European Journal of Clinical Pharmacology

, Volume 70, Issue 2, pp 215–223 | Cite as

Patient- and physician-related risk factors for hyperkalaemia in potassium-increasing drug–drug interactions

  • Emmanuel EschmannEmail author
  • Patrick E. Beeler
  • Vladimir Kaplan
  • Markus Schneemann
  • Gregor Zünd
  • Jürg Blaser
Pharmacoepidemiology and Prescription



Hyperkalaemia due to potassium-increasing drug–drug interactions (DDIs) is a clinically important adverse drug event. The purpose of this study was to identify patient- and physician-related risk factors for the development of hyperkalaemia.


The risk for adult patients hospitalised in the University Hospital Zurich between 1 December 2009 and 31 December 2011 of developing hyperkalaemia was correlated with patient characteristics, number, type and duration of potassium-increasing DDIs and frequency of serum potassium monitoring.


The 76,467 patients included in this study were prescribed 8,413 potentially severe potassium-increasing DDIs. Patient-related characteristics associated with the development of hyperkalaemia were pulmonary allograft [relative risk (RR) 5.1; p < 0.0001), impaired renal function (RR 2.7; p < 0.0001), diabetes mellitus (RR 1.6; p = 0.002) and female gender (RR 1.5; p = 0.007). Risk factors associated with medication were number of concurrently administered potassium-increasing drugs (RR 3.3 per additional drug; p < 0.0001) and longer duration of the DDI (RR 4.9 for duration ≥6 days; p < 0.0001). Physician-related factors associated with the development of hyperkalaemia were undetermined or elevated serum potassium level before treatment initiation (RR 2.2; p < 0.001) and infrequent monitoring of serum potassium during a DDI (interval >48 h: RR 1.6; p < 0.01).


Strategies for reducing the risk of hyperkalaemia during potassium-increasing DDIs should consider both patient- and physician-related risk factors.


Drug–drug interactions Hyperkalaemia Monitoring Potassium Risk factors 


Disclosure of conflict of interests


Supplementary material

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Emmanuel Eschmann
    • 1
    Email author
  • Patrick E. Beeler
    • 1
  • Vladimir Kaplan
    • 2
  • Markus Schneemann
    • 3
  • Gregor Zünd
    • 4
  • Jürg Blaser
    • 1
  1. 1.Research Centre for Medical Informatics, Directorate of Research and EducationUniversity Hospital ZurichZurichSwitzerland
  2. 2.Division of Internal MedicineKreisspital für das Freiamt MuriMuriSwitzerland
  3. 3.Division of Internal MedicineUniversity Hospital ZurichZurichSwitzerland
  4. 4.Directorate of Research and EducationUniversity Hospital ZurichZurichSwitzerland

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