Document Detail

Increasingly restrictive definitions of hyperkalemia outcomes in a database study: effect on incidence estimates.
MedLine Citation:
PMID:  19937982     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To determine the incidence of hyperkalemia-associated adverse outcomes among ambulatory patients with diabetes newly initiating renin-angiotensin-aldosterone system (RAAS) inhibitor therapy and to examine to what extent increasingly restrictive definitions of hyperkalemia-associated outcomes influenced incidence estimates. METHODS: Retrospective cohort study of 27 355 individuals with diabetes who were new users of RAAS inhibitors at three integrated healthcare systems. RESULTS: Using the least restrictive definition of hyperkalemia-associated outcome, an ambulatory visit (AV), inpatient hospitalization (IP), or emergency department (ED) visit co-occurring within 7 days of coded hyperkalemia diagnosis and/or potassium concentration of > or =5.5 mmol/L, the incidence rate of hyperkalemia was 30.1 per 1000 person-years (p-y). Restricting to only IP or ED visits co-occurring within 24 hours of coded diagnosis and/or potassium > or =6 mmol/L, the incidence rate was 10.2 per 1000 p-y. When this latter definition was further restricted by removing available potassium laboratory values, the incidence rate declined to 9.5 per 1000 p-y. CONCLUSIONS: Modifying the definition of hyperkalemia-associated outcome resulted in up to threefold differences in incidence rate estimates. Our results demonstrate the value of including potassium laboratory results and AVs in identifying hyperkalemia from electronic data. Comparing incidence estimates across published studies requires consideration of differences in outcome definitions.
Marsha A Raebel; Colleen Ross; Craig Cheetham; Hans Petersen; Gwyn Saylor; David H Smith; Leslie A Wright; Douglas W Roblin; Stanley Xu
Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Pharmacoepidemiology and drug safety     Volume:  19     ISSN:  1099-1557     ISO Abbreviation:  Pharmacoepidemiol Drug Saf     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2009-12-30     Completed Date:  2010-03-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9208369     Medline TA:  Pharmacoepidemiol Drug Saf     Country:  England    
Other Details:
Languages:  eng     Pagination:  19-25     Citation Subset:  IM    
Kaiser Permanente Colorado Institute for Health Research, Denver, CO 80237, USA.
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MeSH Terms
Aldosterone Antagonists / adverse effects*,  therapeutic use
Ambulatory Care
Angiotensin-Converting Enzyme Inhibitors / adverse effects*,  therapeutic use
Cohort Studies
Databases, Factual
Diabetes Mellitus, Type 2 / drug therapy,  epidemiology
Drug Monitoring
Hyperkalemia / blood,  chemically induced*,  epidemiology*
Middle Aged
Potassium / blood,  metabolism
Receptors, Angiotensin / antagonists & inhibitors*
Renin-Angiotensin System / drug effects*
Retrospective Studies
Grant Support
Reg. No./Substance:
0/Aldosterone Antagonists; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Receptors, Angiotensin; 7440-09-7/Potassium

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