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10.1161/JAHA.116.005428

http://scihub22266oqcxt.onion/10.1161/JAHA.116.005428
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C5586281!5586281!28724651
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suck abstract from ncbi


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pmid28724651      J+Am+Heart+Assoc 2017 ; 6 (7): ä
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  • Hyperkalemia After Initiating Renin?Angiotensin System Blockade: The Stockholm Creatinine Measurements (SCREAM) Project #MMPMID28724651
  • Bandak G; Sang Y; Gasparini A; Chang AR; Ballew SH; Evans M; Arnlov J; Lund LH; Inker LA; Coresh J; Carrero J; Grams ME
  • J Am Heart Assoc 2017[Jul]; 6 (7): ä PMID28724651show ga
  • Background: Concerns about hyperkalemia limit the use of angiotensin?converting enzyme inhibitors (ACE?I) and angiotensin receptor blockers (ARBs), but guidelines conflict regarding potassium?monitoring protocols. We quantified hyperkalemia monitoring and risks after ACE?I/ARB initiation and developed and validated a hyperkalemia susceptibility score. Methods and Results: We evaluated 69 426 new users of ACE?I/ARB therapy in the Stockholm Creatinine Measurements (SCREAM) project with medication initiation from January 1, 2007 to December 31, 2010, and follow?up for 1 year thereafter. Three fourths (76%) of SCREAM patients had potassium checked within the first year. Potassium >5 and >5.5 mmol/L occurred in 5.6% and 1.7%, respectively. As a comparison, we propensity?matched new ACE?I/ARB users to 20 186 new ??blocker users in SCREAM: 64% had potassium checked. The occurrence of elevated potassium levels was similar between new ??blocker and ACE?I/ARB users without kidney disease; only at estimated glomerular filtration rate <60 mL/min per 1.73 m2 were risks higher among ACE?I/ARB users. We developed a hyperkalemia susceptibility score that incorporated estimated glomerular filtration rate, baseline potassium level, sex, diabetes mellitus, heart failure, and the concomitant use of potassium?sparing diuretics in new ACE?I/ARB users; this score accurately predicted 1?year hyperkalemia risk in the SCREAM cohort (area under the curve, 0.845, 95% CI: 0.840?0.869) and in a validation cohort from the US?based Geisinger Health System (N=19 524; area under the curve, 0.818, 95% CI: 0.794?0.841), with good calibration. Conclusions: Hyperkalemia within the first year of ACE?I/ARB therapy was relatively uncommon among people with estimated glomerular filtration rate >60 mL/min per 1.73 m2, but rates were much higher with lower estimated glomerular filtration rate. Use of the hyperkalemia susceptibility score may help guide laboratory monitoring and prescribing strategies.
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