Angiotensin-convertingenzyme (ACE) inhibitors and angiotensin-receptorblockers are used commonly in clinical practice to treat hypertensionand decrease cardiovascular events in high-risk patients. Aside effect of such therapy is the development of hyperkalemia.Hyperkalemia has been attributed to the use of ACE inhibitorsin 10 to 38 percent of hospitalized patients with this complication.1,2,3,4Hyperkalemia develops in approximately 10 percent of outpatientswithin a year after these drugs are prescribed.5 Patients atgreatest risk for hyperkalemia include those with diabetes andthose with impaired renal function in whom a defect in the excretionof renal potassium may already exist.
Abnormal Functioning of the Cortical Collecting Tubule
Minimizing the Risk of Hyperkalemia
Source Information
From the Department of Medicine, Division of Nephrology, University of Texas Southwestern Medical School, Dallas.
Address reprint requests to Dr. Palmer at the Department of Medicine, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd., Dallas, TX 75390-8856, or at biff.palmer@utsouthwestern.edu.
HIRSCH, S.
(2008). An update on proteinuric chronic kidney disease: The dual-goal approach. Cleveland Clinic Journal of Medicine
75: 705-713
[Abstract][Full Text]
Henz, S., Maeder, M. T., Huber, S., Schmid, M., Loher, M., Fehr, T.
(2008). Influence of drugs and comorbidity on serum potassium in 15 000 consecutive hospital admissions. Nephrol Dial Transplant
0: gfn380v1-gfn380
[Abstract][Full Text]
Desai, A. S., Swedberg, K., McMurray, J. J.V., Granger, C. B., Yusuf, S., Young, J. B., Dunlap, M. E., Solomon, S. D., Hainer, J. W., Olofsson, B., Michelson, E. L., Pfeffer, M. A., on behalf of the CHARM Program Investigators,
(2007). Incidence and Predictors of Hyperkalemia in Patients With Heart Failure: An Analysis of the CHARM Program. J Am Coll Cardiol
50: 1959-1966
[Abstract][Full Text]
Coleman, C. I, Makanji, S., Kluger, J., White, C M.
(2007). Effect of Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers on the Frequency of Post-Cardiothoracic Surgery Atrial Fibrillation. The Annals of Pharmacotherapy
41: 433-437
[Abstract][Full Text]
Raebel, M. A, McClure, D. L, Chan, K A., Simon, S. R, Feldstein, A. C, Lafata, J. E., Andrade, S. E, Gunter, M. J, Nelson, W. W, Roblin, D., Platt, R.
(2007). Laboratory Evaluation of Potassium and Creatinine Among Ambulatory Patients Prescribed Spironolactone: Are We Monitoring for Hyperkalemia?. The Annals of Pharmacotherapy
41: 193-200
[Abstract][Full Text]
Martin, U., Coleman, J. J
(2006). Monitoring renal function in hypertension.. BMJ
333: 896-899
[Full Text]
Formica, R. N. Jr, Friedman, A. L., Lorber, M. I., Smith, J. D., Eisen, T., Bia, M. J.
(2006). A randomized trial comparing losartan with amlodipine as initial therapy for hypertension in the early post-transplant period. Nephrol Dial Transplant
21: 1389-1394
[Abstract][Full Text]
Kraft, M. D., Btaiche, I. F., Sacks, G. S., Kudsk, K. A.
(2006). Preferred treatment of hyperkalemia. Am J Health Syst Pharm
63: 514-516
[Full Text]
Marcy, T. R., Ripley, T. L.
(2006). Aldosterone antagonists in the treatment of heart failure. Am J Health Syst Pharm
63: 49-58
[Abstract][Full Text]
Warnock, D. G., Rossier, B. C.
(2005). Renal Sodium Handling: The Role of the Epithelial Sodium Channel. J. Am. Soc. Nephrol.
16: 3151-3153
[Full Text]
Gil, P., Justo, S., Caramelo, C.
(2005). Cardio-renal failure: an emerging clinical entity. Nephrol Dial Transplant
20: 1780-1783
[Full Text]
Warnock, D. G., Bell, P. D.
(2005). Improvement of Blood Pressure With Inhibition of the Epithelial Sodium Channel in Blacks With Hypertension. Hypertension
46: 469-470
[Full Text]
Buck, M. L
(2005). Clinical Experience with Spironolactone in Pediatrics. The Annals of Pharmacotherapy
39: 823-828
[Abstract][Full Text]
Humphreys, B. D., Soiffer, R. J., Magee, C. C.
(2005). Renal Failure Associated with Cancer and Its Treatment: An Update. J. Am. Soc. Nephrol.
16: 151-161
[Full Text]
Goldfarb, D. S., Newsome, B. B., Warnock, D. G., Witham, M. D., Gillespie, N. D., Struthers, A. D., Cavallari, L., Vaitkus, P., Groo, V., Juurlink, D. N., Mamdani, M. M., Redelmeier, D. A.
(2004). Hyperkalemia after the Publication of RALES. NEJM
351: 2448-2450
[Full Text]
Segal, A., Palmer, B. F.
(2004). Hyperkalemia and Inhibitors of the Renin-Angiotensin-Aldosterone System. NEJM
351: 2450-2451
[Full Text]