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Evaluation of ACE/ARBs dosage in Stockholm healthcare patients experiencing hyperkalaemia: dose adjustment and clinical decisions after the event
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
2017 (English)Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
Abstract [en]

Introduction: Hyperkalaemia, defined as elevated potassium levels (> 5mmol/l), is a life-threatening condition. Studies have shown that one of the highest risk factors for developing hyperkalaemia is chronic kidney disease, especially those treated with potassium sparing drugs such as angiotensin converting enzyme or aldosterone receptor blockers (ACE/ARBs). Because of hyperkalaemia risk, these drugs require reduced dosing, but it is uncertain if this is being done in real-life clinical practice. Aim: The aim of this project was to explore the hyperkalaemia risk in relation to prescribed dosages and underlying kidney function. Furthermore, the clinician’s decisions after the event (whether to continue, to stop the medication or to reduce the dosages) were evaluated. This was performed to identify opportunities to improve medication use and reduce the risk of drug-induced hyperkalaemia. Method: New users of mineralocorticoid receptor antagonist therapy who in addition were consuming ACEi or ARBs and had developed an event of hyperkalaemia were evaluated. To estimate the drug dose before and after the event, the concept of daily defined dose and drug usage were used. Results: Before the event, Spearman correlation analysis between estimated dose and eGFR showed a significant association, but this association explained only 11% of the variability of the sample, meaning that many patients were not having their dosages adapted to their kidney function. After the event, 41% continued with the same dose, 37% discontinued and 22% had a dose reduction. Conclusion: It is possible that the dosages of ACEi/ARBs were not adjusted by the patient’s kidney function. Discontinuation of these therapies after a hyperkalaemia event was relatively common. 

Place, publisher, year, edition, pages
2017. , p. 19
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-323302OAI: oai:DiVA.org:uu-323302DiVA, id: diva2:1105695
External cooperation
Department of Renal Medicine, Karolinska Institute
Subject / course
Pharmacotherapy
Educational program
Master of Science Programme in Pharmacy
Supervisors
Examiners
Available from: 2017-08-09 Created: 2017-06-05 Last updated: 2017-08-09Bibliographically approved

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CiteExportLink to record
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Citation style
  • apa
  • ieee
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Output format
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