Evaluation of the concurrent use of potassium-influencing drugs as risk factors for the development of hyperkalemia

Kuijvenhoven, Marianne; Haak, Eric A F; Gombert-Handoko, Kim B.; Crul, Mirjam

doi:10.1007/s11096-013-9830-8

Cited by 17 publications

(14 citation statements)

References 13 publications

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“…[1][2][3][4][5] However, these patients often have co-morbid conditions such as chronic kidney disease (CKD) and/or Type 2 diabetes mellitus (DM) that increase their risk of developing hyperkalaemia. [6][7][8][9] The use of RAASi further amplifies the risk of developing hyperkalaemia in these patients, especially those with CKD or who receive ≥1 RAASi. [10][11][12][13] The fear of inducing hyperkalaemia has led to underuse of RAASi in these patients.…”

Section: Introductionmentioning

confidence: 99%

Long‐term effects of patiromer for hyperkalaemia treatment in patients with mild heart failure and diabetic nephropathy on angiotensin‐converting enzymes/angiotensin receptor blockers: results from AMETHYST‐DN

et al. 2018

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AimsChronic kidney disease (CKD) in heart failure (HF) increases the risk of hyperkalaemia (HK), limiting angiotensin‐converting enzyme inhibitor (ACE‐I) or angiotensin receptor blocker (ARB) use. Patiromer is a sodium‐free, non‐absorbed potassium binder approved for HK treatment. We retrospectively evaluated patiromer's long‐term safety and efficacy in HF patients from AMETHYST‐DN.Methods and resultsPatients with Type 2 diabetes, CKD, and HK [baseline serum potassium >5.0–5.5 mmol/L (mild) or >5.5–<6.0 mmol/L (moderate)], with or without HF (New York Heart Association Class I and II, by investigator judgement), on ACE‐I/ARB, were randomized to patiromer 8.4–33.6 g to start, divided twice daily. Overall, 105/304 (35%) patients had HF (75%, Class II). Mean (standard deviation) ejection fraction (EF) was 44.9% (8.2) (n = 81) in patients with HF; 26 had EF ≤40%. In HF patients, mean serum potassium decreased by Day 3 through Week 52. At Week 4, estimated mean (95% confidence interval) change in serum potassium was −0.64 mmol/L (−0.72, −0.55) in mild and −0.97 mmol/L (−1.14, −0.80) in moderate HK (both P < 0.0001). Most HF patients with mild (>88%) and moderate (≥73%) HK had normokalaemia at each visit from Weeks 12 to 52. Three HF patients were withdrawn because of high (n = 1) or low (n = 2) serum potassium. The most common patiromer‐related adverse event was hypomagnesaemia (8.6%).ConclusionsIn patients with a clinical diagnosis of HF, diabetes, CKD, and HK on ACE‐I/ARB, patiromer was well tolerated and effective for HK treatment over 52 weeks.

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Section: Introductionmentioning

confidence: 99%

Long‐term effects of patiromer for hyperkalaemia treatment in patients with mild heart failure and diabetic nephropathy on angiotensin‐converting enzymes/angiotensin receptor blockers: results from AMETHYST‐DN

et al. 2018

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“…Hyperkalemia and hypokalemia are both commonly seen during the management of patients with HF. The former is most commonly seen in patients on more than one of ACEi, ARB, or MRA medications, diabetes or stage 3 or higher chronic kidney disease (22,23). Hypokalemia is most often seen with combination or intravenous diuretic therapy, especially if a thiazide, such as metolazone is used as part of the regimen.…”

Section: A Note On New Therapiesmentioning

confidence: 99%

The Canadian Cardiovascular Society Heart Failure Companion: Bridging Guidelines to Your Practice

Howlett

Chan

Ezekowitz

et al. 2016

Canadian Journal of Cardiology

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The Canadian Cardiovascular Society Heart Failure (HF) Guidelines Program has generated annual HF updates, including formal recommendations and supporting Practical Tips since 2006. Many clinicians indicate they routinely use the Canadian Cardiovascular Society HF Guidelines in their daily practice. However, many questions surrounding the actual implementation of the Guidelines into their daily practice remain. A consensus-based approach was used, including feedback from the Primary and Secondary HF Panels. This companion is intended to answer several key questions brought forth by HF practitioners such as appropriate timelines for initial assessments and subsequent reassessments of patients, the order in which medications should be added, how newer medications should be included in treatment algorithms, and when left ventricular function should be reassessed. A new treatment algorithm for HF with reduced ejection fraction is included. Several other practical issues are addressed such as an approach to management of hyperkalemia/hypokalemia, treatment of gout, when medications can be stopped, and whether a target blood pressure or heart rate is suggested. Finally, elements and teaching of self-care are described. This tool will hopefully function to allow better integration of the HF Guidelines into clinical practice.

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“…Conditions such as arrhythmia, worsening renal function, and infections [12,13] are common complications in patients suffering from HF and were described to be precipitating factors for HF hospitalization [3,[14][15][16][17][18]. Additionally, electrolyte imbalances appear frequently in HF patients [19][20][21][22], especially as several drugs commonly used in heart failure treatment may lead to hypo-or hyperkalemia, respectively [23,24]. Although prescription of potassium supplements was previously described to be associated with HF hospitalization in the long-term [22], and "infection" is reported to be a common precipitating factor, neither prescriptions of potassium nor amoxicillin/clavulanic acid have been assessed as acute risk factors for heart failure hospitalization.…”

Section: Introductionmentioning

confidence: 99%

Medication as a risk factor for hospitalization due to heart failure and shock: a series of case-crossover studies in Swiss claims data

Jödicke

Burden

Zellweger

et al. 2020

Eur J Clin Pharmacol

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Purpose Heart failure is among the leading causes for hospitalization in Europe. In this study, we evaluate potential precipitating factors for hospitalization for heart failure and shock. Methods Using Swiss claims data (2014-2015), we evaluated the association between hospitalization for heart failure and shock, and prescription of oral potassium supplements, non-steroidal anti-inflammatory drugs (NSAIDs), and amoxicillin/clavulanic acid. We conducted case-crossover analyses, where exposure was compared for the hazard period and the primary control period (e.g., 1-30 days before hospitalization vs. 31-60 days, respectively). Conditional logistic regression was applied and subsequently adjusted for addressing potential confounding by disease progression. Sensitivity analyses were conducted and stratification for co-medication was performed. Results We identified 2185 patients hospitalized with heart failure or shock. Prescription of potassium supplements, NSAIDs, and amoxicillin/clavulanic acid was significantly associated with an increased risk for hospitalization for heart failure and shock with crude odds ratios (OR) of 2.04 for potassium (95% CI 1.24-3.36, p = 0.005, 30 days), OR 1.8 for NSAIDs (95% CI 1.39-2.33, p < 0.0001, 30 days), and OR 3.25 for amoxicillin/clavulanic acid (95% CI 2.06-5.14, p < 0.0001, 15 days), respectively. Adjustment attenuated odds ratios, while the significant positive association remained (potassium OR 1.70 (95% CI 1.01-2.86, p = 0.046), NSAIDs OR 1.50 (95% CI 1.14-1.97, p = 0.003), and amoxicillin/clavulanic acid OR 2.26 (95% CI 1.41-3.62, p = 0.001). Conclusion Prescription of potassium supplements, NSAIDs, and amoxicillin/clavulanic acid is associated with increased risk for hospitalization. Underlying conditions such as pain, electrolyte imbalances, and infections are likely contributing risk factors. Physicians may use this knowledge to better identify patients at risk and adapt patient management.

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Evaluation of the concurrent use of potassium-influencing drugs as risk factors for the development of hyperkalemia

Cited by 17 publications

References 13 publications

Long‐term effects of patiromer for hyperkalaemia treatment in patients with mild heart failure and diabetic nephropathy on angiotensin‐converting enzymes/angiotensin receptor blockers: results from AMETHYST‐DN

Long‐term effects of patiromer for hyperkalaemia treatment in patients with mild heart failure and diabetic nephropathy on angiotensin‐converting enzymes/angiotensin receptor blockers: results from AMETHYST‐DN

The Canadian Cardiovascular Society Heart Failure Companion: Bridging Guidelines to Your Practice

Medication as a risk factor for hospitalization due to heart failure and shock: a series of case-crossover studies in Swiss claims data

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