Abstract: SA-PO880
Impact of ACE Inhibitor/ARB Discontinuation After an Episode of Hyperkalemia in Patients with CKD
Session Information
- CKD: Pharmacoepidemiology
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Leon mantilla, Silvia Juliana, University of Manitoba, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
- Whitlock, Reid, University of Manitoba, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
- Rigatto, Claudio, University of Manitoba, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
- Komenda, Paul, University of Manitoba, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
- Tangri, Navdeep, University of Manitoba, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
Background
Angiotensin-converting-enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) are recommended in diabetic and proteinuric nondiabetic chronic kidney disease (CKD). However, therapy with ACEi/ARBs is also associated with an increased risk of hyperkalemia (HK+) that ranges from mild to life-threatening. After an acute episode of hyperkalemia is treated, physicians are faced with the important clinical decision of whether to discontinue ACEi/ARBs. With this study we aim to evaluate the effect of discontinuation of ACEi/ARBs after an episode of HK+ in patients with CKD.
Methods
We performed a retrospective cohort study using administrative health data from Manitoba, Canada. We included all adults (≥ 18 years) with an episode of de novo HK+ (defined as serum potassium ≥ 5.5 mmol/L) between January 1st, 2007 and December 31, 2016. We identified a subgroup of patients with CKD who were current ACEi/ARB users at the time of their HK+ episode. Discontinuation was defined as the absence of a new prescription for an ACEi/ARB within 90 days of the index date among surviving patients. Cox proportional hazards were used to examine the association of ACEi/ARB discontinuation and all-cause and cardiovascular mortality, and initiation of dialysis.
Results
In our cohort, 37,633 episodes of hyperkalemia were identified. Among those, 10,273 had CKD and were current ACEi/ARB users at the time of the hyperkalemia episode. Ninety days after the episode of hyperkalemia, 7,699 surviving patients were included for analysis. A total of 1,707 (22.3%) patients discontinued the ACEi/ARB. ACEi/ARB discontinuation was associated with a more than 2-fold higher risk of all-cause and cardiovascular mortality [hazard ratio (HR) 2.15, 95% CI: 1.99-2.32] for all-cause mortality and [HR 2.04, 95% CI 1.81-2.31] for cardiovascular mortality. Discontinuation of ACEi/ARB was not associated with initiation of dialysis [HR 0.76, 95% CI: 0.49-1.18].
Conclusion
ACEi/ARB discontinuation was associated with a more than 2-fold higher rate of all-cause mortality compared with those who continued ACEi/ARB. Newer therapies for hyperkalemia may be better tolerated and can allow patients to stay on ACEi/ARB therapy.
Funding
- Commercial Support – Astra Zeneca