Biochemical monitoring after initiation of aldosterone antagonist therapy in users of renin-angiotensin system blockers: A UK primary care cohort study

<p>Objective To determine the frequency of biochemical monitoring after initiation of aldosterone antagonists(AA) in patients also using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB). Setting UK primary care. Participants ACEI/ARB users who initiated AA between 2004 and 2014. Outcomes We calculated the proportions with: (1) biochemical monitoring ?2 weeks post initiation of AA, (2) adverse biochemical values ?2 months (potassium ?6 mmol/L, creatinine ?220 ?mol/L and ?30% increase in creatinine from baseline) and (3) discontinuers of AA in those with an adverse biochemical value. We used logistic regression to study patient characteristics associated with monitoring and adverse biochemical values. Results In 10 546 initiators of AA, 3291 (31.2%) had a record of biochemical monitoring ?2 weeks post initiation. A total of 2.0% and 2.7% of those with follow-up monitoring within 2 months of initiation experienced potassium ?6 mmol/L and creatinine ?220 ?mol/L, respectively, whereas 13.5% had a ?30% increase in creatinine. Baseline potassium (OR 3.59, 95% CI 2.43 to 5.32 for 5.0-5.5 mmol/L compared with <5.0 mmol/L) and estimated glomerular filtration rate 45-59 ml/min/1.73 m 2 (OR 2.06, 95% CI 1.26 to 3.35 compared with ?60 ml/min/1.73 m 2) were independently predictive of potassium ?6 mmol/L. Women and people with diabetes had higher odds of ?30% increase in creatinine. Conclusion Less than one-third of patients taking ACEI/ARB had biochemical monitoring within 2 weeks of initiating AAs. Higher levels of monitoring may reduce adverse biochemical events. � Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.</p>