Risk of hyperkalemia in nondiabetic patients with chronic kidney disease receiving antihypertensive therapy.

Full Abstract

BACKGROUND: The incidence and factors associated with hyperkalemia in patients with chronic kidney disease (CKD) treated with angiotensin converting enzyme inhibitors (ACEIs) and other antihypertensive drugs was investigated using the African American Study of Kidney Disease and Hypertension (AASK) database. METHODS: A total of 1094 nondiabetic adults with hypertensive CKD (glomerular filtration rate [GFR], 20-65 mL/min/1.73 m(2)) were followed for 3.0 to 6.4 years in the AASK trial. Participants were randomly assigned to ACEI, beta-blocker (BB), or dihydropyridine calcium channel blocker (CCB). The outcome variables for this analysis were a serum potassium level higher than 5.5 mEq/L (to convert to millimoles per liter, multiply by 1.0), or a clinical center initiated hyperkalemia stop point. RESULTS: A total of 6497 potassium measurements were obtained, and 80 events in 51 subjects were identified (76 events driven by a central laboratory result and 4 driven by a clinical center-initiated hyperkalemia stop point). Compared with a GFR higher than 50 mL/min/1.73 m(2), after multivariable adjustment, the hazard ratio (HR) for hyperkalemia in patients with a GFR between 31 and 40 mL/min/1.73 m(2) and a GFR lower than 30 mL/min/1.73 m(2) was 3.61 (95% confidence interval [CI], 1.42-9.18 [P = .007]) and 6.81 (95% CI, 2.67-17.35 [P < .001]), respectively; there was no increased risk of hyperkalemia if GFR was 41 to 50 mL/min/1.73 m(2). Use of ACEIs was associated with more episodes of hyperkalemia compared with CCB use (HR, 7.00; 95% CI, 2.29-21.39 [P < .001]) and BB group (HR, 2.85; 95% CI, 1.50-5.42 [P = .001]). Diuretic use was associated with a 59% decreased risk of hyperkalemia. CONCLUSIONS: In nondiabetic patients with hypertensive CKD treated with ACEIs, the risk of hyperkalemia is small, particularly if baseline and follow-up GFR is higher than 40 mL/min/1.73 m(2). Including a diuretic in the regimen may markedly reduce risk of hyperkalemia.

Author information

Author/s: Weinberg, Joy M (JM); Appel, Lawrence J (LJ); Bakris, George (G); Gassman, Jennifer J (JJ); Greene, Tom (T); Kendrick, Cynthia A (CA); Wang, Xuelei (X); Lash, James (J); Lewis, Julia A (JA); Pogue, Velvie (V); Thornley-Brown, Denyse (D); Phillips, Robert A (RA); African American Study of Hypertension and Kidney Disease Collaborative Research Group;

Affiliation: Nephrology Division, Lenox Hill Hospital, New York, New York, USA.

Grants: 5U01 DK48689 (Agency:NIDDK NIH HHS)

Journal and publication information

Publication Type: Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't

Journal: Archives of internal medicine (Arch Intern Med), published in United States. (Language: eng)

Reference: 2009-Sep; vol 169 (issue 17) : pp 1587-94

Dates: Created 2009/09/29; Completed 2009/10/15;

PMID: 19786678, status: MEDLINE (last retrieval date: 10/15/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Humans
Hyperkalemia - blood; epidemiology
Hypertension - drug therapy; epidemiology
Incidence
Male
Middle Aged
Potassium - blood
Renal Insufficiency, Chronic - diagnosis; drug therapy; epidemiology
Risk Assessment
Risk Factors
Treatment Outcome
Young Adult

Associated Chemicals: Adrenergic beta-Antagonists (0) ; Angiotensin-Converting Enzyme Inhibitors (0) ; Antihypertensive Agents (0) ; Calcium Channel Blockers (0) ; Potassium (7440-09-7)

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