33813 Retrospective study of the prevalence of hyperkalemia in women taking spironolactone for acne, hair loss, and hirsutism

Abstract

Background: This study measured hyperkalemia rates in women taking spironolactone for acne/hair loss/hirsutism to assess the need for laboratory monitoring, and explored differences in hyperkalemia rates among women of various ages, races, and ethnicities. Methods: WCM’s EPIC was queried for females taking spironolactone for acne, hair loss, androgenic alopecia, androgenetic alopecia, hirsutism. Patients with hypertension, heart failure, renal failure and taking medications affecting the renin-angiotensin-aldosterone system were excluded. Hyperkalemia was defined as potassium ≥ 5.1 mmol/L. Results: 974 patients had baseline and end potassium values, representing 1273 courses of spironolactone. 395 patients completed 451 courses with ≥ 1 monitoring value available. 447 courses (35.1%) resulted in potassium increase from baseline to end, and 171 (13.4%) resulted in an increase ≥ 10%. 25 courses (2.0%) had end values outside upper limit of normal (ULN); of these, 7 (0.5%) corresponded with baseline values outside ULN. Fisher’s exact and chi-square tests indicated age group, race, ethnicity, course duration and cumulative dose were not statistically significant predictors of hyperkalemia or increases in potassium levels ≥10%. Conclusion: The rate of hyperkalemia among patients was low. Due to the number of courses with a % elevation in potassium, it may be advisable for dermatologists to monitor potassium trends during a spironolactone course. This is limited by the fact that age, race, ethnicity, course duration, and cumulative dose were not significant predictors. Providers should stratify among patients via baseline laboratory values and history of elevated potassium to identify those at greatest risk for clinically significant increases in potassium.