Risk of hyperkalemia in nondiabetic patients with chronic kidney disease receiving antihypertensive therapy

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

Research output: Contribution to journalArticle

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Abstract

Background: The incidence and factors associated with hyperkalemia in patients with chronic kidney disease (CKD) treated with angiotensin converting enzyme inhibitors (ACEIs) and other antihypertensive drugs was investigated using the African American Study of Kidney Disease and Hypertension (AASK) database. Methods: A total of 1094 nondiabetic adults with hypertensive CKD (glomerular filtration rate [GFR], 20-65 mL/min/1.73 m2) were followed for 3.0 to 6.4 years in the AASK trial. Participants were randomly assigned to ACEI, β-blocker (BB), or dihydropyridine calcium channel blocker (CCB). The outcome variables for this analysis were a serum potassium level higher than 5.5 mEq/L (to convert to millimoles per liter, multiply by 1.0), or a clinical center initiated hyperkalemia stop point. Results: A total of 6497 potassium measurements were obtained, and 80 events in 51 subjects were identified (76 events driven by a central laboratory result and 4 driven by a clinical center-initiated hyperkalemia stop point). Compared with a GFR higher than 50 mL/min/ 1.73 m2, after multivariable adjustment, the hazard ratio (HR) for hyperkalemia in patients with a GFR between 31 and 40 mL/min/1.73 m2 and a GFR lower than 30 mL/min/1.73 m2 was 3.61 (95% confidence interval [CI], 1.42-9.18 [P=.007]) and 6.81 (95% CI, 2.67-17.35 [P<.001]), respectively; there was no increased risk of hyperkalemia if GFR was 41 to 50 mL/min/1.73 m2. Use of ACEIs was associated with more episodes of hyperkalemia compared with CCB use (HR, 7.00; 95% CI, 2.29-21.39 [P<.001]) and BB group (HR, 2.85; 95% CI, 1.50-5.42 [P=.001]). Diuretic use was associated with a 59% decreased risk of hyperkalemia. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)1587-1594
Number of pages8
JournalArchives of Internal Medicine
Volume169
Issue number17
DOIs
StatePublished - 2009
Externally publishedYes

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Hyperkalemia
Chronic Renal Insufficiency
Antihypertensive Agents
Glomerular Filtration Rate
Angiotensin-Converting Enzyme Inhibitors
Confidence Intervals
Therapeutics
Calcium Channel Blockers
Diuretics
Potassium
Kidney Diseases
African Americans
Databases
Hypertension
Incidence

ASJC Scopus subject areas

  • Internal Medicine

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Risk of hyperkalemia in nondiabetic patients with chronic kidney disease receiving antihypertensive therapy. / Weinberg, Joy M.; Appel, Lawrence J.; Bakris, George; Gassman, Jennifer J.; Greene, Tom; Kendrick, Cynthia A.; Wang, Xuelei; Lash, James; Lewis, Julia A.; Pogue, Velvie; Thornley-Brown, Denyse; Phillips, Robert A.

In: Archives of Internal Medicine, Vol. 169, No. 17, 2009, p. 1587-1594.

Research output: Contribution to journalArticle

Weinberg, JM, Appel, LJ, Bakris, G, Gassman, JJ, Greene, T, Kendrick, CA, Wang, X, Lash, J, Lewis, JA, Pogue, V, Thornley-Brown, D & Phillips, RA 2009, 'Risk of hyperkalemia in nondiabetic patients with chronic kidney disease receiving antihypertensive therapy', Archives of Internal Medicine, vol. 169, no. 17, pp. 1587-1594. https://doi.org/10.1001/archinternmed.2009.284
Weinberg, Joy M. ; Appel, Lawrence J. ; Bakris, George ; Gassman, Jennifer J. ; Greene, Tom ; Kendrick, Cynthia A. ; Wang, Xuelei ; Lash, James ; Lewis, Julia A. ; Pogue, Velvie ; Thornley-Brown, Denyse ; Phillips, Robert A. / Risk of hyperkalemia in nondiabetic patients with chronic kidney disease receiving antihypertensive therapy. In: Archives of Internal Medicine. 2009 ; Vol. 169, No. 17. pp. 1587-1594.
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title = "Risk of hyperkalemia in nondiabetic patients with chronic kidney disease receiving antihypertensive therapy",
abstract = "Background: The incidence and factors associated with hyperkalemia in patients with chronic kidney disease (CKD) treated with angiotensin converting enzyme inhibitors (ACEIs) and other antihypertensive drugs was investigated using the African American Study of Kidney Disease and Hypertension (AASK) database. Methods: A total of 1094 nondiabetic adults with hypertensive CKD (glomerular filtration rate [GFR], 20-65 mL/min/1.73 m2) were followed for 3.0 to 6.4 years in the AASK trial. Participants were randomly assigned to ACEI, β-blocker (BB), or dihydropyridine calcium channel blocker (CCB). The outcome variables for this analysis were a serum potassium level higher than 5.5 mEq/L (to convert to millimoles per liter, multiply by 1.0), or a clinical center initiated hyperkalemia stop point. Results: A total of 6497 potassium measurements were obtained, and 80 events in 51 subjects were identified (76 events driven by a central laboratory result and 4 driven by a clinical center-initiated hyperkalemia stop point). Compared with a GFR higher than 50 mL/min/ 1.73 m2, after multivariable adjustment, the hazard ratio (HR) for hyperkalemia in patients with a GFR between 31 and 40 mL/min/1.73 m2 and a GFR lower than 30 mL/min/1.73 m2 was 3.61 (95{\%} confidence interval [CI], 1.42-9.18 [P=.007]) and 6.81 (95{\%} CI, 2.67-17.35 [P<.001]), respectively; there was no increased risk of hyperkalemia if GFR was 41 to 50 mL/min/1.73 m2. Use of ACEIs was associated with more episodes of hyperkalemia compared with CCB use (HR, 7.00; 95{\%} CI, 2.29-21.39 [P<.001]) and BB group (HR, 2.85; 95{\%} CI, 1.50-5.42 [P=.001]). Diuretic use was associated with a 59{\%} decreased risk of hyperkalemia. Conclusions: 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.",
author = "Weinberg, {Joy M.} and Appel, {Lawrence J.} and George Bakris and Gassman, {Jennifer J.} and Tom Greene and Kendrick, {Cynthia A.} and Xuelei Wang and James Lash and Lewis, {Julia A.} and Velvie Pogue and Denyse Thornley-Brown and Phillips, {Robert A.}",
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T1 - Risk of hyperkalemia in nondiabetic patients with chronic kidney disease receiving antihypertensive therapy

AU - Weinberg, Joy M.

AU - Appel, Lawrence J.

AU - Bakris, George

AU - Gassman, Jennifer J.

AU - Greene, Tom

AU - Kendrick, Cynthia A.

AU - Wang, Xuelei

AU - Lash, James

AU - Lewis, Julia A.

AU - Pogue, Velvie

AU - Thornley-Brown, Denyse

AU - Phillips, Robert A.

PY - 2009

Y1 - 2009

N2 - Background: The incidence and factors associated with hyperkalemia in patients with chronic kidney disease (CKD) treated with angiotensin converting enzyme inhibitors (ACEIs) and other antihypertensive drugs was investigated using the African American Study of Kidney Disease and Hypertension (AASK) database. Methods: A total of 1094 nondiabetic adults with hypertensive CKD (glomerular filtration rate [GFR], 20-65 mL/min/1.73 m2) were followed for 3.0 to 6.4 years in the AASK trial. Participants were randomly assigned to ACEI, β-blocker (BB), or dihydropyridine calcium channel blocker (CCB). The outcome variables for this analysis were a serum potassium level higher than 5.5 mEq/L (to convert to millimoles per liter, multiply by 1.0), or a clinical center initiated hyperkalemia stop point. Results: A total of 6497 potassium measurements were obtained, and 80 events in 51 subjects were identified (76 events driven by a central laboratory result and 4 driven by a clinical center-initiated hyperkalemia stop point). Compared with a GFR higher than 50 mL/min/ 1.73 m2, after multivariable adjustment, the hazard ratio (HR) for hyperkalemia in patients with a GFR between 31 and 40 mL/min/1.73 m2 and a GFR lower than 30 mL/min/1.73 m2 was 3.61 (95% confidence interval [CI], 1.42-9.18 [P=.007]) and 6.81 (95% CI, 2.67-17.35 [P<.001]), respectively; there was no increased risk of hyperkalemia if GFR was 41 to 50 mL/min/1.73 m2. Use of ACEIs was associated with more episodes of hyperkalemia compared with CCB use (HR, 7.00; 95% CI, 2.29-21.39 [P<.001]) and BB group (HR, 2.85; 95% CI, 1.50-5.42 [P=.001]). Diuretic use was associated with a 59% decreased risk of hyperkalemia. Conclusions: 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.

AB - Background: The incidence and factors associated with hyperkalemia in patients with chronic kidney disease (CKD) treated with angiotensin converting enzyme inhibitors (ACEIs) and other antihypertensive drugs was investigated using the African American Study of Kidney Disease and Hypertension (AASK) database. Methods: A total of 1094 nondiabetic adults with hypertensive CKD (glomerular filtration rate [GFR], 20-65 mL/min/1.73 m2) were followed for 3.0 to 6.4 years in the AASK trial. Participants were randomly assigned to ACEI, β-blocker (BB), or dihydropyridine calcium channel blocker (CCB). The outcome variables for this analysis were a serum potassium level higher than 5.5 mEq/L (to convert to millimoles per liter, multiply by 1.0), or a clinical center initiated hyperkalemia stop point. Results: A total of 6497 potassium measurements were obtained, and 80 events in 51 subjects were identified (76 events driven by a central laboratory result and 4 driven by a clinical center-initiated hyperkalemia stop point). Compared with a GFR higher than 50 mL/min/ 1.73 m2, after multivariable adjustment, the hazard ratio (HR) for hyperkalemia in patients with a GFR between 31 and 40 mL/min/1.73 m2 and a GFR lower than 30 mL/min/1.73 m2 was 3.61 (95% confidence interval [CI], 1.42-9.18 [P=.007]) and 6.81 (95% CI, 2.67-17.35 [P<.001]), respectively; there was no increased risk of hyperkalemia if GFR was 41 to 50 mL/min/1.73 m2. Use of ACEIs was associated with more episodes of hyperkalemia compared with CCB use (HR, 7.00; 95% CI, 2.29-21.39 [P<.001]) and BB group (HR, 2.85; 95% CI, 1.50-5.42 [P=.001]). Diuretic use was associated with a 59% decreased risk of hyperkalemia. Conclusions: 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.

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