{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T22:58:45Z","timestamp":1793228325942,"version":"4.5.0"},"reference-count":31,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2017,10,11]]},"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine the frequency of biochemical monitoring after initiation of aldosterone antagonists(AA) in patients also using angiotensin-converting enzyme inhibitors\/angiotensin receptor blockers (ACEI\/ARB).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>UK primary care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>ACEI\/ARB users who initiated AA between 2004 and 2014.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>We calculated the proportions with: (1) biochemical monitoring \u22642 weeks post initiation of AA, (2) adverse biochemical values \u22642 months (potassium \u22656\u2009mmol\/L, creatinine \u2265220 \u00b5mol\/L and \u226530%\u2009increase in creatinine from baseline) and (3) discontinuers of AA in those with an adverse biochemical value. We used logistic regression to study patient characteristics associated with monitoring and adverse biochemical values.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In 10\u2009546 initiators of AA, 3291 (31.2%) had a record of biochemical monitoring \u22642 weeks post initiation. A total of 2.0% and 2.7% of those with follow-up monitoring within 2 months of initiation experienced potassium \u22656\u2009mmol\/L and creatinine \u2265220 \u00b5mol\/L, respectively, whereas 13.5% had a \u226530%\u2009increase in creatinine. Baseline potassium (OR 3.59, 95%\u2009CI 2.43 to 5.32 for 5.0\u20135.5\u2009mmol\/L compared with &lt;5.0\u2009mmol\/L) and estimated glomerular filtration rate 45-59 ml\/min\/1.73\u2009m\n                      <jats:sup>2<\/jats:sup>\n                      (OR 2.06, 95%\u2009CI 1.26 to 3.35 compared with \u226560 ml\/min\/1.73\u2009m\n                      <jats:sup>2<\/jats:sup>\n                      ) were independently predictive of potassium \u22656\u2009mmol\/L. Women and people with diabetes had higher odds of \u226530%\u2009increase in creatinine.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Less than one-third of patients taking ACEI\/ARB had biochemical monitoring within 2 weeks of initiating AAs. Higher levels of monitoring may reduce adverse biochemical events.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-018153","type":"journal-article","created":{"date-parts":[[2017,11,16]],"date-time":"2017-11-16T23:30:22Z","timestamp":1510875022000},"page":"e018153","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Biochemical monitoring after initiation of aldosterone antagonist therapy in users of renin\u2013angiotensin system blockers: a UK primary care cohort study"],"prefix":"10.1136","volume":"7","author":[{"given":"Sarah-Jo","family":"Sinnott","sequence":"first","affiliation":[{"name":"Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"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":"Morten","family":"Schmidt","sequence":"additional","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 Cardiology, Regional Hospital West Jutland, Herning, Denmark"}],"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":"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":"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":"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":[[2017,11,16]]},"reference":[{"key":"2025121407104028000_7.11.e018153.1","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1056\/NEJM199909023411001","article-title":"The effect of spironolactone on morbidity and mortality in patients with severe heart failure","volume":"341","author":"Pitt","year":"1999","journal-title":"N Engl J Med Overseas Ed"},{"key":"2025121407104028000_7.11.e018153.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00257-3"},{"key":"2025121407104028000_7.11.e018153.3","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.113.000709"},{"key":"2025121407104028000_7.11.e018153.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa040135"},{"key":"2025121407104028000_7.11.e018153.5","unstructured":"MHRA\u00a0Drug Safety Notice. Spironolactone and renin angiotensin system drugs in heart failure: risk of potentially fatal hyperkalaemia. 2016 https:\/\/www.gov.uk\/drug-safety-update\/spironolactone-and-renin-angiotensin-system-drugs-in-heart-failure-risk-of-potentially-fatal-hyperkalaemia"},{"key":"2025121407104028000_7.11.e018153.6","first-page":"1","article-title":"The safety of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure","volume":"62","author":"Pitt","year":"2016","journal-title":"Expert Opin Drug Saf"},{"key":"2025121407104028000_7.11.e018153.7","unstructured":"National Institute for Health and Clinical Excellence (NICE). NICE Guideline CG108 chronic heart failure appendix D\u2014practical notes. 2010 https:\/\/www.nice.org.uk\/guidance\/cg108\/evidence\/full-guideline-appendix-d-practical-notes-separate-file-136060532"},{"key":"2025121407104028000_7.11.e018153.8","unstructured":"National Institute for Health and Clinical Excellence (NICE). NICE Guideline CG127 hypertension: clinical management of primary hypertension in adults, 2011."},{"key":"2025121407104028000_7.11.e018153.9","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c1768"},{"key":"2025121407104028000_7.11.e018153.10","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1016\/j.ahj.2015.06.006","article-title":"Facility variation and predictors of serum potassium monitoring after initiation of a mineralocorticoid receptor antagonist in patients with heart failure","volume":"170","author":"Chauhan","year":"2015","journal-title":"Am Heart J"},{"key":"2025121407104028000_7.11.e018153.11","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.11904"},{"key":"2025121407104028000_7.11.e018153.12","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyv098"},{"key":"2025121407104028000_7.11.e018153.13","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.2009.03537.x"},{"key":"2025121407104028000_7.11.e018153.14","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f2350"},{"key":"2025121407104028000_7.11.e018153.15","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2016-012818","article-title":"Adherence to guidelines for creatinine and potassium monitoring and discontinuation following renin-angiotensin system blockade: a UK general practice-based cohort study","volume":"7","author":"Schmidt","year":"2017","journal-title":"BMJ Open"},{"key":"2025121407104028000_7.11.e018153.16","unstructured":"McDonald H . The epidemiology of infections among older people with diabetes mellitus and chronic kidney disease. London: School of Hygiene & Tropical Medicine, 2015."},{"key":"2025121407104028000_7.11.e018153.17","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60892-8"},{"key":"2025121407104028000_7.11.e018153.18","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-150-9-200905050-00006"},{"key":"2025121407104028000_7.11.e018153.19","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1016\/j.kint.2016.09.038","article-title":"Acute change in glomerular filtration rate with\u00a0inhibition of the renin\u2013angiotensin system\u00a0does not\u00a0predict subsequent renal and cardiovascular outcomes","volume":"91","author":"Clase","year":"2017","journal-title":"Kidney Int"},{"key":"2025121407104028000_7.11.e018153.20","unstructured":"National Institute for Health and Clinical Excellence (NICE). NICE guideline CG182 - Chronic kidney disease in adults: assessment and management, 2014."},{"key":"2025121407104028000_7.11.e018153.21","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/fdt116"},{"key":"2025121407104028000_7.11.e018153.22","unstructured":"StataCorp. Stata statistical software: release 14. College Station, TX: StataCorp LP, 2015."},{"key":"2025121407104028000_7.11.e018153.23","unstructured":"Office for National Statistics. Census: key statistics for local authorities in England and Wales, table number KS201EW [online]. 2012 www.ons.gov.uk\/Fons\/Frel\/Fcensus\/F2011-census\/Fkey-statistics-for-local-authorities-in-england-and-wales\/Frft-table-ks201ew.xls"},{"key":"2025121407104028000_7.11.e018153.24","unstructured":"Nitsch DCB , Hull S , Wheeler DC , et al . National chronic kidney disease audit - national report. 2017 https:\/\/www.hqip.org.uk\/public\/cms\/253\/625\/19\/704\/08532%20CKD%20Audit%20Report%20Jan%2017%20FINAL.pdf?realName=HtoEm0.pdf&v=0"},{"key":"2025121407104028000_7.11.e018153.25","doi-asserted-by":"crossref","unstructured":"Beldhuis IE , Streng KW , Ter Maaten JM , et al . Renin\u2013angiotensin system inhibition, worsening renal function, and outcome in heart failure patients with reduced and preserved ejection fraction: A meta-analysis of published study data. Circ Heart Fail 2017;10.doi:10.1161\/CIRCHEARTFAILURE.116.003588","DOI":"10.1161\/CIRCHEARTFAILURE.116.003588"},{"key":"2025121407104028000_7.11.e018153.26","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1136\/bmj.j791","article-title":"Serum creatinine elevation after renin\u2013angiotensin system blockade and long term cardiorenal risks: cohort study","volume":"356","author":"Schmidt","year":"2017","journal-title":"BMJ"},{"key":"2025121407104028000_7.11.e018153.27","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1H520"},{"key":"2025121407104028000_7.11.e018153.28","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.778811"},{"key":"2025121407104028000_7.11.e018153.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.06.010"},{"key":"2025121407104028000_7.11.e018153.30","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2003.10.012"},{"key":"2025121407104028000_7.11.e018153.31","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2004.10.005"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2017-018153","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T15:10:49Z","timestamp":1765725049000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2017-018153"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11]]},"references-count":31,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2017,11,16]]},"published-print":{"date-parts":[[2017,11]]}},"alternative-id":["10.1136\/bmjopen-2017-018153"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2017-018153","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,11]]}}}