{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T22:59:15Z","timestamp":1793228355465,"version":"4.5.0"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2017,7]]},"abstract":"\n Background<\/jats:title>\n \n Concerns about hyperkalemia limit the use of angiotensin\u2010converting enzyme inhibitors (\n ACE<\/jats:styled-content>\n \u2010I) and angiotensin receptor blockers (\n ARB<\/jats:styled-content>\n s), but guidelines conflict regarding potassium\u2010monitoring protocols. We quantified hyperkalemia monitoring and risks after\n ACE<\/jats:styled-content>\n \u2010I\/\n ARB<\/jats:styled-content>\n initiation and developed and validated a hyperkalemia susceptibility score.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n We evaluated 69\u00a0426 new users of\n ACE<\/jats:styled-content>\n \u2010I\/\n ARB<\/jats:styled-content>\n therapy in the Stockholm Creatinine Measurements (\n SCREAM<\/jats:styled-content>\n ) project with medication initiation from January 1, 2007 to December 31, 2010, and follow\u2010up for 1 year thereafter. Three fourths (76%) of\n SCREAM<\/jats:styled-content>\n patients had potassium checked within the first year. Potassium >5 and >5.5\u00a0mmol\/L occurred in 5.6% and 1.7%, respectively. As a comparison, we propensity\u2010matched new\n ACE<\/jats:styled-content>\n \u2010I\/\n ARB<\/jats:styled-content>\n users to 20\u00a0186 new \u03b2\u2010blocker users in\n SCREAM<\/jats:styled-content>\n : 64% had potassium checked. The occurrence of elevated potassium levels was similar between new \u03b2\u2010blocker and\n ACE<\/jats:styled-content>\n \u2010I\/\n ARB<\/jats:styled-content>\n users without kidney disease; only at estimated glomerular filtration rate <60\u00a0mL\/min per 1.73\u00a0m\n 2<\/jats:sup>\n were risks higher among\n ACE<\/jats:styled-content>\n \u2010I\/\n ARB<\/jats:styled-content>\n users. We developed a hyperkalemia susceptibility score that incorporated estimated glomerular filtration rate, baseline potassium level, sex, diabetes mellitus, heart failure, and the concomitant use of potassium\u2010sparing diuretics in new\n ACE<\/jats:styled-content>\n \u2010I\/\n ARB<\/jats:styled-content>\n users; this score accurately predicted 1\u2010year hyperkalemia risk in the\n SCREAM<\/jats:styled-content>\n cohort (area under the curve, 0.845, 95%\n CI<\/jats:styled-content>\n : 0.840\u20130.869) and in a validation cohort from the\n US<\/jats:styled-content>\n \u2010based Geisinger Health System (N=19\u00a0524; area under the curve, 0.818, 95%\n CI<\/jats:styled-content>\n : 0.794\u20130.841), with good calibration.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Hyperkalemia within the first year of\n ACE<\/jats:styled-content>\n \u2010I\/\n ARB<\/jats:styled-content>\n therapy was relatively uncommon among people with estimated glomerular filtration rate >60\u00a0mL\/min per 1.73\u00a0m\n 2<\/jats:sup>\n , but rates were much higher with lower estimated glomerular filtration rate. Use of the hyperkalemia susceptibility score may help guide laboratory monitoring and prescribing strategies.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.116.005428","type":"journal-article","created":{"date-parts":[[2017,7,19]],"date-time":"2017-07-19T20:10:18Z","timestamp":1500495018000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":162,"title":["Hyperkalemia After Initiating Renin\u2013Angiotensin System Blockade: The Stockholm Creatinine Measurements (SCREAM) Project"],"prefix":"10.1161","volume":"6","author":[{"given":"Ghassan","family":"Bandak","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingying","family":"Sang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Gasparini","sequence":"additional","affiliation":[{"name":"Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex R.","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Geisinger Health System, Danville, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoshana H.","family":"Ballew","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Evans","sequence":"additional","affiliation":[{"name":"Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"Arnlov","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden"},{"name":"School of Health and Social Studies, Dalarna University, Falun, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars H.","family":"Lund","sequence":"additional","affiliation":[{"name":"Unit of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lesley A.","family":"Inker","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Tufts Medical Center, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josef","family":"Coresh","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan\u2010Jesus","family":"Carrero","sequence":"additional","affiliation":[{"name":"Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morgan E.","family":"Grams","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD"},{"name":"Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199604113341502"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1994.03510280037029"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199108013250501"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198807143190204"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200001203420301"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/MAJ.0b013e3181836ac7"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2015.07.022"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-7061(98)00117-4"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-115-7-513"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.3109\/0886022X.2012.717478"},{"key":"e_1_3_5_12_2","first-page":"1","article-title":"KDIGO clinical practice guideline for acute kidney injury","year":"2012","unstructured":"KDIGO clinical practice guideline for acute kidney injury. 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