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Faré PB, Memoli E, Treglia G, Bianchetti MG, Milani GP, Marchisio P, Lava SAG, Janett S. Trimethoprim-associated hyperkalaemia: a systematic review and meta-analysis. J Antimicrob Chemother 2022; 77:2588-2595. [PMID: 36018069 DOI: 10.1093/jac/dkac262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 07/07/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Trimethoprim is structurally similar to potassium-sparing diuretics and may induce hyperkalaemia. The prevalence and the factors that predispose to trimethoprim-associated hyperkalaemia have never been extensively addressed. METHODS A literature search with no date or language limits was carried out using the National Library of Medicine, Embase and Web of Science in March and repeated during August 2021. The principles underlying the Economic and Social Research Council guidance on the conduct of synthesis and the PRISMA guidelines were employed. For the analysis, we retained reports including ≥10 subjects on treatment with trimethoprim, which addressed the possible occurrence of hyperkalaemia. RESULTS Eighteen reports were retained for the final analysis. The pooled prevalence of potassium value >5.0 mmol/L, >5.5 mmol/L and >6.0 mmol/L or symptomatic, was, respectively, 22%, 10% and 0.2%. The analysis disclosed that the risk of trimethoprim-associated hyperkalaemia is dose-related and enhanced by drugs with known hyperkalaemic potential including potassium-sparing diuretics, renin-angiotensin-aldosterone system inhibitors, β-blockers and non-steroidal anti-inflammatory agents. Poor kidney function also increased the tendency towards hyperkalaemia. The time to onset of hyperkalaemia was generally 1 week or less after starting trimethoprim. CONCLUSIONS The present analysis documents the hyperkalaemic potential of trimethoprim, a widely prescribed drug that was introduced more than 50 years ago. Clinicians must recognize patients at risk of trimethoprim-associated hyperkalaemia.
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Affiliation(s)
- Pietro B Faré
- Infectious Diseases Division, Department of Medicine, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
| | - Erica Memoli
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
| | - Giorgio Treglia
- Academic Education, Research and Innovation Area, General Directorate, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland.,Faculty of Biomedical Science, Università della Svizzera italiana, 6900 Lugano, Switzerland
| | - Mario G Bianchetti
- Faculty of Biomedical Science, Università della Svizzera italiana, 6900 Lugano, Switzerland.,Family Medicine Institute, Faculty of Biomedical Science, Università della Svizzera italiana, 6900 Lugano, Switzerland
| | - Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Paola Marchisio
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Sebastiano A G Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois, and University of Lausanne, 1011 Lausanne, Switzerland
| | - Simone Janett
- Department of Pneumology, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
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