CHU de Toulouse, Service de Pharmacologie Clinique, Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, F-31000 Toulouse, France.
Pharmacoepidemiol Drug Saf. 2011 Jul;20(7):747-53. doi: 10.1002/pds.2128. Epub 2011 Mar 16.
Life-threatening hyperkalemia may be induced by drugs and preventable in at-risk patients. This study was designed to describe cases of 'serious' drug-associated hyperkalemia.
Adult subjects with a serum potassium concentration above 6.5 mmol/L detected at admission or during hospital stay in nephrology, cardiology, geriatric, emergency or intensive care units were identified by biology laboratories of hospitals and clinics located in Midi-Pyrenees (southwest France). Patients dialyzed for end-stage kidney disease were excluded. Data were collected from medical files. Hyperkalemia was defined as drug-associated if at least one drug known to increase serum potassium concentration was taken when hyperkalemia occurred (among drugs taken in outpatient care for hyperkalemia detected at admission and among drugs taken in outpatient care and continued at hospital and drugs introduced from admission for hyperkalemia detected during hospital stay).
Of 168 hyperkalemia cases, 102 (60.7%) were classified as drug-associated. They concerned elderly patients (mean age: 76.1 years) often having arterial hypertension and/or cardiac diseases (88.2%). Risk factors, mainly acute kidney failure, were observed in almost all cases (98.0%). Drugs predominantly involved were angiotensin-converting enzyme inhibitors (47.1%), spironolactone (41.2%), angiotensin II receptor antagonists (23.5%) and potassium supplements (23.5%). In 10% of cases, death could be attributed to hyperkalemia.
Laboratory databases allowed an exhaustive identification of hyperkalemia cases. The frequency of drug-related hyperkalemia and their characteristics suggest that treatment with drugs known to increase serum potassium concentration can be inappropriate, especially regarding associations or indications, and is highly risky for predisposed patients.
危及生命的高钾血症可由药物引起，且在高危患者中可预防。本研究旨在描述“严重”药物相关高钾血症病例。
通过医院和诊所的生物学实验室，在肾脏科、心内科、老年科、急诊或重症监护病房住院的患者中，识别出血清钾浓度在入院时或住院期间高于 6.5mmol/L 的成年患者。接受终末期肾病透析的患者被排除在外。数据从病历中收集。如果高钾血症发生时正在服用至少一种已知会增加血清钾浓度的药物（在因入院时检测到的高钾血症而在门诊接受治疗的药物中，以及在门诊接受治疗且在住院期间继续使用的药物中，或在因住院期间检测到的高钾血症而入院时使用的药物中），则将高钾血症定义为药物相关性。
在 168 例高钾血症病例中，102 例（60.7%）被归类为药物相关性。这些患者为老年患者（平均年龄：76.1 岁），常患有高血压和/或心脏病（88.2%）。几乎所有病例（98.0%）均观察到危险因素，主要是急性肾衰竭。主要涉及的药物为血管紧张素转换酶抑制剂（47.1%）、螺内酯（41.2%）、血管紧张素 II 受体拮抗剂（23.5%）和钾补充剂（23.5%）。在 10%的病例中，高钾血症可能导致死亡。
实验室数据库可全面识别高钾血症病例。药物相关性高钾血症的频率及其特征表明，特别是在药物联合使用或适应证方面，治疗中使用已知会增加血清钾浓度的药物可能不恰当，且对易患患者风险极高。
