Association of Changes in Creatinine and Potassium Levels After Initiation of Renin Angiotensin Aldosterone System Inhibitors With Emergency Department Visits, Hospitalizations, and Mortality in Individuals With Chronic Kidney Disease

Key Points Question Are acute increases in creatinine levels and hyperkalemia after initiation of renin angiotensin aldosterone system inhibitor (RAASI) therapy associated with a risk of emergency department visits, hospitalization, or mortality at 1 year in patients with chronic kidney disease? Findings In this cohort study of 4661 patients with chronic kidney disease, increases in creatinine level and hyperkalemia after initiation of RAASI therapy were not associated with emergency department visits or hospitalizations and often resolved at a second measurement. Mortality was increased among individuals with an increase in creatinine level of at least 30% but the association was not significant after adjustment. Meaning Structured laboratory monitoring may guide appropriate continuation of RAASI therapy for outpatient health care professionals, but closer monitoring may be needed for individuals with acute increases in creatinine levels.