Abstract: TH-PO1111

Post-Hyperkalemia Prescription Patterns for Renin–Angiotensin–Aldosterone System Inhibitors (RAASis) in England

Session Information

Category: Fluid, Electrolytes, and Acid-Base

  • 704 Fluid, Electrolyte, Acid-Base Disorders

Authors

  • Horne, Laura, AstraZeneca, Gaithersburg, Maryland, United States
  • LoCasale, Robert J., AstraZeneca, Gaithersburg, Maryland, United States
  • Maclachlan, Sharon, Evidera, London, United Kingdom
  • Sinsakul, Marvin V., AstraZeneca, Gaithersburg, Maryland, United States
  • Wetmore, James B., Hennepin County Medical Center, Minneapolis, Minnesota, United States
Background

It is unclear how physicians may adjust RAASi prescriptions for patients with hyperkalemia (HiK; elevated serum potassium [K+]). We evaluated whether RAASi use is modified after incident HiK in England.

Methods

A retrospective cohort analysis of the linked Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) databases identified RAASi prescription changes after HiK. Patients (≥18 years) with an incident HiK event (first measurement of K+ ≥5.0 mmol/L or HiK diagnosis code) using RAASis from 2009–2013 were included. Change in next RAASi prescription was defined as dose increase, augmentation with diuretic, no change, switch to other RAASi, dose decrease, or interruption. HiK severity was defined as K 5.0–≤5.5 (K+ 5.0–≤5.5 mmol/L or CPRD diagnosis code with no lab results); K 5.5–≤6.0 (K+ >5.5–≤6.0 mmol/L); or K >6.0 (K+ >6.0 mmol/L or HES diagnosis code, regardless of K+). Frequencies of post-HiK RAASi use were calculated overall, by clinical comorbidities, and by HiK severity.

Results

An HiK event was experienced by 59,465 RAASi users. Most patients (74.6%), including most with CKD (72.2%), continued the same RAASi drug/dose after HiK, even after K 5.5–≤6.0 (67.9%) and K >6.0 (45.6%). Augmentation with diuretics was uncommon, occurring in only 4.8% of the overall cohort, 10.4% of patients with heart failure (HF) and 13.0% of patients with K >6.0. Patients with HF more often switched RAASi and patients with K >6.0 more often interrupted treatment (Table).

Conclusion

Most patients continued the same RAASi drug and dose after incident HiK, even with K >6.0 and when renal function was likely reduced; addition of diuretics was uncommon. Whether this represents an optimal HiK treatment strategy needs further study.

 Overall Chronic Kidney DiseaseDiabetesHypertensionHeart FailureK 5.0–≤5.5K 5.5–≤6.0K >6.0
N (%)59,465 (100.0)20,659 (34.7)13,902 (23.4)54,874 (92.3)3344 (5.6)54,532 (91.7)4004 (6.7)929 (1.6)
Dose increase, %4.52.82.84.62.64.54.32.9
Augmentation, %4.86.95.14.910.44.66.913.0
Continued, %74.672.275.774.751.975.667.945.6
Switched, %5.17.25.94.923.64.96.77.4
Dose decrease, %1.01.30.91.01.40.91.92.0
Interruption, %10.09.69.69.810.09.512.329.0

Funding

  • Veterans Affairs Support