Abstract: SA-PO436

Beta Blockers as the Cause of Hyperkalemia in Near-End Stage Renal Disease Patients: A Cross-Sectional Study

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 304 CKD: Epidemiology, Outcomes - Non-Cardiovascular

Authors

  • Okamura, Kazuhiro, Iizuka Hospital, Iizuka-city, Japan
  • Sasaki, Sho, Iizuka Hospital, Iizuka-city, Japan
  • Furusho, Masahide, Iizuka Hospital, Iizuka-city, Japan
  • Hirakawa, Makoto, Iizuka Hospital, Iizuka-city, Japan

Group or Team Name

  • JOINT-KD
Background

Although there are several case reports on hyperkalemia caused by beta blockers so far, few studies have verified its causal relationship based on epidemiological methods. The objectives of this study were to assess the association between beta blocker use and risk of hyperkalemia among patients with near end-stage renal failure (ESRD).

Methods

Design and participants: We performed a cross-sectional study at seven Japanese teaching hospitals. Consecutive adult patients with eGFR <15 ml/min/1.73m2 that visited outpatient departments from April 1 to June 30, 2013, were enrolled. Patients with dialysis, post-transplantation, or hospitalization within 30 days were excluded. Exposure: We set the usage of beta blockers as the exposure to be tested. Outcomes: Serum K+ concentration was taken as the outcome. Statistical analysis: Descriptive analysis was done. Next, multivariate analysis adjusted for age, sex, eGFR, presence of diabetes mellitus, RAAS inhibitor use, K-sparing diuretics use, loop diuretics use, and K absorption drugs use was conducted. In addition, analysis stratified by age (cut off: 75 yo) and RAAS inhibitor use was performed.

Results

Of 517 patients (56.9% male) who were at a median age of 72 (interquartile range, 63 to 80), with median eGFR 11.1 ml/min/1.73m2 (interquartile range, 9.2 to 13.1) included, 239 (46.2%) had diabetes mellitus, 305 (59%) used RAAS inhibitors, and 148 (28.6%) used beta blockers. In the results of the multivariate analysis adjusted for possible confounders, there was no significant difference in the serum K+ value between the group using the beta blockers and the group not using the beta blockers (+0.07mEq/L, 95% Confidence Interval [CI] -0.067 to - 0.211, p=0.3). An additional analysis stratified for age showed that beta blocker use in participants with an age of 75 yo or older results in significantly higher serum K+ levels (+0.24 mEq/L, 95%CI 0.012 to 0.470, p= 0.04) compared with participants without beta blockers. Further, the combined use of RAAS inhibitors and beta blockers resulted in higher serum K+ levels (+0.42mEq/L, 95% CI 0.14 - 0.71, p<0.01) compared with participants who used neither in the subgroup of 75 yo or older.

Conclusion

In patients with near ESRD who were 75 years of age or older, it was suggested that the use of beta blockers may raise the serum K+ value.