University of South Carolina College of Pharmacy, Columbia, SC, USA.
University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Ann Pharmacother. 2020 Sep;54(9):852-857. doi: 10.1177/1060028020909539. Epub 2020 Feb 28.
Sulfamethoxazole-trimethoprim (SXT) therapy is commonly used in HIV-infected patients and is associated with hyperkalemia and elevated serum creatinine (SCr). The purpose of this study was to examine the frequency of hyperkalemia and elevated SCr in hospitalized, HIV-infected patients receiving SXT. This was a retrospective, single-center cohort study. HIV-infected hospitalized patients receiving a minimum of 3 consecutive days of SXT were included. Patients were grouped according to high dose (≥10 mg/kg/d) and low dose (<10 mg/kg/d) trimethoprim. The primary end point was the frequency of hyperkalemia, severe hyperkalemia, and elevated SCr. Secondary end points included an evaluation of concomitant potassium-altering medications and concomitant nephrotoxic drugs. A total of 100 consecutive patients were selected from all possible patients who met inclusion criteria. Overall, 47 patients experienced at least 1 adverse drug event (ADE) of either hyperkalemia or increased SCr, with 20 patients experiencing these ADEs in the low-dose group and 27 patients experiencing these ADEs in the high-dose group ( = 0.229). The ADEs of hyperkalemia or increased SCr occurred after a shorter period (5.5 vs 8.7 days) in the high-dose group ( = 0.049). Overall frequency of elevated SCr was 24% and of elevated serum K was 36%. Hyperkalemia requiring a therapeutic intervention occurred in 12 patients in the high-dose group compared with 2 in the low-dose group ( = 0.009). Rates of elevated SCr and hyperkalemia in hospitalized HIV-infected patients receiving SXT are significant. Hyperkalemia requiring intervention is more common in patients receiving high-dose SXT.
复方磺胺甲噁唑-甲氧苄啶（SXT）治疗常用于 HIV 感染者，并与高钾血症和血清肌酐升高（SCr）有关。本研究的目的是研究接受 SXT 治疗的住院 HIV 感染患者中高钾血症和血清肌酐升高的频率。这是一项回顾性、单中心队列研究。纳入至少连续 3 天接受 SXT 治疗的住院 HIV 感染患者。根据大剂量（≥10 mg/kg/d）和小剂量（<10 mg/kg/d）甲氧苄啶将患者分组。主要终点是高钾血症、严重高钾血症和血清肌酐升高的频率。次要终点包括评估同时使用的改变钾的药物和同时使用的肾毒性药物。从所有符合纳入标准的可能患者中选择了 100 例连续患者。总的来说，47 例患者至少发生了 1 次高钾血症或 SCr 升高的不良药物事件（ADE），其中低剂量组有 20 例，高剂量组有 27 例（=0.229）。高剂量组的 ADE（高钾血症或 SCr 升高）发生时间较短（5.5 天 vs 8.7 天）（=0.049）。总的血清肌酐升高发生率为 24%，血清钾升高发生率为 36%。高剂量组有 12 例需要治疗干预的高钾血症，而低剂量组有 2 例（=0.009）。接受 SXT 治疗的住院 HIV 感染患者中血清肌酐和高钾血症的发生率较高。接受大剂量 SXT 治疗的患者更常见需要干预的高钾血症。
