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Diabetes and Drug-Associated Hyperkalemia: Effect of Potassium Monitoring

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Abstract

BACKGROUND

Renin-angiotensin-aldosterone system (RAAS) inhibitors are associated with hyperkalemia, but there is little evidence demonstrating patients who receive potassium monitoring have a lower rate of hyperkalemia.

OBJECTIVE

To evaluate the association between potassium monitoring and serious hyperkalemia-associated adverse outcomes among patients with diabetes newly initiating RAAS inhibitor therapy.

DESIGN

Retrospective observational study.

PARTICIPANTS

Patients with diabetes without end-stage renal disease initiating RAAS inhibitor therapy between 2001 and 2006 at three integrated health care systems.

MEASUREMENTS

Potassium monitoring and first hyperkalemia-associated adverse event during the initial year of therapy. Hyperkalemia-associated adverse events included hospitalizations, emergency department visits or deaths within 24 h of hyperkalemia diagnosis and/or diagnostic potassium ≥6 mmol/l. Incidence rates were calculated in person-years (p-y). We used inverse probability propensity score weighting to adjust for differences between patients with and without monitoring; Poisson regression was used to obtain adjusted relative risks.

RESULTS

A total of 19,391 of 27,355 patients (71%) received potassium monitoring. Serious hyperkalemia-associated events occurred at an incidence rate of 10.2 per 1,000 p-y. Compared to patients without monitoring, adjusted relative risk of hyperkalemia-associated adverse events among all patients with monitoring was 0.50 (0.37, 0.66); in the subset of patients who also had chronic kidney disease (n = 2,176), adjusted relative risk was 0.29 (0.18, 0.46).

CONCLUSIONS

Patients prescribed RAAS inhibitors who have both diabetes and chronic kidney disease and receive potassium monitoring are less likely to experience a serious hyperkalemia-associated adverse event compared to similar patients who did not receive potassium monitoring. This evidence supports existing consensus-based guidelines.

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Acknowledgements

“Diabetes and Drug-Associated Hyperkalemia: Effect of Laboratory Monitoring” was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) under the following grant number: R21DK075076. NIDDK did not participate in any of the following: design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript.

We thank Xiuhai Yang, MS, Hans Petersen, MS, and Junling Ren, MEd, for programming efforts, and Leslie A. Wright, MA, and Jill Mesa for project management.

Conflicts of Interest Disclosure

Marsha Raebel reports being a co-investigator in a research study funded by Sanofi-Aventis. This study does not involve the evaluation of any commercial product. Dr. Raebel also owns ≤400 shares of stock in each of Merck, Genentech, Teva, Biogen and Pfizer. Douglas Roblin reports receiving research grants within the last 3 years from GlaxoSmithKline and Gilead. Craig Cheetham reports being a co-investigator on a research study funded by Merck, owns stock in Allergan Pharmaceuticals and has a family member employed by Allergan Pharmaceuticals. Christopher Blanchette was previously employed by GlaxoSmithKline, during which time he owned stock in that company. He has received research grants from GlaxoSmithKline, AstraZeneca, Wyeth, Amgen and Premier, Inc., and serves as a consultant for NovoNordisk, GlaxoSmithKline, AstraZeneca, Sepracor and Viostat. David Smith has received research grants from Genzyme, Sanofi-Aventis, Amgen and Abbott. These research grants do not involve the evaluation of any commercial product. Colleen Ross, Stanley Xu and Gwyn Saylor report no potential conflicts of interest.

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Authors and Affiliations

  1. Kaiser Permanente Colorado Institute for Health Research, P.O. Box 378066, Denver, CO 80237, CO, USA

    Marsha A. Raebel PharmD, Colleen Ross MS, Stanley Xu PhD & Gwyn Saylor BA

  2. School of Pharmacy, University of Colorado at Denver, Denver, CO, USA

    Marsha A. Raebel PharmD

  3. HMO Research Network Center for Education and Research in Therapeutics (CERTs), Boston, MA, USA

    Marsha A. Raebel PharmD, Douglas W. Roblin PhD, Craig Cheetham PharmD, MS & David H. Smith PhD

  4. Kaiser Permanente Center for Health Research, Atlanta, GA, USA

    Douglas W. Roblin PhD

  5. Pharmacy Analytic Services, Kaiser Permanente Southern California, Downey, CA, USA

    Craig Cheetham PharmD, MS

  6. Lovelace Respiratory Research Institute, Kannapolis, NC, USA

    Christopher M. Blanchette PhD

  7. School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Christopher M. Blanchette PhD

  8. Salisbury VAMC, Salisbury, NC, USA

    Christopher M. Blanchette PhD

  9. Kaiser Permanente Center for Health Research, Portland, OR, USA

    David H. Smith PhD

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  1. Marsha A. Raebel PharmD
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Correspondence to Marsha A. Raebel PharmD.

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Raebel, M.A., Ross, C., Xu, S. et al. Diabetes and Drug-Associated Hyperkalemia: Effect of Potassium Monitoring. J GEN INTERN MED 25, 326–333 (2010). https://doi.org/10.1007/s11606-009-1228-x

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  • DOI: https://doi.org/10.1007/s11606-009-1228-x

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