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Spot urine potassium as a potential screening test for aldosterone breakthrough
R Sakthiswary1, M Wong, Z M Isa
1Department of Medicine, National University of Malaysia. sakthis5@hotmail.com
La Clinica Terapeutica
|September 12, 2012
Summary
Aldosterone breakthrough, a rise in aldosterone after initial suppression by ACE inhibitors or ARBs, can be screened using spot urine potassium levels. This study found higher urine potassium in patients experiencing aldosterone breakthrough.
Area of Science:
- Endocrinology
- Nephrology
- Pharmacology
Background:
- Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) can cause aldosterone breakthrough.
- Aldosterone breakthrough is characterized by a rise in aldosterone levels after initial suppression.
- Currently, serial plasma aldosterone levels are the primary method to identify aldosterone breakthrough.
Purpose of the Study:
- To evaluate spot urine potassium as a potential screening test for aldosterone breakthrough.
- To determine if urine potassium levels can identify patients experiencing aldosterone breakthrough.
Main Methods:
- A cross-sectional study of 94 patients on ACEIs or ARBs for at least 40 weeks.
- Exclusion of patients with primary/secondary hyperaldosteronism or interfering medications.
- Analysis of plasma aldosterone, renin, renal profile, and spot urine potassium.
Main Results:
- The incidence of aldosterone breakthrough was 23.4%.
- Median urine potassium was significantly higher in the aldosterone breakthrough group (62.0 mmol/L) versus the non-breakthrough group (38.5 mmol/L).
- A statistically significant correlation was found between urine potassium and aldosterone breakthrough (p=0.006).
Conclusions:
- Raised urinary potassium is a potential screening test for aldosterone breakthrough.
- Spot urine potassium offers a possible alternative to serial plasma aldosterone measurements.
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