Prevalence of Hyperkalemia in Type 2 Diabetics Treated with Inhibitors of the Renin-Angiotensin-Aldosterone System: A Multicenter Study

Background and Aim: Hyperkalemia is a common risk among patients treated with renin-angiotensin-aldosterone system (RAAS) inhibitors, especially diabetics. The aim of this study was to measure the prevalence of hyperkalemia among patients with type-2 diabetics treated with ARBs and/or ACEIs, and compare them with controls. Subjects and methods: This study was carried out in four primary health care centers in Bahrain using a comparative ex-post-facto cross-sectional design with a control group. It included 305 type-2 diabetes patients in these settings. They were categorized into four groups: A) controls not on RAAS medications; B) ARB alone; C) ACE Inhibitors alone; D) combination of both. Data were collected from medical records. The study protocol was approved by the research committee in the Ministry of Health in the Kingdom of Bahrain. Results: The prevalence of hyperkalemia among those on ACE inhibitor and/or ARB medications was 16.51% (95% CI: 11.84 – 22.12%), while severe hyperkalemia was 1.38% (95% CI: 0.28 – 3.97%). The patients in the group taking both ARB and ACE inhibitor medications had significantly higher level of serum potassium but better control of their Fasting Blood Sugar (FBS) compared to the other 3 groups. In multivariate analysis, the medication group was not a statistically significant predictor of hyperkalemia. Conclusion: A combined ACEi/ARB therapy may pose a higher risk of increased serum potassium compared with mono-treatment or control. Hence, caution should be exercised especially in those with advanced kidney disease, heart failure, on renal replacement therapy, on potassium sparing diuretics.