Raebel Marsha A, McClure David L, Chan K Arnold, Simon Steven R, Feldstein Adrianne C, Lafata Jennifer Elston, Andrade Susan E, Gunter Margaret J, Nelson Winnie W, Roblin Douglas, Platt Richard
Kaiser Permanente Colorado Clinical Research Unit and School of Pharmacy, University of Colorado at Denver and Health Sciences Center, Denver, CO 80237, USA.
Ann Pharmacother. 2007 Feb;41(2):193-200. doi: 10.1345/aph.1H520. Epub 2007 Feb 6.
Serum potassium and creatinine evaluation is recommended in patients prescribed spironolactone, yet the proportion of ambulatory patients chronically dispensed spironolactone receiving evaluation is not well understood.
To estimate the rate of potassium and creatinine evaluation and identify factors associated with conducting these tests among ambulatory patients dispensed spironolactone.
A retrospective cohort study was designed to evaluate patients at 10 health maintenance organizations with ongoing spironolactone dispensing for one year (N = 2257). Potassium and creatinine evaluation were determined from administrative data. Associations between patient characteristics and laboratory testing were assessed, using logistic regression modeling.
Serum creatinine and potassium were evaluated in 72.3% of patients during a 13 month period. The likelihood of potassium and creatinine monitoring was greater among patients who were older (OR 1.28; 95% CI 1.17 to 1.41 per decade of life); male (OR 1.25; 95% CI 1.01 to 1.54); had diabetes (OR 1.63; 95% CI 1.31 to 2.03); received concomitant therapy with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (OR 2.23; 95% CI 1.74 to 2.87), potassium supplements (OR 1.96; 95% CI 1.51 to 2.54), or digoxin (OR 2.10 95% CI 1.48 to 2.98); or had more outpatient visits (OR 1.31; 95% CI 1.19 to 1.44). Among patients with heart failure (n = 790), factors associated with the incidence of laboratory testing were diabetes (OR 1.64, 95% CI 1.14 to 2.34), outpatient visits (OR 1.20; 95% CI 1.02 to 1.41), and digoxin therapy (OR 2.26; 95% CI 1.38 to 3.69).
Three-fourths of ambulatory patients dispensed spironolactone receive recommended laboratory evaluation, with monitoring more likely to be completed in patients prescribed concomitant therapy with drugs that increase hyperkalemia risk, older patients, and those with diabetes.
对于开具螺内酯处方的患者，建议进行血清钾和肌酐评估，但长期接受螺内酯治疗的门诊患者接受评估的比例尚不清楚。
评估钾和肌酐评估率，并确定在接受螺内酯治疗的门诊患者中进行这些检查的相关因素。
设计了一项回顾性队列研究，以评估10家健康维护组织中持续接受螺内酯治疗一年的患者（N = 2257）。通过管理数据确定钾和肌酐评估情况。使用逻辑回归模型评估患者特征与实验室检查之间的关联。
在13个月期间，72.3%的患者接受了血清肌酐和钾的评估。年龄较大的患者（每增加十岁，OR 1.28；95% CI 1.17至1.41）、男性（OR 1.25；95% CI 1.01至1.54）、患有糖尿病（OR 1.63；95% CI 1.31至2.03）、接受血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂联合治疗（OR 2.23；95% CI 1.74至2.87）、服用钾补充剂（OR 1.96；95% CI 1.51至2.54）或地高辛（OR 2.10，95% CI 1.48至2.98）的患者，以及门诊就诊次数较多的患者（OR 1.31；95% CI 1.19至1.44），进行钾和肌酐监测的可能性更大。在心力衰竭患者（n = 790）中，与实验室检查发生率相关的因素包括糖尿病（OR 1.64，95% CI 1.14至2.34）、门诊就诊（OR 1.20；95% CI 1.02至1.41）和地高辛治疗（OR 2.26；95% CI 1.38至3.69）。
接受螺内酯治疗的门诊患者中有四分之三接受了推荐的实验室评估，在开具增加高钾血症风险药物联合治疗的患者、老年患者和糖尿病患者中，监测更有可能完成。
Zotero 插件