Abstract

RESTREPO, César A. Is the combination of ACE inhibitors and ASA with spirolactone safe?. Acta Med Colomb [online]. 2005, vol.30, n.4, pp.255-260. ISSN 0120-2448.

Objectives: To determine if in patients evaluated by hyperkalemia in a nephrology service the combination ACE inhibitors or angiotensin receptor blocker with spironolactone was present and what consequences it had on the group of identified patients. Design: Study of retrospective, prospective, observational and descriptive type. Place: Renal Unit STR (Service of Renal Therapy) of Caldas, Hospital Santa Sofia, Manizales. Population: All the patients interconsulted to the Service of Renal Therapy of Caldas to present hyperkalemia. Materials: The clinical histories of the patients interconsulted to the STR of Caldas were revised initially retrospectively and then prospectively because they present hyperkalemia, the next step was to proceed to discard those patients that presented illness renal chronic stadium 4 and 5, next the ones that had been receiving the combination ACE inhibitors or angiotensin receptor blocker with spironolactone were identified, their evolution, complications and predisposition factors were established. Results: 17 patients fulfilled the requirements for this work, 8 males and 9 females, mean age 65 years, 7 presented diabetes mellitus and 10 presented essential hypertension, 12 patients had cardiac illness of some type, 2 with base nephropathy (diabetic and hypertensive), 3 with rheumatologic disease and 1 with cirrhosis, among the factors that predispose to hyperkalemia, the following were detected: sharp decrease of renal perfusion in 5, active infection in 3, sharp obstructive nephropathy in one, and a new medication that affected renal secretion of potassium in two. Ten patients required hospitalization in the intensive care unit, with an average time of hospitalization of 7 days. 12 patients required hemodialysis and 5 died in the first 24 hours due to refractory shock because of therapies with vasoconstrictors and inotropic drugs. The concomitant use of medications that inhibited the Renin-Angiotensin-Aldosterone axis was very frequent. Conclusions: The indiscriminate use of the combination of ACE inhibitors or angiotensin receptor blocker with spironolactone is not safe; it has precise indications in cardiology and nephrology; in all patients it is indispensable to determine their renal function, heart failure's state, base illness and medications that they receive, before starting with the treatment. It is necessary to be attentive in detecting any factor that affects the renal perfusion or the renal elimination of potassium, in which case you should adjust the dose of these medications.

Keywords : hyperkalemia; ACE inhibitors; angiotensin receptor blocker; spironolactone.

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