Diabetes and Drug-Associated Hyperkalemia: Effect of Potassium Monitoring

Raebel, Marsha A.; Ross, Colleen; Xu, Stanley; Roblin, Douglas W.; Cheetham, Craig; Blanchette, Christopher M.; Saylor, Gwyn; Smith, David H.

doi:10.1007/s11606-009-1228-x

Cited by 69 publications

(63 citation statements)

References 55 publications

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“…Thus, in deciding whether to start RAAS-blocking agents in an older patient with CKD, the clinician should consider whether the patient has proteinuria, whether his or her CKD is clearly progressive, and whether he or she has other health concerns or priorities that might make another antihypertensive agent preferable. It has been shown that potassium monitoring decreases RAAS blocker-induced hyperkalemia, especially in patients who have both diabetes and CKD (72). Thus, RAAS blockade, particularly in patients with CKD, mandates careful monitoring for acute renal failure and hyperkalemia, often requiring extra laboratory testing and clinic visits after initiation of these agents and after any change in dosage.…”

Section: Conclusion and Recommendationsmentioning

confidence: 99%

Renin-Angiotensin-Aldosterone System Blockade Effects on the Kidney in the Elderly

Turgut¹,

Balogun²,

Abdel‐Rahman³

2010

Clinical Journal of the American Society of Nephrology

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The proportion of the population that is elderly (age >65 years) is growing across the world. The increasing longevity of humans results in a higher number of elderly patients' presenting with multiple chronic diseases such as hypertension, diabetes, and chronic kidney disease (CKD). These problems increase morbidity and mortality in the elderly. Overactivity of the renin-angiotensin-aldosterone system (RAAS) is associated with the development of hypertension, cardiovascular events, and CKD, so targeting the RAAS is a logical therapeutic approach. Elderly patients present special concerns regarding the benefits versus risks of using RAAS blockers. Plasma renin activity declines with age, which has been attributed to the effect of age-associated nephrosclerosis. Plasma aldosterone is also reduced with age, resulting in a greater risk for hyperkalemia in older individuals, especially when coupled with the age-associated decline in GFR. Moreover, the elderly have a higher frequency of concurrent conditions and are on many medications, which may further increase the risk for adverse effects of RAAS blocking agents. Unfortunately, there is a paucity of literature that is specifically aimed at studying elderly using the RAAS blockers. We present in our in-depth review data regarding benefits and limitations of the use of the RAAS blockades on the various sites along the RAAS pathway for elderly patients. Specific attention was given to the role of combination RAAS blockade therapy and higher monotherapy dosing in the treatment of hypertension in the elderly.

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Section: Conclusion and Recommendationsmentioning

confidence: 99%

Renin-Angiotensin-Aldosterone System Blockade Effects on the Kidney in the Elderly

Turgut¹,

Balogun²,

Abdel‐Rahman³

2010

Clinical Journal of the American Society of Nephrology

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“…(ii) Furthermore, lack of serum level monitoring at onset of potassium-increasing DDIs correlated with an increased risk for developing hyperkalaemia (Table 2). Previously such an association has been reported for outpatients [19].…”

Section: Hyperkalaemiamentioning

confidence: 68%

“…One study considered the effect of potassium monitoring during potassium-increasing DDIs in outpatients [19]. To our knowledge, no study investigated the effect of physician-related risk factors as missing serum potassium measurement at start of therapy and periodicity of serum potassium monitoring during drug therapy in hospitalised patients.…”

mentioning

confidence: 99%

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

Eschmann

Beeler

Kaplan

et al. 2013

Eur J Clin Pharmacol

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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.

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“…Consequently, diabetic patients (especially the elderly) on medications known to interfere with K + homeostasis are at increased risk for hyperkalemia 37,38 . In such cases, close K + monitoring is fully warranted 39 .…”

Section: Potassiummentioning

confidence: 99%

Electrolyte Disturbances in Patients with Diabetes Mellitus

Khanduker

Ahmed²,

Khondker

et al. 2018

Bangladesh J Med Biochem

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Diabetic patients frequently develop a constellation of electrolyte disorders. These derangement results from insulin deficiency, hyperglycemia and hyperketonemia. Hyperglycemia sets the internal environment for osmotic diuresis while causing a dilutional effect on electrolyte concentrations.The osmotic effect of glucose results in decreased circulating blood volume and fluid shift from the intracellular spaces causing cellular dehydration. These disturbances are particularly common in decompensated diabetes, especially in the context of diabetic ketoacidosis or non ketotic hyperglycemic hyperosmolar syndrome.These patients are markedly sodium, magnesium and phosphate depleted. Diabetes mellitus is linked to both hypo and hyperkalemia and also hypo and hypercalcemia reflecting coexistence of hyperglycemia related mechanisms, which tend to change serum potassium and calcium to opposite directions. This article provides an overview of the electrolyte disturbances occurring in Diabetes and mechanisms underlying those disturbances.Bangladesh J Med Biochem 2017; 10(1): 27-35

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Diabetes and Drug-Associated Hyperkalemia: Effect of Potassium Monitoring

Cited by 69 publications

References 55 publications

Renin-Angiotensin-Aldosterone System Blockade Effects on the Kidney in the Elderly

Renin-Angiotensin-Aldosterone System Blockade Effects on the Kidney in the Elderly

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

Electrolyte Disturbances in Patients with Diabetes Mellitus

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