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Onset time of hyperkalaemia after angiotensin receptor blocker initiation: when should we start serum potassium monitoring?

Authors

  • I.-W. Park MD PhD,

    1. Department of Nephrology, Ajou University School of Medicine, Suwon, Korea
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    • The first two authors contributed equally to this work.
  • S. S. Sheen MD PhD,

    1. Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea
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    • The first two authors contributed equally to this work.
  • D. Yoon MD MS,

    1. Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
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  • S.-H. Lee PharmD PhD,

    1. College of Pharmacy, Ajou University, Suwon, Korea
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  • G.-T. Shin MD FASN,

    1. Department of Nephrology, Ajou University School of Medicine, Suwon, Korea
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  • H. Kim MD PhD,

    1. Department of Nephrology, Ajou University School of Medicine, Suwon, Korea
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  • R. W. Park MD PhD

    Corresponding author
    1. Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
    2. Center for Clinical Epidemiology, and Biostatistics, and Department of Biostatistics & Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
    3. Center for Pharmacoepidemiololgy Research and Training, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
    • Correspondence: Rae Woong Park, Department of Biomedical Informatics, Ajou University School of Medicine, Wonchon-dong, Yeongtong-gu, Suwon, Gyeonggi-do 442-749, Korea.

      and

      Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics & Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA. Tel.: +82-31-219-4471; fax: +82-31-219-4472; e-mail: veritas@ajou.ac.kr

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Summary

What is known and objective

Angiotensin receptor blockers (ARBs) frequently induce hyperkalaemia in high-risk patients. Early detection of hyperkalaemia can reduce the subsequent harmful effects. This study was performed to examine the onset time of hyperkalaemia after ARB therapy.

Methods

We carried out a retrospective analysis to determine the onset time of hyperkalaemia (serum potassium >5·5 mm) among hospitalized patients newly starting ARB therapy between 2004 and 2012, in a tertiary teaching hospital. Predefined possible risk factors and concomitant medications were evaluated.

Results and discussion

During the 97-month study period, a total of 4267 hospitalized patients started ARBs as new drugs and 225 patients showed hyperkalaemia. A significantly increased risk of hyperkalaemia was detected among patients with a high baseline potassium [odds ratio (OR) 6·0] and those who took non-potassium-sparing diuretics (OR 2·2) or potassium supplements (OR 1·6). A high glomerular filtration rate (GFR) was associated with a lower risk of hyperkalaemia (OR 0·992). Fifty-two percentage of hyperkalaemic events occurred within the first week after initiation of ARB therapy. The highest frequency of hyperkalaemia occurred on the first day after initiation of ARBs. Hyperkalaemia occurred earlier in patients with a high baseline serum potassium level, reduced GFR, diabetes and in those without heart failure.

What is new and conclusion

Hyperkalaemia occurs most frequently at the beginning of ARB therapy in hospitalized patients. Monitoring of serum potassium and estimated GFR after initiation of ARBs should be started within a few days or not later than 1 week, especially in patients with risk factors.

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