Trimethoprim-associated hyperkalaemia: a systematic review and meta-analysis

source extracted confidence: high 2026-04-09
#anti-inflammatory-agents-non-steroidal #diuretics #humans #hyperkalemia #potassium

Trimethoprim-associated hyperkalaemia: a systematic review and meta-analysis

Faré et al., 2022 | J Antimicrob Chemother | Meta Analysis

Citation

Faré Pietro B, Memoli Erica, ... Janett Simone. Trimethoprim-associated hyperkalaemia: a systematic review and meta-analysis. J Antimicrob Chemother. 2022-Sep-30;77(10):2588-2595. doi:10.1093/jac/dkac262

Abstract

INTRODUCTION: Trimethoprim is structurally similar to potassium-sparing diuretics and may induce hyperkalaemia. The prevalence and the factors that predispose to trimethoprim-associated hyperkalaemia have never been extensively addressed. METHODS: A literature search with no date or language limits was carried out using the National Library of Medicine, Embase and Web of Science in March and repeated during August 2021. The principles underlying the Economic and Social Research Council guidance on the conduct of synthesis and the PRISMA guidelines were employed. For the analysis, we retained reports including ≥10 subjects on treatment with trimethoprim, which addressed the possible occurrence of hyperkalaemia. RESULTS: Eighteen reports were retained for the final analysis. The pooled prevalence of potassium value >5.0 mmol/L, >5.5 mmol/L and >6.0 mmol/L or symptomatic, was, respectively, 22%, 10% and 0.2%. The analysis disclosed that the risk of trimethoprim-associated hyperkalaemia is dose-related and enhanced by drugs with known hyperkalaemic potential including potassium-sparing diuretics, renin-angiotensin-aldosterone system inhibitors, β-blockers and non-steroidal anti-inflammatory agents. Poor kidney function also increased the tendency towards hyperkalaemia. The time to onset of hyperkalaemia was generally 1 week or less after starting trimethoprim. CONCLUSIONS: The present analysis documents the hyperkalaemic potential of trimethoprim, a widely prescribed drug that was introduced more than 50 years ago. Clinicians must recognize patients at risk of trimethoprim-associated hyperkalaemia.

Key Findings

Eighteen reports were retained for the final analysis. The pooled prevalence of potassium value >5.0 mmol/L, >5.5 mmol/L and >6.0 mmol/L or symptomatic, was, respectively, 22%, 10% and 0.2%. The analysis disclosed that the risk of trimethoprim-associated hyperkalaemia is dose-related and enhanced by drugs with known hyperkalaemic potential including potassium-sparing diuretics, renin-angiotensin-aldosterone system inhibitors, β-blockers and non-steroidal anti-inflammatory agents. Poor k

Outcomes Measured

  • inflammatory markers

Population

Field Value
Population See abstract
Sample Size 10
Age Range See abstract
Condition See abstract

MeSH Terms

  • Anti-Inflammatory Agents, Non-Steroidal
  • Diuretics
  • Humans
  • Hyperkalemia
  • Potassium
  • Trimethoprim
  • United States

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Journal Article, Meta-Analysis, Systematic Review, Research Support, Non-U.S. Gov't
  • Vertical: potassium

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09