#5603 HYPERKALAEMIA MAY LIMIT POTENTIAL RENAL INTERVENTIONS IN PATIENTS WITH LOW GFR AND SIGNIFICANT PROTEINURIA

Abstract

Abstract Background and Aims Evidence-based therapies including ACE inhibitors, ARBs and mineralocorticoid receptor antagonists (MRA) can significantly delay progression of CKD, yet their use is potentially limited by hyperkalaemia risk. In this study, we describe hyperkalaemia events among CKD patients to provide a better understanding of the current unmet need. Method This was a retrospective secondary data analysis from electronic medical records (EMR) in the US TriNetX analytics data CKD subset from Jan 2015-Dec 2019. Patients with ≥1 uACR measure were included, whereby the first date of the uACR measure was considered the index date. The study cohort included patients aged > 18 years with a) two consecutive estimated glomerular filtration rate (eGFR) values between 20 and 90 mL/min/1.73m2 recorded 91–730 days apart prior to the index date, or, b) at least one CKD diagnosis code before the index date. Patient demographics, ACE/ARB, MRA and SGLT2i treatments on index were described. The frequency of HK (defined as serum potassium >5.5 mmol/L or a diagnosis code) during a 1-year baseline period and 1-year follow-up period was described by uACR (>700mg/g, 300–700mg/g, <300mg/g) and eGFR (<20mL/min/1.73m2, 20–45mL/min/1.73m2, 45–60mL/min/1.73m2, 60–90mL/min/1.73m2 and >90mL/min/1.73m2) categories. Results Baseline characteristics of the included patients are described in the table below. During the 1-year follow-up period, HK events were more frequently recorded for patients with uACR>700mg/g (15.3%), eGFR<60ml/min/1.73m2 (9.3%) and combined uACR>700mg/g and eGFR<60ml/min/<1.73m2 (18.3%). Conclusion The preliminary results of this analysis shows that HK occurs more frequently among patients with low eGFR and/or high uACR. Despite guidelines, uACR testing is not done frequently in clinical practice and likely performed more frequently among patients with high uACR. Further analyses and more conservative study definitions will be applied to more comprehensively clarify the unmet need among patients at risk of HK. Of particular interest are the patients who discontinued RAASi treatment after a hyperkalemia event during baseline and were not on renoprotective treatment, yet who had recurrent hyperkalemia. Adequate treatment options for these patients are currently limited, and there is a need for more renoprotective treatments with limited hyperkalemia risk.