Effect of angiotensin converting enzyme inhibitors and angiotensin receptor blockers on serum potassium levels and renal function in ambulatory outpatients

Risk factors analysis

Supriya Khan, Akram Khan, Andrea Vincent, Kai Lau

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: Angiotensin II inhibition with angiotensin converting enzyme inhibitors (ACEinh) and angiotensin receptor blockers (ARB) has reno- and cardioprotective effects but can also cause acute renal insufficiency and/or hyperkalemia. Study Design: A retrospective analysis was performed in an ambulatory population, to define the incidence and risk factors for hyperkalemia in ACEinh/ARB naïve patients. Setting and Participants: Records of patients from 10 Oklahoma regional VA outpatient facilities, in whom ACEinh/ARB was initiated from January 2000 to May 2004, were reviewed. Diabetes mellitus, estimated glomerular filtration rate (eGFR), in mL/min/1.73 m2, according to the KDOQI guidelines for chronic kidney disease (CKD), and concurrent medications were recorded. Results: ACEinh/ARB were well tolerated in unselected consecutive ACEinh/ARB naïve patients with baseline serum potassium (sK) ≤5.0 mEq/L in a general ambulatory population with 2.5% (23) of 931 developing hyperkalemia (sK ≥5.5 mEq/L). sK ≥6 mEq/L was seen in 5.0 mEq/L also tolerated ACEinh/ARB with 7.5% (3/40) developing sK >6.0 mEq/L. Diabetes mellitus did not affect the incidence of hyperkalemia independent of CFR. Conclusions: Although generally safe, ACEinh/ ARB poses a small risk for hyperkalemia in patients with reduced CFR. Because the propensity is incremental with declining CFR, these agents should be used with caution in advancing stages of CKD. Presence of diabetes does not affect the development of hyperkalemia.

Original languageEnglish (US)
Pages (from-to)330-335
Number of pages6
JournalAmerican Journal of the Medical Sciences
Volume336
Issue number4
DOIs
StatePublished - Oct 2008
Externally publishedYes

Fingerprint

Angiotensin Receptor Antagonists
Hyperkalemia
Angiotensin-Converting Enzyme Inhibitors
Statistical Factor Analysis
Potassium
Outpatients
Kidney
Serum
Chronic Renal Insufficiency
Diabetes Mellitus
Incidence
Glomerular Filtration Rate
Acute Kidney Injury
Angiotensin II
Population
Guidelines

Keywords

  • ACE
  • Angiotensin II type 1 receptor blockers
  • Hyperkalemia
  • Inhibitors
  • Renal failure

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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title = "Effect of angiotensin converting enzyme inhibitors and angiotensin receptor blockers on serum potassium levels and renal function in ambulatory outpatients: Risk factors analysis",
abstract = "Background: Angiotensin II inhibition with angiotensin converting enzyme inhibitors (ACEinh) and angiotensin receptor blockers (ARB) has reno- and cardioprotective effects but can also cause acute renal insufficiency and/or hyperkalemia. Study Design: A retrospective analysis was performed in an ambulatory population, to define the incidence and risk factors for hyperkalemia in ACEinh/ARB na{\"i}ve patients. Setting and Participants: Records of patients from 10 Oklahoma regional VA outpatient facilities, in whom ACEinh/ARB was initiated from January 2000 to May 2004, were reviewed. Diabetes mellitus, estimated glomerular filtration rate (eGFR), in mL/min/1.73 m2, according to the KDOQI guidelines for chronic kidney disease (CKD), and concurrent medications were recorded. Results: ACEinh/ARB were well tolerated in unselected consecutive ACEinh/ARB na{\"i}ve patients with baseline serum potassium (sK) ≤5.0 mEq/L in a general ambulatory population with 2.5{\%} (23) of 931 developing hyperkalemia (sK ≥5.5 mEq/L). sK ≥6 mEq/L was seen in 5.0 mEq/L also tolerated ACEinh/ARB with 7.5{\%} (3/40) developing sK >6.0 mEq/L. Diabetes mellitus did not affect the incidence of hyperkalemia independent of CFR. Conclusions: Although generally safe, ACEinh/ ARB poses a small risk for hyperkalemia in patients with reduced CFR. Because the propensity is incremental with declining CFR, these agents should be used with caution in advancing stages of CKD. Presence of diabetes does not affect the development of hyperkalemia.",
keywords = "ACE, Angiotensin II type 1 receptor blockers, Hyperkalemia, Inhibitors, Renal failure",
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T1 - Effect of angiotensin converting enzyme inhibitors and angiotensin receptor blockers on serum potassium levels and renal function in ambulatory outpatients

T2 - Risk factors analysis

AU - Khan, Supriya

AU - Khan, Akram

AU - Vincent, Andrea

AU - Lau, Kai

PY - 2008/10

Y1 - 2008/10

N2 - Background: Angiotensin II inhibition with angiotensin converting enzyme inhibitors (ACEinh) and angiotensin receptor blockers (ARB) has reno- and cardioprotective effects but can also cause acute renal insufficiency and/or hyperkalemia. Study Design: A retrospective analysis was performed in an ambulatory population, to define the incidence and risk factors for hyperkalemia in ACEinh/ARB naïve patients. Setting and Participants: Records of patients from 10 Oklahoma regional VA outpatient facilities, in whom ACEinh/ARB was initiated from January 2000 to May 2004, were reviewed. Diabetes mellitus, estimated glomerular filtration rate (eGFR), in mL/min/1.73 m2, according to the KDOQI guidelines for chronic kidney disease (CKD), and concurrent medications were recorded. Results: ACEinh/ARB were well tolerated in unselected consecutive ACEinh/ARB naïve patients with baseline serum potassium (sK) ≤5.0 mEq/L in a general ambulatory population with 2.5% (23) of 931 developing hyperkalemia (sK ≥5.5 mEq/L). sK ≥6 mEq/L was seen in 5.0 mEq/L also tolerated ACEinh/ARB with 7.5% (3/40) developing sK >6.0 mEq/L. Diabetes mellitus did not affect the incidence of hyperkalemia independent of CFR. Conclusions: Although generally safe, ACEinh/ ARB poses a small risk for hyperkalemia in patients with reduced CFR. Because the propensity is incremental with declining CFR, these agents should be used with caution in advancing stages of CKD. Presence of diabetes does not affect the development of hyperkalemia.

AB - Background: Angiotensin II inhibition with angiotensin converting enzyme inhibitors (ACEinh) and angiotensin receptor blockers (ARB) has reno- and cardioprotective effects but can also cause acute renal insufficiency and/or hyperkalemia. Study Design: A retrospective analysis was performed in an ambulatory population, to define the incidence and risk factors for hyperkalemia in ACEinh/ARB naïve patients. Setting and Participants: Records of patients from 10 Oklahoma regional VA outpatient facilities, in whom ACEinh/ARB was initiated from January 2000 to May 2004, were reviewed. Diabetes mellitus, estimated glomerular filtration rate (eGFR), in mL/min/1.73 m2, according to the KDOQI guidelines for chronic kidney disease (CKD), and concurrent medications were recorded. Results: ACEinh/ARB were well tolerated in unselected consecutive ACEinh/ARB naïve patients with baseline serum potassium (sK) ≤5.0 mEq/L in a general ambulatory population with 2.5% (23) of 931 developing hyperkalemia (sK ≥5.5 mEq/L). sK ≥6 mEq/L was seen in 5.0 mEq/L also tolerated ACEinh/ARB with 7.5% (3/40) developing sK >6.0 mEq/L. Diabetes mellitus did not affect the incidence of hyperkalemia independent of CFR. Conclusions: Although generally safe, ACEinh/ ARB poses a small risk for hyperkalemia in patients with reduced CFR. Because the propensity is incremental with declining CFR, these agents should be used with caution in advancing stages of CKD. Presence of diabetes does not affect the development of hyperkalemia.

KW - ACE

KW - Angiotensin II type 1 receptor blockers

KW - Hyperkalemia

KW - Inhibitors

KW - Renal failure

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JO - American Journal of the Medical Sciences

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