Among patients with chronic kidney disease (CKD) with or without heart failure taking renin-angiotensin-aldosterone system inhibitors (RAASi), dose reductions or therapy discontinuation are common following new-onset hyperkalemia, according to data presented at the National Kidney Foundation’s 2022 Spring Clinical Meetings in Boston, Massachusetts.

The finding is from a study of 7875 patients with hyperkalemia (defined as a serum potassium level of 5.0 mEq/L or higher) receiving care at the Kaiser Permanente Southern California health system. Of these, 78% had CKD only, 10% had heart failure only, and 13% had both CKD and heart failure. The proportion of patients who discontinued RAASi rose from 18% within 3 months of new-onset hyperkalemia to 28% and 36% within 6 months and 12 months, respectively, Jaejin An, MD, of Kaiser Permanente in Pasadena, California, and colleagues reported in a poster presentation. During those same time periods, the proportion of patients who received a reduced RAASi dose increased from 9% to 10% and 11%, respectively.

The proportion of patients who had RAASi discontinuation or dose reduction within 12 months rose from 40% of patients with borderline hyperkalemia (serum potassium level of 5.0-5.1 mEq/L) to 63% of those with severe hyperkalemia (serum potassium level higher than 6.0 mEq/L).

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Dr An’s team also documented low adherence to RAASi therapy after new-onset hyperkalemia, which increased from 15% of patients at baseline to 19%, 30%, and 35% of patients within 3, 6, and 12 months, respectively. The investigators defined low adherence as less than 80% of days covered by medication during the 3, 6, and 12 months of follow-up based on outpatient pharmacy dispense records.

Disclosure: The study was funded by AstraZeneca. Please see the original reference for a full list of disclosures.


An J, Zhou H, Sim J, et al. Renin-angiotensin-aldosterone system inhibitor (RAASi) use after new-onset hyperkalemia in a US integrated healthcare system. Presented at the National Kidney Foundation’s 2022 Spring Clinical Meetings, Boston, Massachusetts, April 6-10, 2022. Poster 184.