WASHINGTON—Patients with chronic kidney disease (CKD) who discontinue treatment with angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) following an episode of hyperkalemia are at increased risk of death, according to study findings presented at the American Society of Nephrology’s 2019 Kidney Week meeting.

In a retrospective cohort study that included 8,070 adult patients with CKD who were on ACE inhibitors or ARBs, Silvia J. Leon, MD, and colleagues at the Chronic Disease Innovation Centre and the University of Manitoba in Winnipeg, Canada, found that patients who stopped taking the drugs following an episode of hyperkalemia had a significant 2.6-fold and 2.3-fold increased risk of all-cause and cardiovascular mortality, respectively, in adjusted analyses compared with patients who continued taking the medications. They also had a significant 1.7-fold increased risk for any cardiovascular event (fatal and nonfatal).

Discontinuation was not associated with dialysis initiation or cataract surgery (which the investigators used as a negative control outcome).

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The investigators defined hyperkalemia as a serum potassium level of 5.5 mmol/L or higher. The exposure (medication continuation vs discontinuation) was analyzed in a time-dependent manner among surviving patients 90 days after the hyperkalemia episode.  At baseline, patients had a mean age of 71 years and mean estimated glomerular filtration rate of 38.5 mL/min/1.73 m2. Of the 8,070 patients, 7,792 (96.6%) had hypertension, 2,913 (36.1%) had heart failure, 5163 (64.0%) had diabetes mellitus, and 2,140 (26.5%) had atrial fibrillation.

With regard to study limitations, the authors noted that they could not account for use of over-the-counter medications and they did not know the reasons for treatment discontinuation.


Leon SJ, Whitlock R, Komenda P, et al. Impact of ACEi/ARB discontinuation after an episode of hyperkalemia in patients with CKD. Presented at the American Society of Nephrology’s 2019 Kidney Week meeting held November 5-10 in Washington, DC. Poster SA-PO880.