 + /- 0.2 mEq/l ; patients in group C exhibited a significantly greater decrement in serum potassium , when compared to group B at 60 ( -1.5 + /- 0.2 vs -1 + /- 0.1 mEq/l , respectively ; P less than 0.01 ) and 180 min ( -1.2 + /- 0.2 vs -0.7 + /- 0.1 mEq/l , respectively ; P less than 0.05 ) . There were no significant differences between groups A and C. Patients from group C had moderate tachycardia and more prolonged hyperglycaemia than those from group B , but all treatments were well tolerated Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies Hyperkalemia contributes to significant mortality and limits the use of cardioprotective and renoprotective renin – angiotensin – aldosterone blockers . Current therapies are poorly tolerated and not always effective . Here we conducted a phase 2 r and omized , double-blind , placebo-controlled dose-escalation study to assess safety and efficacy of ZS-9 . This oral selective cation exchanger that preferentially entraps potassium in the gastrointestinal tract was given to patients with stable Stage 3 chronic kidney disease and hyperkalemia ( 5.0 to 6.0 mEq/l ) during a 2-day period . Of 90 eligible patients with mean baseline serum potassium of 5.1 mEq/l , 30 were r and omized to placebo , 12–0.3 g , 24–3 g , or 24 to 10 g of ZS-9 three times daily for 2 days with regular meals . None withdrew and ZS-9 dose-dependently reduced serum potassium . The primary efficacy end point ( rate of serum potassium decline in the first 48 h ) was met with significance in the 3- and 10-g cohorts . From baseline , mean serum potassium was significantly decreased by 0.92±0.52 mEq/l at 38 h. Urinary potassium excretion significantly decreased with 10-g ZS-9 as compared to placebo at day 2 ( + 15.8 + /− 21.8 vs. + 8.9 + /− 22.9 mEq per 24h ) from placebo at day 2 . In this short-term study , no serious adverse events were reported ; only mild constipation in the 3-g dose group was possibly related to treatment . Thus , ZS-9 was well-tolerated in patients with stable chronic kidney disease and hyperkalemia leading to a rapid , sustained reduction in serum potassium Chronic kidney disease ( CKD ) in heart failure ( HF ) increases the risk of hyperkalaemia ( HK ) , limiting angiotensin‐converting enzyme inhibitor ( ACE‐I ) or angiotensin receptor blocker ( ARB ) use . Patiromer is a sodium‐free , non‐absorbed potassium binder approved for HK treatment . We retrospectively evaluated patiromer 's long‐term safety and efficacy in HF patients from AMETHYST‐DN BACKGROUND Hyperkalaemia is a commonly encountered problem in dialysis patients with end-stage renal disease ( ESRD ) . The aim of the present study was to assess the effect of fludrocortisone acetate ( FCA ) on reducing serum potassium levels in haemodialysis ( HD ) patients with hyperkalaemia . METHODS Prospect ively , 21 HD patients with hyperkalaemia were enrolled in this study . Patients were divided into two groups , including FCA ( 0.1 mg/d , n = 13 ) administration or no treatment ( control , n = 8) for 10 months . No changes in dialysis or drug regimens were made during this period . Result . There were no significant differences in the baseline characteristics and biochemical parameters between the two groups ( FCA therapy and control ) . At 10-months after FCA therapy , serum potassium levels were not significantly different between the treatment and control groups [ median value ( range ) : 5.2 ( 4.4 - 6.0 ) vs 5.8 ( 4.8 - 6.3 ) mEq/l , P = 0.121 ] . However , using the Wilcoxon signed ranks test , serum potassium levels were significantly lower at the end of the 10 month time period after FCA therapy compared with serum potassium levels of the pre-treatment period [ 5.2 ( 4.4 - 6.0 ) vs 6.1 ( 5.3 - 6.8 ) , P = 0.01 ] . The biochemical values , including sodium , chloride , protein , albumin , blood nitrogen , creatinine , interdialytic weight change and blood pressure , did not show significant difference in comparisons between the two groups and pre- and post-FCA therapy period . CONCLUSIONS FCA therapy appears to slightly decrease serum potassium value in hyperkalaemic HD patients . However , these results are insufficient to explain the effectiveness of FCA . Therefore , potentially large-scale studies with increased dose concentrations are needed to minimize the positive potassium balance in hyperkalaemic HD patients BACKGROUND AND OBJECTIVES Hyperkalemia affects up to 10 % of patients with CKD .  Sodium polystyrene sulfonate has long been prescribed for this condition , although evidence is lacking on its efficacy for the treatment of mild hyperkalemia over several days . This study aim ed to evaluate the efficacy of sodium polystyrene sulfonate in the treatment of mild hyperkalemia . DESIGN , SETTING , PARTICIPANTS , & MEASUREMENTS In total , 33 out patients with CKD and mild hyperkalemia ( 5.0 - 5.9 mEq/L ) in a single teaching hospital were included in this double-blind r and omized clinical trial . We r and omly assigned these patients to receive either placebo or sodium polystyrene sulfonate of 30 g orally one time per day for 7 days . The primary outcome was the comparison between study groups of the mean difference of serum potassium levels between the day after the last dose of treatment and baseline . RESULTS The mean duration of treatment was 6.9 days . Sodium polystyrene sulfonate was superior to placebo in the reduction of serum potassium levels ( mean difference between groups , -1.04 mEq/L ; 95 % confidence interval , -1.37 to -0.71 ) . A higher proportion of patients in the sodium polystyrene sulfonate group attained normokalemia at the end of their treatment compared with those in the placebo group , but the difference did not reach statistical significance ( 73 % versus 38 % ; P=0.07 ) . There was a trend toward higher rates of electrolytic disturbances and an increase in gastrointestinal side effects in the group receiving sodium polystyrene sulfonate . CONCLUSIONS Sodium polystyrene sulfonate was superior to placebo in reducing serum potassium over 7 days in patients with mild hyperkalemia and CKD BACKGROUND Previous small uncontrolled studies suggested that fludrocortisone may significantly decrease serum potassium concentrations in hemodialysis patients , possibly through enhancement of colonic potassium secretion . The aim of this study is to evaluate the effect of oral fludrocortisone on serum potassium concentrations in hyperkalemic hemodialysis patients in an open-label r and omized controlled trial . METHODS Thirty-seven hemodialysis patients with predialysis hyperkalemia were r and omly allocated to administration of either oral fludrocortisone ( 0.1 mg/d ; n = 18 ) or no treatment ( control ; n = 19 ) for 3 months . The primary outcome measure was midweek predialysis serum potassium concentration , which was measured monthly during the trial . Prospect i ve power calculations indicated that the study had an 80 % probability of detecting a decrease in serum potassium levels of 0.7 mEq/L ( 0.7 mmol/L ) . RESULTS Baseline patient characteristics were similar , except for slightly longer total weekly dialysis hours in the fludrocortisone group ( 13.0 + /- 1.3 versus 12.1 + /- 1.0 ; P = 0.02 ) . At the end of the study period , no significant changes in serum potassium concentrations were observed between the fludrocortisone and control groups ( 4.8 + /- 0.5 versus 5.2 + /- 0.7 mEq/L [ mmol/L ] , respectively ; P = 0.10 ) . Similar results were obtained when changes in serum potassium levels over time were examined between the 2 arms by using repeated- measures analysis of variance , with or without adjustment for total weekly dialysis hours . Secondary outcomes , including predialysis mean arterial pressure , interdialytic weight gain , serum sodium level , and hospitalization for hyperkalemia , were not significantly different between groups . There were no observed adverse events . CONCLUSION Administering fludrocortisone to hyperkalemic hemodialysis patients is safe and well tolerated , but does not achieve clinical ly important decreases in serum potassium levels Background : Hyperkalemia is a common medical emergency that may result in serious cardiac arrhythmias . St and ard therapy with insulin plus glucose reliably lowers the serum potassium concentration ( [ K+ ] ) but carries the risk of hypoglycemia 
    Output:
    
Sodium or calcium polystyrene sulfonate ( moderate confidence ) , sodium zirconium cyclosilicate ( moderate confidence ) , and insulin plus dextrose ( moderate confidence ) showed superior efficacy to , respectively , placebo , no treatment , placebo , and dextrose .
Other therapies ( low confidence ) showed similar efficacy compared to active or inactive alternatives .