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%.
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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.
Reference
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
