{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T22:58:44Z","timestamp":1793228324380,"version":"4.5.0"},"reference-count":39,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2016,10,12]]},"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To examine adherence to serum creatinine and potassium monitoring and discontinuation guidelines following initiation of treatment with ACE inhibitors (ACEI) or angiotensin receptor blockers (ARBs); and whether high-risk patients are monitored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A general practice-based cohort study using electronic health records from the UK Clinical Practice Research Datalink and Hospital Episode Statistics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>UK primary care, 2004\u20132014.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Subjects<\/jats:title>\n                    <jats:p>223\u2005814 new ACEI\/ARB users.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Proportion of patients with renal function monitoring before and after ACEI\/ARB initiation; creatinine increase \u226530% or potassium levels &gt;6\u2005mmol\/L at first follow-up monitoring; and treatment discontinuation after such changes. Using logistic regression models, we also examined patient characteristics associated with these biochemical changes, and with follow-up monitoring within the guideline recommendation of 2\u2005weeks after treatment initiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>10% of patients had neither baseline nor follow-up monitoring of creatinine within 12\u2005months before and 2\u2005months after initiation of an ACEI\/ARB, 28% had monitoring only at baseline, 15% only at follow-up, and 47% both at baseline and follow-up. The median period between the most recent baseline monitoring and drug initiation was 40\u2005days (IQR 12\u2013125\u2005days). 34% of patients had baseline creatinine monitoring within 1\u2005month before initiating therapy, but &lt;10% also had the guideline-recommended follow-up test recorded within 2\u2005weeks. Among patients experiencing a creatinine increase \u226530% (n=567, 1.2%) or potassium level &gt;6\u2005mmol\/L (n=191, 0.4%), 80% continued treatment. Although patients with prior myocardial infarction, hypertension or baseline potassium &gt;5\u2005mmol\/L were at high risk of \u226530% increase in creatinine after ACEI\/ARB initiation, there was no evidence that they were more frequently monitored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Only one-tenth of patients initiating ACEI\/ARB therapy receive the guideline-recommended creatinine monitoring. Moreover, the vast majority of the patients fulfilling postinitiation discontinuation criteria for creatinine and potassium increases continue on treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2016-012818","type":"journal-article","created":{"date-parts":[[2017,1,9]],"date-time":"2017-01-09T20:50:21Z","timestamp":1483995021000},"page":"e012818","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":49,"title":["Adherence to guidelines for creatinine and potassium monitoring and discontinuation following renin\u2013angiotensin system blockade: a UK general practice-based cohort study"],"prefix":"10.1136","volume":"7","author":[{"given":"Morten","family":"Schmidt","sequence":"first","affiliation":[{"name":"Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK"},{"name":"Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark"},{"name":"Department of Internal Medicine, Regional Hospital of Randers, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2551-410X","authenticated-orcid":false,"given":"Kathryn E","family":"Mansfield","sequence":"additional","affiliation":[{"name":"Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishnan","family":"Bhaskaran","sequence":"additional","affiliation":[{"name":"Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorothea","family":"Nitsch","sequence":"additional","affiliation":[{"name":"Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik Toft","family":"S\u00f8rensen","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liam","family":"Smeeth","sequence":"additional","affiliation":[{"name":"Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurie A","family":"Tomlinson","sequence":"additional","affiliation":[{"name":"Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,1,9]]},"reference":[{"key":"2025121400465651000_7.1.e012818.1","unstructured":"National Institute for Health and Clinical Excellence (NICE). 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