Journal of General Internal Medicine

, Volume 25, Issue 4, pp 326–333

Diabetes and Drug-Associated Hyperkalemia: Effect of Potassium Monitoring

  • Marsha A. Raebel
  • Colleen Ross
  • Stanley Xu
  • Douglas W. Roblin
  • Craig Cheetham
  • Christopher M. Blanchette
  • Gwyn Saylor
  • David H. Smith
Original Article

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

hyperkalemia hyperpotassemia angiotensin-converting enzyme inhibitor ACEi angiotensin receptor blocker ARB spironolactone RAAS inhibitor 

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Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Marsha A. Raebel
    • 1
    • 2
    • 3
  • Colleen Ross
    • 1
  • Stanley Xu
    • 1
  • Douglas W. Roblin
    • 3
    • 4
  • Craig Cheetham
    • 3
    • 5
  • Christopher M. Blanchette
    • 6
    • 7
    • 8
  • Gwyn Saylor
    • 1
  • David H. Smith
    • 3
    • 9
  1. 1.Kaiser Permanente Colorado Institute for Health ResearchDenverUSA
  2. 2.School of PharmacyUniversity of Colorado at DenverDenverUSA
  3. 3.HMO Research Network Center for Education and Research in Therapeutics (CERTs)BostonUSA
  4. 4.Kaiser Permanente Center for Health ResearchAtlantaUSA
  5. 5.Pharmacy Analytic ServicesKaiser Permanente Southern CaliforniaDowneyUSA
  6. 6.Lovelace Respiratory Research InstituteKannapolisUSA
  7. 7.School of PharmacyUniversity of North Carolina at Chapel HillChapel HillUSA
  8. 8.Salisbury VAMCSalisburyUSA
  9. 9.Kaiser Permanente Center for Health ResearchPortlandUSA

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