Kidney Week

Abstract: PUB251

Borderline but Not Benign: Exposing the Therapeutic Divide in 5.0-5.5 mmol/L Hyperkalemia

Session Information

• Publication Only

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

• Chen, Hongbo, Zhejiang Provincial Hospital of TCM, Hangzhou, China

Hongbo Chen

• Zhang, Hao, Third Xiangya Hospital, Central South University, Changsha, China

Hao Zhang

• Bian, Xueyan, The Affiliated Hospital of Ningbo University, Ningbo, China

Xueyan Bian, MD, DrMed

• Wang, Lihua, The Second Hospital of Shanxi Medical University, Taiyuan, China

Lihua Wang, MD, PhD

• Shu, Ying, Chengdu Third People's Hospital, Chengdu, China

Ying Shu

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

Xiaoqiang Ding

Background

Hyperkalemia (HK) is a common and potentially life-threatening electrolyte disorder in patients with chronic kidney disease (CKD). According to the NORMALIZE study presented at 2024 ASN Kidney Week, even modest elevations to 5.0–5.5 mmol/L significantly heighten cardiovascular and all-cause mortality risk-but this common "borderline" range sits in guideline limbo, trapping patients in a fragmented treatment divide. Profiles and potassium-lowering therapy patterns in this subgroup remain poorly defined. We map the clinical landscape of this gray zone to expose the true magnitude of the care gap.

Methods

This prospective cohort study enrolled 1,000 adults with CKD and serum potassium ≥5.0 mmol/L across 50 clinical sites in China. Baseline demographic characteristics and potassium-lowering therapy patterns utilization were systematically analyzed, with particular focus on the 5.0–5.5 mmol/L subgroup.

Results

A total of 1000 patients were included (mean age was 58.7±13.2years, 66.6% were male). The baseline means sK⁺ is 5.5±0.8mmol/L. The 5.0–5.5 mmol/L comprised 625 patients (62.9% of the total HK cohort), with a mean age of 58.6±12.9 years. Mean eGFR was 33.8±20.4mL/min/1.73m², with CKD stage distribution as follows: G3a 13.5%, G3b 26.5%, G4 37%, and G5 13.6%. G4–G5 CKD (50.5%),type 2 diabetes mellitus (50.1%), heart failure (9.1%), and without RAASi therapy (50.8%), these are high-risk patients with progressive cardiorenal disease. Despite this considerable risk profile, only 43% of patients in the 5.0–5.5 mmol/L range received potassium-lowering therapy, exposing a stark therapeutic divide. Among the 57% of 5.0–5.5 mmol/L patients who remained untreated, 46.3% had G4–G5 CKD, 47.5% had type 2 diabetes mellitus, 8.9% had heart failure, and 52.5% were not on RAASi—demonstrating that therapeutic inertia in this gray zone leaves clinically high-risk patients unprotected.

Conclusion

The 5.0–5.5 mmol/L subgroup represents a large proportion of HK patients at high cardiorenal risk yet faces suboptimal hyperkalemia treatment rates, warranting urgent, targeted efforts to expand therapeutic coverage in this potassium range.

Funding

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