Diabetes and drug-associated hyperkalemia: effect of potassium monitoring.
BACKGROUND
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.


OBJECTIVE
To evaluate the association between potassium monitoring and serious hyperkalemia-associated adverse outcomes among patients with diabetes newly initiating RAAS inhibitor therapy.


METHODS
Retrospective observational study.


METHODS
Patients with diabetes without end-stage renal disease initiating RAAS inhibitor therapy between 2001 and 2006 at three integrated health care systems.


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Raebel
Marsha A
MA
Kaiser Permanente Colorado Institute for Health Research, Denver, CO 80237, USA. Marsha.A.Raebel@kp.org
Ross
Colleen
C
Xu
Stanley
S
Roblin
Douglas W
DW
Cheetham
Craig
C
Blanchette
Christopher M
CM
Saylor
Gwyn
G
Smith
David H
DH
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D000959:Antihypertensive Agents / Q000009:adverse effects*; D003920:Diabetes Mellitus; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000009:adverse effects; D016012:Poisson Distribution; D011188:Potassium / Q000097:blood*; D011945:Receptors, Angiotensin / Q000187:drug effects; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D013148:Spironolactone / Q000009:adverse effects*
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D000451:Mineralocorticoid Receptor Antagonists; D011945:Receptors, Angiotensin; D013148:Spironolactone; D011188:Potassium