Incidence of Co-Trimoxazole-Induced Hyperkalemia in a Tertiary Care Hospital

Abstract

Background: Co-trimoxazole is a broad-spectrum antibiotic associated with hyperkalemia. Objective: To determine the incidence of hyperkalemia and its risk factors in patients receiving co-trimoxazole. Materials and Methods: A retrospective observational study involving all patients who received co-trimoxazole between 1 January 2012 and 1 January 2013 was conducted. Subjects were identified through a list generated from a computerized pharmacy system. The patients' demographic and clinical characteristics were retrieved from electronic medical records. Data were analyzed using univariate and multivariate logistic regression. Results: One hundred sixty-one patients fulfilled the eligibility criteria. Of these, 46 (28.6%) experienced hyperkalemia. Around 35 (76%) of the patients who experienced hyperkalemia received co-administered medications that might induce hyperkalemia. The coadministration of co-trimoxazole with other medications that may induce hyperkalemia was found to be associated with higher incidence of hyperkalemia when compared to cotrimoxazole administration alone [adjusted OR 3.2, 95% CI (1.4-7.3), p=0.005]. Additionally, age > 60 years was associated with an increased risk of hyperkalemia when compared to younger age group 18-39 years [adjusted OR 6.5, 95% CI (2.1-19.7); p=0.001]. Conclusion: Co-trimoxazole use is associated with high incidence of hyperkalemia, especially among older patients and those receiving it in combination with other medications that might contribute to hyperkalemia development such as calcineurin inhibitors and β-blockers.

Cotrimoxazole‐induced hyperkalemia in renal transplant patient—Case report

“… 3 A study conducted by Rana M Al AdAwi et al about the incidence of cotrimoxazole‐induced hyperkalemia in tertiary care showed 28% regardless of interacting drugs and 33% without interacting drugs. 4 Though hyperkalemia by TMP‐SMX is common in patients with renal insufficiency, it can even occur in patients with normal renal function 5 and with a standard dose. 6 Similarly, More AS et al presented a case of TMP‐SMX induced hyperkalemia in renal transplant.…”

“…Trimethoprim inhibits sodium transport in the apical membrane of the distal nephron, reducing the transepithelial voltage and causing decreased potassium secretion, similar to amiloride 3 . A study conducted by Rana M Al AdAwi et al about the incidence of cotrimoxazole‐induced hyperkalemia in tertiary care showed 28% regardless of interacting drugs and 33% without interacting drugs 4 . Though hyperkalemia by TMP‐SMX is common in patients with renal insufficiency, it can even occur in patients with normal renal function 5 and with a standard dose 6 .…”

Prevalence and management of hyperkalemia in chronic kidney disease and heart failure patients in the Gulf Cooperation Council (GCC)

“…Reported rates depend on the investigated population, setting and applied cut‐off levels (Table 1). 2,15–21 The scarcity of data is a limitation for the awareness about hyperkalemia in the GCC region and its appropriate management. Well‐designed studies to explore the prevalence of hyperkalemia in the GCC and potential relations with complications in patients with HF or CKD are warranted.…”