Kidney Week

Abstract: SA-PO0511

Two-Pronged Success: High Medication Possession Ratio of Potassium Binders Enables Normokalemia and Optimization of Renin-Angiotensin-Aldosterone System Inhibitors: 12-Week Results from the HK-QIP Study

Session Information

• CKD: Clinical - Therapies, CKM Health, Special Populations, and More
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2202 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Xie, Yeqing, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China

Yeqing Xie

• Li, Yang, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China

Yang Li, PhD

• Li, Qing, AstraZeneca Pharmaceutical Co. Ltd., Hangzhou, China

Qing Li

• Liu, Xiaoyan, The Second Affiliated Hospital of Dalian Medical University, Dalian, China

Xiaoyan Liu, MD, PhD

• Huang, Xinzhong, Affiliated Hospital of Nantong University, Nantong, China

Xinzhong Huang, MD, PhD

• Wan, Jian-xin, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China

Jian-xin Wan, MD, PhD

• Wu, Yu, Liaoning Health Industry Group Tiemei General Hospital, Diaobingshan, China

Yu Wu

• Chang, Wenxiu, Tianjin First Central Hospital, Tianjin, China

Wenxiu Chang, MD

• Ding, Xiaoqiang, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China

Xiaoqiang Ding

Background

Hyperkalemia (HK) often leads to renin-angiotensin-aldosterone system inhibitors (RAASi) down-titration or discontinuation, which undermines or disrupts cardiorenal protection. While potassium binders (PBs) maintain normokalemia (<5.0 mmol/L) and permit continued RAASi use, the impact of treatment adherence—quantified by medication possession ratio (MPR)—on these effects remains unclear. We examined if high PB adherence improved normokalemia and enabled RAASi optimization.

Methods

HK-QIP (NCT06884267) is a prospective, single-arm, 96-week study conducted at 50 sites in China. Patients (pts) with estimated glomerular filtration rate (eGFR) >10 mL/min/1.73m² and serum potassium (sK⁺) >5.0 mmol/L were enrolled. The quality improvement program included standard HK management training and quality audit. The proportion of responders (pts who achieved dual endpoints of normokalemia and RAASi optimization) and urinary albumin/creatinine ratio (UACR) at week (wk) 12 were analyzed overall and according to PB adherence (high: MPR ≥80%; suboptimal: MPR <80%).

Results

In the analysis, 199 pts (mean age, 60.3 yrs; male, 63.3%) were included with mean baseline eGFR of 27.8 mL/min/1.73m², sK⁺ of 5.6 mmol/L, and UACR of 1197.7 mg/g. At wk 12, 52.3% of pts had received ≥1 PB and mean sK⁺ was 4.9 mmol/L. Normokalemia was achieved in 49.7% of pts; however, only 18.4% were responders. Pts with high adherence had a higher rate of normokalemia (61.5% vs 40.4%) compared with those with suboptimal adherence. The response rate was higher in the high adherence group (28.8% vs 8.8%) compared with the suboptimal group. Mean UACR decreased from 1095.1 mg/g at baseline to 1025.9 mg/g at wk 12 in the high adherence group and increased from 1589.1 to 2535.6 mg/g in the suboptimal group. A multivariable regression analysis showed MRP ≥0.8 was a predictor (odds ratio, 2.98; p=0.019) of response.

Conclusion

High medication adherence independently tripled the response rate and emerged as a significant predictor of normokalemia and guideline-concordant RAASi optimization. These findings support PB adherence as a critical, modifiable therapeutic target to bridge the divide between sK⁺ control and cardiorenal protection, supporting long-term use of PBs as a strategy to maximize RAASi therapeutic potential in clinical practice.

Funding

• Commercial Support – This work was supported by AstraZeneca Global R&D (China) Co., Ltd