Clinics often pause renin-angiotensin-aldosterone inhibitors in patients with hyperkalemia
Key takeaways:
- After a hyperkalemia event, mineralocorticoid receptor antagonists were discontinued in up to 46% of patients.
- Of patients who restarted treatment, up to 37% of patients had dose reduced by more than 25%.
Discontinuing or reducing renin-angiotensin-aldosterone system inhibitor treatment may have negative outcomes for patients with hyperkalemia, but it is a common practice in many clinics, according to recently presented research.
“Guidelines recommend renin-angiotensin-aldosterone system inhibitor (RAASi) therapy at the maximal tolerated dose to achieve optimal treatment benefits in chronic kidney disease and heart failure,” Eiichiro Kanda, MD, PhD, MPH, a medical science professor at the Kawasaki Medical School in Japan, and colleagues wrote in data presented at European Renal Association Congress. “However, hyperkalemia is a barrier to achieving target dosing and RAASi is often compromised in patients who experience hyperkalemia.”
In the observational study, researchers studied 25,963 cardiorenal patients in the United States and 8,722 cardiorenal patients in Japan who had an index hyperkalemia event and a CKD and/or hyperkalemia diagnosis with RAASi use in the prior 6 months. RAASi classes included angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, mineralocorticoid receptor antagonists and angiotensin receptor neprilysin inhibitors, according to the study. For patients who stopped RAASi after a hyperkalemia episode, the duration of discontinuation was within 6 months from the date they paused treatment.
Overall, 85% of U.S. patients filled a RAASi prescription in the 3 months before a hyperkalemia episode, and 91% of patients did so in Japan. Following the hyperkalemia event, researchers found angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers were discontinued in 23% to 26% of patients, respectively, while mineralocorticoid receptor antagonists were discontinued in 33% to 46% of patients. Of patients who discontinued, reinitiation within 6 months occurred in 10% to 15% of patients in the United States and 6% to 8% of patients in Japan. Among patients who restarted treatment, 17% to 37% had the dose reduced by more than 25%.
“Cardiorenal patients face a serious, unmet need in controlling [hyperkalemia], leading to higher cardiac risk and incidence of hospitalizations,” Anjay Rastogi, MD, PhD, clinical chief of nephrology at UCLA Health and coauthor on the study, said in a press release. “Hyperkalemia should not be a barrier to patients with chronic kidney disease or heart failure achieving guideline-directed RAASi treatment, especially when there are treatment options, like potassium binders, which may better manage this chronic condition.”
References:
- Kanda E, et al. Abstract 3303. Presented at: European Renal Association Congress, June 15-8, 2023; Milan, Italy (hybrid).
- Real-world evidence study shows the significant impact of hyperkalaemia on cardiorenal patient outcomes. https://www.astrazeneca.com/media-centre/medical-releases/real-world-evidence-study-shows-the-significant-impact-of-hyperkalaemia-on-cardiorenal-patient-outcomes.html. Published June 17, 2023. Accessed June 23, 2023.