RAAS Inhibitor Use and Hyperkalemia in CKD

Patients treated with renin-angiotensin-aldosterone system inhibitors (RAASis) commonly experience hyperkalemia. According to Eleonora Riccio, MD, and colleagues, the prevalence of hyperkalemia in patients with chronic kidney disease (CKD) is related to the gap reported between guideline recommendations and real-world practice in CKD.

The researchers conducted a CKD-population-based retrospective study designed to examine the prevalence of patients with CKD treated with RAASis, the incidence of hyperkalemia in that patient population, and the proportion of patients with RAASI medication change following development of incident hyperkalemia. Results of the study were reported online in Frontiers in Cardiovascular Medicine [doi.org/10.3389/fcvm.2022.824095].

Of the total study cohort of 809 patients with CKD, 68.7% (n=556) were treated with RAASis; prescription of an RAASi was greater among patients with stage 2 to 4 CKD. Among the 556 patients treated with RAASis, 9.2% experienced hyperkalemia. The adjusted rate of hyperkalemia among patients with stage 4-5 CKD was 3-fold higher than among patients with estimated glomerular filtration rate >60 mL/min/1.73 m².

The medication regimen was modified in 55.3% of patients after the hyperkalemia event: 74.2% discontinued RAASi therapy; 3.2% received a reduced dose of RAASi; and 22.6% reduced the number of RAASi drugs.

In conclusion, the authors said, “This study shows that the incidence of hyperkalemia is frequently observed in patients with CKD [treated with] RAASis, and that rates increase with deteriorating levels of kidney function from stages 1 to 3. RAASi medication change following an episode of hyperkalemia occurred in almost half of the patients after experiencing hyperkalemia.”