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Abstract: TH-PO1029

Association Between Hyperkalemia, CKD Progression, and All-Cause Mortality: The REVOLUTIONIZE II Study

Session Information

Category: CKD (Non-Dialysis)

  • 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Agiro, Abiy, AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, United States
  • Greatsinger, Alexandra, Analysis Group Inc Boston, Boston, Massachusetts, United States
  • Chen, Jingyi, Analysis Group Inc Boston, Boston, Massachusetts, United States
  • Cook, Erin, Analysis Group Inc Boston, Boston, Massachusetts, United States
  • Mu, Fan, Analysis Group Inc Boston, Boston, Massachusetts, United States
  • Zhao, Angela, Analysis Group Inc Boston, Boston, Massachusetts, United States
  • Louden, Elaine Maria, Analysis Group Inc Boston, Boston, Massachusetts, United States
  • Colman, Ellen, AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, United States
  • Desai, Pooja N., AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, United States
  • Chertow, Glenn, Stanford University, Stanford, California, United States
Background

The association of hyperkalemia (HK) with progression of chronic kidney disease (CKD) has not been well studied. This real-world study described and compared CKD progression and mortality among patients with HK and matched patients without HK.

Methods

Adults with stage 3b or 4 CKD with HK (defined as serum K>5.0 mmol/L and a HK diagnosis) and matched patients without HK were identified from the Optum de-identified Market Clarity database (1/2016-8/2022). Index date was the first eligible CKD diagnosis. Time to CKD progression (defined as stage 4 or 5 CKD, provision of dialysis, or kidney transplantation) and time to death were compared between cohorts using cause-specific Cox proportional hazard models reported as hazard ratios (HR) and 95% confidence intervals (CI). Subgroup analyses were conducted by CKD stage and renin-angiotensin-aldosterone system inhibitor (RAASi) use.

Results

6,619 matched pairs were included in the overall sample. Mean age was 74.5 years, 47% male, 76% white, and 71% had stage 3b CKD at index date. Among all groups, patients with HK had statistically significantly higher rates of CKD progression (overall: HR 1.60 [95% CI 1.50, 1.71], p<0.001) (Figure 1). Patients with HK also had higher rates of all-cause mortality than patients without HK in the overall cohort (1.09 [1.02, 1.16]), RAASi subgroup (1.14 [1.05. 1.23]) and CKD stage 3b subgroup (1.11 [1.03, 1.20]) (all p<0.01).

Conclusion

Patients with HK experienced significantly higher rates of CKD progression and all-cause mortality compared to patients without HK, with consistent findings irrespective of use/non-use of RAASi.

Figure 1. Hazard ratio of CKD progression among patients with HK vs. patients without HK

Funding

  • Commercial Support – AstraZeneca