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Abstract: FR-PO547

Recurrent Hyperkalemia and Renin-Angiotensin-Aldosterone System Inhibitor (RAASi) Down-Titration in a US Integrated Healthcare System

Session Information

Category: Fluid‚ Electrolyte‚ and Acid-Base Disorders

  • 1002 Fluid‚ Electrolyte‚ and Acid-Base Disorders: Clinical

Authors

  • Zhou, Hui, Kaiser Permanente Southern California, Pasadena, California, United States
  • Ni, Liang, Kaiser Permanente Southern California, Pasadena, California, United States
  • Sim, John J., Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, United States
  • Harrison, Teresa N., Kaiser Permanente Southern California, Pasadena, California, United States
  • Ogun, Oluwaseye, Kaiser Permanente Southern California, Pasadena, California, United States
  • Wei, Rong, Kaiser Permanente Southern California, Pasadena, California, United States
  • Agiro, Abiy, AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, United States
  • Brahmbhatt, Yasmin G., AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, United States
  • Oluwatosin, Yemisi, AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, United States
  • Schilling, Craig G., AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, United States
  • An, Jaejin, Kaiser Permanente Southern California, Pasadena, California, United States
Background

While RAASi down-titration (discontinuation and dose reduction) is common after new-onset hyperkalemia, how RAASi down-titration is related to recurrent hyperkalemia is not well understood. We evaluated recurrent hyperkalemia and factors associated with RAASi down-titration among patients with chronic kidney disease (CKD) and/or heart failure (HF).

Methods

A retrospective cohort study was conducted among adults with CKD and/or HF who experienced new-onset hyperkalemia (potassium ≥5.0 mEq/L, index) at Kaiser Permanente Southern California. We required patients to have ≥2 fills of RAASi within 1 year prior to the index and followed them for up to 1 year. We evaluated recurrent hyperkalemia every 3 months from Month 1 to 9 and RAASi down-titration [discontinuation (≥90-day gap in refills of ≥1 RAASi) or ≥25% dose reduction compared with the dose prior to the index] in the following 3 months from Month 4 to 12. Secondary analysis was conducted using discontinuation as an outcome. Generalized estimating equation models were performed to identify factors associated with RAASi down-titration.

Results

Of 7,875 patients, the percentages of RAASi dose reduction were stable at 17% in all 3-month periods and discontinuation decreased from 12% to 7% in the last 3 months. The percentages of recurrent hyperkalemia were 10% and 8% in the first and the last 3 months, respectively. Recurrent hyperkalemia was associated with a higher likelihood of RAASi down-titration [rate ratio (RR) 1.36, 95%CI 1.16-1.60] and discontinuation [RR 1.75, 95%CI 1.48-2.08] (Figure). Inpatient recurrent hyperkalemia and worse kidney function were associated with a higher likelihood of RAASi down-titration.

Conclusion

After new-onset hyperkalemia, those who developed recurrent hyperkalemia were more likely to discontinue or reduce the dose of RAASi.

Funding

  • Commercial Support