Hyperkalemia as a constraint to therapy with combination renin-angiotensin system blockade: The elephant in the room

Journal of Clinical Hypertension

Volumn 11, Issue 2, 2009, Pages 55-60

  Epstein, Murray ^a,b  

^a UNIVERSITY OF MIAMI MILLER SCHOOL OF MEDICINE   (United States)

^b VETERANS AFFAIRS MEDICAL CENTER   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ALDOSTERONE; ALDOSTERONE ANTAGONIST; ANGIOTENSIN; ANGIOTENSIN II; ANGIOTENSIN RECEPTOR ANTAGONIST; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; DIPEPTIDYL CARBOXYPEPTIDASE INHIBITOR; ENALAPRIL; EPLERENONE; IRBESARTAN; LOSARTAN; PLACEBO; POTASSIUM; RAMIPRIL; RENIN; RENIN INHIBITOR; SPIRONOLACTONE; TELMISARTAN;

BLOOD PRESSURE REGULATION; CLINICAL TRIAL; COMBINATION CHEMOTHERAPY; DIABETIC NEPHROPATHY; DIALYSIS; DISEASE SEVERITY; DRUG DOSE TITRATION; EDITORIAL; GLOMERULUS FILTRATION RATE; HEART FAILURE; HEART INFARCTION; HUMAN; HYPERKALEMIA; HYPERTENSION; INSULIN DEPENDENT DIABETES MELLITUS; KIDNEY DISEASE; MONOTHERAPY; PATIENT MONITORING; POTASSIUM BLOOD LEVEL; PRACTICE GUIDELINE; PRIORITY JOURNAL; RENAL PROTECTION; RENIN ANGIOTENSIN ALDOSTERONE SYSTEM; RISK ASSESSMENT; STROKE;

ANGIOTENSIN II TYPE 1 RECEPTOR BLOCKERS; ANGIOTENSIN-CONVERTING ENZYME INHIBITORS; CARDIOVASCULAR DISEASES; GLOMERULAR FILTRATION RATE; HUMANS; HYPERKALEMIA; KIDNEY FAILURE, CHRONIC; POTASSIUM; RISK FACTORS; SEVERITY OF ILLNESS INDEX; TREATMENT OUTCOME;

EID: 60549113949     PISSN: 15246175     EISSN: 17517176     Source Type: Journal    
DOI: 10.1111/j.1751-7176.2008.00071.x     Document Type: Editorial

References (25)

1. Lewis EJ, Hunsicker LG, Bain RP, et al. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. N Engl J Med. 1993;329:1456-1462.
2. Maschio G, Alberti D, Janin G, et al. Effect of the angiotensin-converting enzyme inhibitor benazepril on the progression of chronic renal insufficiency. N Engl J Med. 1996;334:939-945.
3. The GISEN Group. Randomized placebo controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. Lancet. 1997;349:1857-1863.
4. Brenner BM, Cooper ME, de Zeeuw D, et al; RENAAL Study Investigators. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001;345:861-869.
5. Lewis E, Hunsicker LG, Clarke WR, et al; Collaborative Study Group. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med. 2001;345:851-860.
6. Parving HH, Lehnert H, Brochner-Mortensen J, et al; Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria Study Group. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med. 2001;345:870-878.
7. Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med. 1999;341:709-717.
8. Pitt B, Remme W, Zannad F, et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 2003;348:1309-1321.
9. Epstein M. Aldosterone and the hypertensive kidney: Its emerging role as a mediator of progressive renal dysfunction: A paradigm shift. J Hypertens. 2001;19:829-842.
10. National Kidney Foundation. K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis. 2004;43(suppl):S1-S290.
11. American Diabetes Association. Hypertension management in adults with diabetes. Diabetes Care. 2004;27:S65-S67.
12. Bakris GL, Williams M, Dworkin L, et al. Preserving renal function in adults with hypertension and diabetes: A consensus approach. National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group. Am J Kidney Dis. 2000;36:646-661.
13. Jafar TH, Schmid CH, Landa M, et al. Angiotensin-converting enzyme inhibitors and progression of nondiabetic renal disease. A meta-analysis of patient-level data. Ann Intern Med. 2001;135:73-87.
14. Palmer BF. Managing hyperkalemia caused by inhibitors of the renin-angiotensin-aldosterone system. N Engl J Med. 2004;351:585-592.
15. Juurlink DN, Mamdani MM, Lee DS, et al. Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. N Engl J Med. 2004;351:543-551.
16. Levinsky NG. Management of emergencies, VI: Hyperkalemia. N Engl J Med. 1966;274:1076-1077.
17. Velazquez H, Perazella MA, Wright FS, et al. Renal mechanism of trimethoprim - induced hyperkalemia. Ann Intern Med. 1993;119:296-301.
18. Surawicz B, Chlebus H, Mazzoleni A. Hemodynamic and electrocardiographic effects of hyperpotassemia: Differences in response to slow and rapid increases in concentration of plasma K. Am Heart J. 1967;73:647-664.
19. Tarail R. Relationship of abnormalities in concentration of serum potassium to electrocardiographic disturbances. Am J Med. 1948;5:828-837.
20. Svensson M, Gustafsson F, Galatius S, et al. How prevalent is hyperkalemia and renal dysfunction during treatment with spironolactone in patients with congestive heart failure? J Card Fail. 2004;10:297-303.
21. Bianchi S, Bigazzi R, Campese VM. Antagonists of aldosterone and proteinuria in patients with CKD: An uncontrolled pilot study. Am J Kidney Dis. 2005;46:45-51.
22. Epstein M. Aldosterone blockade: An emerging strategy for abrogating progressive renal disease. Am J Med. 2006;119:912-919.
23. Epstein M, Buckalew V, Martinez F, et al. Antiproteinuric efficacy of eplerenone, enalapril, and eplerenone/enalapril combination in diabetic hypertensives with microalbuminuria [abstract]. Am J Hypertens. 2002;15:24A.
24. Epstein M, Williams GH, Weinberger M, et al. Selective aldosterone blockade with eplerenone reduces albuminuria in patients with type 2 diabetes. Clin J Am Soc Nephrol. 2006;1:940-951.
25. Delgado MC, Delgado-Almeida A. Red blood cell potassium and blood pressure in adolescents: A mixture analysis. Nutr Metab Cardiovasc Dis. 2002;12(3):112-116.