We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Diabetes and drug-associated hyperkalemia: effect of potassium monitoring.
- Authors
Raebel, Marsha; Ross, Colleen; Xu, Stanley; Roblin, Douglas; Cheetham, Craig; Blanchette, Christopher; Saylor, Gwyn; Smith, David H.; Raebel, Marsha A; Roblin, Douglas W; Blanchette, Christopher M
- Abstract
<bold>Background: </bold>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.<bold>Objective: </bold>To evaluate the association between potassium monitoring and serious hyperkalemia-associated adverse outcomes among patients with diabetes newly initiating RAAS inhibitor therapy.<bold>Design: </bold>Retrospective observational study.<bold>Participants: </bold>Patients with diabetes without end-stage renal disease initiating RAAS inhibitor therapy between 2001 and 2006 at three integrated health care systems.<bold>Measurements: </bold>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 >or=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.<bold>Results: </bold>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).<bold>Conclusions: </bold>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.
- Subjects
RENIN-angiotensin system; DIABETES; POTASSIUM in the body; PEOPLE with diabetes; KIDNEY diseases; INTEGRATED health care delivery; ALDOSTERONE antagonists; ACE inhibitors; CELL receptors; DRUG monitoring; ANTIHYPERTENSIVE agents; POISSON distribution; POTASSIUM; RESEARCH funding; SPIRONOLACTONE; RELATIVE medical risk; DISEASE incidence; RETROSPECTIVE studies; HYPERKALEMIA
- Publication
JGIM: Journal of General Internal Medicine, 2010, Vol 25, Issue 4, p326
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1007/s11606-009-1228-x