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Adherence to guidelines for creatinine and potassium monitoring and discontinuation following renin–angiotensin system blockade: a UK general practice-based cohort study
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    A call for more adherence to guidelines for creatinine and potassium monitoring and discontinuation following renin–angiotensin system blockade.
    • MACAULAY A ONUIGBO, PHYSICIAN/NEPHROLOGIST/HYPERTENSION SPECIALIST MAYO CLINIC, ROCHESTER, MN, USA & MAYO CLINIC HEALTH SYSTEM, EAU CLAIRE, WI, USA
    • Other Contributors:
      • NNEOMA C AGBASI, PSYCHIATRY NURSE

    Schmidt et al examined the adherence to serum creatinine and potassium monitoring and discontinuation guidelines following initiation of treatment with ACE inhibitors (ACEI) or angiotensin receptor blockers (ARBs) in a general practice-based cohort study using electronic health records from the UK Clinical Practice Research Datalink and Hospital Episode Statistics.; and whether high-risk patients were monitored.1 223,814 new ACEI/ARB users were investigated.1 Only 10% of patients had neither baseline nor follow-up monitoring of creatinine within 12 months before and 2 months 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.1 The median period between the most recent baseline monitoring and drug initiation was 40 days (IQR 12–125 days). 34% of patients had baseline creatinine monitoring within 1 month before initiating therapy, but <10% also had the guideline-recommended follow-up test recorded within 2 weeks. Among patients experiencing a creatinine increase ≥30% (n=567, 1.2%) or potassium level >6 mmol/L (n=191, 0.4%), 80% continued treatment.1 Although patients with prior myocardial infarction, hypertension or baseline potassium >5 mmol/L were at high risk of ≥30% increase in creatinine after ACEI/ARB initiation, there was no evidence that they were more frequently monitored.1

    In our opinion, it is indeed disheartening and most disappointing that healthcare providers contin...

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    Conflict of Interest:
    None declared.