engleski

HYPERKALEMIA AND BLOCKADE OF RENIN-ANGIOTENSIN SYSTEM IN CHRONICALLY HEMODIALYZED PATIENTS

Objective: Examination of increased risk of hyperkalemia in chronic hemodialysis (HD) patients upon blockade of the renin-angiotensin system by angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers. Patients and methods: Study included 194 chronically hemodialyzed patients (82 women, 112 men), mean age 59&plusmn ; 13 years, treated by HD for median time of 4 years (from 1 to 27 years). They underwent predialysis serum potassium concentration determination every 2 months for 5 times. Mean and maximal patient's potassium was analyzed. Hyperkalemia was defined by mean serum potassium concentration of more than 5.5 mmol/L. Medication was recorded from medical data and checked by patient interview. There were 63 patients treated by angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers. Results: Patients receiving ACE inhibitors or angiotensin receptor blockers did not have significantly higher mean or maximal potassium serum concentration in comparison with the patients without such therapy (Mann-Whitney test, z=-1.015, p=0.310 ; z=-0.325, p=0.745, resp.). The patients receiving this medication were not at increased risk for hyperkalemia (OR 0.812, 95%CI 0.444-1.485). Conclusion: Potassium excess in chronically hemodialyzed patients was not additionally worsened by angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers therapy. The results encourage their use in HD patients. However, close potassium monitoring remains mandatory.

Hyperkaliemia; Haemodialysis; ACE

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