POS-328 THE BURDEN OF HYPERKALEMIA IN PATIENTS WITH CHRONIC KIDNEY DISEASE: A REPORT FROM THE DISCOVER CKD RETROSPECTIVE COHORT

Abstract

Hyperkalemia (HK), defined as serum potassium (sK+) >5.0 mmol/L, is a potentially fatal condition most often observed in patients with chronic kidney disease (CKD), heart failure (HF) or diabetes and exacerbated by medications that inhibit the renin-angiotensin aldosterone system (RAASi). This real-world study describes characteristics of patients with and without HK in a large international observational study of patients with CKD. The DISCOVER CKD retrospective cohort was extracted using the US TriNetX hospital-EMR, UK Clinical Practice Research Datalink (CPRD) linked to hospital data, the US Dialysis Outcomes and Practice Patterns Study (DOPPS) and Japan Medical Data Vision (JMDV) databases. The study cohort included patients aged >18 years (>20 in JMDV database) with a diagnostic CKD code (stage 3a+ to stage 5 including renal replacement therapy) or 2 estimated glomerular filtration rate (eGFR) measures <75 mL/min/1.73 m2 at least 90 days apart between January 2008 and March 2020. For patients with eGFRs 60–75 mL/min/1.73 m2, one or more of the following was also required inclusive or prior to the second eGFR measurement: CKD diagnostic code, history/presence of albuminuria, history of kidney transplant, or confirmed cause of CKD, including any of the following: IgA nephropathy, glomerulonephritis, lupus nephritis, ANCA nephritis, or polycystic kidney disease. The index date for patients with HK was 2nd sK+measurement >5.0 mmol/L and for non-HK patients, date of CKD. Descriptive analyses were used. In patients with CKD, 125,196 with HK (48.5% female, mean±SD age 68.0±14.1 years, mean±SD sK+ 5.3±0.5 mmol/L) and 1,672,595 without HK (57.6% female, mean±SD age 63.6±14.0 years, mean±SD sK+ 4.2±0.05 mmol/L) were identified (Table 1). Compared to CKD patients without HK, patients with HK were older, had substantially higher proportions of comorbidities and about 25 mL/min/1.73 m2lower eGFR which decreased with increasing comorbidity burden. Diuretic and K+ binder use increased with additional comorbidities in HK and was greatest in patients with CKD + T2D + HF. Even among patients with comorbid HF, the highest proportion of RAASi use was 57.7%. This large cohort of patients with CKD demonstrates the high burden of HK even though HK was generally mild. Patients with HK and CKD + T2D + HF had the greatest CKD burden as evidenced by AKI, albuminuria, and diabetic nephropathy, though similar sK+ ranges were seen across groups. The use of HK treatments was low overall. Use of RAASi, representing life-saving guideline recommended therapy for patients with CKD and HF, was absent in >40% of patients regardless of the presence of HK.