TY - JOUR
T1 - Hyperkalemia after initiating renin-angiotensin system blockade
T2 - The Stockholm Creatinine Measurements (SCREAM) project
AU - Bandak, Ghassan
AU - Sang, Yingying
AU - Gasparini, Alessandro
AU - Chang, Alex R.
AU - Ballew, Shoshana H.
AU - Evans, Marie
AU - Arnlov, Johan
AU - Lund, Lars H.
AU - Inker, Lesley A.
AU - Coresh, Josef
AU - Carrero, Juan Jesus
AU - Grams, Morgan E.
N1 - Publisher Copyright:
© 2017 The Authors.
PY - 2017/7/1
Y1 - 2017/7/1
N2 - Background-Concerns about hyperkalemia limit the use of angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARBs), but guidelines conflict regarding potassium-monitoring protocols. We quantified hyperkalemia monitoring and risks after ACE-I/ARB initiation and developed and validated a hyperkalemia susceptibility score. Methods and Results-We evaluated 69 426 new users of ACE-I/ARB therapy in the Stockholm Creatinine Measurements (SCREAM) project with medication initiation from January 1, 2007 to December 31, 2010, and follow-up for 1 year thereafter. Three fourths (76%) of SCREAM patients had potassium checked within the first year. Potassium > 5 and > 5.5 mmol/L occurred in 5.6% and 1.7%, respectively. As a comparison, we propensity-matched new ACE-I/ARB users to 20 186 new b-blocker users in SCREAM: 64% had potassium checked. The occurrence of elevated potassium levels was similar between new b-blocker and ACEI/ ARB users without kidney disease; only at estimated glomerular filtration rate < 60 mL/min per 1.73 m2 were risks higher among ACE-I/ARB users. We developed a hyperkalemia susceptibility score that incorporated estimated glomerular filtration rate, baseline potassium level, sex, diabetes mellitus, heart failure, and the concomitant use of potassium-sparing diuretics in new ACE-I/ARB users; this score accurately predicted 1-year hyperkalemia risk in the SCREAM cohort (area under the curve, 0.845, 95% CI: 0.840- 0.869) and in a validation cohort from the US-based Geisinger Health System (N=19 524; area under the curve, 0.818, 95% CI: 0.794-0.841), with good calibration. Conclusions-Hyperkalemia within the first year of ACE-I/ARB therapy was relatively uncommon among people with estimated glomerular filtration rate > 60 mL/min per 1.73 m2, but rates were much higher with lower estimated glomerular filtration rate. Use of the hyperkalemia susceptibility score may help guide laboratory monitoring and prescribing strategies.
AB - Background-Concerns about hyperkalemia limit the use of angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARBs), but guidelines conflict regarding potassium-monitoring protocols. We quantified hyperkalemia monitoring and risks after ACE-I/ARB initiation and developed and validated a hyperkalemia susceptibility score. Methods and Results-We evaluated 69 426 new users of ACE-I/ARB therapy in the Stockholm Creatinine Measurements (SCREAM) project with medication initiation from January 1, 2007 to December 31, 2010, and follow-up for 1 year thereafter. Three fourths (76%) of SCREAM patients had potassium checked within the first year. Potassium > 5 and > 5.5 mmol/L occurred in 5.6% and 1.7%, respectively. As a comparison, we propensity-matched new ACE-I/ARB users to 20 186 new b-blocker users in SCREAM: 64% had potassium checked. The occurrence of elevated potassium levels was similar between new b-blocker and ACEI/ ARB users without kidney disease; only at estimated glomerular filtration rate < 60 mL/min per 1.73 m2 were risks higher among ACE-I/ARB users. We developed a hyperkalemia susceptibility score that incorporated estimated glomerular filtration rate, baseline potassium level, sex, diabetes mellitus, heart failure, and the concomitant use of potassium-sparing diuretics in new ACE-I/ARB users; this score accurately predicted 1-year hyperkalemia risk in the SCREAM cohort (area under the curve, 0.845, 95% CI: 0.840- 0.869) and in a validation cohort from the US-based Geisinger Health System (N=19 524; area under the curve, 0.818, 95% CI: 0.794-0.841), with good calibration. Conclusions-Hyperkalemia within the first year of ACE-I/ARB therapy was relatively uncommon among people with estimated glomerular filtration rate > 60 mL/min per 1.73 m2, but rates were much higher with lower estimated glomerular filtration rate. Use of the hyperkalemia susceptibility score may help guide laboratory monitoring and prescribing strategies.
KW - Angiotensin receptor blockers
KW - Angiotensin-converting enzyme inhibition
KW - Angiotensin-converting enzyme inhibitors
KW - Chronic kidney disease
KW - Hyperkalemia
KW - Potassium
KW - Risk score
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U2 - 10.1161/JAHA.116.005428
DO - 10.1161/JAHA.116.005428
M3 - Article
C2 - 28724651
AN - SCOPUS:85025428711
SN - 2047-9980
VL - 6
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 7
M1 - e005428
ER -