Incidence of hyperkalemia associated with aldosterone antagonists in a hypertension referral center

Abstract

The use of aldosterone antagonists has increased significantly since publication of RALES and other landmark clinical trials. As with other medications, the incidence of adverse effects with “real world” use is much higher than that observed in original trials. Recent reports have documented the increased incidence of hyperkalemia associated with widespread use of spironolactone, including hospitalizations and mortality. A retrospective analysis was designed to review the incidence of hyperkalemia associated with use of aldosterone antagonists in a hypertension referral center. Over 4000 unique prescriptions for aldosterone antagonists were identified. Patient charts were reviewed for concurrent medication use (ACEI, ARB, beta blocker, NSAID), laboratory values (potassium, creatinine) and other conditions predisposing to hyperkalemia. Preliminary results from over 300 patient chart reviews indicate no cases of hyperkalemia associated with the use of spironolactone or eplerenone. With the exception of those patients receiving spironolactone and ARB combination therapy, females had higher average potassium levels than males. Whites had higher potassium levels than African-Americans with one category exception. African-Americans receiving concurrent aldosterone antagonist/ACEI/ARB therapy had the highest potassium levels (avg 5.0 mEq/L), though there were no cases of hyperkalemia. Based on these preliminary results, the risk of hyperkalemia associated with aldosterone antagonists is much less in this population when compared to the general population. With thoughtful attention to appropriate patient selection, the incidence of hyperkalemia appears to be minimal.