RAAS Inhibitor Use and Prevalence of Potassium Derangements

In a recent issue of Clinical Epidemiology, Santiago-Jiménez-Marrero and colleagues reported results of an analysis designed to examine the prevalence of five key chronic cardiovascular, metabolic, and renal conditions at the population level, the prevalence of use of renin-angiotensin-aldosterone system (RAAS) inhibitor medications, and the magnitude of potassium derangements among RAAS inhibitor users.

The analysis included data from more than 375,000 individuals ≥55 years of age who were included in the population-based healthcare database of the Catalan Institute of Health between 2015 and 2017. The conditions of interest were chronic heart failure, chronic kidney disease (CKD), diabetes mellitus, ischemic heart disease, and hypertension. RAAS inhibitors included in the analysis were angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, mineralocorticoid receptor antagonists (MRAs), and renin inhibitors. Hyperkalemia was defined as serum potassium levels >5.0 mEq/L and hypokalemia was defined as serum potassium <3.5 mEq/L.

Results of the analysis demonstrated high prevalence of chronic cardiovascular, metabolic, and renal conditions; hypertension prevalence was particularly high (prevalence ranging from 48.2% to 48.9%). The use of RAAS inhibitors was very high in this patient population: 75.2% to 77.3%.

Among the RAAS inhibitor users, the frequency of potassium derangements, primarily of hyperkalemia, was “very noticeable” (12% overall). Potassium derangements were particularly prevalent in patients with CKD or chronic heart failure, elderly patients, and MRA users. Hypokalemia was less frequent (1%).

“The high prevalence of potassium derangements, and particularly hyperkalemia, among RAAS inhibitor users highlights the real-world relevance of potassium derangements, and the importance of close monitoring and management of potassium levels in routine clinical practice. This is likely to benefit a large number of patients, particularly those at higher risk,” the researchers said.