Abstract
Purpose: Angiotensin-converting enzyme (ACE) inhibitors are recommended for patients with chronic kidney disease (CKD) because they slow disease progression. But physicians' concerns about the risk of hyperkalemia (elevated serum potassium level), a potentially fatal adverse effect, may limit optimal management with ACE-inhibitors.We synthesized known predictors of hyperkalemia into a prognostic risk score to predict the risk of hyperkalemia. Methods: We assembled a retrospective cohort of adult patients with possible CKD (at least one estimated glomerular filtration rate (eGFR) value less than 60 ml/min/1.73m2) who started an ACE-inhibitor (i.e., incident users) between 1998 and 2006 at a health maintenance organization. We followed patients for hyperkalemia: (1) potassium value >5.5 mmol/L; or (2) diagnosis code for hyperkalemia. Cox regression synthesized a priori predictors recorded in the electronic medical record into a risk score. Results: We followed 5171 patients and 145 experienced hyperkalemia, a 90-day risk of 2.8%. Predictors included: age, eGFR, diabetes, heart failure, potassium supplements, potassium-sparing diuretics, and a high dose for the ACE-inhibitor (lisinopril). The risk score separated high-risk patients (top quintile, observed risk of 6.9%) from low-risk patients (bottom quintile, observed risk of 0.7%). Predicted and observed risks agreed within 1% for each quintile. The risk increased gradually in relation to declining eGFR with no apparent threshold for contraindicating ACE-inhibitors. Conclusions: The risk score separated high-risk patients (who may need more intensive laboratory monitoring) from low-risk patients. The risk score should be validated in other populations before it is ready for use in clinical practice.
Original language | English (US) |
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Pages (from-to) | 266-272 |
Number of pages | 7 |
Journal | Pharmacoepidemiology and Drug Safety |
Volume | 19 |
Issue number | 3 |
DOIs | |
State | Published - Mar 2010 |
Externally published | Yes |
Keywords
- ACE-inhibitors
- Adverse effects
- Chronic kidney disease
- Cohort study
- Hyperkalemia
- Risk score
ASJC Scopus subject areas
- Epidemiology
- Pharmacology (medical)