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Kidney Week

Abstract: PO0481

Hyperkalemia, CKD, and RAAS Inhibition: A Triad with a Fine Balance to Prevent Mortality

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention


  • Goncalves, Luis Falcao, Hospital Beatriz Angelo, Loures, Lisboa, Portugal
  • Raimundo, Mario Rui, Hospital Beatriz Angelo, Loures, Lisboa, Portugal

Hyperkalemia (HK) is a common and dangerous complication of CKD. HK is also a complication of beneficial therapeutic agents acting on the RAAS. Our goal was to investigate incidence, prevalence and clinical outcomes of at least one episode of HK in a CKD population outpatient setting. Additionally, we investigated the association of HK with changes in RAAS inhibition and mortality risk.


Retrospective analysis of all adult patients referred to a nephrology clinic over a 6 years period. We included CKD stage 3 patients with at least 24 months of follow up and 3 or more serum potassium determinations. The prevalence of HK at first consultation and incidence during follow up were accessed. Patients were spited in two groups prior to analysis: A) Patients without any HK episode and B) Patients with at least one HK episode.


Out of the 3008 patients referred, 575 (19.1%) met the inclusion criteria (mean age: 70.4 years; 63.7% male and 94.0% white color). Mean follow-up was 4.1±1.8 years. The prevalence of HK at first consultation was 8.7% and follow up incidence 21.7%. From this cohort, 164 (28.5%) had at least on episode of HK (Group B) and 101 (17.6%) died. During the follow up, RAAS inhibition drugs was removed or not started in 200 (34.8%) and diuretic was initiated in 165 (28.7%). At least one HK episode was associated with Diabetes (65.9 vs 42.3%, p<0.001), Heart failure (36.6 vs 28.0%, p=0.007), Macroalbuminuria (34.1 vs 21.2%, p=0.001), CKD progression (33.5 vs 16.3. p<0.001) higher frequency of diuretic initiation (38.4 vs 24.8%, p<0.001) and higher mortality (27.6 vs 13.7%, p<0.001).
The independent predictors of mortality were: At least one HK episode (OR 1.82, 95% CI 1.08-3.04); Heart Failure (OR 1.97, 95% CI 1.16-3.35); Older age (OR per 1 year increase 1.04, 95% CI 1.02-1.07); CKD progression (OR 4.18, 95% CI 2.43-7.19); Patients who maintained RAAS inhibition during follow up (OR 0.50, 95% CI 0.26-0.96); Patients who started RAAS inhibition during follow up (OR 0.38, 95% CI 0.16-0.88).


Our study confirms that RAAS inhibition had and protector and independent impact in mortality when prescribed in CKD early stages. Patients with at least one episode of HK have a higher risk of mortality. All efforts should be made to maintain these therapeutic agents, looking for other ways to control hyperkalemia rather than stop it.