Abstract: SA-PO1164
Optimization of Renin-Angiotensin System Inhibitors and Mineralocorticoid Receptor Antagonists in Patients with CKD and Heart Failure at High Risk for Hyperkalemia: Data from the CARE-HK in HF Registry
Session Information
- CKD: SGLT2 Inhibitors and GLP-1 RAs for Kidney Health
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Quinn, Ghazal Z., University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Greene, Stephen, Duke University Duke Clinical Research Institute, Durham, North Carolina, United States
- Sauer, Andrew J, St Luke's Mid America Heart Institute, Missouri, Kansas, United States
- Anker, Stefan D., Charite - Universitatsmedizin Berlin ChariteCentrum 13 fur Innere Medizin mit Gastroenterologie und Nephrologie, Berlin, BE, Germany
- Böhm, Michael, Universitat des Saarlandes Medizinische Fakultat, Homburg, SL, Germany
- Bozkurt, Biykem, Michael E DeBakey VA Medical Center, Houston, Texas, United States
- Butler, Javed, Baylor Scott & White Research Institute, Dallas, Texas, United States
- Cleland, John G.F., University of Glasgow, Glasgow, Scotland, United Kingdom
- Coats, Andrew, Heart Research Institute Ltd, Newtown, Sydney, New South Wales, Australia
- Desai, Nihar, Yale School of Medicine Section of Cardiovascular Medicine, New Haven, Connecticut, United States
- Pinto, Fausto J, Hospital Universitário de Santa Maria, Lisbon, Portugal
- Rosano, Giuseppe M C, Universita Telematica San Raffaele Roma, Rome, Lazio, Italy
- Brandes, Carla-Maria, Vifor Pharma Management AG, Glattbrugg, Zurich, Switzerland
- Donachie, Victoria, Vifor Pharma Management AG, Glattbrugg, Zurich, Switzerland
- Kelepouris, Ellie, University of Pennsylvania, Philadelphia, Pennsylvania, United States
Background
Patients with chronic kidney disease (CKD) are at high risk for developing cardiovascular (CV) disease which accounts for a large number of deaths in this population. Key prevention therapies include renin–angiotensin system inhibitors (RASis) and mineralocorticoid receptor antagonists (MRAs), but their use is limited by concerns about hyperkalemia (HK). Patients with heart failure (HF) and advanced CKD at high risk of HK have poorer outcomes yet are often excluded from clinical trials. Here, we characterize the clinical profile of patients with HF and CKD at high risk of HK.
Methods
CARE-HK in HF is a prospective multinational registry of outpatients with HF, treated with RASis and eligible for MRAs. Risk of HK was defined as baseline serum potassium (sK+) of >5.0 mmol/L or estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2. Data were analyzed for HK events and achievement of RASi/MRA optimization (≥50% target doses). Patients were followed for a minimum of 6 months.
Results
Of 2,558 (1,726 in Europe, 832 in the USA) eligible participants, the median age was 73 (interquartile range [IQR] 65–80) years, 31% were women, and 48% had type 2 diabetes. Median baseline eGFR for the entire cohort was 44 (IQR 33–60) mL/min/1.73 m2, with 1,638 (64%) having a record of CKD, 70% of whom had eGFR <45 mL/min/1.73 m2. Baseline sK+ was 4.8 (IQR 4.3–5.2) mmol/L in patients with CKD stages 3–5. In the 24 months prior to enrollment (or from RASi/MRA initiation), up to two-thirds of patients in the registry experienced at least one HK episode. Among patients with CKD, 52% experienced at least one episode of HK compared with 66% of those without CKD. RASi/MRA optimization on or after enrollment remained ≤40%.
Conclusion
Patients with CKD are suboptimally treated with RASi/MRA even when sK+ is in the normal range. With appropriate monitoring and interventions, guideline-directed medical therapy could be optimized.
Funding
- Commercial Support – CSL Vifor