Iatrogenic hyperpotassaemia in elderly patients with hidden kidney failure in Primary Care
Hiperpotasemia iatrogénica en pacientes ancianos en Atención Primaria con insuficiencia renal oculta
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"apellidos" => "de Vera Floristán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Unidad de Nefrología, Hospital de Barbastro, Barbastro, Huesca, España, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => " Centro de Salud de El Grado, El Grado, Huesca, España, " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Lleida, España, " "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hiperpotasemia iatrogénica en pacientes ancianos en Atención Primaria con insuficiencia renal oculta" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "42318078_t1_pag488.jpg" "Alto" => 372 "Ancho" => 543 "Tamanyo" => 38834 ] ] "descripcion" => array:1 [ "en" => "Drug combinations that caused hyperpotassaemia in patients with ORF" ] ] ] "textoCompleto" => "<p class="elsevierStylePara">Dear Editor,</p><p class="elsevierStylePara">One of the practical applications of estimating glomerular filtration (GF) using formulas is the possibility of being able to adapt the prescription for patients with hidden chronic kidney disease,<span class="elsevierStyleSup">1</span> thereby avoiding potential iatrogenic complications, with potential to induce hyperpotassaemia.<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">By means of a randomized sampling process, we selected a population made up of 4,014 patients over the age of 65 from the Spanish province of Huesca, who were seen in health centres with the OMI-AP IT system (Primary Care IT Organisation and Management, Stacks @), which allowed us to check the prescriptions. After excluding certain patients for different reasons, we established the GF using the abbreviated MDRD formula for 3,286 subjects. As a result, we detected 291 patients with hidden kidney failure (normal serum creatinine levels and an estimated GF < 60ml/min/1.73m<span class="elsevierStyleSup">2</span>). We recorded the active ingredients prescribed by the general practitioners of 269 patients for acute or chronic conditions during a 12 month period (2007). Within this group, 211 patients (72.5%) were exposed to drugs, either alone or in combination, that could favour hyperpotassaemia. The mean serum potassium for the 211 patients was 4.553 ± 0.52meq/L (CI 95% 4.48-4.62) (median 4.6) (range 3.1-6). If we consider  hyperpotassaemia<span class="elsevierStyleSup">3</span> levels above 5meq/l, the results indicate that thirty of the 211 patients presented this condition during the 12 month follow up. Table 1 shows the different drugs prescribed to these patients along with the serum potassium levels of each subgroup. The most common combination was NSAID with ACE inhibitors or ARA II. In monotherapy, NSAID were the drugs that were most commonly associated with hyperpotassaemia. Because of the design of the study, an individualised follow up of the patients was not carried out in order to determine whether there were any clinical consequences of the hyperpotassaemia. Nevertheless, the fact that  this may have occurred in extreme cases should not be ruled out (seven patients had blood potassium levels of 5.7meq/l or higher).</p><p class="elsevierStylePara">Our study highlights the importance of correct dosage adjustment and prescription checks carried out by the professional to verify the use of certain drugs in patients with chronic kidney disease, which could remain undetected if only creatinine levels are estimated.<span class="elsevierStyleSup">4</span> Fortunately, GF estimation using MDRD has been available in our province for a few months now. In the same way that pharmacies in some hospitals in Spain issue a series of warnings when a potentially dangerous drug is prescribed to patients admitted with reduced GF, it would be good if a similar system were introduced in Primary Care. For example, currently the OMI-AP system issues a warning when doctors prescribe a drug which has been highlighted for causing an allergic reaction. Furthermore, if this system or any other IT system were able to combine the information about the patient¿s GF with the precise  djustments in the handbook, it would be possible to avoid many of the consequences associated with incorrect prescriptions. </p><p class="elsevierStylePara"><a href="grande/42318078_t1_pag488.jpg" class="elsevierStyleCrossRefs"><img src="42318078_t1_pag488.jpg" alt="Drug combinations that caused hyperpotassaemia in patients with ORF"></img></a></p><p class="elsevierStylePara">Table 1. Drug combinations that caused hyperpotassaemia in patients with ORF</p>" "pdfFichero" => "P-E-S-A423-EN.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "42318078_t1_pag488.jpg" "Alto" => 372 "Ancho" => 543 "Tamanyo" => 38834 ] ] "descripcion" => array:1 [ "en" => "Drug combinations that caused hyperpotassaemia in patients with ORF" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Stevens LA, Coresh J, Greene T, Levey AS. Assessing Kidney function- measured and estimated glomerular filtration rate. N Engl J Med 2006;354:2473-83. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16760447" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Gross P, Pistrosch F. Hyperkalaemia: again. Nephrol Dial Transplant 2009;19:2163-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15299094" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "American Heart Association 2005 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 10.1: Life-Threatening Electrolyte Abnormalities. Circulation 2005;112:IV-121-IV-125." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Fernández-Fresnedo G, de Francisco ALM, Rodrigo E, Piñera C, Herráez I, Ruiz C, Arias M. Insuficiencia renal ¿oculta¿ por valoración de la función renal mediante creatinina sérica. Nefrología 2002;22:144-51. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12085415" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Macia M, del castillo N, Navarro J, Jarque A, Marín JA, Bermúdez C, et al. Control de la ERC en el ámbito hospitalario: implantación de un sistema de alerta para la dosificación automática de fármacos nefrotóxicos. Nefrología 2008;28(4):45 (abstract)." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000002900000005/v0_201502091625/X2013251409003844/v0_201502091626/en/main.assets" "Apartado" => array:4 [ "identificador" => "35436" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000002900000005/v0_201502091625/X2013251409003844/v0_201502091626/en/P-E-S-A423-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409003844?idApp=UINPBA000064" ]
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