Diabetes and Drug-Associated Hyperkalemia: Effect of Laboratory Monitoring

糖尿病和药物相关高钾血症：实验室监测的效果

• 批准号: 7199328
• 负责人: MARSHA Ann RAEBEL
• 金额: $ 28万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-25 至 2009-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7199328
• 关键词: Accident and Emergency department; Aldosterone Receptors; Ambulatory Care; Angiotensin Receptor; Angiotensin-Converting Enzyme Inhibitors; Cessation of life; Characteristics; Clinical Research; Cohort Studies; Colorado; Diabetes Mellitus; Drug Prescriptions; Education; Environment; Epidemiology; Event; Frequencies; Funding Mechanisms; Future; Health Maintenance Organizations; Hospitalization; Incidence; Kidney Diseases; Knowledge; Laboratories; Life; Medical Records; Mineralocorticoid Receptor; Modality; Monitor; Obesity; Outcome; Patients; Pharmaceutical Preparations; Pharmacotherapy; Population; Potassium; Recommendation; Research; Research Personnel; Risk; Risk Factors; Safety; Serum; Site; Subgroup; System; Therapeutic; Time; Visit; Work; base; cost; design; hyperkalemia; improved; patient safety; response

DESCRIPTION (provided by applicant): In this project we build upon ongoing efforts of the researchers and practitioners of the HMO Research Network Center for Education and Research in Therapeutics (CERTs) and of the Kaiser Permanente Colorado Clinical Research Unit to improve medication safety in the ambulatory care environment. This project is a population-based retrospective cohort study in response to PA-05-094 (Secondary Analyses in Obesity, Diabetes, Digestive and Kidney Diseases) that uses the large existing automated record linkage systems and associated medical records of four HMO Research Network CERTs sites. This study will assess the associations between both receipt and timing of serum potassium monitoring and the occurrence of hyperkalemia-associated hospitalizations, emergency department visits, and deaths in approximately 17,000 ambulatory patients with diabetes who are newly-prescribed angiotensin converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), and/or aldosterone receptor antagonists (ARA). ACEi, ARB and/or ARA are important therapeutic modalities. Unfortunately, they are associated with potentially life-threatening hyperkalemia. Patients with diabetes comprise up to half of all patients prescribed these drugs and are at increased risk of hyperkalemia-associated adverse outcomes, but whether potassium monitoring helps to decrease these adverse outcomes is not clear. Results from this project will supply evidence about whether patients with diabetes who receive potassium monitoring after being newly- prescribed ACEi, ARB, and/or ARA have a lower incidence of hyperkalemia-associated adverse outcomes than patients who are not monitored. Additionally, knowledge gained will include information about patient characteristics associated with increased risks. Our intent is to use the findings from this exploratory project for future work to develop and evaluate evidence-based serum potassium monitoring recommendations for patients with diabetes who are prescribed these drugs. The findings will also assist in developing a framework for future studies to evaluate the effects and costs of medication-laboratory monitoring among patients with diabetes.

描述（由申请人提供）：在本项目中，我们建立在HMO研究网络治疗学教育和研究中心（CERT）和Kaiser Permanente科罗拉多临床研究单位的研究人员和从业人员的持续努力基础上，以提高门诊护理环境中的药物安全性。该项目是一项基于人群的回顾性队列研究，旨在响应PA-05-094（肥胖、糖尿病、消化和肾脏疾病的二次分析），该研究使用了大型现有自动记录链接系统和四个HMO研究网络CERT站点的相关病历。本研究将在约17，000例新处方血管紧张素转换酶抑制剂（ACEi）、血管紧张素受体阻滞剂（ARB）和/或醛固酮受体拮抗剂（ARA）的非卧床糖尿病患者中评估血清钾监测的接受和时间与高钾血症相关住院、急诊就诊和死亡发生率之间的相关性。ACEi、ARB和/或ARA是重要的治疗方式。不幸的是，它们与可能危及生命的高钾血症有关。糖尿病患者占所有处方这些药物的患者的一半，并且高钾血症相关不良后果的风险增加，但钾监测是否有助于减少这些不良后果尚不清楚。本项目的结果将提供证据，证明接受新处方ACEi、ARB和/或ARA后接受钾监测的糖尿病患者的高钾血症相关不良结局发生率是否低于未接受监测的患者。此外，获得的知识将包括与风险增加相关的患者特征信息。我们的目的是利用这个探索性项目的结果，为未来的工作，以制定和评估基于证据的血清钾监测建议的糖尿病患者谁是处方这些药物。这些发现还将有助于为未来的研究制定一个框架，以评估糖尿病患者药物实验室监测的效果和成本。