Serum potassium changes due to concomitant ACEI/ARB and spironolactone therapy: A systematic review and meta-analysis

Autor:	Vignesh Subbian, Briggs S Carhart, John R. Horn, Andrew Romero, Daniel C. Malone, Lorenzo Villa-Zapata, Sheila M. Gephart, Malinda Tan, Philip D. Hansten
Rok vydání:	2021
Předmět:	Clinical Review 2019-20 coronavirus outbreak Hyperkalemia Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 030232 urology & nephrology 030204 cardiovascular system & hematology Pharmacology Angiotensin Receptor Antagonists 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Humans Medicine cardiovascular diseases Acei arb business.industry Health Policy Reproducibility of Results hyperkalemia angiotensin-converting enzyme inhibitors angiotensin receptor blockers spironolactone chemistry Serum potassium Meta-analysis Concomitant Potassium Spironolactone AcademicSubjects/MED00410 medicine.symptom business
Zdroj:	American Journal of Health-System Pharmacy: AJHP
ISSN:	1535-2900 1079-2082
Popis:	Purpose To provide evidence of serum potassium changes in individuals taking angiotensin-converting enzyme inhibitors (ACEIs) and/or angiotensin receptor blockers (ARBs) concomitantly with spironolactone compared to ACEI/ARB therapy alone. Methods PubMed, Embase, Scopus, and Web of Science were searched for studies including exposure to both spironolactone and ACEI/ARB therapy compared to ACEI/ARB therapy alone. The primary outcome was serum potassium change over time. Main effects were calculated to estimate average treatment effect using random effects models. Heterogeneity was assessed using Cochran’s Q and I2. Risk of bias was assessed using the revised Cochrane risk of bias tool. Results From the total of 1,225 articles identified, 20 randomized controlled studies were included in the meta-analysis. The spironolactone plus ACEI/ARB group included 570 patients, while the ACEI/ARB group included 547 patients. Treatment with spironolactone and ACEI/ARB combination therapy compared to ACEI/ARB therapy alone increased the mean serum potassium concentration by 0.19 mEq/L (95% CI, 0.12-0.26 mEq/L), with intermediate heterogeneity across studies (Q statistic = 46.5, P = 0.004; I2 = 59). Sensitivity analyses showed that the direction and magnitude of this outcome did not change with the exclusion of individual studies, indicating a high level of reliability. Reporting risk of bias was low for 16 studies (80%), unclear for 3 studies (15%) and high for 1 study (5%). Conclusion Treatment with spironolactone in combination with ACEI/ARB therapy increases the mean serum potassium concentration by less than 0.20 mEq/L compared to ACEI/ARB therapy alone. However, serum potassium and renal function must be monitored in patients starting combination therapy to avoid changes in serum potassium that could lead to hyperkalemia.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::3ce797adabddeb794b94bde5f560388f https://doi.org/10.1093/ajhp/zxab215 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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