Hirai T, Yamaga R, Fujita A, Itoh T
Department of Pharmacy, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
J Clin Pharm Ther. 2018 Dec;43(6):829-835. doi: 10.1111/jcpt.12720. Epub 2018 Jun 16.
Angiotensin converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) represent the cornerstones of hypertension and congestive heart failure treatment. Risk factors for hyperkalaemia associated with ACEI and ARB are chronic kidney disease and concomitant medications which increase serum potassium level. Body mass index (BMI) also affects pharmacokinetics of ACEI and ARB and potassium disposition. We evaluated the relationship between BMI and hyperkalaemia associated with ACEI and ARB treatments.
Study design is a retrospective case-control analysis. Patients who had been prescribed ACEI or ARB between June 2015 and June 2017 at Tokyo Women's Medical University, Medical Center East, were included. Patient clinical background was collected from medical records. Hyperkalaemia was defined as serum potassium above 5.5 meq/L. The concomitant use of ACEI and ARB, aldosterone antagonists, direct renin inhibitor, sulfamethoxazole-trimethoprim and non-steroidal anti-inflammatory drugs (NSAIDs) was regarded as hyperkalaemia-inducing medications. The relationship between BMI and hyperkalaemia associated with ACEI and ARB treatments was assessed using multivariable logistic regression analysis.
The study included 2987 patients aged 70.1 ± 12.9 years, 61.0% were men, and BMI was 23.8 ± 4.4 kg/m . The incidence of hyperkalaemia was 7.8%. Multivariable logistic regression analysis revealed that age >65 years, low BMI, diabetes, history of treatment for hyperkalaemia, serum sodium <135 meq/L, eGFR <30 mL/min/1.73m and the concomitant use of hyperkalaemia-inducing medications were independent risk factors for hyperkalaemia associated with ACEI and ARB.
This study demonstrated that BMI provides useful information for the identification of potential risk for hyperkalaemia associated with ACEI and ARB treatments.
血管紧张素转换酶抑制剂（ACEI）和血管紧张素II受体阻滞剂（ARB）是治疗高血压和充血性心力衰竭的基石。与ACEI和ARB相关的高钾血症危险因素包括慢性肾病以及可使血清钾水平升高的合并用药。体重指数（BMI）也会影响ACEI和ARB的药代动力学以及钾的代谢。我们评估了BMI与ACEI和ARB治疗相关的高钾血症之间的关系。
研究设计为回顾性病例对照分析。纳入2015年6月至2017年6月期间在东京女子医科大学东医疗中心接受ACEI或ARB治疗的患者。从病历中收集患者的临床背景信息。高钾血症定义为血清钾高于5.5毫当量/升。同时使用ACEI和ARB、醛固酮拮抗剂、直接肾素抑制剂、磺胺甲恶唑-甲氧苄啶和非甾体抗炎药（NSAIDs）被视为可导致高钾血症的药物。使用多变量逻辑回归分析评估BMI与ACEI和ARB治疗相关的高钾血症之间的关系。
该研究纳入了2987例年龄为70.1±12.9岁的患者，其中61.0%为男性，BMI为23.8±4.4kg/m²。高钾血症的发生率为7.8%。多变量逻辑回归分析显示，年龄>65岁、低BMI、糖尿病、高钾血症治疗史、血清钠<135毫当量/升、估算肾小球滤过率（eGFR）<30毫升/分钟/1.73平方米以及同时使用可导致高钾血症的药物是与ACEI和ARB相关的高钾血症的独立危险因素。
本研究表明，BMI为识别与ACEI和ARB治疗相关的高钾血症潜在风险提供了有用信息。
