Adequate intake of potassium does not cause hyperkalemia in hypertensive individuals taking medications that antagonize the renin angiotensin aldosterone system

Malta, Daniela; Arcand, JoAnne; Ravindran, Anju; Floras, Vanessa; Allard, Johane P.; Newton, Gary E.

doi:10.3945/ajcn.115.129635

“…We did not find such an interaction, but it should be stated that our study design was not appropriate to this end. However, in patients treated with RAAS inhibitors it may be wise to consider the development of hyperkalemia when increasing vegetable protein intake 36, 37…”

Section: Discussionmentioning

confidence: 99%

High Dietary Intake of Vegetable Protein Is Associated With Lower Prevalence of Renal Function Impairment: Results of the Dutch DIALECT-1 Cohort

Oosterwijk

¹

,

Soedamah‐Muthu

²

,

Geleijnse

³

et al. 2019

Kidney International Reports

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Introduction Dietary protein intake may influence development of renal function impairment in diabetes mellitus type 2 (T2DM). We assessed the association between sources of protein and prevalence of renal function impairment. Methods Cross-sectional analyses were performed in baseline data of 420 patients of the DIAbetes and LifEstyle Cohort Twente-1 (DIALECT-1) study. Protein intake was assessed using a Food Frequency Questionnaire, modified for accurate assessment of protein intake, including types and sources of protein. Renal function impairment was defined as estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m 2 (Chronic Kidney Disease Epidemiology Collaboration formula). Results Among 420 patients with T2DM, 99 renal function impairment cases were identified. Multivariate Cox proportional hazard models were used and adjusted for the main lifestyle and dietary factors. The prevalence ratios in the fully adjusted model were 1 (reference), 0.74 (95% confidence interval [CI]: 0.44–1.27; P = 0.28) and 0.47 (95% CI: 0.23–0.98; P = 0.04) according to increasing tertiles of vegetable protein intake. For animal protein intake the prevalence ratios were 1 (reference), 1.10 (95% CI: 0.64–1.88; P = 0.74) and 1.06 (95% CI: 0.56–1.99; P = 0.87) according to increasing tertiles of intake. Theoretical replacement models showed that replacing 3 energy percent from animal protein by vegetable protein lowered the prevalence ratio for the association with renal function impairment to 0.20 (95% CI: 0.06–0.63; P = 0.01). Conclusion In conclusion, we found that higher intake of vegetable protein was associated with a lower prevalence of renal function impairment, and theoretical replacement of animal protein with vegetable protein was inversely associated with renal function impairment among patients with T2DM.

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“…According to the previous studies, there were no significant changes in urinary K+ excretion, transtubular K+ gradient, and fractional excretion of K+ after RAAS inhibitor administration [18-19]. Furthermore, there were no changes in urinary K+ excretion before versus after RAAS inhibitor administration (before, 2652 ± 897 mg/day; after, 2691 ± 936 mg/day) under a normal K+ intake [20]. Our results might be similar to those of that report, although the patients included in this study all had advanced CKD, and the daily K+ intake would be restricted in the clinical setting [20].…”

Section: Discussionmentioning

confidence: 95%

“…Furthermore, there were no changes in urinary K+ excretion before versus after RAAS inhibitor administration (before, 2652 ± 897 mg/day; after, 2691 ± 936 mg/day) under a normal K+ intake [20]. Our results might be similar to those of that report, although the patients included in this study all had advanced CKD, and the daily K+ intake would be restricted in the clinical setting [20]. In addition, loop diuretics and thiazides are known to increase urinary K+ excretion, which would be induced by the stimulation of flow-dependent K+ secretion from the CCD [21].…”

Section: Discussionmentioning

confidence: 99%

Changes in Serum and Urinary Potassium Handling Associated with Renin-Angiotensin-Aldosterone System Inhibitors in Advanced Chronic Kidney Disease Patients

Ueda

¹

,

Ookawara

²

,

Miyazawa

³

et al. 2019

Cureus

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ObjectiveThis study aimed to (i) compare the extent of urinary potassium (K+) excretion in addition to the changes in serum K+ concentration: and (ii) clarify the association between changes in serum K+ concentration, urinary K+ excretion, and acid-base status with or without renin-angiotensin-aldosterone system (RAAS) inhibitors in patients with advanced chronic kidney disease (CKD) stages.MethodsSix hundred and ninety-one patients with advanced CKD (CKD G3b, 161; G4, 271; G5, 259) were retrospectively evaluated. Differences in serum K+ concentration, urinary K+ excretion, and serum sodium and chloride differences (Na+−Cl-) were compared among patients with RAAS inhibitors, RAAS inhibitors and diuretic agents, and without either medication in each CKD stage.ResultsSerum K+ concentrations in patients with RAAS inhibitors were significantly higher than in those with RAAS inhibitors and diuretics in CKD stage G3b and the other two treatment groups in CKD stage G4. Urinary K+ excretion among the three groups did not differ significantly in each CKD stage. Serum Na+−Cl- differences in patients with RAAS inhibitors were significantly smaller than in those with RAAS inhibitors and diuretics in CKD stages G3b (p = 0.006) and the other two groups in CKD stage G4 (vs. RAAS inhibitors and diuretics, p <0.001; vs. without either medication, p = 0.008).ConclusionOur study demonstrated that RAAS inhibitor use might be associated with hyperkalemia via not decreased urinary K+ excretion but rather K+ redistribution from intracellular to extracellular fluid induced by the progression of metabolic acidosis in patients with advanced CKD, particularly stages G3b and G4.

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“…Most previous studies on ARB-induced hyperkalemia have focused on methods of measuring potassium levels after administration of ACEI or ARB. The number of times that potassium levels were mea-sured during a given period of one year or three years [20] and the relationship between that number and the incidence of hyperkalemia, the factors for potassium monitoring (age, number of outpatient visits, hospitalization, sex, race, and baseline potassium level of subjects) [21], and the comorbidities that require meticulous monitoring of potassium levels [22] were investigated. Moreover, a score-based study has been performed to help predict hyperkalemia occurrence using baseline characteristics [23].…”

Section: Cardiovascular Therapeuticsmentioning

confidence: 99%

Onset of Hyperkalemia following the Administration of Angiotensin-Converting Enzyme Inhibitor or Angiotensin II Receptor Blocker

Jun

¹

,

Kim

²

,

Lee

³

et al. 2021

Cardiovascular Therapeutics

1

0

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Introduction. In spite of the established importance of detecting angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker- (ARB-) induced hyperkalemia, there have not been many studies on the time of its occurrence. Methods. We retrospectively analyzed electronic medical records to determine the onset time and incidence rate of hyperkalemia ( serum potassium > 5.5 mEq / L or 6.0 mEq/L) among hospitalized patients newly started on a 15-day ACEI or ARB therapy. Results. Among 3101 hospitalized patients, hyperkalemia incidence was 0.5%–0.9% and 0.8%–2.1% in the ACEI and ARB groups, respectively. However, it was not significantly different among different ARB types. Hyperkalemia’s onset was distributed throughout 15 days, without any trend. Hyperkalemia incidence was 7.3 and 35.1 times higher at 5.5 mEq/L ( hazard ratio HR = 7.31 , 95 % confidence interval CI = 4.19 – 12.76 , p < 0.001 ) and 6.0 mEq/L ( HR = 35.11 , 95 % CI = 8.25 – 149.52 , p < 0.001 ), respectively, than the baseline creatinine level. Hyperkalemia incidence in patients with chronic renal failure was 5.7 and 9.2 times higher at 5.5 mEq/L ( HR = 5.72 , 95 % CI = 3.24 – 10.12 , p < 0.001 ) and 6.0 mEq/L ( HR = 9.16 , 95 % CI = 4.02 – 20.88 , p < 0.001 ), respectively. Conclusions. It is unlikely that it is necessary to monitor hyperkalemia immediately after administration of ACEI or ARB. However, when prescribed for patients with abnormal kidney function, clinicians should always consider the possibility of developing hyperkalemia.

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Adequate intake of potassium does not cause hyperkalemia in hypertensive individuals taking medications that antagonize the renin angiotensin aldosterone system

Abstract: This study demonstrates that an increase in dietary potassium over a 4-wk period is safe in hypertensive subjects who have normal renal function and are receiving ACEi and/or ARB therapy. This trial was registered at www.clinicaltrials.gov as NCT02759367.

Cited by 8 publications

References 30 publications

High Dietary Intake of Vegetable Protein Is Associated With Lower Prevalence of Renal Function Impairment: Results of the Dutch DIALECT-1 Cohort

High Dietary Intake of Vegetable Protein Is Associated With Lower Prevalence of Renal Function Impairment: Results of the Dutch DIALECT-1 Cohort

Changes in Serum and Urinary Potassium Handling Associated with Renin-Angiotensin-Aldosterone System Inhibitors in Advanced Chronic Kidney Disease Patients

Onset of Hyperkalemia following the Administration of Angiotensin-Converting Enzyme Inhibitor or Angiotensin II Receptor Blocker

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