title: Prevalence of hyperkalemia in adult patients taking spironolactone and angiotensin converting enzyme inhibitors or angiotensin receptor blockers.
abstract: BACKGROUND
  Hyperkalemia is common when spironolactone and angiotensin converting enzyme inhibitors (ACEls) or angiotensin receptor blockers (ARBs) are combined.
  
  
  OBJECTIVE
  To determine the prevalence and risk factors of hyperkalemia in adult patients taking spironolactone and ACEls or ARBs.
  
  
  METHODS
  A retrospective descriptive study was conducted. Adult patients taking spironolactone and ACEls or ARBs who visited the outpatient department of Siriraj Hospital between January and December 2009 were included. Exclusion criteria were chronic kidney disease patients who had undergone dialysis and patients with hyperkalemia from other causes. The authors defined hyperkalemia as serum potassium of more than 5.0 mmol/L.
  
  
  RESULTS
  Five hundred thirty four patients were included during the study period. The prevalence of hyperkalemia was 11.2% (60 patients). The risk factors of hyperkalemia were chronic kidney disease (OR 2.47, 95% CI 1.07-5. 70), initial serum potassium level > 4.0 mmol/L (OR 2.65, 95% CI 1.44-4.88), and dosing of spironolactone more than 25 mg per day (OR 2.42, 95% CI 1.23-4.74).
  
  
  CONCLUSIONS
  The prevalence of hyperkalemia in adult patients taking spironolactone and ACEIs or ARBs is 11.2%. Risk of hyperkalemia is chronic kidney disease, high serum potassium, and high spironolactone use.
authors.affiliation: Department of Emergency Medicine, Siriraj Hospital, Bangkok, Thailand.
authors.forename: Usapan
authors.initials: U
authors.lastname: Surabenjawong
authors.forename: Nat
authors.initials: N
authors.lastname: Thunpiphat
authors.forename: Somruedee
authors.initials: S
authors.lastname: Chatsiricharoenkul
authors.forename: Apichaya
authors.initials: A
authors.lastname: Monsomboon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D004347:Drug Interactions; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013148:Spironolactone / Q000009:adverse effects* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone