ArticleCureus2026
Bradycardia, Renal Dysfunction, Atrioventricular Node Blockade, Shock, and Hyperkalemia (BRASH) Syndrome: Clinical Features, Outcomes, and Therapeutic Implications.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionBRASH 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.
methodsWe 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.
resultsFifty-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%.
conclusionsEarly 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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