Frequency of laboratory measurement and hyperkalaemia in hospitalised patients using serum potassium concentration increasing drugs

Abstract

PurposeAlthough, drug–drug interactions (DDIs) between potassium-increasing drugs (PIDs) are known risk factors for developing hyperkalaemia, not much is known about their risk and management strategies during hospitalisation. This study examines the frequency of serum potassium measurements and hyperkalaemia in hospitalised patients, based on the use of one or more PIDs, and the determinants thereof.MethodsAdult patients hospitalised in the University Medical Centre Utrecht between 2006 and 2008 were included in this cross-sectional study. The frequency of serum potassium measurements and of hyperkalaemia were compared between patients using only one PID at a time (monotherapy group) and patients using two or more PIDs concomitantly (interaction group). The determinants studied were renal failure, diabetes mellitus, use of diuretics, type of DDI, start of the PIDs within the hospital versus continued home medication and medical speciality.ResultsSerum potassium was measured more frequently in the interaction group than in the monotherapy group [67 vs. 56%; relative risk (RR) 1.19, 95% confidence interval (CI) 1.14–1.24] and the risk of hyperkalaemia was also increased in the interaction group (9.9 vs. 5.9%, RR 1.7, 95% CI 1.3–2.1). The combination of potassium-sparing diuretics plus a potassium supplement, start of the PID within the hospital and hospitalisation in non-internal medicine departments was associated with higher relative risk estimates for hyperkalaemia.ConclusionsAmong our patient cohort, even when physicians received a direct pop-up to monitor serum potassium levels when prescribing two PIDs concomitantly, serum potassium levels were not measured in 33% of patients, and 10% of patients developed hyperkalaemia. Improved management strategies and/or clinical decision-support systems are needed to decrease the frequency of hyperkalaemia following DDIs.

Hyperkalaemia in people with diabetes: occurrence, risk factors and outcomes in a Danish population‐based cohort study

“…A cross‐sectional study from 1995 of diabetes outpatients in the UK, found that 15% of the individuals had a serum potassium level >5.0 mmol/l over a 12‐month period, and that hyperkalaemia was also common among people with normal kidney function and in those not receiving drugs known to have an effect on potassium levels . In line with our findings, studies have documented an increasing risk of hyperkalaemia in patients with progressively worsening kidney function and in patients with heart failure , as well as among those receiving renin angiotensin aldosterone system inhibitors and in those with advanced age . Although it is well‐known that hyperkalaemia is associated with increased ventricular arrhythmias and may be associated with other adverse outcomes , to the best of our knowledge, there have been no previous studies of these associations specifically in people with diabetes.…”

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

“…2); (ii) diabetes mellitus [6,31]; (iii) the highest risk concerned pulmonary allograft, mainly due to PID combinations of immunosuppressive agents, trimethoprim, and ACE inhibitor [32,33]; (iv) female gender, confirming another analysis of gender as a predictor in drug-induced hyperkalaemia [34]; (v) elevated serum potassium (> 4.5 mEq/l) at onset of the DDI. 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 In contrast to other studies, we couldn't establish an association between hyperkalaemia during potassium-increasing DDIs and age or hospitalisation in surgical versus non-surgical specialties [12].…”

“…However, unspecific alerts will lead to alert fatigue [7][8][9]. The present study improves the understanding of factors associated with hyperkalaemia [12] and adds physician-related factors, which may help to design more specific alerts.…”

“…Serum potassium levels were categorized into 4 groups: (i) hypokalaemia: serum potassium ≤ 3.2 mEq/l [21]; (ii) reference range: ≥ 3.3 mEq/l to ≤ 4.5 mEq/l [22]; (iii) moderately increased: ≥ 4.6 mEq/l to ≤ 5.4 mEq/l; and (iv) hyperkalaemia: ≥ 5.5 mEq/l [12].…”

“…Several studies analysed the risk factors for developing hyperkalaemia during potassium-increasing DDIs, focussing on patient-related risk factors such as demographic parameters and comorbidities and on medication such as number and types of the involved drugs [12][13][14][15][16][17][18]. One study considered the effect of potassium monitoring during potassium-increasing DDIs in outpatients [19].…”