Hyperkalemia and renal function during monotherapy and dual renin-angiotensin blockade in the community setting.

Abstract

BACKGROUND:

In controlled trials, dual therapy with angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARBs) is associated with hyperkalemia and decreased renal function, but there is no information about these adverse effects in clinical practice.

OBJECTIVE:

The aim of this study was to assess the incidence of hyperkalemia and decreased renal function during dual therapy (ACE-I plus ARB) in a community-based setting.

METHODS:

In a retrospective cohort database study, we identified patients who received ARBs added to ongoing ACE-I therapy and who had at least 1 measurement of serum creatinine and potassium during each treatment period. We compared rates of hyperkalemia (>5.5 mmol/L) during equal periods of monotherapy and dual therapy and the rate of a significant rise in serum creatinine (≥0.5 mg/dL) between study periods. We assessed the impact of potential confounders on outcomes by logistic regression analysis.

RESULTS:

Among 425 patients (median follow-up 19 months for each treatment period), hyperkalemia was 2-fold more common during dual therapy than monotherapy (11.1% and 5.6% of patients, respectively) (relative risk = 1.96; 95% CI, 1.22-3.14; P < 0.001). In 77 patients with reduced renal function on monotherapy (serum creatinine ≥1.5 mg/dL), the rate of hyperkalemia was 20.8/100 patient-years, resulting in a number needed to harm of 10.1 patients, compared with 52.6 patients among those with preserved renal function. Mean serum creatinine between treatment periods increased >0.5 mg/dL in 7.5% of patients, more commonly in patients with decreased (18.2%) than with preserved (5.2%) baseline renal function (P < 0.001).

CONCLUSION:

In the community setting, dual therapy was associated with hyperkalemia and a decrease in renal function. The absolute risks were especially high among patients with reduced baseline renal function.

• Authors: Daniel Kurnik, Janet Vesterman-Landes, Martin Bialik, Itzhak Katzir, Yosef Lomnicky, Hillel Halkin, Ronen Loebstein
• Journal: Clinical therapeutics (Clin Ther) Vol. 33 Issue 4 Pg. 456-64 (Apr 2011) ISSN: 1879-114X [Electronic] United States
• PMID: 21635991 (Publication Type: Journal Article)
• Copyright: Copyright © 2011 Elsevier HS Journals, Inc. All rights reserved.

Chemical References

• Angiotensin Receptor Antagonists
• Angiotensin-Converting Enzyme Inhibitors
• Creatinine

Topics

• Adult
• Aged
• Aged, 80 and over
• Angiotensin Receptor Antagonists (administration & dosage, adverse effects)
• Angiotensin-Converting Enzyme Inhibitors (administration & dosage, adverse effects)
• Cohort Studies
• Creatinine (blood)
• Databases, Factual
• Drug Therapy, Combination
• Female
• Follow-Up Studies
• Humans
• Hyperkalemia (chemically induced, epidemiology)
• Kidney Diseases (chemically induced, epidemiology)
• Logistic Models
• Male
• Middle Aged
• Renin-Angiotensin System (drug effects)
• Retrospective Studies