Laboratory monitoring of potassium and creatinine in ambulatory patients receiving angiotensin converting enzyme inhibitors and angiotensin receptor blockers

Marsha A. Raebel, David L. McClure, Steven R. Simon, K. Arnold Chan, Adrianne Feldstein, Susan E. Andrade, Jennifer Elston Lafata, Douglas Roblin, Robert Davis, Margaret J. Gunter, Richard Platt

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Purpose: Serum potassium and creatinine monitoring is recommended for patients prescribed angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB). Much has been written about hyperkalemia associated with these drugs; little is known about laboratory monitoring patterns. The purpose of this retrospective cohort study was to assess creatinine and potassium monitoring and characteristics associated with monitoring among patients dispensed ACEi or ARB. Methods: This study was conducted in 10 United States health maintenance organizations. Study patients (n = 52906) were aged 18 or older with dispensings of ACEi or ARB for at least 1 year. Serum potassium and creatinine monitoring were assessed from administrative data and medical records. Results: More than two-thirds (68.4%) of patients received laboratory monitoring. Likelihood of monitoring increased with age (adjusted odds ratio [OR] 2.10; 95% confidence interval [95%CI] 1.93, 2.28 [individuals ≥ 80 compared to <50 years]), >9 outpatient visits (OR 1.46; 95%CI 1.39, 1.54), hospitalization (OR 1.15; 95%CI 1.06, 1.25), concomitant medications (potassium [OR 2.01; 95%CI 1.84, 2.20], diuretics [OR 1.54; 95%CI 1.47, 1.61], digoxin [OR 1.15; 95%CI 1.01, 1.30]), and comorbidities (diabetes [OR 1.68; 95%CI 1.61, 1.75], heart failure [OR 1.73; 95%CI 1.57, 1.90], chronic kidney disease [OR 2.95; 95%CI 2.48. 3.51]). Conclusions: Nearly one-third of patients dispensed ACEi or ARE did not undergo laboratory monitoring at least yearly. Though patients at increased risk of hyperkalemia were more likely to be monitored, many remained unmonitored.

Original languageEnglish (US)
Pages (from-to)55-64
Number of pages10
JournalPharmacoepidemiology and Drug Safety
Volume16
Issue number1
DOIs
StatePublished - Jan 1 2007
Externally publishedYes

Fingerprint

Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Creatinine
Potassium
Odds Ratio
Confidence Intervals
Hyperkalemia
Health Maintenance Organizations
Digoxin
Physiologic Monitoring
Serum
Chronic Renal Insufficiency
Diuretics
Medical Records
Comorbidity
Hospitalization
Cohort Studies
Outpatients
Heart Failure
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Pharmacology (medical)

Cite this

Laboratory monitoring of potassium and creatinine in ambulatory patients receiving angiotensin converting enzyme inhibitors and angiotensin receptor blockers. / Raebel, Marsha A.; McClure, David L.; Simon, Steven R.; Chan, K. Arnold; Feldstein, Adrianne; Andrade, Susan E.; Lafata, Jennifer Elston; Roblin, Douglas; Davis, Robert; Gunter, Margaret J.; Platt, Richard.

In: Pharmacoepidemiology and Drug Safety, Vol. 16, No. 1, 01.01.2007, p. 55-64.

Research output: Contribution to journalArticle

Raebel, MA, McClure, DL, Simon, SR, Chan, KA, Feldstein, A, Andrade, SE, Lafata, JE, Roblin, D, Davis, R, Gunter, MJ & Platt, R 2007, 'Laboratory monitoring of potassium and creatinine in ambulatory patients receiving angiotensin converting enzyme inhibitors and angiotensin receptor blockers', Pharmacoepidemiology and Drug Safety, vol. 16, no. 1, pp. 55-64. https://doi.org/10.1002/pds.1217
Raebel, Marsha A. ; McClure, David L. ; Simon, Steven R. ; Chan, K. Arnold ; Feldstein, Adrianne ; Andrade, Susan E. ; Lafata, Jennifer Elston ; Roblin, Douglas ; Davis, Robert ; Gunter, Margaret J. ; Platt, Richard. / Laboratory monitoring of potassium and creatinine in ambulatory patients receiving angiotensin converting enzyme inhibitors and angiotensin receptor blockers. In: Pharmacoepidemiology and Drug Safety. 2007 ; Vol. 16, No. 1. pp. 55-64.
@article{9c767333ed05445492b278d3c9e84c97,
title = "Laboratory monitoring of potassium and creatinine in ambulatory patients receiving angiotensin converting enzyme inhibitors and angiotensin receptor blockers",
abstract = "Purpose: Serum potassium and creatinine monitoring is recommended for patients prescribed angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB). Much has been written about hyperkalemia associated with these drugs; little is known about laboratory monitoring patterns. The purpose of this retrospective cohort study was to assess creatinine and potassium monitoring and characteristics associated with monitoring among patients dispensed ACEi or ARB. Methods: This study was conducted in 10 United States health maintenance organizations. Study patients (n = 52906) were aged 18 or older with dispensings of ACEi or ARB for at least 1 year. Serum potassium and creatinine monitoring were assessed from administrative data and medical records. Results: More than two-thirds (68.4{\%}) of patients received laboratory monitoring. Likelihood of monitoring increased with age (adjusted odds ratio [OR] 2.10; 95{\%} confidence interval [95{\%}CI] 1.93, 2.28 [individuals ≥ 80 compared to <50 years]), >9 outpatient visits (OR 1.46; 95{\%}CI 1.39, 1.54), hospitalization (OR 1.15; 95{\%}CI 1.06, 1.25), concomitant medications (potassium [OR 2.01; 95{\%}CI 1.84, 2.20], diuretics [OR 1.54; 95{\%}CI 1.47, 1.61], digoxin [OR 1.15; 95{\%}CI 1.01, 1.30]), and comorbidities (diabetes [OR 1.68; 95{\%}CI 1.61, 1.75], heart failure [OR 1.73; 95{\%}CI 1.57, 1.90], chronic kidney disease [OR 2.95; 95{\%}CI 2.48. 3.51]). Conclusions: Nearly one-third of patients dispensed ACEi or ARE did not undergo laboratory monitoring at least yearly. Though patients at increased risk of hyperkalemia were more likely to be monitored, many remained unmonitored.",
author = "Raebel, {Marsha A.} and McClure, {David L.} and Simon, {Steven R.} and Chan, {K. Arnold} and Adrianne Feldstein and Andrade, {Susan E.} and Lafata, {Jennifer Elston} and Douglas Roblin and Robert Davis and Gunter, {Margaret J.} and Richard Platt",
year = "2007",
month = "1",
day = "1",
doi = "10.1002/pds.1217",
language = "English (US)",
volume = "16",
pages = "55--64",
journal = "Pharmacoepidemiology and Drug Safety",
issn = "1053-8569",
publisher = "John Wiley and Sons Ltd",
number = "1",

}

TY - JOUR

T1 - Laboratory monitoring of potassium and creatinine in ambulatory patients receiving angiotensin converting enzyme inhibitors and angiotensin receptor blockers

AU - Raebel, Marsha A.

AU - McClure, David L.

AU - Simon, Steven R.

AU - Chan, K. Arnold

AU - Feldstein, Adrianne

AU - Andrade, Susan E.

AU - Lafata, Jennifer Elston

AU - Roblin, Douglas

AU - Davis, Robert

AU - Gunter, Margaret J.

AU - Platt, Richard

PY - 2007/1/1

Y1 - 2007/1/1

N2 - Purpose: Serum potassium and creatinine monitoring is recommended for patients prescribed angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB). Much has been written about hyperkalemia associated with these drugs; little is known about laboratory monitoring patterns. The purpose of this retrospective cohort study was to assess creatinine and potassium monitoring and characteristics associated with monitoring among patients dispensed ACEi or ARB. Methods: This study was conducted in 10 United States health maintenance organizations. Study patients (n = 52906) were aged 18 or older with dispensings of ACEi or ARB for at least 1 year. Serum potassium and creatinine monitoring were assessed from administrative data and medical records. Results: More than two-thirds (68.4%) of patients received laboratory monitoring. Likelihood of monitoring increased with age (adjusted odds ratio [OR] 2.10; 95% confidence interval [95%CI] 1.93, 2.28 [individuals ≥ 80 compared to <50 years]), >9 outpatient visits (OR 1.46; 95%CI 1.39, 1.54), hospitalization (OR 1.15; 95%CI 1.06, 1.25), concomitant medications (potassium [OR 2.01; 95%CI 1.84, 2.20], diuretics [OR 1.54; 95%CI 1.47, 1.61], digoxin [OR 1.15; 95%CI 1.01, 1.30]), and comorbidities (diabetes [OR 1.68; 95%CI 1.61, 1.75], heart failure [OR 1.73; 95%CI 1.57, 1.90], chronic kidney disease [OR 2.95; 95%CI 2.48. 3.51]). Conclusions: Nearly one-third of patients dispensed ACEi or ARE did not undergo laboratory monitoring at least yearly. Though patients at increased risk of hyperkalemia were more likely to be monitored, many remained unmonitored.

AB - Purpose: Serum potassium and creatinine monitoring is recommended for patients prescribed angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB). Much has been written about hyperkalemia associated with these drugs; little is known about laboratory monitoring patterns. The purpose of this retrospective cohort study was to assess creatinine and potassium monitoring and characteristics associated with monitoring among patients dispensed ACEi or ARB. Methods: This study was conducted in 10 United States health maintenance organizations. Study patients (n = 52906) were aged 18 or older with dispensings of ACEi or ARB for at least 1 year. Serum potassium and creatinine monitoring were assessed from administrative data and medical records. Results: More than two-thirds (68.4%) of patients received laboratory monitoring. Likelihood of monitoring increased with age (adjusted odds ratio [OR] 2.10; 95% confidence interval [95%CI] 1.93, 2.28 [individuals ≥ 80 compared to <50 years]), >9 outpatient visits (OR 1.46; 95%CI 1.39, 1.54), hospitalization (OR 1.15; 95%CI 1.06, 1.25), concomitant medications (potassium [OR 2.01; 95%CI 1.84, 2.20], diuretics [OR 1.54; 95%CI 1.47, 1.61], digoxin [OR 1.15; 95%CI 1.01, 1.30]), and comorbidities (diabetes [OR 1.68; 95%CI 1.61, 1.75], heart failure [OR 1.73; 95%CI 1.57, 1.90], chronic kidney disease [OR 2.95; 95%CI 2.48. 3.51]). Conclusions: Nearly one-third of patients dispensed ACEi or ARE did not undergo laboratory monitoring at least yearly. Though patients at increased risk of hyperkalemia were more likely to be monitored, many remained unmonitored.

UR - http://www.scopus.com/inward/record.url?scp=33846550667&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33846550667&partnerID=8YFLogxK

U2 - 10.1002/pds.1217

DO - 10.1002/pds.1217

M3 - Article

VL - 16

SP - 55

EP - 64

JO - Pharmacoepidemiology and Drug Safety

JF - Pharmacoepidemiology and Drug Safety

SN - 1053-8569

IS - 1

ER -