Beers Criteria recommends avoiding routinely using two or more of which category of medications due to hyperkalemia risk in CKD stage 3a or higher?

• A. RAS inhibitors or potassium-sparing diuretics with another RAS inhibitor or potassium-sparing diuretic
• B. Any two antihypertensive agents
• C. Two loop diuretics together
• D. Any diuretic with aspirin

Answer: (A)

Beers Criteria flags the risk of hyperkalemia when two or more medicines with potassium-sparing effects or RAAS blockade are used together, especially in CKD stage 3a or higher. The concern is that a RAS inhibitor (like an ACE inhibitor or ARB) or a potassium-sparing diuretic (such as spironolactone, eplerenone, amiloride, or triamterene) paired with another drug in the same category can significantly raise potassium levels because kidney potassium excretion is already reduced in CKD. This combination can lead to dangerous hyperkalemia and cardiac complications. Other choices don’t carry this specific high-risk pattern: two loop diuretics tend to cause potassium loss, and combining any diuretic with aspirin doesn’t target the hyperkalemia risk seen with multiple potassium-sparing/RAAS‑blocking agents.