[Hyperkalemia during prolonged use of angiotensin II-converting enzyme inhibitors in end-stage renal insufficiency].
Hyperkalemia is a severe complication of end-stage renal failure. To evaluate whether ACE inhibitors may even worsen the propensity to develop hyperkalemia in this condition, we have analyzed retrospectively pre-dialytic blood pressure and serum potassium in 15 patients on chronic hemodialysis before and during long-term ACE inhibition. This treatment induced a significant drop in blood pressure (from 173 +/- 3/90 +/- 2 to 159 +/- 5/85 +/- 2 mm Hg [p < 0.05]), whereas serum potassium increased from 4.9 +/- 0.2 to 5.5 +/- 0.2 mM (p < 0.05), irrespective of the dosage of ACE inhibitor and of the residual diuresis. Hyperkalemia was well tolerated and was corrected in all patients by dialysis; treatment was discontinued in only one case. In conclusion, ACE inhibitors represent effective antihypertensive treatment in end-stage renal failure. However, long-term ACE inhibition may be accompanied by a worsening of hyperkalemia, which could be accounted for by a reduced effect of aldosterone on extrarenal potassium homeostasis.
Mooser
V
V
Clinique de médecine interne, Hôpital cantonal, Fribourg.
Fellay
G
G
Regamey
C
C
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced*; D007676:Kidney Failure, Chronic / Q000188:drug therapy / Q000628:therapy*; D011188:Potassium / Q000097:blood; D006435:Renal Dialysis; D012189:Retrospective Studies
D000806:Angiotensin-Converting Enzyme Inhibitors; D011188:Potassium
Hyperkaliémie lors d'inhibition prolongée de l'enzyme de conversion de l'angiotensine II dans l'insuffisance rénale terminale.