Discontinuation of renin–angiotensin-aldosterone system (RAAS) inhibitors after the first hyperkalemia episode may worsen cardiorenal outcomes and increase the risk for death, investigators reported at the American Society of Nephrology’s Kidney Week 2022 meeting.

Among 7875 patients with chronic kidney disease (CKD) and/or heart failure who experienced new-onset hyperkalemia (75% had serum potassium 5.0 to 5.4 mEq/L), 15% discontinued RAAS inhibitors within 3 months. Over a median 2 years, 32% experienced a composite of cardiovascular events (myocardial infarction, stroke, heart failure hospitalization) or all-cause mortality, and 33% experienced a composite of renal events (40% reduction in estimated glomerular filtration rate, dialysis, or kidney transplant) or all-cause mortality.

Compared with those who continued RAAS inhibitors, patients who discontinued these drugs had a significant 18% increased risk of the composite cardiovascular outcome and a significant 19% increased risk of the composite renal outcome, Jaejin An, PhD, of Kaiser Permanente Southern California in Pasadena, reported on behalf of her team. RAASi discontinuation was significantly associated with a 25% increased risk for all-cause mortality in and of itself. The risk for hyperkalemia recurrence was a significant 14% lower after RAAS inhibitor discontinuation.

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These findings underscore the benefits of continuing RAAS inhibitors in CKD and/or heart failure and highlight the need for targeted treatment of hyperkalemia to facilitate optimal RAAS inhibitor management, Dr An concluded.

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


An J, Zhou H, Ni L, et al. Cardiorenal and mortality outcomes associated with renin-angiotensin-aldosterone system inhibitor (RAASi) discontinuation after new-onset hyperkalemia. Presented at: Kidney Week 2022; November 3-6, Orlando, Florida. Poster FR-PO548.