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Serum potassium changes due to concomitant ACEI/ARB and spironolactone therapy: A systematic review and meta-analysis.
Villa-Zapata, Lorenzo; Carhart, Briggs S; Horn, John R; Hansten, Philip D; Subbian, Vignesh; Gephart, Sheila; Tan, Malinda; Romero, Andrew; Malone, Daniel C.
  • Villa-Zapata L; Department of Pharmacy Practice, College of Pharmacy, Mercer University, Atlanta, GA, USA.
  • Carhart BS; Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
  • Horn JR; Department of Pharmacy Practice, School of Pharmacy, University of Washington, Seattle, WA.
  • Hansten PD; Pharmacy Services, UW Medicine, Seattle, WA, USA.
  • Subbian V; School of Pharmacy, University of Washington, Seattle, WA, USA.
  • Gephart S; Department of Biomedical Engineering and Department of Systems & Industrial Engineering, College of Engineering, The University of Arizona, Tucson, AZ, USA.
  • Tan M; Community and Health Systems Science, College of Nursing, The University of Arizona, Tucson, AZ, USA.
  • Romero A; College of Pharmacy, L.S. Skaggs Research Institute, University of Utah, Salt Lake City, UT, USA.
  • Malone DC; Department of Pharmacy, Banner University Medical Center, Tucson, AZ, USA.
Am J Health Syst Pharm ; 78(24): 2245-2255, 2021 Dec 09.
Article in English | MEDLINE | ID: covidwho-1236214
ABSTRACT

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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Spironolactone / Angiotensin Receptor Antagonists Type of study: Experimental Studies / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Humans Language: English Journal: Am J Health Syst Pharm Journal subject: Pharmacy / Hospitals Year: 2021 Document Type: Article Affiliation country: Ajhp

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Spironolactone / Angiotensin Receptor Antagonists Type of study: Experimental Studies / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Humans Language: English Journal: Am J Health Syst Pharm Journal subject: Pharmacy / Hospitals Year: 2021 Document Type: Article Affiliation country: Ajhp