Abstract: TH-PO0398
Association Between Chronic Hyperkalemia (CHK) and Clinical Outcomes in China (NORMALIZE Study)
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Clinical - 1
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Wang, Bin, Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, Jiangsu, China
- Li, Zuolin, Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, Jiangsu, China
- Pan, Mingming, Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, Jiangsu, China
- Wu, Min, Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, Jiangsu, China
- Zou, Liangqiang, Medical Affairs, AstraZeneca Investment China Co, Shanghai, China
- Li, Ying, Department of Nephrology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Yu, Pei, Department of Nephrology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Liu, Bi-Cheng, Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, Jiangsu, China
Background
Hyperkalaemia (HK, sK+ >5.0 mmol/L) has a high recurrence rate and CHK may be associated with poor clinical outcomes. This study evaluated clinical outcomes between patients (pts) with CHK and matched controls with normokalemia (NK) or single-HK in China.
Methods
This retrospective study included adult pts with ≥2 serum potassium (sK+) values (≥7 days apart) within a 12-month baseline period between Jan 1, 2017-Dec 31, 2023 from the Tianjin Inspur Database. Pts with CHK (≥2 HK episodes) were separately matched (1:1) to controls with NK and single-HK (only 1 HK episode) via propensity score matching. Composite cardiovascular (CV) outcomes (primary endpoint) of myocardial infarction (MI), stroke or heart failure (HF), and all-cause mortality were evaluated by Kaplan-Meier method.
Results
CHK prevalence was 20-fold higher with ≥5 vs. 2 annual sK+ tests (12.2% vs. 0.6%). Overall, 9,368 and 14,762 CHK pts were matched to 9,368 NK and 14,762 single-HK pts, respectively; baseline characteristics were balanced. In matched pts without CV events at baseline, observed cumulative incidences of composite CV outcomes were 35.1% (1,602/4,560) vs. 31.3% (1,480/4,730) for CHK vs. NK, and 40.2% (2,345/5,833) vs. 41.9% (2,455/5,863) for CHK vs. single-HK. Risk of composite CV was 34% higher for CHK vs. NK (Hazard Ratio [HR] 1.34 [95% CI 1.25-1.44], P <0.0001, Fig. 1a). When excluding baseline chronic kidney disease status and eGFR from the matching variables (given the impact of estimated glomerular filtration rate on both CHK and single-HK), composite CV risk also increased by 31% for CHK vs. single-HK (HR 1.31 [1.25-1.38], P <0.0001). HF risk was higher for CHK vs. NK (HR 2.19 [2.03-2.37]), and for CHK vs. single-HK (HR 1.11 [1.05-1.17]). All-cause mortalities were 22.7% vs. 10.5% for CHK vs. NK (HR 2.75 [2.55-2.95], P <0.0001, Fig. 1b), and 25.3% vs. 22.2% for CHK vs. single-HK (HR 1.22 [1.16-1.28], P <0.0001).
Conclusion
Patients with CHK had significantly higher risks of clinical outcomes than NK or single-HK pts. Close monitoring and long-term management of CHK are needed.
Fig 1. KM plots of composite CV outcomes (a) and all-cause mortality (b) in CHK vs. NK.
Funding
- Commercial Support – AstraZeneca