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Incidence of and risk factors for newly diagnosed hyperkalemia after hospital discharge in non-dialysis-dependent CKD patients treated with RAS inhibitors
- Source :
- PLoS ONE, Vol 12, Iss 9, p e0184402 (2017), PLoS ONE
- Publication Year :
- 2017
- Publisher :
- Public Library of Science (PLoS), 2017.
-
Abstract
- Introduction Renin-angiotensin system (RAS) inhibitors have been increasingly prescribed due to their beneficial effects on end-organ protection. Iatrogenic hyperkalemia is a well-known life-threatening complication of RAS inhibitor use in chronic kidney disease (CKD) patients. We hypothesized that CKD patients treated with RAS inhibitors frequently develop hyperkalemia after hospital discharge even if they were normokalemic during their hospitalization because their lifestyles change substantially after discharge. The present study aimed to examine the incidence of newly diagnosed hyperkalemia, the timing of hyperkalemia, and its risk factors in CKD patients treated with RAS inhibitors at the time of hospital discharge. Methods We retrospectively enrolled patients aged 20 years or older with CKD G3-5 (estimated glomerular filtration rate < 60 mL/min/1.73 m2) and who were treated with RAS inhibitors and discharged from St. Luke’s International Hospital between July 2011 and December 2015. Patients who were under maintenance dialysis or had hyperkalemic events before discharge were excluded. Data regarding the patients’ age, sex, CKD stage, diabetes mellitus status, malignancy status, combined use of RAS inhibitors, concurrent medication, and hyperkalemic events after discharge were extracted from the hospital database. Our primary outcome was hyperkalemia, defined as serum potassium ≥ 5.5 mEq/L. Multiple logistic regression and Kaplan-Meier analyses were performed to identify the risk factors for and the timing of hyperkalemia, respectively. Results Among the 986 patients, 121 (12.3%) developed hyperkalemia after discharge. In the regression analysis, relative to CKD G3a, G3b [odds ratio (OR): 1.88, 95% confidence interval 1.20–2.97] and G4-5 (OR: 3.40, 1.99–5.81) were significantly associated with hyperkalemia. The use of RAS inhibitor combinations (OR: 1.92, 1.19–3.10), malignancy status (OR: 2.10, 1.14–3.86), and baseline serum potassium (OR: 1.91, 1.23–2.97) were also significantly associated with hyperkalemia. The Kaplan-Meier analysis showed that hyperkalemia was most frequent during the early period after discharge, particularly within one month. Conclusion Hyperkalemia was frequent during the early period after discharge among previously normokalemic CKD patients who were treated with RAS inhibitors. Appropriate follow-up after discharge should be required for these patients, particularly those with advanced CKD or malignancy status, such as hematological malignancy or late-stage malignancy, and those who are treated with multiple RAS inhibitors.
- Subjects :
- Male
Hyperkalemia
NSAIDs
Peptide Hormones
medicine.medical_treatment
Cancer Treatment
030232 urology & nephrology
lcsh:Medicine
Kaplan-Meier Estimate
urologic and male genital diseases
Biochemistry
Renin-Angiotensin System
Endocrinology
0302 clinical medicine
Risk Factors
Chronic Kidney Disease
Medicine and Health Sciences
030212 general & internal medicine
Diuretics
lcsh:Science
Aged, 80 and over
Analgesics
Multidisciplinary
Incidence
Incidence (epidemiology)
Drugs
Middle Aged
Patient Discharge
female genital diseases and pregnancy complications
Hospitalization
Oncology
Nephrology
Female
medicine.symptom
Glomerular Filtration Rate
Research Article
Adult
medicine.medical_specialty
Endocrine Disorders
Renal function
Malignancy
Young Adult
03 medical and health sciences
Diagnostic Medicine
Internal medicine
Medical Dialysis
Cancer Detection and Diagnosis
Diabetes Mellitus
medicine
Humans
Intensive care medicine
Life Style
Dialysis
Aged
Retrospective Studies
Pharmacology
business.industry
lcsh:R
Biology and Life Sciences
Retrospective cohort study
Odds ratio
medicine.disease
Hormones
Pain management
Metabolic Disorders
Kidney Failure, Chronic
lcsh:Q
business
Kidney disease
Subjects
Details
- Language :
- English
- ISSN :
- 19326203
- Volume :
- 12
- Issue :
- 9
- Database :
- OpenAIRE
- Journal :
- PLoS ONE
- Accession number :
- edsair.doi.dedup.....dbbd4b7276b1f5cb42de36b7e11a75b6