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Abstract: TH-PO360

Association Between Hyperkalemia and Cardiovascular Outcomes in Patients with Stage 3b/4 CKD: REVOLUTIONIZE II Study

Session Information

Category: Fluid, Electrolytes, and Acid-Base Disorders

  • 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • Agiro, Abiy, US Evidence, US Medical Affairs, AstraZeneca, Wilmington, Delaware, United States
  • Colman, Ellen, US Renal, US Medical Affairs, AstraZeneca, Wilmington, Delaware, United States
  • Greatsinger, Alexandra, Analysis Group, New York City, New York, United States
  • Chen, Jingyi, Analysis Group, Boston, Massachusetts, United States
  • Zhao, Angela, Analysis Group, Boston, Massachusetts, United States
  • Louden, Elaine Maria, Analysis Group, Boston, Massachusetts, United States
  • Cook, Erin, Analysis Group, Boston, Massachusetts, United States
  • Mu, Fan, Analysis Group, Boston, Massachusetts, United States
  • Desai, Pooja N., US Renal, US Medical Affairs, AstraZeneca, Wilmington, Delaware, United States
  • Chertow, Glenn, Stanford University School of Medicine, Stanford, California, United States
Background

Hyperkalemia (HK) is a common complication of moderate to advanced chronic kidney disease (CKD). The impact of HK (defined here as serum K+ >5.0 mEq and diagnosis code in any setting) on the time to cardiovascular (CV) outcomes among patients (pts) with CKD has not been well studied. Here we report cardiovascular (CV) outcome analyses from the REVOLUTIONIZE II study.

Methods

This observational study compared propensity score matched adult pts with stage 3b/4 CKD, with and without HK (HK and non-HK cohorts), in Optum’s de-identified Market Clarity database. Index dates were the first CKD stage 3b/4 diagnosis date after ≥1 HK diagnosis in the 12 months (mo) prior (HK cohort) and a randomly selected CKD stage 3b/4 diagnosis date (non-HK cohort). Continuous insurance coverage was required for 12 mo before the index date. CV outcomes were major adverse CV events (MACE; all-cause mortality or inpatient [IP] admission with myocardial infarction or stroke), MACE+ (MACE or IP admission with heart failure), and IP admission with arrhythmia, analyzed in 3 matched subsets.

Results

Of 6619 matched pairs overall, CV analysis subsets included 5949 pairs for MACE, 5301 for MACE+, and 5564 for IP arrhythmia. Baseline variables were balanced between the two cohorts in all subsets.
In each subset, the HK cohort had significantly higher rates of CV outcomes than the non-HK cohort during follow-up (P<0.001 for each CV subset; Table).

Conclusion

Among pts with stage 3b/4 CKD, rates of MACE, MACE+, and IP arrhythmia are significantly higher for pts with HK than those without HK. This reveals an unmet need for long-term outpatient treatment of HK.

CV outcomes in pts with stage 3b/4 CKD

Funding

  • Commercial Support – AstraZeneca