Journal of Nephrology & Therapeutics

Acute Kidney Injury Hyperkalemia in Patients Undergoing Renin-Angiotensin-Aldosterone Blockade

Abstract

Francesco Falaschi,Lorena Fenoglio,Mirosa Dellagiovanna,Valentina de Vecchi,Vincenzo Sepe*,Maria Antonietta Bressan

Introduction: In order to minimize the risk of hyperkalemia (hK+) in patients with heart failure (HF), in 2005 and 2009 ACC/AHA (American College of Cardiology; American Heart Association) joint guidelines recommended associating renin-angiotensin system (RAS) inhibition with low-dose ALD-block in patients with serum creatinine (sCr) less than 2.5 mg/dl and serum potassium (sK+) lower than 5 mEq/l. A prevalence of HF in individuals aged 65 and over with mild renal failure at risk of hyperkalemia is steeply increasing. Such data has persuaded us to analyze the association between over-65 HF standard treatment and hK+.

Aim: This observational retrospective study analyzed emergency room admissions aged 65 and over undergoing ACEI with ALD-block or potassium sparing diuretics (K+-sparing) and hK+ (sK+ > 6 mEq/l) over a one year period, from January to December 2010.

Methods: 8,407 over-65 emergency admissions of 62,348 adult entries have been selected from the hospital database. Data was matched with the Local Medical District pharmaceutical database with joint use of ACEI and ALDblock or K+-sparing medications. Acute Kidney Injury (AKI) was defined according to AKIN (Acute Kidney Injury Criteria) guidelines.

Results: ACEI with spironolactone or K+-sparing was found in 332 (3.9%) out of the 8,407 over-65 emergency admissions. Seven HF patients (2.1% aged 79-82, 5F 2M) of 332 had hK+ (sK+, 6.3-8.5 mEq/l). Six patients had spironolactone and 1 K+-sparing treatment. sCr before admission was available in 3 (sCr, 1.1-1.4 mg/dl) out of 7 patients, all of which developed AKI. All 7 patients with hK+ received conservative medical treatment only.

Conclusions: hK+ occurred in 7 (2.1%) out of the 332 HF over-65 emergency admissions on ACEI. It might suggest a strict application of the current ACC/AHA guidelines with a closer follow-up for those HF patients at risk of developing AKI and hK+.