Impaired aldosterone response to potassium and hyperkalemia in patients receiving a renin-angiotensin-aldosterone system inhibitor
Background/Aims Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are associated with the development of hyperkalemia. We evaluated the relationship between the serum aldosterone-to-potassium ratio (APR) and the risk of developing hyperkalemia in patients w...
Saved in:
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
The Korean Association of Internal Medicine
2025-05-01
|
| Series: | The Korean Journal of Internal Medicine |
| Subjects: | |
| Online Access: | http://kjim.org/upload/kjim-2024-160.pdf |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849734679855366144 |
|---|---|
| author | Miyeon Kim Hwa Young Lee Hyunwoo Kim |
| author_facet | Miyeon Kim Hwa Young Lee Hyunwoo Kim |
| author_sort | Miyeon Kim |
| collection | DOAJ |
| description | Background/Aims Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are associated with the development of hyperkalemia. We evaluated the relationship between the serum aldosterone-to-potassium ratio (APR) and the risk of developing hyperkalemia in patients with chronic kidney disease (CKD) receiving ACEIs or ARBs. Methods One hundred eighty-six patients with stage 3–4 CKD receiving an ACEI or ARB for at least 3 months were evaluated. Serum aldosterone and potassium concentrations were measured simultaneously, and serum APR was calculated (ng/mL per mmol/L). Patients were divided into two groups for comparison according to the median value above or below 2.42. The primary outcome was the difference between the two groups in the development of hyperkalemia (defined as a serum potassium level > 5.5 mmol/L). Incidence rates and risk factors of hyperkalemia were assessed. Results During the follow-up period, 144 hyperkalemic events in 81 patients (43.5%) were identified, yielding an incidence rate of 24.6 events/100 person-years. The incidence rate was significantly higher in patients with a low serum APR than in patients with a high APR (35.8 events/100 patient-years vs. 12.9 events/100 patient-years, p < 0.001). In addition, diabetes mellitus, history of hyperkalemia, CKD progression during the follow-up period, and low serum APR were predictors of the development of hyperkalemia. Conclusions Low serum APR was associated with the occurrence of hyperkalemia in patients with CKD receiving ACEIs or ARBs, suggesting that the identification of patients administered these drugs who are at high risk for hyperkalemia may be achieved using this index. |
| format | Article |
| id | doaj-art-592b5cbe23d241a194cfe7a7105d2e06 |
| institution | DOAJ |
| issn | 1226-3303 2005-6648 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | The Korean Association of Internal Medicine |
| record_format | Article |
| series | The Korean Journal of Internal Medicine |
| spelling | doaj-art-592b5cbe23d241a194cfe7a7105d2e062025-08-20T03:07:44ZengThe Korean Association of Internal MedicineThe Korean Journal of Internal Medicine1226-33032005-66482025-05-0140346848110.3904/kjim.2024.160171021Impaired aldosterone response to potassium and hyperkalemia in patients receiving a renin-angiotensin-aldosterone system inhibitorMiyeon Kim0Hwa Young Lee1Hyunwoo Kim2Division of Nephrology, Department of Internal Medicine, Jeju National University Hospital, Jeju National University, School of Medicine, Jeju, KoreaDivision of Nephrology, Department of Internal Medicine, Jeju National University Hospital, Jeju National University, School of Medicine, Jeju, KoreaDivision of Nephrology, Department of Internal Medicine, Jeju National University Hospital, Jeju National University, School of Medicine, Jeju, KoreaBackground/Aims Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are associated with the development of hyperkalemia. We evaluated the relationship between the serum aldosterone-to-potassium ratio (APR) and the risk of developing hyperkalemia in patients with chronic kidney disease (CKD) receiving ACEIs or ARBs. Methods One hundred eighty-six patients with stage 3–4 CKD receiving an ACEI or ARB for at least 3 months were evaluated. Serum aldosterone and potassium concentrations were measured simultaneously, and serum APR was calculated (ng/mL per mmol/L). Patients were divided into two groups for comparison according to the median value above or below 2.42. The primary outcome was the difference between the two groups in the development of hyperkalemia (defined as a serum potassium level > 5.5 mmol/L). Incidence rates and risk factors of hyperkalemia were assessed. Results During the follow-up period, 144 hyperkalemic events in 81 patients (43.5%) were identified, yielding an incidence rate of 24.6 events/100 person-years. The incidence rate was significantly higher in patients with a low serum APR than in patients with a high APR (35.8 events/100 patient-years vs. 12.9 events/100 patient-years, p < 0.001). In addition, diabetes mellitus, history of hyperkalemia, CKD progression during the follow-up period, and low serum APR were predictors of the development of hyperkalemia. Conclusions Low serum APR was associated with the occurrence of hyperkalemia in patients with CKD receiving ACEIs or ARBs, suggesting that the identification of patients administered these drugs who are at high risk for hyperkalemia may be achieved using this index.http://kjim.org/upload/kjim-2024-160.pdfaldosteroneangiotensin-converting enzyme inhibitorsangiotensin receptor antagonistschronic kidney diseasehyperkalemia |
| spellingShingle | Miyeon Kim Hwa Young Lee Hyunwoo Kim Impaired aldosterone response to potassium and hyperkalemia in patients receiving a renin-angiotensin-aldosterone system inhibitor The Korean Journal of Internal Medicine aldosterone angiotensin-converting enzyme inhibitors angiotensin receptor antagonists chronic kidney disease hyperkalemia |
| title | Impaired aldosterone response to potassium and hyperkalemia in patients receiving a renin-angiotensin-aldosterone system inhibitor |
| title_full | Impaired aldosterone response to potassium and hyperkalemia in patients receiving a renin-angiotensin-aldosterone system inhibitor |
| title_fullStr | Impaired aldosterone response to potassium and hyperkalemia in patients receiving a renin-angiotensin-aldosterone system inhibitor |
| title_full_unstemmed | Impaired aldosterone response to potassium and hyperkalemia in patients receiving a renin-angiotensin-aldosterone system inhibitor |
| title_short | Impaired aldosterone response to potassium and hyperkalemia in patients receiving a renin-angiotensin-aldosterone system inhibitor |
| title_sort | impaired aldosterone response to potassium and hyperkalemia in patients receiving a renin angiotensin aldosterone system inhibitor |
| topic | aldosterone angiotensin-converting enzyme inhibitors angiotensin receptor antagonists chronic kidney disease hyperkalemia |
| url | http://kjim.org/upload/kjim-2024-160.pdf |
| work_keys_str_mv | AT miyeonkim impairedaldosteroneresponsetopotassiumandhyperkalemiainpatientsreceivingareninangiotensinaldosteronesysteminhibitor AT hwayounglee impairedaldosteroneresponsetopotassiumandhyperkalemiainpatientsreceivingareninangiotensinaldosteronesysteminhibitor AT hyunwookim impairedaldosteroneresponsetopotassiumandhyperkalemiainpatientsreceivingareninangiotensinaldosteronesysteminhibitor |