Abstract: FR-PO967

Changes in Creatinine and Potassium after Initiating Renin Aldosterone Inhibitor and Diuretic Therapy in CKD: A Cohort Study from Outpatient Practices

Session Information

  • Patient Safety
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Patient Safety

  • 1501 Patient Safety

Authors

  • Garlo, Katherine, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Seger, Diane, Partners Healthcare System, Somerville, Massachusetts, United States
  • Fiskio, Julie, Partners Healthcare System, Somerville, Massachusetts, United States
  • Bates, David W., Brigham and Women's Hospital/Harvard Medical School, Brookline, Massachusetts, United States
  • Charytan, David M., Brigham and Women's Hospital, Boston, Massachusetts, United States
Background

Clinical trials of renin aldosterone system inhibitors (RASi) have demonstrated major cardiovascular and renal benefits to patients with chronic kidney disease (CKD), but these benefits must be weighed against the risks of a decline in estimated glomerular filtration rate (eGFR) and hyperkalemia. Since randomized controlled trials do not include the breadth of patients in real world clinical settings, we assessed changes in creatinine (Cr), estimated glomerular filtration rate (eGFR), and potassium in a large cohort of CKD patients prescribed a new RASi or diuretic.

Methods

Retrospective cohort study of adults with pre-dialysis CKD stage 3-5 who received a new outpatient RASi or diuretic prescription during 2009-2011. Lab data was collected electronically and analyzed for changes in Cr, eGFR, and potassium.

Results

A total of 8,272 individuals (mean age 72 yrs ±13.5, 44% male, 86% white) with CKD (90% stage 3, 7% stage 4, 2% stage 5) were included; 52% received a RASi and 48% received a diuretic. Follow up labs were done within 2 weeks in 28% (RASi: 24%, diuretic: 31%). The mean percent change within 2 weeks of drug prescription in Cr was lower in the RASi group compared to the diuretic group (3.8%±19.6 and 5.6%±21.8 ml/min/1.732m2, p<0.01). Over half of the subjects had <30% increase in Cr (RASi: 51.0%, diuretic: 52.2%) and over one third had an improvement in Cr (RASi: 37.5%, diuretic: 34.1%). Very few patients had a rise in Cr >50% (RASi: 2.2%, diuretic: 2.4%). The mean change in potassium was 0.07±0.5 in the RASi group and -0.03±0.6 in the diuretic group p <0.01. At follow up, the majority had a potassium <5.0 mmol/L (RASi: 80.4%, diuretic: 84.4%). Significant hyperkalemia (potassium >5.5) was rare (RASi: 1.9%, diuretic: 2.0%).

Conclusion

The low rate of meaningful changes in Cr and potassium following new prescriptions supports use in patients with moderate to advanced CKD. Further study is needed to determine lab monitoring strategies that improve safety and are cost-effective.