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Liquorice-induced hypokalaemia in patients treated with Yokukansan preparations: identification of the risk factors in a retrospective cohort study
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    Re: Liquorice-induced hypokalaemia in patients treated with Yokukansan preparations: identification of the risk factors in a retrospective cohort study
    • Tetsuhiro Yoshino, Instructor Center of Kampo Medicine, Keio University School of Medicine

    We read, with great interest, the retrospective cohort study by Shimada et al. on liquorice-induced hypokalaemia in patients treated with Yokukansan (YK) preparations (1). Their findings suggest that monitoring of serum potassium should be performed at least monthly in patients with the following risk factors: YK administration, co-administration of potassium-lowering drugs, hypoalbuminaemia, and administration of a full dose of YK preparation. These recommendations can be easily applied in a daily clinical setting, and might reduce future pseudoaldosteronism cases. However, we would like to highlight two points that we believe should be considered when interpreting the results of the study.

    Our first concern is the uncertainty of the criteria for selecting variables in the Cox proportional hazard model.

    Table 3, “Demographic data of the subjects”, shows the P value of each item.
    The authors included items with P value < 0.05 in the Cox proportional hazard model, namely YK administration, co-administration of potassium-lowering drugs, hypoalbuminaemia, administration of a full dose of YK preparation, and baseline serum potassium. At the same time, sex and age were included in the model shown in table 4 even though they had P values > 0.05.

    As been pointed out by one reviewer, Eiseki Usami, authors should clarify a relationship between table 3 and 4. If authors have analyzed all items in table 3, it should be mentioned and shown in table 4 a...

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    Conflict of Interest:
    None declared.