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Adherence to Biochemical Monitoring Recommendations in Patients Starting with Renin Angiotensin System Inhibitors

A Retrospective Cohort Study in the Netherlands

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Abstract

Background: Renin angiotensin system inhibitors (RASIs) are frequently involved in serious adverse events. These events principally occur in high-risk patients and often arise within the first days after treatment initiation; therefore, guidelines recommend biochemical monitoring within 3 weeks after the start of therapy with RASIs.

Objective: The purpose of this study was to examine the level of biochemical monitoring directly after treatment initiation with RASIs in patients with different risk profiles and to study the attitudes of the physicians involved towards biochemical monitoring.

Methods: We carried out a retrospective analysis of 202 patients who started RASI therapy in 2006 in Groesbeek, the Netherlands. We determined the rate of serum creatinine and potassium monitoring within 3 weeks after the start of therapy. In addition, we studied the intentions and attitudes towards biochemical monitoring during RASI therapy among 68 general practitioners and medical specialists by way of a brief questionnaire.

Results: Serum creatinine and potassium monitoring after treatment initiation was performed in 34% and 28% of patients, respectively. Of all the patients, 29% had two or more additional risk factors for renal function deterioration. In these high-risk patients, creatinine was significantly less often monitored compared with low-risk patients (22% vs 39%). In contrast to these findings, the prescribing physicians claimed to check serum creatinine within 2 weeks after treatment initiation in 85% of their patients. Most of the prescribing physicians (88%) rated this monitoring as (very) important.

Conclusions: We demonstrated that, despite positive intentions of physicians, the biochemical monitoring recommendation in patients treated with RASIs is poorly met. In addition, serum creatinine monitoring was significantly less often performed in high-risk patients compared with low-risk patients.

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Acknowledgements

The authors would like to thank F. Sa’ado for her assistance in data acquisition.

No sources of funding were used to conduct this study or prepare this manuscript. All authors declare there were no competing interests directly relevant to the content of this study.

Janet Bootsma, Margreet Warlé-van Herwaarden, Peter De Smet, Marcel Olde Rikkert and Cornelis Kramers contributed to the conception and design of this study. Janet Bootsma, Margreet Warlé-van Herwaarden and Peter Füssenich worked on the acquisition of data. Janet Bootsma designed and prepared the database. Janet Bootsma, André Verbeek and Cornelis Kramers completed the statistical analysis. Janet Bootsma, Margreet Warlé-van Herwaarden and Cornelis Kramers took part in the drafting phase of the manuscript. All authors contributed to the revision of the manuscript, took part in the interpretation of the results and approved the final version of the report.

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Authors and Affiliations

  1. Department of Pharmacology-Toxicology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands

    Janet E. M. Bootsma MD & Cornelis Kramers

  2. Department of Geriatrics, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands

    Janet E. M. Bootsma MD & Marcel G. Olde Rikkert

  3. Community Pharmacy, Groesbeek, the Netherlands

    Margreet F. Warlé-van Herwaarden

  4. IQ Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands

    Margreet F. Warlé-van Herwaarden

  5. Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands

    André L. M. Verbeek

  6. General Practice Füssenich-Dral, Groesbeek, the Netherlands

    Peter Füssenich

  7. Department of Clinical Pharmacy, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands

    Peter A. G. M. De Smet

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  1. Janet E. M. Bootsma MD
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Correspondence to Janet E. M. Bootsma MD.

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Bootsma, J.E.M., Herwaarden, M.F.Wv., Verbeek, A.L.M. et al. Adherence to Biochemical Monitoring Recommendations in Patients Starting with Renin Angiotensin System Inhibitors. Drug-Safety 34, 605–614 (2011). https://doi.org/10.2165/11587250-000000000-00000

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