Risk of Hyperkalemia in Nondiabetic Patients With Chronic Kidney Disease Receiving Antihypertensive Therapy&lt;alt-title&gt;Hyperkalemia in CKD Adults Using Antihypertensives&lt;/alt-title&gt;

Weinberg, Joy M.; Appel, Lawrence J.; Bakris, George L.; Gassman, Jennifer; Greene, Tom; Kendrick, Cynthia; Wang, Xuelei; Lash, James P.; Lewis, Julia A.; Pogue, Velvie A.; Thornley‐Brown, Denyse; Phillips, Robert A.

doi:10.1001/archinternmed.2009.284

Cited by 100 publications

(69 citation statements)

References 25 publications

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“…Of these 22 studies, 14 studies were excluded for the following reasons: duplicate data in 4 studies; there were 3 studies concerning renal outcomes but no ESRD or all-cause mortality [12][13][14] ; two studies were not randomized controlled trials 15,16 ; all the participants in two studies were hemodialysis patients 17,18 ; one study was about the survival only in kidney transplant patients 19 ; the number of participants in two trials was less than 100 20,21 ; Totally, eight studies were therefore included in this meta-analysis.…”

Section: Study Selectionmentioning

confidence: 99%

Effect of calcium channels blockers and inhibitors of the renin-angiotensin system on renal outcomes and mortality in patients suffering from chronic kidney disease: systematic review and meta-analysis

Zhao

Liu³

et al. 2016

Renal Failure

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(2016) Effect of calcium channels blockers and inhibitors of the renin-angiotensin system on renal outcomes and mortality in patients suffering from chronic kidney disease: systematic review and meta-analysis, Renal Failure, 38:6,[849][850][851][852][853][854][855][856] Background:The renoprotective effect of inhibitors of renin-angiotensin system (RAS) has been identified through placebo-controlled trials. However, the effect of calcium-channel blockers (CCBs) on renal system is still controversial. Our current meta-analysis includes available evidences to compare the effect of dihydropyridine CCBs and ACEIs or ARBs on renal outcomes and mortality. We also further investigate whether CCBs can be used in combination with inhibitors of RAS to improve the prognosis of patients with chronic kidney disease (CKD). Methods and results: Electronic databases were searched up to July 2012, for clinical randomized controlled trials, assessing the effect of dihydropyridine CCBs on the incidence of end-stage renal disease (ESRD) and all-cause mortality in contrast to ACEIs or ARBs. Eight clinical trials were included containing 25,647 participants. ESRD showed significantly higher frequency with CCBs therapy compared with ACEIs or ARBs therapy, though blood pressure was decreased similarly in both groups in every trial (OR, 1.25; 95% CI, 1.05-1.48; p ¼ 0.01). In contrast, there was no significant difference in the incidence of all-cause mortality between these two groups, though ACEIs or ARBs exhibited better renoprotective effect compared to CCBs (OR, 0.96; 95% CI, 0.89-1.03; p ¼ 0.24). Conclusions: CCBs did not increase all-cause mortality incidence in patients with CKD though they displayed weaker renoprotective, compared to ACEIs or ARBs therapy. Our results suggest the combination of a CCB and an ACEI or ARB should be a preferable antihypertensive therapy in patients with CKD, considering their higher effect in decreasing blood pressure and fewer adverse metabolic problems caused.

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Section: Study Selectionmentioning

confidence: 99%

Effect of calcium channels blockers and inhibitors of the renin-angiotensin system on renal outcomes and mortality in patients suffering from chronic kidney disease: systematic review and meta-analysis

Zhao

Liu³

et al. 2016

Renal Failure

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“…There are some reports that ACE inhibitor or ARB use in advancing stages of chronic kidney disease elevates the risk of hyperkalemia [22] [23] [24]. In patients with hypertensive chronic kidney disease treated with ACE inhibitors, hyperkalemia occurs frequently if the baseline and follow-up GFR is lower than 40 mL/min/1.73 m 2 [22].…”

Section: Resultsmentioning

confidence: 99%

“…In patients with hypertensive chronic kidney disease treated with ACE inhibitors, hyperkalemia occurs frequently if the baseline and follow-up GFR is lower than 40 mL/min/1.73 m 2 [22]. Renal disease is identified as one of the predictors of hyperkalemia secondary to ACE inhibitor drug interaction [23].…”

Section: Resultsmentioning

confidence: 99%

The Significance of Angiotensin Converting Enzyme Inhibitor or Angiotensin II Receptor Blocker Use in Sudden Cardiac Death

Onodera¹,

Kikuchi²,

Fujino³

et al. 2017

IJCM

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Objectives: To investigate the relationship between the use of angiotensin converting enzyme (ACE) inhibitor or angiotensin II receptor blocker (ARB) and hyperkalemia in patients diagnosed with sudden cardiac death. Methods: We examined oral ACE inhibitor or ARB use among cardiopulmonary arrest patients brought by ambulance to our emergency room during a 5-year period from January 2012 to December 2016. The cause of death was determined to be sudden cardiac death, despite temporary return of spontaneous circulation after starting cardiopulmonary resuscitation. Subjects were dichotomized into 2 groups, those taking and those not taking an ACE inhibitor or ARB. Variables determined retrospectively included serum potassium, estimated glomerular filtration rate as an index of kidney function and time from cardiopulmonary arrest to return of spontaneous circulation. The Mann-Whitney U-test was used to compare continuous data, and the chi-square test to compare categorical data between groups. The results are expressed as the median plus range. Statistical significance was assumed at p < 0.05. Results: Thirtyfive patients met the inclusion criteria. The mean age was 77.1 years (range, 35 -93 years), and there were 26 males and 9 females. Eleven subjects were ACE inhibitor or ARB users, and 24 were non-users. The serum potassium level was significantly higher in users than non-users (median, 6.2 mEq/L (range,

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“…Both classes of agents increase the risk of hyperkalemia and the odds of mortality increase when hyperkalemia is present [36]. The risk of hyperkalemia can be mitigated by the concomitant use of diuretics [37], dietary potassium restriction, and potassium resin binders.…”

Section: Pharmacologic Interventionsmentioning

confidence: 99%

Hypertension in Cardiovascular and Kidney Disease

2011

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The relationship between hypertension and chronic kidney disease (CKD) is bidirectional in nature and, generally, management strategies for cardiovascular risk reduction also attenuate progression of CKD. Prevalent hypertension increases with diminishing kidney function, and the management strategy changes with level of kidney function. In this review, we will examine the evidence for management of hypertension, as a modifiable risk factor for cardiovascular disease in CKD, and the impact of this management on progression of CKD.

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Risk of Hyperkalemia in Nondiabetic Patients With Chronic Kidney Disease Receiving Antihypertensive Therapy<alt-title>Hyperkalemia in CKD Adults Using Antihypertensives</alt-title>

Abstract: In nondiabetic patients with hypertensive CKD treated with ACEIs, the risk of hyperkalemia is small, particularly if baseline and follow-up GFR is higher than 40 mL/min/1.73 m(2). Including a diuretic in the regimen may markedly reduce risk of hyperkalemia.

Cited by 100 publications

References 25 publications

Effect of calcium channels blockers and inhibitors of the renin-angiotensin system on renal outcomes and mortality in patients suffering from chronic kidney disease: systematic review and meta-analysis

Effect of calcium channels blockers and inhibitors of the renin-angiotensin system on renal outcomes and mortality in patients suffering from chronic kidney disease: systematic review and meta-analysis

The Significance of Angiotensin Converting Enzyme Inhibitor or Angiotensin II Receptor Blocker Use in Sudden Cardiac Death

Hypertension in Cardiovascular and Kidney Disease

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