Low body mass index is a risk factor for hyperkalaemia associated with angiotensin converting enzyme inhibitors and angiotensin II receptor blockers treatments

Hirai, Toshinori; Yamaga, Ryosuke; Fujita, Akiko; Itoh, Toshimasa

doi:10.1111/jcpt.12720

Cited by 5 publications

(6 citation statements)

References 38 publications

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“…21 One explanation of the lower risk of HK in patients with obesity may be due to the increase in hyperaldosteronism among patients with high BMI, which leads to an increase in K + excretion. 22 In our study, a dialysate K + bath concentration ≥ 3 mEq/L was associated with lower odds of predialysis HK. Similarly, a previous DOPPS study found that after adjusting for confounding variables, there was an inverse relationship between dialysate K + bath concentrations and predialysis serum K + levels, with a change of À0.25 (95% CI, À0.26 to À0.24) mEq/L in serum K + per 1-mEq/L increase in dialysate K + bath concentration.…”

Section: Discussionsupporting

confidence: 47%

“…This finding is consistent with a previous registry study of patients with CKD, which found that low BMI (<18.5 kg/m 2 ) was associated with increased odds of HK (OR, 1.60; 95% CI, 1.23–2.08) and high BMI (>30 kg/m 2 ) with lower odds of HK (OR, 0.77; 95% CI, 0.70–0.85) 21 . One explanation of the lower risk of HK in patients with obesity may be due to the increase in hyperaldosteronism among patients with high BMI, which leads to an increase in K + excretion 22 …”

Section: Discussionmentioning

confidence: 99%

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The prevalence of predialysis hyperkalemia and associated characteristics among hemodialysis patients: The RE‐UTILIZE study

Agiro

Duling

Eudicone

et al. 2022

Hemodialysis International

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Introduction: Hyperkalemia (HK), defined as serum potassium (K + ) >5.0 mEq/L, is an independent predictor of mortality in patients on maintenance hemodialysis (HD). This study investigated the annual prevalence of HK and examined patient characteristics potentially associated with a higher annual HK prevalence. Methods: This retrospective observational cohort study used Dialysis Outcomes and Practice Patterns Study (DOPPS) survey data from US patients undergoing in-center HD thrice weekly from 2018 to 2019. The primary endpoint was the proportion of patients with any predialysis HK (K + >5.0 mEq/L) within 1 year from the index date (date of DOPPS enrollment), using the first hyperkalemic K + value. Secondary endpoints were the proportion of patients with moderate-to-severe (K + >5.5 mEq/L) or severe (K + >6.0 mEq/L) HK. Findings: Overall, 9347 patients on HD were included in this analysis (58% male and 49% aged >66 years). Any predialysis HK (K + >5.0 mEq/L) occurred in 74% of patients within 1 year of the index date, 52% within 3 months, and 38% within 1 month. The annual prevalence of moderate-to-severe and severe HK was 43% and 17%, respectively. Recurrent HK (at least two K + >5.0 mEq/L within 1 year) occurred in 60% of patients, and 2.8% of patients were prescribed an oral K + binder. Multivariable logistic regression analysis showed younger age, female sex, Hispanic ethnicity, and renin-angiotensin-aldosterone system inhibitor use were significantly associated with a higher annual prevalence of any predialysis HK, while Black race, obesity, recent initiation of HD, and dialysate K + bath concentration ≥3 mEq/L were associated with a lower prevalence of HK.

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Section: Discussionsupporting

confidence: 47%

Section: Discussionmentioning

confidence: 99%

The prevalence of predialysis hyperkalemia and associated characteristics among hemodialysis patients: The RE‐UTILIZE study

Agiro

Duling

Eudicone

et al. 2022

Hemodialysis International

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“…BMI does not correlate with false or true hyperkalaemia, which is in contrast to a retrospective case-control Japanese study which concluded that patients on ACE-i or ARB with a lower BMI are more prone to hyperkalaemia with K>5.5 mmol/L. 10 Patients on ACE-i are more likely to have true hyperkalaemia compared with those on ARB. Patients on neither ACE-i or ARB are more likely to have false hyperkalaemia.…”

Section: Open Accesscontrasting

confidence: 92%

“…(1) Specimen collection time, (2) Time processed by central laboratory, (3) Polyclinic collected from, (4) Age, (5) Gender, (6) BMI based on most recent body weight and height, (7) Potassium levels,(8) presence of haemolysis (yes/no), (9) Repeat potassium (value and date) within 8 days of first K>5.5 mmol/L inclusive, (10) Polyclinic where repeat potassium was collected, (11) Creatinine at date of reported hyperkalaemia (µmol/L) and within 12 months prior, (12) Latest full blood count (FBC) results (within 6 months before and 6 months after first reported K>5.5 mmol/L) and (13) Medications prescribed within 6 months prior and 3 months after first hyperkalaemia (filtered). The filtered medications extracted were ACE-i (captopril, enalapril, lisinopril, perindopril, ramipril), ARB (candesartan, irbesartan, losartan, olmesartan, telmisartan, valsartan), potassiumsparing diuretics (spironolactone), potassium supplements (potassium chloride tablet, potassium citrate mixture) and the cation-exchange resin, SPS.…”

Section: Data Extractionmentioning

confidence: 99%

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Prevalence and factors associated with false hyperkalaemia in Asians in primary care: a cross-sectional study (the Unlysed Hyperkalaemia- the Unseen Burden (UHUB) study)

Boo

Koh

et al. 2020

BMJ Open

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Serum potassium is part of routine laboratory tests done for patients with hypertension or diabetes mellitus in primary care. Those found to have raised potassium (K>5.5 mmol/L) are recalled for repeat potassium in emergency departments or primary care clinics. Repeat potassium are often normal (≤5.5 mmo/L), that is, false hyperkalaemia. Haemolysis is known to cause false hyperkalaemia. We postulated that unlysed false hyperkalamia was prevalent and was associated with factors such as delayed processing time.ObjectiveWe aimed to determine the prevalence of unlysed false hyperkalaemia and the factors associated with false-and-true-hyperkalaemia.SettingOutpatients in a cluster of public primary care clinics (polyclinics) in Singapore.ParticipantsAll patients of any ethnicity aged ≥21 with serum potassium test done.MethodsElectronic health records of index patients with potassium >5.5 mmol/L and its corresponding laboratory processing time in seven local polyclinics were reviewed between August 2015 and August 2017. Haemolysed specimens and patients on sodium polystyrene sulfonate (SPS) suspension were excluded. If repeat potassium level was ≤5.5 mmol/L within 8 days, the case was defined as false hyperkalaemia. The proportion of such patients was computed to determine its prevalence. Linear and logistic regressions were used to identify the associated factors.ResultsThe study population comprised of 3014 index cases, of which 1575 had repeat potassium tests without preceding SPS. 86.4% (1362/1575) of them had potassium ≤5.5 mmol/L. The average processing time among specimens with potassium ≥6.0 mmol/L was 50 min longer, compared with those with potassium <5.1 mmol/L. Risk factors significantly associated with false hyperkalaemia included estimated glomerular filtration rate (eGFR) (60–89 mL/min/1.73 m2, OR=3.25, p<0.001;>90 mL/min/1.73 m2, OR=3.77, p<0.001) and delayed laboratory processing time (beta coefficient 0.001, p<0.001).ConclusionThe prevalence of false hyperkalaemia was 86.4%. Recommendation to repeat potassium tests may target those with eGFR<60ml/min/1.73m2.

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Evaluation of machine learning algorithms for renin-angiotensin-aldosterone system inhibitors associated renal adverse event prediction

Güven

Özdede

Şener

et al. 2023

European Journal of Internal Medicine

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Low body mass index is a risk factor for hyperkalaemia associated with angiotensin converting enzyme inhibitors and angiotensin II receptor blockers treatments

Abstract: This study demonstrated that BMI provides useful information for the identification of potential risk for hyperkalaemia associated with ACEI and ARB treatments.

Cited by 5 publications

References 38 publications

The prevalence of predialysis hyperkalemia and associated characteristics among hemodialysis patients: The RE‐UTILIZE study

The prevalence of predialysis hyperkalemia and associated characteristics among hemodialysis patients: The RE‐UTILIZE study

Prevalence and factors associated with false hyperkalaemia in Asians in primary care: a cross-sectional study (the Unlysed Hyperkalaemia- the Unseen Burden (UHUB) study)

Evaluation of machine learning algorithms for renin-angiotensin-aldosterone system inhibitors associated renal adverse event prediction

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