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Potassium homeostasis and renin-angiotensin-aldosterone system inhibitors.

Abstract

Inhibition of the renin-angiotensin-aldosterone system (RAAS) is a key strategy in treating hypertension and cardiovascular and renal diseases. However, RAAS inhibitors (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, aldosterone receptor antagonists, and direct renin inhibitors) increase the risk of hyperkalemia (serum potassium >5.5 mmol/L). This review evaluates the effects on serum potassium levels of RAAS inhibitors. Using PubMed, we searched for clinical trials published up to December 2008 assessing the effects on serum potassium levels of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, aldosterone receptor antagonists, and direct renin inhibitors, alone and in combination, in patients with hypertension, heart failure (HF), or chronic kidney disease (CKD); 39 studies were identified. In patients with hypertension without risk factors for hyperkalemia, the incidence of hyperkalemia with RAAS inhibitor monotherapy is low (< or =2%), whereas rates are higher with dual RAAS inhibition ( approximately 5%). The incidence of hyperkalemia is also increased in patients with HF or CKD (5% to 10%). However, increases in serum potassium levels are small ( approximately 0.1 to 0.3 mmol/L), and rates of study discontinuation due to hyperkalemia are low, even in high-risk patient groups (1% to 5%). Patients with HF or CKD are at greater risk of hyperkalemia with RAAS inhibitors than those without these conditions. However, the absolute changes in serum potassium are generally small and unlikely to be clinically significant. Moreover, these patients are likely to derive benefit from RAAS inhibition. Rather than denying them an effective treatment, electrolyte levels should be closely monitored in these patients.

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  • Authors+Show Affiliations

    ,

    Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, 22 South Greene Street, Room N3W143, Baltimore, MD 21201, USA. mweir@medicine.umaryland.edu

    Source

    MeSH

    Angiotensin II Type 1 Receptor Blockers
    Angiotensin-Converting Enzyme Inhibitors
    Chronic Disease
    Drug Therapy, Combination
    Heart Failure
    Homeostasis
    Humans
    Hyperkalemia
    Kidney Diseases
    Mineralocorticoid Receptor Antagonists
    Potassium
    Renin
    Renin-Angiotensin System
    Risk Assessment
    Risk Factors

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't
    Review

    Language

    eng

    PubMed ID

    20150448

    Citation

    Weir, Matthew R., and Mark Rolfe. "Potassium Homeostasis and Renin-angiotensin-aldosterone System Inhibitors." Clinical Journal of the American Society of Nephrology : CJASN, vol. 5, no. 3, 2010, pp. 531-48.
    Weir MR, Rolfe M. Potassium homeostasis and renin-angiotensin-aldosterone system inhibitors. Clin J Am Soc Nephrol. 2010;5(3):531-48.
    Weir, M. R., & Rolfe, M. (2010). Potassium homeostasis and renin-angiotensin-aldosterone system inhibitors. Clinical Journal of the American Society of Nephrology : CJASN, 5(3), pp. 531-48. doi:10.2215/CJN.07821109.
    Weir MR, Rolfe M. Potassium Homeostasis and Renin-angiotensin-aldosterone System Inhibitors. Clin J Am Soc Nephrol. 2010;5(3):531-48. PubMed PMID: 20150448.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Potassium homeostasis and renin-angiotensin-aldosterone system inhibitors. AU - Weir,Matthew R, AU - Rolfe,Mark, Y1 - 2010/02/11/ PY - 2010/2/13/entrez PY - 2010/2/13/pubmed PY - 2010/5/29/medline SP - 531 EP - 48 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 5 IS - 3 N2 - Inhibition of the renin-angiotensin-aldosterone system (RAAS) is a key strategy in treating hypertension and cardiovascular and renal diseases. However, RAAS inhibitors (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, aldosterone receptor antagonists, and direct renin inhibitors) increase the risk of hyperkalemia (serum potassium >5.5 mmol/L). This review evaluates the effects on serum potassium levels of RAAS inhibitors. Using PubMed, we searched for clinical trials published up to December 2008 assessing the effects on serum potassium levels of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, aldosterone receptor antagonists, and direct renin inhibitors, alone and in combination, in patients with hypertension, heart failure (HF), or chronic kidney disease (CKD); 39 studies were identified. In patients with hypertension without risk factors for hyperkalemia, the incidence of hyperkalemia with RAAS inhibitor monotherapy is low (< or =2%), whereas rates are higher with dual RAAS inhibition ( approximately 5%). The incidence of hyperkalemia is also increased in patients with HF or CKD (5% to 10%). However, increases in serum potassium levels are small ( approximately 0.1 to 0.3 mmol/L), and rates of study discontinuation due to hyperkalemia are low, even in high-risk patient groups (1% to 5%). Patients with HF or CKD are at greater risk of hyperkalemia with RAAS inhibitors than those without these conditions. However, the absolute changes in serum potassium are generally small and unlikely to be clinically significant. Moreover, these patients are likely to derive benefit from RAAS inhibition. Rather than denying them an effective treatment, electrolyte levels should be closely monitored in these patients. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/20150448/Potassium_homeostasis_and_renin_angiotensin_aldosterone_system_inhibitors_ L2 - http://cjasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=20150448 DB - PRIME DP - Unbound Medicine ER -