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Abstract: PO1462

Ambulatory Treatments for RAAS Inhibitor-Related Hyperkalemia and the 1-Year Risk of Recurrence

Session Information

Category: Fluid, Electrolyte, and Acid-Base Disorders

  • 902 Fluid, Electrolyte, and Acid-Base Disorders: Clinical


  • Hundemer, Gregory L., Ottawa Hospital, Ottawa, Ontario, Canada
  • Tangri, Navdeep, University of Manitoba, Winnipeg, Manitoba, Canada
  • Leon mantilla, Silvia Juliana, University of Manitoba, Winnipeg, Manitoba, Canada
  • Sood, Manish M., Ottawa Hospital, Ottawa, Ontario, Canada

Hyperkalemia commonly occurs with RAAS inhibitor (RAASi) use. The effectiveness of common outpatient interventions in preventing recurrent hyperkalemia has never been directly compared.


Population-based, retrospective cohort study of Ontario (Canada) residents ≥66 years old on RAASi therapy with ≥1 outpatient hyperkalemia (≥5.3 mmol/L) measurements between 2007-16. RAASi included ACE inhibitors, ARBs, MR antagonists, and ENaC inhibitors. Patients were included if they had one of the following interventions performed within 30 days of the hyperkalemia measurement: a) RAASi discontinuation, b) RAASi dose decrease, c) new K+ wasting diuretic prescription, d) K+ wasting diuretic dose increase, or e) sodium polystyrene sulfonate [SPS] prescription. The primary outcome was recurrence of hyperkalemia within 1 year. Secondary outcomes included major adverse cardiovascular events (MACE) and all-cause mortality within 1 year. Multivariable Fine and Gray sub-distribution models accounting for the competing risk of death were used for recurrent hyperkalemia and MACE outcomes. Multivariable Cox proportional hazards models were used for the all-cause mortality outcome.


A total of 21,723 patients were included: RAASi discontinuation (N=13,539), RAASi decrease (N=5,075), new diuretic (N=1,010), diuretic increase (N=1,245), and SPS (N=854). RAASi discontinuation was associated with a lower risk for recurrent hyperkalemia and MACE over 1 year compared with other common hyperkalemia interventions (see Figure). However, there was no clear difference in 1-year all-cause mortality among these interventions.


RAASi discontinuation is associated with a lower 1-year risk for recurrent hyperkalemia and MACE compared with other common ambulatory interventions for hyperkalemia.