Harel Z, Gilbert C, Wald R, et al.
The effect of combination treatment with aliskiren and blockers of the
renin-angiotensin system on hyperkalaemia and acute kidney injury:
systematic review and meta-analysis. BMJ. 2012 Jan 9;344:e42. doi: 10.1136/bmj.e42. (Review) PMID: 22232539
OBJECTIVE: To examine the safety of using aliskiren combined with agents used to block the renin-angiotensin system.
DESIGN: Systematic review and meta-analysis of randomised controlled trials.
DATA SOURCES: Medline, Embase, the Cochrane Library, and two trial registries, published up to 7 May 2011.
STUDY
SELECTION: Published and unpublished randomised controlled trials that
compared combined treatment using aliskiren and angiotensin converting
enzyme inhibitors or angiotensin receptor blockers with monotherapy
using these agents for at least four weeks and that provided numerical
data on the adverse event outcomes of hyperkalaemia and acute kidney
injury. A random effects model was used to calculate pooled risk ratios
and 95% confidence intervals for these outcomes.
RESULTS: 10
randomised controlled studies (4814 participants) were included in the
analysis. Combination therapy with aliskiren and angiotensin converting
enzyme inhibitors or angiotensin receptor blockers significantly
increased the risk of hyperkalaemia compared with monotherapy using
angiotensin converting enzymes or angiotensin receptor blockers
(relative risk 1.58, 95% confidence interval 1.24 to 2.02) or aliskiren
alone (1.67, 1.01 to 2.79). The risk of acute kidney injury did not
differ significantly between the combined therapy and monotherapy groups
(1.14, 0.68 to 1.89).
CONCLUSION: Use of aliskerin in combination
with angiotensin converting enzyme inhibitors or angiotensin receptor
blockers is associated with an increased risk for hyperkalaemia. The
combined use of these agents warrants careful monitoring of serum
potassium levels.
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