Frequency of laboratory measurement and hyperkalaemia in hospitalised patients using serum potassium concentration increasing drugs

PurposeAlthough, drug–drug interactions (DDIs) between potassium-increasing drugs (PIDs) are known risk factors for developing hyperkalaemia, not much is known about their risk and management strategies during hospitalisation. This study examines the frequency of serum potassium measurements and hyperkalaemia in hospitalised patients, based on the use of one or more PIDs, and the determinants thereof.MethodsAdult patients hospitalised in the University Medical Centre Utrecht between 2006 and 2008 were included in this cross-sectional study. The frequency of serum potassium measurements and of hyperkalaemia were compared between patients using only one PID at a time (monotherapy group) and patients using two or more PIDs concomitantly (interaction group). The determinants studied were renal failure, diabetes mellitus, use of diuretics, type of DDI, start of the PIDs within the hospital versus continued home medication and medical speciality.ResultsSerum potassium was measured more frequently in the interaction group than in the monotherapy group [67 vs. 56%; relative risk (RR) 1.19, 95% confidence interval (CI) 1.14–1.24] and the risk of hyperkalaemia was also increased in the interaction group (9.9 vs. 5.9%, RR 1.7, 95% CI 1.3–2.1). The combination of potassium-sparing diuretics plus a potassium supplement, start of the PID within the hospital and hospitalisation in non-internal medicine departments was associated with higher relative risk estimates for hyperkalaemia.ConclusionsAmong our patient cohort, even when physicians received a direct pop-up to monitor serum potassium levels when prescribing two PIDs concomitantly, serum potassium levels were not measured in 33% of patients, and 10% of patients developed hyperkalaemia. Improved management strategies and/or clinical decision-support systems are needed to decrease the frequency of hyperkalaemia following DDIs.

[1]  N. Hollenberg.  ACE inhibition or angiotensin receptor blockade: impact on potassium in renal failure. , 2001, Current hypertension reports.

[2]  A. Egberts,et al.  Clinical Risk Management in Dutch Community Pharmacies , 2006, Drug safety.

[3]  J. Beizer,et al.  Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. , 2005, The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists.

[4]  L. Appel,et al.  Risk of hyperkalemia in nondiabetic patients with chronic kidney disease receiving antihypertensive therapy. , 2009, Archives of internal medicine.

[5]  P. Timmermans,et al.  Rationale, background, and design of the randomized angiotensin receptor antagonist--angiotensin-converting enzyme inhibitor study (RAAS). , 1996, The American journal of cardiology.

[6]  B. Pitt.  Effectiveness of spironolactone added to an angiotensin-converting enzyme inhibitor and a loop diuretic for severe chronic congestive heart failure (the Randomized Aldactone Evaluation Study [RALES]). , 1996, The American journal of cardiology.

[7]  A. Egberts,et al.  Frequency and nature of drug-drug interactions in a Dutch university hospital. , 2009, British journal of clinical pharmacology.

[8]  Robert W Platt,et al.  Predicting the risk of hyperkalemia in patients with chronic kidney disease starting lisinopril , 2010, Pharmacoepidemiology and drug safety.

[9]  Marc Berg,et al.  Drug safety alert generation and overriding in a large Dutch university medical centre , 2009, Pharmacoepidemiology and drug safety.

[10]  A. Levey,et al.  A More Accurate Method To Estimate Glomerular Filtration Rate from Serum Creatinine: A New Prediction Equation , 1999, Annals of Internal Medicine.

[11]  M. Perazella,et al.  Hyperkalemia in the elderly: drugs exacerbate impaired potassium homeostasis. , 1997, Journal of general internal medicine.

[12]  Roger B. Davis,et al.  Physicians' decisions to override computerized drug alerts in primary care. , 2003, Archives of internal medicine.

[13]  Marc Berg,et al.  Overriding of drug safety alerts in computerized physician order entry. , 2006, Journal of the American Medical Informatics Association : JAMIA.

[14]  Thomas Fehr,et al.  Influence of drugs and comorbidity on serum potassium in 15 000 consecutive hospital admissions. , 2008, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[15]  J. Groenewoud,et al.  Risk calculation for hyperkalaemia in heart failure patients. , 2007, The Netherlands journal of medicine.

[16]  A. Laupacis,et al.  Drug-drug interactions among elderly patients hospitalized for drug toxicity. , 2003, JAMA.

[17]  R. Dunlay,et al.  Hyperkalemia in hospitalized patients , 2004, International Urology and Nephrology.

[18]  G. Bakris,et al.  ACE inhibition or angiotensin receptor blockade: impact on potassium in renal failure. VAL-K Study Group. , 2000, Kidney international.

[19]  M. Zhan,et al.  The frequency of hyperkalemia and its significance in chronic kidney disease. , 2009, Archives of internal medicine.

[20]  Akshay S. Desai,et al.  Hyperkalemia associated with inhibitors of the renin-angiotensin-aldosterone system: balancing risk and benefit. , 2008, Circulation.

[21]  Á. Cruz,et al.  Hyperkalaemia in congestive heart failure patients using ACE inhibitors and spironolactone. , 2003, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[22]  N. Madias,et al.  Drug‐Induced Hyperkalemia , 1985, Medicine.

[23]  A. Egberts,et al.  Linking laboratory and medication data: new opportunities for pharmacoepidemiological research , 2007, Clinical chemistry and laboratory medicine.

[24]  P. Souverein,et al.  Emerging Themes in Epidemiology Open Access Methodology Testing Bias in Clinical Databases: Methodological Considerations , 2022 .

[25]  J. Brouwers,et al.  Clinical Relevance of Drug-Drug Interactions , 2005, Drug safety.

[26]  A. Egberts,et al.  Frequency of and Risk Factors for Preventable Medication-Related Hospital Admissions in the Netherlands , 2009 .

[27]  Tom Greene,et al.  Using Standardized Serum Creatinine Values in the Modification of Diet in Renal Disease Study Equation for Estimating Glomerular Filtration Rate , 2006, Annals of Internal Medicine.