No rise in hyperkalemia rate with increased spironolactone use in UK
MedWire News: Hospital admissions for hyperkalemia did not rise in Tayside, UK, between 1994 and 2007 despite a marked increase in use of spironolactone in patients with and without heart failure (HF), research shows.
Prescriptions for spironolactone increased after the release of RALES results in 1999, from 2847 in the first half of 1999, to 6582 in the second half of 2001, and 8619 by 2007.
Meanwhile there were three hospital admissions for hyperkalemia among these patients in the first quarter of 1995, two in the last quarter of 2001, and three in 2007.
The findings contrast with experience in Canada, where a rapid increase in spironolactone use after the publication of RALES (Randomized Aldactone Evaluation Study) was accompanied by a marked increase in hospital admissions (and subsequent deaths) from hyperkalemia.
Thomas MacDonald, from Ninewells Hospital and Medical School in Dundee, and co-authors believed that the risk associated with spironolactone use was managed better in their region than in Canada.
Their study confirmed that measurements of serum creatinine and serum potassium increased in parallel with increased prescription of spironolactone, from 5345 and 5246 in 1999 to 10,753 and 10,534 in 2001 and 17,844 and 17,649 in 2007.
Among patients taking ACE inhibitors who had recently been hospitalized for HF, the rate of spironolactone use increased from 19.8 per 100 patients in early 1999, to 70.1 per 100 patients by late 2001, and 61.3 per 100 patients by 2007. Again, rates of hyperkalemia did not increase among these patients, however. In fact, they fell from 9.9 per 100 patients in early 1999 to 6.9 per 100 patients by 2001 and 2.9 per 100 patients in 2007.
“Spironolactone prescribing seems to be safe in the setting of the National Health Service, probably owing to careful monitoring of electrolytes and renal function,” the authors conclude in the British Medical Journal.
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By Caroline Price