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Abstract: FR-PO549

Impact of Chronic Potassium Binder Treatment on Clinical Outcome in Patients With Hyperkalemia: A Nationwide Hospital-Based Cohort Study

Session Information

Category: Fluid‚ Electrolyte‚ and Acid-Base Disorders

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


  • Kanda, Eiichiro, Kawasaki Medical School, Kurashiki, Japan
  • Kikuchi, Takashi, AstraZeneca K.K., Osaka, Japan
  • Morita, Naru, AstraZeneca K.K., Osaka, Japan
  • Yajima, Toshitaka, AstraZeneca K.K., Osaka, Japan

While hyperkalemia (HK) is often a chronic condition, short-term and intermittent treatment of potassium binders (PB) has been largely applied to control the serum potassium (S-K) level. In this study we investigated the impact of the long-term and chronic PB treatment on the clinical outcomes.


A retrospective observational study using a Japanese hospital-based claim database (April 2008–September 2018) was conducted. HK was defined as at least two S-K ≥5.1 mmol/L within a 12-months (M) interval. The index date was defined as initial PB prescription date and S-K values were examined at 3M, 6M and 12M after the index. Medication possession ratio (MPR), which is usually used for adherence measures, was used to evaluate the proportion of a time period where PB were prescribed since no prescription refill is allowed in Japan. Clinical outcomes were analyzed by comparing HK patients with MPR ≥ 80% to those < 80% using Cox proportional hazards regression analysis.


Out of 1,353,826 patients, 4,321 patients who were on initial PB treatments with HK (mean age 74.6 ± 12.83 years, mean eGFR 28.5 ± 20.8, mean S-K value 5.71 ± 0.64 mmol/L). In MPR < 80% (n=993) and MPR ≥ 80% (n=3,328) groups, mean prescription days were 114.7 ± 9.1 and 1151.2 ± 22.5, and S-K value at 12M were 4.67 mmol/L and 4.64 mmol/L (p< 0.307), respectively. Compared to MPR ≥ 80% group, the patients with MPR < 80% group had significantly higher risks for introduction of hospitalization (HR1.41, p<0.001), recurrence of HK (HR 1.67, p<0.001), eGFR decline (HR 1.41, p<0.001) and renal replacement therapy (HR 1.25, p=0.003) (Figure 1).


Although S-K levels were similarly controlled in the two groups, PBs treatment with MPR < 80% increased the risk of adverse clinical outcomes compared to that with MPR ≥ 80%. The results suggest that chronic and continuous treatment with PBs might be beneficial for better clinical outcomes, including renoprotective effects in patients with HK.


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