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Martín-Pérez M, Ruigómez A, Michel A, García Rodríguez LA. Impact of hyperkalaemia definition on incidence assessment: implications for epidemiological research based on a large cohort study in newly diagnosed heart failure patients in primary care. BMC FAMILY PRACTICE 2016; 17:51. [PMID: 27145981 PMCID: PMC4857380 DOI: 10.1186/s12875-016-0448-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 04/22/2016] [Indexed: 01/06/2023]
Abstract
Background Various definitions of hyperkalaemia have been used in clinical research, and data from routine clinical practice on its incidence are sparse. We aimed to establish the incidence of hyperkalaemia in patients with newly diagnosed heart failure in the UK general population using different definitions for the condition. Methods We conducted a large retrospective cohort study using data from The Health Improvement Network primary care database. Patients with newly diagnosed heart failure (N = 19,194) were identified and followed until the first occurrence of hyperkalaemia. Different serum potassium (K+) thresholds were evaluated as possible definitions for hyperkalaemia, and incidence rates (IRs) calculated using a final operational definition both overall and among patient sub-groups. Results IRs of hyperkalaemia ranged from 0.92–7.93 per 100 person-years according to the definition. Based on considerable differences in the serum K+ normal range used between practices, 2176 (11.3 %) individuals were identified with a record of hyperkalaemia using our operational definition of a proportional increase of ≥10 % above the upper bound of the normal range: IR 2.90 per 100 person-years (95 % CI 2.78–3.02) over a mean follow-up of 3.91 years. Incidence rates were higher in older patients, and in those with diabetes or renal impairment. Conclusions Hyperkalaemia is a common finding in heart failure patients in primary care, but its incidence can vary nearly ten-fold depending on its definition. Since assessment of hyperkalaemia risk is essential for therapeutic decision making in heart failure patients, this finding warrants consideration in future epidemiological studies.
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Affiliation(s)
- Mar Martín-Pérez
- Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Madrid, Spain
| | - Ana Ruigómez
- Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Madrid, Spain
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Vardeny O, Cavallari LH, Claggett B, Desai AS, Anand I, Rossignol P, Zannad F, Pitt B, Solomon SD. Race Influences the Safety and Efficacy of Spironolactone in Severe Heart Failure. Circ Heart Fail 2013; 6:970-6. [DOI: 10.1161/circheartfailure.113.000530] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Orly Vardeny
- From the University of Wisconsin School of Pharmacy, Madison, WI (O.V.); University of Illinois at Chicago, IL (L.H.C.); Brigham and Women’s Hospital, Boston, MA (B.C., A.S.D., S.D.S.); University of Minnesota, Minneapolis, MN (I.A.); INSERM, Centre d’Investigations Cliniques-9501 and INSERM U961, Université de Lorraine, Nancy, France (P.R., F.Z.); and University of Michigan, Ann Arbor, MI (B.P.)
| | - Larisa H. Cavallari
- From the University of Wisconsin School of Pharmacy, Madison, WI (O.V.); University of Illinois at Chicago, IL (L.H.C.); Brigham and Women’s Hospital, Boston, MA (B.C., A.S.D., S.D.S.); University of Minnesota, Minneapolis, MN (I.A.); INSERM, Centre d’Investigations Cliniques-9501 and INSERM U961, Université de Lorraine, Nancy, France (P.R., F.Z.); and University of Michigan, Ann Arbor, MI (B.P.)
| | - Brian Claggett
- From the University of Wisconsin School of Pharmacy, Madison, WI (O.V.); University of Illinois at Chicago, IL (L.H.C.); Brigham and Women’s Hospital, Boston, MA (B.C., A.S.D., S.D.S.); University of Minnesota, Minneapolis, MN (I.A.); INSERM, Centre d’Investigations Cliniques-9501 and INSERM U961, Université de Lorraine, Nancy, France (P.R., F.Z.); and University of Michigan, Ann Arbor, MI (B.P.)
| | - Akshay S. Desai
- From the University of Wisconsin School of Pharmacy, Madison, WI (O.V.); University of Illinois at Chicago, IL (L.H.C.); Brigham and Women’s Hospital, Boston, MA (B.C., A.S.D., S.D.S.); University of Minnesota, Minneapolis, MN (I.A.); INSERM, Centre d’Investigations Cliniques-9501 and INSERM U961, Université de Lorraine, Nancy, France (P.R., F.Z.); and University of Michigan, Ann Arbor, MI (B.P.)
| | - Inder Anand
- From the University of Wisconsin School of Pharmacy, Madison, WI (O.V.); University of Illinois at Chicago, IL (L.H.C.); Brigham and Women’s Hospital, Boston, MA (B.C., A.S.D., S.D.S.); University of Minnesota, Minneapolis, MN (I.A.); INSERM, Centre d’Investigations Cliniques-9501 and INSERM U961, Université de Lorraine, Nancy, France (P.R., F.Z.); and University of Michigan, Ann Arbor, MI (B.P.)
| | - Patrick Rossignol
- From the University of Wisconsin School of Pharmacy, Madison, WI (O.V.); University of Illinois at Chicago, IL (L.H.C.); Brigham and Women’s Hospital, Boston, MA (B.C., A.S.D., S.D.S.); University of Minnesota, Minneapolis, MN (I.A.); INSERM, Centre d’Investigations Cliniques-9501 and INSERM U961, Université de Lorraine, Nancy, France (P.R., F.Z.); and University of Michigan, Ann Arbor, MI (B.P.)
| | - Faiez Zannad
- From the University of Wisconsin School of Pharmacy, Madison, WI (O.V.); University of Illinois at Chicago, IL (L.H.C.); Brigham and Women’s Hospital, Boston, MA (B.C., A.S.D., S.D.S.); University of Minnesota, Minneapolis, MN (I.A.); INSERM, Centre d’Investigations Cliniques-9501 and INSERM U961, Université de Lorraine, Nancy, France (P.R., F.Z.); and University of Michigan, Ann Arbor, MI (B.P.)
| | - Bertram Pitt
- From the University of Wisconsin School of Pharmacy, Madison, WI (O.V.); University of Illinois at Chicago, IL (L.H.C.); Brigham and Women’s Hospital, Boston, MA (B.C., A.S.D., S.D.S.); University of Minnesota, Minneapolis, MN (I.A.); INSERM, Centre d’Investigations Cliniques-9501 and INSERM U961, Université de Lorraine, Nancy, France (P.R., F.Z.); and University of Michigan, Ann Arbor, MI (B.P.)
| | - Scott D. Solomon
- From the University of Wisconsin School of Pharmacy, Madison, WI (O.V.); University of Illinois at Chicago, IL (L.H.C.); Brigham and Women’s Hospital, Boston, MA (B.C., A.S.D., S.D.S.); University of Minnesota, Minneapolis, MN (I.A.); INSERM, Centre d’Investigations Cliniques-9501 and INSERM U961, Université de Lorraine, Nancy, France (P.R., F.Z.); and University of Michigan, Ann Arbor, MI (B.P.)
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Benge CD, Muldowney JAS. The pharmacokinetics and pharmacodynamics of valsartan in the post-myocardial infarction population. Expert Opin Drug Metab Toxicol 2012; 8:1469-82. [PMID: 22998368 DOI: 10.1517/17425255.2012.725721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The most common risk factors for heart failure are hypertension and myocardial infarction. Angiotensin receptor blockers (ARBs) attenuate the deleterious effects of angiotensin II. Valsartan is a once or twice daily ARB that is FDA-approved for hypertension, LV dysfunction post-myocardial infarction and congestive heart failure as both an adjunct in ACE-inhibitor tolerant, and alternative in ACE-I intolerant patients. AREAS COVERED This article presents a comprehensive review of the literature regarding the pharmacokinetics and pharmacodynamics of valsartan, with particular attention paid to the post-myocardial infarction population. EXPERT OPINION Valsartan is a safe, well-tolerated and readily titratable ARB. In addition to its vasodilatory effects there are pleotropic effects associated with the ARB such as modulation of a number of neurohormonal regulators, cytokines and small molecules. Given the clear evidence-based benefits above and beyond its hypertensive properties, it has the potential, if priced appropriately, to grow in its impact as a pharmacotherapeutic long after its patent expires.
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Affiliation(s)
- Cassandra D Benge
- Nashville Veterans Affairs Medical Center, Cardiology Section, 1310 24th Avenue South, Nashville, TN 37212-263, USA
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Sarafidis PA, Blacklock R, Wood E, Rumjon A, Simmonds S, Fletcher-Rogers J, Ariyanayagam R, Al-Yassin A, Sharpe C, Vinen K. Prevalence and factors associated with hyperkalemia in predialysis patients followed in a low-clearance clinic. Clin J Am Soc Nephrol 2012; 7:1234-41. [PMID: 22595825 DOI: 10.2215/cjn.01150112] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Recent studies evaluated the prevalence of hyperkalemia and related risk factors in patients with CKD of various stages, but there is limited relevant information in predialysis patients. This study aimed to examine the prevalence and factors associated with hyperkalemia in the structured environment of a low-clearance clinic. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In a cross-sectional fashion over a prespecified period of 4 months, information on serum potassium and relevant laboratory variables, comorbidities, medications, and dietician input in patients with advanced CKD under follow-up in the low-clearance clinic of our department was recorded. Univariate and multiple logistic regression analyses were used to identify factors associated with serum potassium ≥ 5.5 meq/L. RESULTS The study population consisted of 238 patients aged 66.2 ± 4.2 years with estimated GFR of 14.5 ± 4.8 ml/min per 1.73 m(2). The prevalence of hyperkalemia. defined as potassium > 5.0, ≥ 5.5, and ≥ 6.0 meq/L., was at 54.2%, 31.5%, and 8.4%, respectively. In univariate comparisons, patients with potassium ≥ 5.5 meq/L had significantly higher urea and lower estimated GFR and serum bicarbonate; also, they were more often using sodium bicarbonate and had received potassium education and attempts for dietary potassium lowering. Use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was not associated with hyperkalemia. In multivariate analyses, estimated GFR<15 ml/min per 1.73 m(2) and sodium bicarbonate use were independently associated with hyperkalemia. CONCLUSIONS The prevalence of hyperkalemia in predialysis patients with CKD is high. Even at this range of renal function, low estimated GFR seems to be the most important factor associated with hyperkalemia among the wide range of demographic, clinical, and laboratory characteristics studied.
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Affiliation(s)
- Pantelis A Sarafidis
- Academic Department of Renal Medicine, King's College Hospital, London, United Kingdom
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Sica DA. What is the role of aldosterone excess in resistant hypertension and how should it be investigated and treated? Curr Cardiol Rep 2012; 13:520-6. [PMID: 21993610 DOI: 10.1007/s11886-011-0224-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Resistant hypertension has evolved as an important global health care problem. Primary aldosteronism is one of several potentially reversible causes of resistant hypertension. Primary aldosteronism can be effectively treated, when recognized, with a mineralocorticoid receptor antagonist, such as spironolactone and eplerenone. Each of these compounds can reduce blood pressure as monotherapy or when given with a range of other antihypertensive drug classes. These compounds have distinctive pharmacokinetic and pharmacodynamic patterns that require some forethought in their use before they are prescribed. However, as the use of mineralocorticoid-blocking agents has gradually increased, the hazards inherent to use of such drugs has become more apparent. Whereas the endocrine side effects of spironolactone are in most cases little more than a cosmetic annoyance, the potassium-sparing effects of both spironolactone and eplerenone can prove fatal if sufficient degrees of hyperkalemia develop. However, for most patients the risk of developing hyperkalemia in and of itself should not discourage the prudent clinician from bringing these compounds into play. Hyperkalemia should always be considered as a likelihood in any patient receiving one or the other of these medications. As such, steps should be taken to lessen the likelihood of it occurring if therapy is being contemplated with agents in this class.
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Affiliation(s)
- Domenic A Sica
- Medicine and Pharmacology, Clinical Pharmacology and Hypertension, Richmond, USA.
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Sarafidis PA, Georgianos PI, Lasaridis AN. Diuretics in clinical practice. Part II: electrolyte and acid-base disorders complicating diuretic therapy. Expert Opin Drug Saf 2010; 9:259-73. [PMID: 20095916 DOI: 10.1517/14740330903499257] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD As with all potent therapeutic agents, the use of diuretic compounds has been linked with several adverse effects that may reduce quality of life and patient compliance and, in some cases, may be associated with considerable morbidity and mortality. Among the various types of adverse effects, disturbances of electrolyte and acid-base balance are perhaps the most common, and some of them are the aetiological factors of other side effects (i.e., hypokalaemia causing ventricular arrhythmias or glucose intolerance). The mechanism and site of action and, therefore, the pharmacological effects of each diuretic class largely determine the specific electrolyte or acid-base abnormalities that will accompany the use of each diuretic agent. AREAS COVERED IN THE REVIEW This article reviews the major electrolyte disturbances (hypokalaemia, hyperkalaemia, hyponatraemia, disorders of magnesium and calcium balance), as well as the acid-base abnormalities complicating the use of the various diuretic agents. WHAT THE READER WILL GAIN The reader will gain insights into the pathogenesis of the diuretic-induced electrolyte and acid-base disorders together with considerations for their prevention and treatment. TAKE HOME MESSAGE Knowledge of the pharmacologic properties of each diuretic class and appropriate monitoring of patients under diuretic treatment represent the most important strategies to prevent the development of diuretic-related adverse events and their consequences.
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Affiliation(s)
- Pantelis A Sarafidis
- Section of Nephrology and Hypertension, 1st Department of Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, St Kiriakidi 1, 54636, Thessaloniki, Greece.
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