Renin-angiotensin system blockade is not associated with hyperkalemia in chronic hemodialysis patients.
BACKGROUND
Serious hyperkalemia was reported in 10% of chronic hemodialysis (HD) patients that could lead to arrhythmia and death. Angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARB) are well accepted for cardio-protective benefits. The relationship between renin-angiotensin system blockade (RASB) and hyperkalemia in chronic HD patients remains controversial. The aim of this study was to find the relationship between RASB and hyperkalemia in these patients.


METHODS
Pre-dialysis serum potassium, clinical factors, and drugs were evaluated in 200 chronic HD patients in one HD center. Hyperkalemia was defined as serum K >or= 5.3 meq/L. Finally, multivariate analysis with logistic regression was used to evaluate the risk of hyperkalemia by RASB and other factors.


RESULTS
In 200 patients, the mean K was 4.93 +/- 0.79 meq/L, and 70 (35%) patients had hyperkalemia. Fifty-eight (29%) patients were prescribed with RASB. Seven variables--non-DM, longer HD duration, lower dialysate calcium, lower serum glucose, higher serum iPTH, not using RASB, and not using furosemide--were more frequent in hyperkalemia group. In logistic regression analysis, RASB was associated with decreased odds for hyperkalemia (OR 0.262, p = 0.001 in model A; OR 0.205, p = 0.001 in model B). In addition, furosemide was associated with decreased odds for hyperkalemia (OR 0.068, p = 0.022 in model B).


CONCLUSIONS
RASB is not associated with hyperkalemia in chronic HD patients.
Lin
Hsin-Hung
HH
Department of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan.
Yang
Ya-Fei
YF
Chang
Ju-Kuang
JK
Ting
I-Wen
IW
Kuo
Huey-Liang
HL
Wang
I-Kuan
IK
Huang
Chiu-Ching
CC
D000328:Adult; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced*; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012084:Renin-Angiotensin System
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors