title: Life-threatening hyperkalemia during a combined therapy with the angiotensin receptor blocker candesartan and spironolactone.
abstract: We describe a hypertensive nephrosclerosis patient presenting with severe hyperkalemia due to a combination therapy of the angiotensin receptor blocker (ARB) candesartan and spironolactone despite mildly decreased renal function. Recently, ARBs are replacing the ACE inhibitors. The combined therapy with ARB and spironolactone will eventually become the standard regimen. The strict attention and close monitoring of serum potassium should be mandatory in combination therapy to prevent hyperkalemia. Assessment of trans-tubular potassium gradient (TTKG) and fractional excretion of potassium (FEK) before starting the therapy would help in identifying the patients at higher risk of developing hyperkalemia. Co-administration of thiazide or loop diuretics is recommended to reduce the risk of hyperkalemia.
authors.affiliation: Division of Hypertension and Nephrology, National Cardiovascular Center, Suita, Osaka, Japan. hideki-f@tg7.so-net.ne.jp
authors.forename: Hideki
authors.initials: H
authors.lastname: Fujii
authors.forename: Hajime
authors.initials: H
authors.lastname: Nakahama
authors.forename: Fumiki
authors.initials: F
authors.lastname: Yoshihara
authors.forename: Satoko
authors.initials: S
authors.lastname: Nakamura
authors.forename: Takashi
authors.initials: T
authors.lastname: Inenaga
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Kawano
mesh_terms: D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage / Q000009:adverse effects*; D001562:Benzimidazoles / Q000008:administration & dosage / Q000009:adverse effects*; D001713:Biphenyl Compounds; D004232:Diuretics / Q000008:administration & dosage / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced*; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008875:Middle Aged; D009400:Nephrosclerosis / Q000150:complications / Q000188:drug therapy*; D013148:Spironolactone / Q000008:administration & dosage / Q000009:adverse effects*; D013777:Tetrazoles / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D004232:Diuretics; D013777:Tetrazoles; D013148:Spironolactone; C081643:candesartan