Patient- and physician-related risk factors for hyperkalaemia in potassium-increasing drug–drug interactions

Abstract

PURPOSE: Hyperkalaemia due to potassium-increasing drug-drug interactions (DDIs) is a clinically important adverse drug event. The purpose of this study was to identify patient-and physicianrelated risk factors for the development of hyperkalaemia. METHODS: The risk for adult patients hospitalised in the University Hospital Zurich between 1 December 2009 and 31 December 2011 of developing hyperkalaemia was correlated with patient characteristics, number, type and duration of potassiumincreasing DDIs and frequency of serum potassium monitoring. RESULTS: The 76,467 patients included in this study were prescribed 8,413 potentially severe potassium-increasing DDIs. Patient-related characteristics associated with the development of hyperkalaemia were pulmonary allograft [relative risk (RR) 5.1; p < 0.0001), impaired renal function (RR 2.7; p < 0.0001), diabetes mellitus (RR 1.6; p = 0.002) and female gender (RR 1.5; p = 0.007). Risk factors associated with medication were number of concurrently administered potassium-increasing drugs (RR 3.3 per additional drug; p < 0.0001) and longer duration of the DDI (RR 4.9 for duration 6 days; p < 0.0001). Physician-related factors associated with the development of hyperkalaemia were undetermined or elevated serum potassium level before treatment initiation (RR 2.2; p < 0.001) and infrequent monitoring of serum potassium during a DDI (interval >48 h: RR 1.6; p < 0.01). CONCLUSION: Strategies for reducing the risk of hyperkalaemia during potassium-increasing DDIs should consider both patient-and physician-related risk factors. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 2 AbstractPurpose Hyperkalaemia due to potassium-increasing drug-drug interactions (DDIs) is a clinically important adverse drug event. The purpose of this study was to identify patient-and physician-related risk factors for the development of hyperkalaemia. MethodsThe risk for adult patients hospitalised in the University Hospital Zurich of developing hyperkalaemia was correlated with (i) patient characteristics, (ii) number, type and duration of potassium-increasing DDIs, and (iii) the frequency of serum potassium monitoring. (iii) Physician-related factors associated with development of hyperkalaemia were: undetermined or elevated serum potassium level before starting treatment (RR 2.2; p < 0.001) and infrequent monitoring of serum potassium during DDI (intervals > 48 h; RR 1.6; p < 0.01). ConclusionStrategies for hyperkalaemia risk reduction during potassium-increasing DDIs should consider patient-as well as physician-related risk factors.

Co-trimoxazole and sudden death in patients receiving inhibitors of renin-angiotensin system: population based study

“…Clinical trials, case reports, and laboratory studies show that co-trimoxazole induced hyperkalemia can occur quickly and can cause life threatening arrhythmias, especially among patients receiving angiotensin converting enzyme inhibitors or angiotensin receptor blockers. 13 15 16 19 33 34 Our previous research on this drug interaction showed a nearly sevenfold increased risk of hospital admission with hyperkalemia following co-trimoxazole treatment but no such risk with the same alternative antibiotics studied here. 14 In the analysis presented here, we found no increased risk of sudden death with nitrofurantoin or norfloxacin.…”

Prevalence and clinical significance of potential drug-drug interactions in diabetic patients attended in a tertiary care outpatient center, Brazil

“…The risk of death after 2 days from the detection of hyperkalemia was 5.3 times greater than in patients who were not exposed to PDDI, which led to this adverse event [34]. The combination, therefore, must be carefully evaluated with regard to the risk and benefit for each patient.…”

Safety of potassium-bearing citrate in patients with renal transplantation

“…In addition to PSHC, some other factors might also contribute to the occurrence of hyperkalemia in the 2 patients, such as the application of calcineurin inhibitors, glucocorticoids, and diuretics. [ 26 – 28 ] In this report, both of the cases received tacrolimus (calcineurin inhibitor) and prednisolone (a type of glucocorticoid) in immunosuppressive treatment that might increase the risk of hyperkalemia. Furthermore, blood transfusion might also stand for a potential risk factor for hyperkalemia.…”

“…It has been suggested that when coprescribing medicine, it would be better to avoid using potassium-bearing citrate that may interfere with potassium homeostasis among patients with renal dysfunction. [ 26 , 32 ] If not, oral dose should be reduced according to the severity of renal dysfunction. In a previous study, sodium bicarbonate did not allow additional potassium into blood, and showed an effect equivalent to potassium-bearing citrate in the treatment of urinary stone, suggesting that sodium bicarbonate might be a better choice for patients who could not tolerate PC.…”