Incidence of risk factors for developing hyperkalemia when using ACE inhibitors in cardiovascular diseases
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Study objective To determine the incidence of and the risk factors associated with hyperkalemia, induced by ACEI–drug interactions among cardiac patients. Setting Five medical and cardiology wards of a tertiary care center in Malaysia. Subjects Five hundred cardiac inpatients, who received ACEIs concomitantly with other interacting drugs. Method This was a prospective cohort study of 500 patients with cardiovascular diseases admitted to Penang Hospital between January to August 2006, who received ACEIs concomitantly with other interacting drugs. ACEI–drug interactions of clinical significance were identified using available drug information resources. Drug Interaction Probability Scale (DIPS) was used to assess the causality of association between ACEI–drug interactions and the adverse outcome (hyperkalemia). Main outcome measure Hyperkalemia as an adverse clinical outcome of the interaction was identified from laboratory investigations. Results Of the 489 patients included in the analysis, 48 (9.8%) had hyperkalemia thought to be associated with ACEI–drug interactions. Univariate analysis using binary logistic regression revealed that advanced age (60 years or more), and taking more than 15 medications were independent risk factors significantly associated with hyperkalemia. However, current and previous smoking history appeared to be a protective factor. Risk factors identified as predictors of hyperkalemia secondary to ACEI–drug interactions by multi-logistic regression were: advanced age (adjusted OR 2.3, CI 1.07–5.01); renal disease (adjusted OR 4.7, CI 2.37–9.39); hepatic disease (adjusted OR 5.2, CI 1.08–25.03); taking 15–20 medications (adjusted OR 4.4, CI 2.08–9.19); and taking 21–26 medications (adjusted OR 9.0, CI 1.64–49.74). Conclusion Cardiac patients receiving ACEIs concomitantly with potentially interacting drugs are at high risk of experiencing hyperkalemia. Old age, renal disease, hepatic disease, and receiving large number of medications are factors that may significantly increase their vulnerability towards this adverse outcome; thus, frequent monitoring is advocated.
KeywordsACE-inhibitors Drug–drug interactions Hyperkalemia Incidence Risk factors
We thank the Ministry of Health, Khartoum State, Sudan for awarding the scholarship for this research. We also thank the Khartoum Medical Insurance Services Corporation, Khartoum State and the staff of pharmacy department, medical and cardiology wards at Penang Hospital, Malaysia for their cooperation.
Conflicts of interest
None to declare.
- 5.RALES Investigators. Effectiveness of spironolactone added to an angiotensin-converting enzyme inhibitor and a loop diuretic for severe chronic congestive heart failure (the randomized aldactone evaluation study, RALES). Am J Cardiol. 1996;78(6):902–7.Google Scholar
- 8.Saito M, Takada M, Hirooka K, Isobe F, Yasumura Y. Serum concentration of potassium in chronic heart failure patients administered spironolactone plus furosemide and either enalapril maleate, losartan potassium or candesartan cilexetil. J Clin Pharm Ther. 2005;30(6):603–10. doi: 10.1111/j.1365-2710.2005.00694.x.PubMedCrossRefGoogle Scholar
- 13.Chan LN, Horn JR. Management of metabolic drug interactions. In: Carter BL, Lake KD, Raebel MA, Bertch KE, Israel MK, Jermain DM, et al., editors. Pharmacotherapy Self-Assessment Program (PSAP). 3rd ed. Module 8. USA: ACCP; 2000. p. 102.Google Scholar
- 14.Hansten PD, Horn JR. Managing clinically important drug interactions. USA: Wolter Kluwer Health, Inc; 2005.Google Scholar
- 15.Lacy CF, Armstrong LL, Goldman MP, Lance LL. Drug information handbook international. 14th ed. Hudson, Ohlo: Lexi-Comp Inc; 2006.Google Scholar
- 16.British National Formulary (BNF). Britain, R. P. S. O. G. 54th ed. London: BMJ Publishing Group Ltd and RPS Publishing; 2007.Google Scholar
- 17.Field A. Discovering statistics using SPSS. London: SAGE Publications Ltd; 2005. p. 208.Google Scholar
- 27.De Denus S, Tardif J, White M, Bourassa MG, Racine N, Levesque S, et al. Quantification of the risk and predictors of hyperkalemia in patients with left ventricular dysfunction: a retrospective analysis of the studies of left ventricular dysfunction (SOLVD) trials. Am Heart J. 2006;152(4):705–12. doi: 10.1016/j.ahj.2006.05.030.PubMedCrossRefGoogle Scholar
- 28.Horn H. Hyperkalemia due to drug interactions. Pharm Times. 2004; www.hanstenandhorn.com. Accessed 28 Aug 2008.