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Abstract: FR-PO546

Persistent Reduction in RAASi Therapy Following an Episode of Hyperkalemia

Session Information

Category: Fluid‚ Electrolyte‚ and Acid-Base Disorders

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


  • Rastogi, Anjay, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, United States
  • Kanda, Eiichiro, Kawasaki Medical School, Okayama, Japan
  • Murohara, Toyoaki, Nagoya University Graduate School of Medicine, Nagoya, Japan
  • Lesén, Eva, AstraZeneca, Gothenburg, Sweden
  • Agiro, Abiy, AstraZeneca, Wilmington, Delaware, United States
  • Khezrian, Mina, AstraZeneca, Cambridge, United Kingdom
  • Chen, Gengshi, AstraZeneca, Cambridge, United Kingdom
  • Morita, Naru, AstraZeneca, Osaka, Japan
  • Järbrink, Krister, AstraZeneca, Gothenburg, Sweden
  • Pollack, Charles V., University of Mississippi School of Medicine, Jackson, Mississippi, United States

RAASi therapy reduces the risk of cardiorenal events in patients with CKD or HF, but fear of hyperkalemia (HK) is a barrier towards achieving guideline-directed target dosing. The objective of this analysis was to describe longitudinal RAASi treatment patterns in patients after a HK episode.


This observational study used hospital records and claims data from the US (Optum MarketClarity) and Japan (Medical Data Vision). Patients with a HK episode (ICD-10 E87.5) from Jul 2019-Sep 2021 (US) or May 2020-Sep 2021 (Japan) and CKD or HF were included. RAASi classes encompassed ACE inhibitors, ARB, MRA and ARNi. Average dose across RAASi classes was described as a percentage of local guideline-directed target dose prior to the HK episode and at 3, 6 and 12 months after.


Of 46,820 patients from the US, 89% had CKD and 52% had HF. In Japan (N=26,979), 52% had CKD and 74% had HF. 18,652 US patients and 8,467 patients in Japan filled ≥1 RAASi prescription in the 3 months prior to the HK episode. The most common RAASi classes were ACE (used by 56.4%), ARB (31.9%) and MRA (21.8%) in the US, and ARB (74.1%), MRA (26.5%) and ACE (17.2%) in Japan. In the US, 60% attained >50% of target dose across RAASi classes prior to the HK episode (Figure), dropping to 41-45% in the subsequent 3-12 months. At 3 months, 28% had discontinued, and 23% had no RAASi treatment at 12 months. While attainment of guideline-target dose prior to the HK episode was lower in Japan, the patterns over time were similar to those in the US.


Despite guideline recommendations to maintain RAASi therapy with antihyperkalemia treatment, RAASi therapy is commonly discontinued following a HK episode and the RAASi reduction persists over time.

Target RAASi dose attainment


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