Kaiser Permanente Colorado Institute for Health Research, Denver, CO 80237, USA.
J Gen Intern Med. 2010 Apr;25(4):326-33. doi: 10.1007/s11606-009-1228-x. Epub 2010 Jan 20.
Renin-angiotensin-aldosterone system (RAAS) inhibitors are associated with hyperkalemia, but there is little evidence demonstrating patients who receive potassium monitoring have a lower rate of hyperkalemia.
To evaluate the association between potassium monitoring and serious hyperkalemia-associated adverse outcomes among patients with diabetes newly initiating RAAS inhibitor therapy.
Retrospective observational study.
Patients with diabetes without end-stage renal disease initiating RAAS inhibitor therapy between 2001 and 2006 at three integrated health care systems.
Potassium monitoring and first hyperkalemia-associated adverse event during the initial year of therapy. Hyperkalemia-associated adverse events included hospitalizations, emergency department visits or deaths within 24 h of hyperkalemia diagnosis and/or diagnostic potassium >or=6 mmol/l. Incidence rates were calculated in person-years (p-y). We used inverse probability propensity score weighting to adjust for differences between patients with and without monitoring; Poisson regression was used to obtain adjusted relative risks.
A total of 19,391 of 27,355 patients (71%) received potassium monitoring. Serious hyperkalemia-associated events occurred at an incidence rate of 10.2 per 1,000 p-y. Compared to patients without monitoring, adjusted relative risk of hyperkalemia-associated adverse events among all patients with monitoring was 0.50 (0.37, 0.66); in the subset of patients who also had chronic kidney disease (n = 2,176), adjusted relative risk was 0.29 (0.18, 0.46).
Patients prescribed RAAS inhibitors who have both diabetes and chronic kidney disease and receive potassium monitoring are less likely to experience a serious hyperkalemia-associated adverse event compared to similar patients who did not receive potassium monitoring. This evidence supports existing consensus-based guidelines.
肾素-血管紧张素-醛固酮系统（RAAS）抑制剂与高钾血症相关，但几乎没有证据表明接受血钾监测的患者发生高钾血症的风险更低。
评估钾监测与新接受 RAAS 抑制剂治疗的糖尿病患者严重高钾血症相关不良结局之间的关联。
回顾性观察性研究。
2001 年至 2006 年期间，在三个综合医疗保健系统中患有糖尿病且无终末期肾病的患者开始接受 RAAS 抑制剂治疗。
在治疗初始一年内的钾监测和首次高钾血症相关不良事件。高钾血症相关不良事件包括高钾血症诊断后 24 小时内的住院、急诊就诊或死亡，和/或诊断性血钾≥6mmol/L。以人年（p-y）计算发生率。我们使用逆概率倾向评分加权来调整监测组和非监测组之间的差异；使用泊松回归获得调整后的相对风险。
共有 27355 例患者中的 19391 例（71%）接受了钾监测。严重高钾血症相关事件的发生率为 10.2/1000 p-y。与未监测的患者相比，所有接受监测的患者中高钾血症相关不良事件的调整后相对风险为 0.50（0.37，0.66）；在同时患有慢性肾脏病（n=2176）的患者亚组中，调整后相对风险为 0.29（0.18，0.46）。
与未接受血钾监测的类似患者相比，同时患有糖尿病和慢性肾脏病且接受 RAAS 抑制剂治疗的患者，接受钾监测的患者发生严重高钾血症相关不良事件的可能性更小。这一证据支持现有的基于共识的指南。
