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Kidney Week

Abstract: TH-PO358

Contemporary Use of Guideline-Directed Medical Therapy and Associated Outcomes in Cardiorenal Patients with Hyperkalemia: An Observational Multi-Country Study

Session Information

Category: Fluid, Electrolytes, and Acid-Base Disorders

  • 1102 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
  • Pollack, Charles, University of Mississippi School of Medicine, Jackson, Mississippi, United States
  • Sanchez-Lazaro, Ignacio J, Hospital Universitari i Politecnic La Fe, Valencia, Spain
  • Lesén, Eva, CVRM Evidence, AstraZeneca, Gothenburg, Sweden
  • Arnold, Matthew, Real World Science and Digital, AstraZeneca, Cambridge, United Kingdom
  • Franzén, Stefan, Medical & Payer Evidence Statistics, AstraZeneca, Gothenburg, Sweden
  • Allum, Alaster, BioPharmaceuticals Medical CVRM, AstraZeneca, Cambridge, United Kingdom
  • Murohara, Toyoaki, Nagoya University Graduate School of Medicine, Nagoya, Japan
  • Kanda, Eiichiro, Kawasaki Medical School, Okayama, Japan

International guidelines recommend renin-angiotensin-aldosterone system inhibitor (RAASi) therapy at the maximal tolerated dose to optimize treatment benefits in chronic kidney disease (CKD) and heart failure (HF). However, RAASi therapy increases the risk of hyperkalemia (HK), which is a barrier to achieving guideline-directed RAASi therapy. Novel oral anti-HK treatments, e.g., sodium zirconium cyclosilicate (SZC), are recommended to manage HK and allow the maintenance of RAASi therapy. This ongoing observational study investigates contemporary use of guideline-concordant RAASi and SZC therapy and associated outcomes in cardiorenal patients (pts) with HK in 3 geographic regions.


This analysis includes data from hospital records and claims from the US (Optum Clinformatics Data Mart), Japan (Medical Data Vision) and Spain (Big-Pac), and evaluates adults with CKD and/or HF who have an HK episode (ICD-10 code E87.5) or initiate outpatient SZC therapy while treated with RAASi. The observation period started when SZC became available in the respective country (July 2019 [US], May 2020 [Japan], June 2021 [Spain]). Across countries, use of guideline-directed medical therapy (GDMT) and associated outcomes will be assessed in terms of maintained/reduced RAASi therapy, SZC treatment, and HK- and cardiorenal-related hospitalizations.


The US dataset includes 125,632 cardiorenal pts (mean age, 74 years; 50% male) who had an HK episode. CKD was present in 83% of pts and HF in 56%. The 3648 pts who initiated SZC were younger (72 years), more often male (54%), and more often had CKD (96%) compared with the overall HK cohort. Data from Japan and Spain will be available for analyses during Q2 2023. Results from analyses of RAASi therapy and SZC treatment patterns and associated outcomes across countries will be presented at the ASN congress.


This study provides contemporary insights into the characteristics of cardiorenal pts with HK and use of GDMT in clinical practice across 3 geographic regions which, together with the associated outcomes, may guide treatment optimization and improve patient prognosis.


  • Commercial Support – AstraZeneca