Even with medical nutrition therapy (MNT), patients with stage 3-4 chronic kidney disease (CKD) continue to experience hyperkalemia recurrence, according to a poster presentation at the National Kidney Foundation’s 2023 Spring Clinical Meetings in Austin, Texas.

In the REVOLUTIONIZE I study including 2048 patients, 37.4% of patients treated with first-line MNT experienced hyperkalemia recurrence, defined as serum potassium greater than 5.0 mmol/L, within 1 month, Christopher G. Rowan, PhD, of COHRDATA in San Clemente, California, and colleagues reported . The hyperkalemia rate at 6 months of MNT grew to 56.0%. At baseline, 44% of patients were taking renin-angiotensin-aldosterone system inhibitors and 71% were taking loop diuretics. A majority had congestive heart failure (58%) and/or diabetes (64%). On average, patients experienced 2.6 hyperkalemia episodes within 6 months.

The time between episodes shortened to less than 30 days as the number of recurrences increased, the investigators reported. The average time to the next hyperkalemia recurrence was 45, 35, 29, and 27 days after the first, second, third, and fourth hyperkalemia episode, respectively. For a majority of patients, hyperkalemia was chronic. The proportion of patients experiencing recurrent hyperkalemia grew from 56% and 58% after 1-2 episodes to 60% and 70% after 3-4 episodes.

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At baseline, mean serum potassium was 5.5 mmol/L, and it remained elevated (less than 0.1 mmol/L change) during successive hyperkalemia episodes. Over 6 months, 13.7% of patients experienced a hyperkalemia-related hospital admission and 63.5% an all-cause admission.

Dr Rowan’s team suggested that to maintain normokalemia and mitigate hyperkalemia, clinicians may consider augmenting MNT with antihyperkalemia therapy such as potassium binders.

Disclosure: This research was supported by AstraZeneca. Please see the original reference for a full list of disclosures.


Rowan CG, Agiro A, Chan A, et al. Recurrence of hyperkalemia following dietary counseling, REVOLUTIONIZE I Real-World Evidence Study.Presented at: National Kidney Foundation 2023 Spring Clinical Meetings, Austin, Texas, April 11-15. Abstract 296.