ArticlePharmacoepidemiology and drug safety2010
Predicting the risk of hyperkalemia in patients with chronic kidney disease starting lisinopril.
Article in Pharmacoepidemiology and drug safety, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 2 of them syntheses that pooled it.
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Who cites it
18 citing papers in PubMed, 2 syntheses or guidelines pooled it, 47 citations in OpenAlex.
- Opportunities and challenges in developing risk prediction models with electronic health records data: a systematic review.Journal of the American Medical Informatics Association : JAMIA · 2017Pooled it
- Efficacy and safety of mineralocorticoid receptor antagonists for patients with heart failure and diabetes mellitus: a systematic review and meta-analysis.BMC cardiovascular disorders · 2016Pooled it
- A nomogram to predict hyperkalemia in patients with hemodialysis: a retrospective cohort study.BMC nephrology · 2022Trial
- Incidence of hyperkalaemia and major creatinine elevation after renin-angiotensin system inhibitor initiation in a Singapore primary care cohort.BMC primary care · 2026Article
- The burden of hyperkalaemia in chronic kidney disease: a systematic literature review.Clinical kidney journal · 2025Article
- Hyperkalemia Incidence in Patients With Non-Dialysis Chronic Kidney Disease: A Large Retrospective Cohort Study From United States Clinical Care.Kidney medicine · 2024Article
- Case Report: Angiotensin converting enzyme inhibitors vs. angiotensin receptor blockers in the management of chronic hypertension: a case of lisinopril-induced rhinorrhea.Frontiers in allergy · 2024Article
- Association between hyperkalemia, RAASi non-adherence and outcomes in chronic kidney disease.Journal of nephrology · 2022Observational
- A Model to Predict Risk of Hyperkalemia in Patients with Chronic Kidney Disease Using a Large Administrative Claims Database.ClinicoEconomics and outcomes research : CEOR · 2020Article
- Revisiting RAAS blockade in CKD with newer potassium-binding drugs.Kidney international · 2018Review
- Kidney Function, ACE-Inhibitor/Angiotensin Receptor Blocker Use, and Survival Following Hospitalization for Heart Failure: A Cohort Study.Canadian journal of kidney health and disease · 2018Article
- Hyperkalemia After Initiating Renin-Angiotensin System Blockade: The Stockholm Creatinine Measurements (SCREAM) Project.Journal of the American Heart Association · 2017Article
- The Clinical and Economic Burden of Hyperkalemia on Medicare and Commercial Payers.American health & drug benefits · 2017Article
- How to Improve Adherence to Life-saving Heart Failure Treatments with Potassium Binders.Cardiac failure review · 2017Article
- Potassium Homeostasis, Oxidative Stress, and Human Disease.International journal of clinical and experimental physiology · 2017Article
- Patient- and physician-related risk factors for hyperkalaemia in potassium-increasing drug-drug interactions.European journal of clinical pharmacology · 2014Article
- Aging and antihypertensive medication-related complications in the chronic kidney disease patient.Current opinion in nephrology and hypertension · 2011Review
- Frequency of laboratory measurement and hyperkalaemia in hospitalised patients using serum potassium concentration increasing drugs.European journal of clinical pharmacology · 2011Article
Corrections and comments
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Authors and funding
8 authors at 4 institutions in 2 countries.
Funding
Abstract
purposeAngiotensin-converting enzyme (ACE) inhibitors are recommended for patients with chronic kidney disease (CKD) because they slow disease progression. But physicians' concerns about the risk of hyperkalemia (elevated serum potassium level), a potentially fatal adverse effect, may limit optimal management with ACE-inhibitors. We synthesized known predictors of hyperkalemia into a prognostic risk score to predict the risk of hyperkalemia.
methodsWe assembled a retrospective cohort of adult patients with possible CKD (at least one estimated glomerular filtration rate (eGFR) value less than 60 ml/min/1.73 m(2)) who started an ACE-inhibitor (i.e., incident users) between 1998 and 2006 at a health maintenance organization. We followed patients for hyperkalemia: (1) potassium value >5.5 mmol/L; or (2) diagnosis code for hyperkalemia. Cox regression synthesized a priori predictors recorded in the electronic medical record into a risk score.
resultsWe followed 5171 patients and 145 experienced hyperkalemia, a 90-day risk of 2.8%. Predictors included: age, eGFR, diabetes, heart failure, potassium supplements, potassium-sparing diuretics, and a high dose for the ACE-inhibitor (lisinopril). The risk score separated high-risk patients (top quintile, observed risk of 6.9%) from low-risk patients (bottom quintile, observed risk of 0.7%). Predicted and observed risks agreed within 1% for each quintile. The risk increased gradually in relation to declining eGFR with no apparent threshold for contraindicating ACE-inhibitors.
conclusionsThe risk score separated high-risk patients (who may need more intensive laboratory monitoring) from low-risk patients. The risk score should be validated in other populations before it is ready for use in clinical practice.
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Registered trials
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