NDT Advance Access originally published online on January 25, 2007
Nephrology Dialysis Transplantation 2007 22(4):1150-1155; doi:10.1093/ndt/gfl752
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
No impact of hyperkalaemia with renin–angiotensin system blockades in maintenance haemodialysis patients
Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea
Correspondence and offprint requests to: Ho-Jung Kim, MD, Division of Nephrology, Department of Internal Medicine, Hanyang University Guri Hospital, 249-1, Gyomoon-dong, Guri, Gyeonggi, 471-701, Republic of Korea Email: kimhj{at}hanyang.ac.kr
 |
Abstract |
|---|
Background. Renin–angiotensin system (RAS) blockades, angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are well accepted for the cardiorenal-protective benefits added to antihypertensive effects in chronic kidney diseases (CKD), but associated with an increased risk of hyperkalaemia. However, few studies have investigated the effect of RAS blockades on serum potassium in dialysis patients.
Methods. Hyperkalaemia associated with RAS blockades by ACEI and/or ARB was evaluated in 69 patients on maintenance haemodialysis, who underwent a three-period crossover study in four groups (no exposure to RAS blockades, ACEI or ARB alone and ACEI plus ARB treatments), lasting one month in each period.
Results. Sixty-two patients completed this prospective 3-month study, and no one stopped the study because of the development of hyperkalaemia and/or complications. Mean serum K was similar among the four periods (no exposure, 5.54 ± 0.67 mmol/l; ACEI alone, 5.54 ± 0.75 mmol/l; ARB alone, 5.50 ± 0.66 mmol/l; ACEI + ARB combination, 5.42 ± 0.66 mmol/l) and was also equal when compared between the two groups with and without exposure to RAS blockades (5.48 ± 0.68 vs 5.54 ± 0.67 mmol/l, P = NS). The incidence of severe hyperkalaemic episodes (>6.0 mmol/l) upon monthly predialysis serum K determination was 25.8% with no exposure to RAS blockades, 29.8% for ACEI alone, 19.6% for ARB alone and 17.7% for ACEI + ARB combination without statistically significant differences among the four periods (P = NS). Among covariables, the degree of Kt/V, intakes of other medications interfering with potassium homeostasis and diabetes mellitus did not result in any significant hyperkalaemic changes during the 3-month study period except anuric patients compared with non-anuric patients (5.58 ± 0.69 vs 5.19 ± 0.65 mmol/l, P < 0.001).
Conclusion. Neither monotherapy (ACEI or ARB) nor combination therapy (ACEI plus ARB) is associated with the additional risk of hyperkalaemia in patients on maintenance haemodialysis. However, those patients with anuria on RAS blockades warrant the cautious monitoring of serum K to prevent hyperkalaemia.
Keywords: angiotensin-converting enzyme inhibitor; angiotensin II receptor blocker; haemodialysis; hyperkalaemia
Received for publication: 20. 9.06
Accepted in revised form: 16.11.06
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  H. Suzuki Therapeutic efficacy of renin--angiotensin blockade in patients receiving dialysis Therapeutic Advances in Cardiovascular Disease, October 1, 2009; 3(5): 397 - 405. [Abstract] [PDF]
|
|
|
|
 |
|
 C. Ronco, M. Haapio, A. A. House, N. Anavekar, and R. Bellomo Cardiorenal Syndrome J. Am. Coll. Cardiol., November 4, 2008; 52(19): 1527 - 1539. [Abstract] [Full Text] [PDF]
|
|