title: Onset time of hyperkalaemia after angiotensin receptor blocker initiation: when should we start serum potassium monitoring?
abstract: OBJECTIVE
  Angiotensin receptor blockers (ARBs) frequently induce hyperkalaemia in high-risk patients. Early detection of hyperkalaemia can reduce the subsequent harmful effects. This study was performed to examine the onset time of hyperkalaemia after ARB therapy.
  
  
  METHODS
  We carried out a retrospective analysis to determine the onset time of hyperkalaemia (serum potassium >5·5 mm) among hospitalized patients newly starting ARB therapy between 2004 and 2012, in a tertiary teaching hospital. Predefined possible risk factors and concomitant medications were evaluated.
  
  
  CONCLUSIONS
  During the 97-month study period, a total of 4267 hospitalized patients started ARBs as new drugs and 225 patients showed hyperkalaemia. A significantly increased risk of hyperkalaemia was detected among patients with a high baseline potassium [odds ratio (OR) 6·0] and those who took non-potassium-sparing diuretics (OR 2·2) or potassium supplements (OR 1·6). A high glomerular filtration rate (GFR) was associated with a lower risk of hyperkalaemia (OR 0·992). Fifty-two percentage of hyperkalaemic events occurred within the first week after initiation of ARB therapy. The highest frequency of hyperkalaemia occurred on the first day after initiation of ARBs. Hyperkalaemia occurred earlier in patients with a high baseline serum potassium level, reduced GFR, diabetes and in those without heart failure.
  
  
  CONCLUSIONS
  Hyperkalaemia occurs most frequently at the beginning of ARB therapy in hospitalized patients. Monitoring of serum potassium and estimated GFR after initiation of ARBs should be started within a few days or not later than 1 week, especially in patients with risk factors.
authors.affiliation: Department of Nephrology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: I-W
authors.initials: IW
authors.lastname: Park
authors.forename: S S
authors.initials: SS
authors.lastname: Sheen
authors.forename: D
authors.initials: D
authors.lastname: Yoon
authors.forename: S-H
authors.initials: SH
authors.lastname: Lee
authors.forename: G-T
authors.initials: GT
authors.lastname: Shin
authors.forename: H
authors.initials: H
authors.lastname: Kim
authors.forename: R W
authors.initials: RW
authors.lastname: Park
mesh_terms: D057911:Angiotensin Receptor Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006333:Heart Failure / Q000097:blood; D006801:Humans; D006947:Hyperkalemia / Q000097:blood* / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood*; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors
chemical_list: D057911:Angiotensin Receptor Antagonists; D011188:Potassium
keywords: adverse effects; angiotensin receptor blockers; hyperkalaemia; potassium