Impact of hyperkalaemia on renin-angiotensin-aldosterone (RAAS) inhibitor reduction or withdrawal following hospitalisation.

IF 3.2 4区医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL

Clinical and Experimental Medicine Pub Date : 2024-12-21 DOI:10.1007/s10238-024-01531-9

Hugh Logan Ellis, Mohammad Al-Agil, Philip A Kelly, James Teo, Claire Sharpe, Martin B Whyte

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引用次数: 0

Abstract

Background: Inhibitors of the renin-angiotensin-aldosterone system (RAAS), such as ACE inhibitors (ACEi), angiotensin-II receptor blockers and mineralocorticoid receptor antagonists, reduce morbidity and mortality in hypertension, congestive heart failure and chronic kidney disease. However, their use can lead to hyperkalaemia. We examined the proportions of RAAS inhibitor (RAASi) reduction or withdrawal, across GFR strata, following hospitalisation and the effect on patient mortality.

Methods: This was a retrospective cohort study of adult patients hospitalised from 1 January2017 to 31 December2020. Biochemistry data, clinical notes and medicines use were extracted using the CogStack platform, from electronic health records. Patients were identified by creatinine measurement during hospitalisation. Hyperkalaemia was defined as potassium > 5.0 mmol/L, with severity categorisation. RAASi discontinuation defined as ≥ 48 h without administration. Mortality risk associated with RAASi cessation was assessed using Cox proportional hazards models.

Results: Among 129,172 patients with potassium measurements, 49,011 were hospitalised. Hyperkalaemia prevalence was 8.57% in the emergency department and 16.79% among hospitalised patients. Higher hyperkalaemia levels correlated with increased CKD and heart failure. RAASi use was more common in hyperkalaemic patients, with higher discontinuation rates during hospitalisation (36% with potassium 5-5.5 mmol/L; 61% with potassium > 6.5 mmol/L). By discharge, 32% of patients had RAASi stopped, and 2% doses reduced. Discontinuation of RAASi was associated with 37% worse survival probability.

Conclusion: RAASi cessation was greater with hyperkalaemia and associated with increased mortality in hospitalised patients. Reinstitution of RAASi after hospital discharge, or alternative management of hyperkalaemia if maintained on RAASi therapy, may improve clinical outcomes.

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高钾血症对住院后肾素-血管紧张素-醛固酮（RAAS）抑制剂减少或停药的影响

背景：肾素-血管紧张素-醛固酮系统（RAAS）抑制剂，如ACE抑制剂（ACEi）、血管紧张素- ii受体阻滞剂和矿皮质激素受体拮抗剂，可降低高血压、充血性心力衰竭和慢性肾脏疾病的发病率和死亡率。然而，它们的使用会导致高钾血症。我们检查了RAAS抑制剂（RAASi）减少或停药的比例，在住院后的GFR层和对患者死亡率的影响。方法：这是一项回顾性队列研究，纳入了2017年1月1日至2020年12月31日住院的成年患者。使用CogStack平台从电子健康记录中提取生物化学数据、临床记录和药物使用情况。患者在住院期间通过肌酐测定进行鉴定。高钾血症定义为钾> 5.0 mmol/L，并按严重程度分级。RAASi停药定义为≥48小时不给药。使用Cox比例风险模型评估与RAASi戒烟相关的死亡风险。结果：在129,172例钾测量患者中，49,011例住院。急诊科高钾血症患病率为8.57%，住院患者患病率为16.79%。较高的高钾血症水平与CKD和心力衰竭的增加相关。RAASi的使用在高钾血症患者中更为常见，住院期间停药率较高(钾5-5.5 mmol/L为36%；61%为钾（6.5 mmol/L）。出院时，32%的患者停止了RAASi治疗，2%的患者减少了剂量。停用RAASi与37%的生存率差相关。结论：RAASi的停止与高钾血症相关，并与住院患者死亡率增加相关。出院后重新使用RAASi，或者如果继续使用RAASi治疗，对高钾血症进行其他管理，可能会改善临床结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical and Experimental Medicine 医学-医学：研究与实验

CiteScore

4.80

自引率

2.20%

发文量

159

审稿时长

2.5 months

期刊介绍： Clinical and Experimental Medicine (CEM) is a multidisciplinary journal that aims to be a forum of scientific excellence and information exchange in relation to the basic and clinical features of the following fields: hematology, onco-hematology, oncology, virology, immunology, and rheumatology. The journal publishes reviews and editorials, experimental and preclinical studies, translational research, prospectively designed clinical trials, and epidemiological studies. Papers containing new clinical or experimental data that are likely to contribute to changes in clinical practice or the way in which a disease is thought about will be given priority due to their immediate importance. Case reports will be accepted on an exceptional basis only, and their submission is discouraged. The major criteria for publication are clarity, scientific soundness, and advances in knowledge. In compliance with the overwhelmingly prevailing request by the international scientific community, and with respect for eco-compatibility issues, CEM is now published exclusively online.