Journal of General Internal Medicine

, Volume 25, Issue 4, pp 326–333

Diabetes and Drug-Associated Hyperkalemia: Effect of Potassium Monitoring

Authors

    • Kaiser Permanente Colorado Institute for Health Research
    • School of PharmacyUniversity of Colorado at Denver
    • HMO Research Network Center for Education and Research in Therapeutics (CERTs)
  • Colleen Ross
    • Kaiser Permanente Colorado Institute for Health Research
  • Stanley Xu
    • Kaiser Permanente Colorado Institute for Health Research
  • Douglas W. Roblin
    • HMO Research Network Center for Education and Research in Therapeutics (CERTs)
    • Kaiser Permanente Center for Health Research
  • Craig Cheetham
    • HMO Research Network Center for Education and Research in Therapeutics (CERTs)
    • Pharmacy Analytic ServicesKaiser Permanente Southern California
  • Christopher M. Blanchette
    • Lovelace Respiratory Research Institute
    • School of PharmacyUniversity of North Carolina at Chapel Hill
    • Salisbury VAMC
  • Gwyn Saylor
    • Kaiser Permanente Colorado Institute for Health Research
  • David H. Smith
    • HMO Research Network Center for Education and Research in Therapeutics (CERTs)
    • Kaiser Permanente Center for Health Research
Original Article

DOI: 10.1007/s11606-009-1228-x

Cite this article as:
Raebel, M.A., Ross, C., Xu, S. et al. J GEN INTERN MED (2010) 25: 326. doi:10.1007/s11606-009-1228-x

Abstract

BACKGROUND

Renin-angiotensin-aldosterone system (RAAS) inhibitors are associated with hyperkalemia, but there is little evidence demonstrating patients who receive potassium monitoring have a lower rate of hyperkalemia.

OBJECTIVE

To evaluate the association between potassium monitoring and serious hyperkalemia-associated adverse outcomes among patients with diabetes newly initiating RAAS inhibitor therapy.

DESIGN

Retrospective observational study.

PARTICIPANTS

Patients with diabetes without end-stage renal disease initiating RAAS inhibitor therapy between 2001 and 2006 at three integrated health care systems.

MEASUREMENTS

Potassium monitoring and first hyperkalemia-associated adverse event during the initial year of therapy. Hyperkalemia-associated adverse events included hospitalizations, emergency department visits or deaths within 24 h of hyperkalemia diagnosis and/or diagnostic potassium ≥6 mmol/l. Incidence rates were calculated in person-years (p-y). We used inverse probability propensity score weighting to adjust for differences between patients with and without monitoring; Poisson regression was used to obtain adjusted relative risks.

RESULTS

A total of 19,391 of 27,355 patients (71%) received potassium monitoring. Serious hyperkalemia-associated events occurred at an incidence rate of 10.2 per 1,000 p-y. Compared to patients without monitoring, adjusted relative risk of hyperkalemia-associated adverse events among all patients with monitoring was 0.50 (0.37, 0.66); in the subset of patients who also had chronic kidney disease (n = 2,176), adjusted relative risk was 0.29 (0.18, 0.46).

CONCLUSIONS

Patients prescribed RAAS inhibitors who have both diabetes and chronic kidney disease and receive potassium monitoring are less likely to experience a serious hyperkalemia-associated adverse event compared to similar patients who did not receive potassium monitoring. This evidence supports existing consensus-based guidelines.

KEY WORDS

hyperkalemiahyperpotassemiaangiotensin-converting enzyme inhibitorACEiangiotensin receptor blockerARBspironolactoneRAAS inhibitor

Copyright information

© Society of General Internal Medicine 2010