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논문분류	춘계학술대회 초록집
제목	Predictors of Hyperkalemia Risk Following Hypertension Control with Aldosterone Blockade According to the Presence or Absence of Chronic Kidney Disease
저자	Sangeon Gwoo, Ye Na Kim, Sun Young Lim, Ho Sik Shin, Yeon Soon Jung, Hark Rim
출판정보	2013; 2013(1):
키워드	알도스테론, 고혈압, 칼륨, 만성콩팥병/ Aldosterone, Hypertension, Potassium, Chronic kidney disease
초록	Background: Aldosterone antagonists have proven efficacy for the management of hypertension and reduction of proteinuria; however, they are not widely used because of the risk of hyperkalemia. We assessed the predictors of hyperkalemia risk following hypertension control using aldosterone blockade according to the presence or absence of chronic kidney disease (CKD). Methods: Patients used in the analysis were observed between January 1, 2000 and November 30, 2012. A total of 6,575 patients with hypertension were evaluated for the safety of an aldosterone blockade added to preexisting blood pressure-lowering regimens. Hyperkalemia was defined as serum K level >5.0 mEq/L. All patients were on 3 mechanistically complementary antihypertensive agents, including a diuretic and a renin-angiotensin system blocker. Patients were evaluated after 4 and 8 weeks of treatment. The incidence of hyperkalemia, significant renal dysfunction (a reduction of estimated glomerular filtration rate [eGFR] ≥30%), and adverse effects according to the presence or absence of CKD were assessed. Results: After 4 weeks of treatment, the incidence of hyperkalemia according to the presence or absence of CKD was 6.9% and 36.6%, respectively. After 8 weeks of treatment, the incidence of hyperkalemia (serum K level ≥5.0 mEq/L) according to the presence or absence of CKD was 0.5% and 2.6%, respectively. According to logistic regression for predicting hyperkalemia following aldosterone antagonism, old age, CKD, male sex, basal hyperkalemia, and a reduction in eGFR predicted hyperkalemia risk. Conclusion: Spironolactone was well tolerated in selected patients with CKD. The risks of serious hyperkalemia or significant renal deterioration appear to be low, particularly after the second month of treatment. Strict monitoring over the first month of treatment followed by standard surveillance as for angiotensin converting enzyme inhibitors and angiotensin II receptor blockers is suggested.
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