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Pharmacotherapy Research Manager and Associate Clinical Professor, Kaiser Permanente Colorado Clinical Research Unit and School of Pharmacy, University of Colorado at Denver and Health Sciences Center, Denver, CO
Epidemiologist, Kaiser Permanente Colorado Clinical Research Unit, Denver
Investigator and Assistant Professor, I3Magnify Epidemiology and Harvard Medical School, Boston, MA
Assistant Professor, Harvard Medical School and Harvard Pilgrim Health Care, Boston
Investigator, Kaiser Permanente Northwest Center for Health Research and Oregon Health Sciences University, Portland, OR
Research Scientist, Center for Health Services Research, Henry Ford Health System, Detroit, MI
Assistant Professor of Medicine, Meyers Primary Care Institute, Fallon Foundation, and University of Massachusetts Medical School, Worcester, MA
President and Executive Director, Lovelace Clinic Foundation, Albuquerque, NM
at time of study, HealthPartners Research Foundation, Minneapolis, MN; now, Consultant, Applied Health Outcomes, Palm Harbor, FL
Research Scientist, Kaiser Permanente Southeast, Atlanta, GA
Professor and Chair, Ambulatory Care and Prevention, Medicine, Harvard Medical School, Harvard Pilgrim Health Care, Channing Laboratory, Brigham and Women's Hospital, Boston
Reprints: Dr. Raebel, Kaiser Permanente Colorado, Clinical Research Unit, PO Box 378066, Denver, CO 80237, fax 303/614-1265, Marsha.A.Raebel{at}kp.org
BACKGROUND: Serum potassium and creatinine evaluation is recommended in patients prescribed spironolactone, yet the proportion of ambulatory patients chronically dispensed spironolactone receiving evaluation is not well understood.
OBJECTIVE: To estimate the rate of potassium and creatinine evaluation and identify factors associated with conducting these tests among ambulatory patients dispensed spironolactone.
METHODS: A retrospective cohort study was designed to evaluate patients at 10 health maintenance organizations with ongoing spironolactone dispensing for one year (N = 2257). Potassium and creatinine evaluation were determined from administrative data. Associations between patient characteristics and laboratory testing were assessed, using logistic regression modeling.
RESULTS: Serum creatinine and potassium were evaluated in 72.3% of patients during a 13 month period. The likelihood of potassium and creatinine monitoring was greater among patients who were older (OR 1.28; 95% CI 1.17 to 1.41 per decade of life); male (OR 1.25; 95% CI 1.01 to 1.54); had diabetes (OR 1.63; 95% CI 1.31 to 2.03); received concomitant therapy with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (OR 2.23; 95% CI 1.74 to 2.87), potassium supplements (OR 1.96; 95% CI 1.51 to 2.54), or digoxin (OR 2.10 95% CI 1.48 to 2.98); or had more outpatient visits (OR 1.31; 95% CI 1.19 to 1.44). Among patients with heart failure (n = 790), factors associated with the incidence of laboratory testing were diabetes (OR 1.64, 95% CI 1.14 to 2.34), outpatient visits (OR 1.20; 95% CI 1.02 to 1.41), and digoxin therapy (OR 2.26; 95% CI 1.38 to 3.69).
CONCLUSIONS: Three-fourths of ambulatory patients dispensed spironolactone receive recommended laboratory evaluation, with monitoring more likely to be completed in patients prescribed concomitant therapy with drugs that increase hyperkalemia risk, older patients, and those with diabetes.
Key Words: potassium, serum creatinine, spironolactone
Published Online, February 6, 2007. www.theannals.com, DOI 10.1345/aph.1H520
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