Recurrent hyperkalemia is a major cause of hospitalization, especially for patients with chronic kidney disease (CKD) and heart failure, according to a European study.

Patrick Rossignol, MD, PhD, of the University of Lorraine in Nancy, France, and colleagues conducted a retrospective chart review of 1457 patients not on dialysis (mean age 66 years) with 2 or more hyperkalemia episodes (serum potassium of 5.5 mEq/L or more) within 12 months who were treated by nephrologists (253; 44.5%) or cardiologists (315; 55.5%) in 5 European countries. Overall, 68% of patients had CKD, 40% heart failure, 36% diabetes, and 72% hypertension. A total of 60.5% of patients were taking renin-angiotensin-aldosterone system inhibitors (RAASis) at baseline, most commonly (40.7%) angiotensin-converting enzyme inhibitors (ACEis). Less than 30% of patients with heart failure and reduced ejection fraction took a mineralocorticoid receptor antagonist).

Of 326 hospitalizations, 112 (36%) related directly to hyperkalemia and 32% to other cardiovascular causes, Dr Rossignol’s team reported in Clinical Kidney Journal. Most (81.3%) patients with CKD had a hyperkalemia hospitalization. Further, patients with both CKD and heart failure had a substantially higher hyperkalemia hospitalization rate than patients with heart failure and no CKD: 77% vs 23%.

Continue Reading

With respect to initial management, hyperkalemia treatment varied by specialty and across countries. Both nephrologists and cardiologists reduced RAASi use between the first and second hyperkalemia episode. Nephrologists reported a higher use of sodium/calcium polystyrene sulphonate (26.4% vs 13.9% of patients) and bicarbonate (21.7% vs 7.3%) compared with cardiologists at the first hyperkalemia episode, and the pattern continued at the second episode.

Higher RAASi use was found in the United Kingdom (78.2%) and Germany (69.7%) but lower in France (42.4%) than across the 5 countries overall (60.5%) at the first hyperkalemia episode. Only heart failure was significantly and independently associated with RAASi discontinuation.

“The availability of new potassium-binding agents, i.e. patiromer and sodium zirconium cyclosilicate, which are now approved in Europe for the treatment of [hyperkalemia], may change [hyperkalemia] treatment patterns and extend the use of RAASis in patients with [heart failure] and CKD as already shown with patiromer,” Dr Rossignol’s team stated. “Whether this translates into better outcomes warrants dedicated clinical trials.”

Disclosure: This clinical trial was supported by Vifor Pharma. Please see the original reference for a full list of authors’ disclosures.


Rossignol P, Ruilope LM, Cupisti A, et al. Recurrent hyperkalaemia management and use of renin-angiotensin-aldosterone system inhibitors: a European multi-national targeted chart review. Clin Kidney J. 13(4):714-719. doi:10.1093/ckj/sfz129