Incidence Of Hyperkalemia In Patients Research Articles

Hyperkalemia Incidence in Patients With Non-Dialysis Chronic Kidney Disease: A Large Retrospective Cohort Study From United States Clinical Care

Estimates of the incidence of hyperkalemia in patients with chronic kidney disease (CKD) vary widely. Our objective was to estimate hyperkalemia incidence in patients with CKD from routine clinical care, including by level of kidney damage or function and among important patient subgroups. Retrospective cohort study. 1,771,900 patients with stage 1-4 CKD identified from the US Optum De-Identified electronic health records database. Impaired kidney damage or function level at baseline based on urinary albumin-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR), respectively, and selected patient subgroups. Hyperkalemia: 2 elevated serum potassium values (≥5.5mmol/L) from the inpatient setting (2-24 hours apart) or outpatient setting (maximum 7 days apart), or 1 elevated serum potassium value plus pharmacotherapy initiation or hyperkalemia diagnosis (maximum 3 days apart). Incidence rates of hyperkalemia were calculated. Estimates were stratified by UACR and eGFR level at baseline and patient subgroups. Over a mean follow-up of 3.9 years, the incidence of hyperkalemia was 3.37 events/100 person-years (95% confidence intervals, 3.36-3.38). Higher incidence rates were observed with increased UACR and lower eGFR. Highest rates were observed with UACR≥3,500 (up to 19.1/100 person-years) irrespective of decreased eGFR level. High rates also occurred in patients with type 2 diabetes mellitus (T2DM, 5.43/100 person-years), heart failure (8.7/100 person-years), and those prescribed steroidal mineralocorticoid receptor antagonists (sMRAs, 7.7/100 person-years). Potential misclassification of variables from possible medical coding errors; potential data incompleteness issues if patients received care at institutions not included in Optum. Hyperkalemia is a frequent occurrence in CKD, particularly in patients with T2DM, heart failure, or prescribed sMRAs, indicating the need for regular serum potassium and UACR monitoring in this patient population to help mitigate risk.

Hyperkalaemia as a cause of undertreatment with mineralocorticoid receptor antagonists in heart failure.

To determine the incidence of hyperkalaemia in patients with heart failure with reduced ejection fraction (HFrEF) during up-titration of guideline-directed medical therapy (GDMT) in real-world settings. A retrospective review of medical records of all patients hospitalized for newly onset HFrEF at Sahlgrenska University Hospital, Sweden, between 1 January 2016 and 31 December 2019. Based on mineralocorticoid receptor antagonist (MRA) treatment within the first 6months, patients were divided into four groups: (i) never received MRA, (ii) needed MRA dose reduction, (iii) needed discontinuation of MRA, and (iv) stable MRA treatment. Potassium levels were assessed at baseline and has the highest potassium level during the 6months of up-titration. Of 3456 patients hospitalized for heart failure, 630 (18%) were eligible (68.4% men, 66.8years, mean EF of 29.4%). After up-titration of GDMT 48.4% of patients received MRAs. Patients without MRA treatment were older (P<0.0001), had lower EF (P=0.022), had higher NTproBNP (P=0.017), had lower eGFR (P=0.001), and were more often treated with angiotensin receptor inhibitors/angiotensin receptor blockers/angiotensin receptor neprilysin inhibitors (all P<0.0001). In overall study population, hyperkalaemia increased from 5.9 to 24.4% after 6months of up-titration of GDMT (P<0.0001). Among four groups, the incidence of hyperkalaemia throughout up-titration of GDMT increased from 6.8 to 54.5% in patients with dose reduction of MRA, from 8.8 to 50.9% in those with discontinuation of MRA, from 5 to 10% in patients with stable MRA treatment, and from 6 to 28% in patients who were MRA naive (all P<0.0001). In the MRA-naive group, normokalaemia/hypokalaemia occurred in 87.5% at baseline, and after 6months of up-titration of GDMT, normokalaemia/hypokalaemia remained in 47.8%, whereas mild, moderate, and severe hyperkalaemia occurred in 22.4%, 5.7%, and 0.9%, respectively. Hyperkalaemia increased significantly during up-titration of GDMT but with varying magnitudes in different clinical phenotypes, which might explain why physicians refrain from prescribing MRAs to patients with HFrEF.

RAAS Inhibitor Prescription and Hyperkalemia Event in Patients With Chronic Kidney Disease: A Single-Center Retrospective Study.

Hyperkalemia is common in patients treated with renin–angiotensin–aldosterone system inhibitors (RAASis), and it represents the main cause of the large gap reported between guideline recommendations and real-world practice in chronic kidney disease (CKD). We conducted a CKD-population-based restrospective study to determine the prevalence of patients with CKD treated with RAASis, incidence of hyperkalemia in patients with CKD treated with RAASis, and proportion of patients with RAASi medication change after experiencing incident hyperkalemia. Among 809 patients with CKD analyzed, 556 (68.7%) were treated with RAASis, and RAASi prescription was greater in stages 2–4 of CKD. Hyperkalemia occurred in 9.2% of RAASi-treated patients, and the adjusted rate of hyperkalemia among patients with stage 4–5 CKD was 3-fold higher compared with patients with eGFR > 60 ml/min/1.73 m2. RAASi treatment was discontinued in 55.3% of the patients after hyperkalemia event (74.2% discontinued therapy, 3.2% received a reduced dose, and 22.6% reduced the number of RAASi drugs). This study shows that the incidence of hyperkalemia is frequently observed in patients with CKD patients with RAASis, and that rates increase with deteriorating levels of kidney function from stages 1 to 3. RAASi medication change following an episode of hyperkalemia occurred in almost half of the patients after experiencing hyperkalemia.

Finerenone: a new approach to the treatment of chronic kidney disease in patients with type 2 diabetes

Chronic kidney disease (CKD) represents one of the leading causes of morbidity and mortality worldwide, being diabetes its first cause. Besides the strict management of risk factors (i.e. hyperglycemia, hypertension and dyslipidemia), several pharmacological strategies aiming at reducing the progression of CKD, including ACE-inhibitors, have been proposed. Finerenone is the first non-steroidal selective mineralocorticoid receptor antagonist (ns-MRA) drug developed for the treatment of diabetic kidney disease (DKD) in patients with type 2 diabetes (T2D). Its properties include a high selectivity for MRs with a lower incidence of side effects such as gynecomastia and hyperkalemia with respect to older steroidal MRAs. In addition, a significant reduction of fibrosis, inflammation and hypertrophy both on myocardium and kidney has been observed. At present, several studies demonstrating the efficacy and safety of finerenone on clinical outcomes have been published. In the phase III studies, FIDELIO-DKD and FIGARO-DKD, finerenone significantly reduced the combined primary endpoints (progression of chronic kidney disease, renal failure or renal death for renal outcomes, and cardiovascular mortality, non-fatal myocardial infarction, non-fatal stroke or hospitalisation for heart failure for cardiovascular outcomes) when compared to placebo and added to the standard of care. A pooled-analysis (FIDELITY) performed on a prespecified pool of patients derived from the combination of the previous two studies confirmed the ability of finerenone to significantly reduce both the incidence or progression of DKD and cardiovascular events. A higher incidence of hyperkalemia in patients treated with finerenone compared to placebo was confirmed. However, the incidence of adverse events with clinical impact was low, and only 1,7% of finerenone-treated patients versus 0,6% of placebo-treated patients discontinued treatment during a 3-year follow-up. Finerenone broadly demonstrates an effective renal and cardiovascular protective capacity in patients with T2D and DKD in the presence of good safety in its use. KEY WORDS: diabetic nephropathy; cardiovascular disease; end stage renal disease; type 2 diabetes.

Prevalence and incidence of hyperkalemia in the Spanish population with heart failure with reduced ejection fraction: A systematic review and populational relevance

Background and objectivesHyperkalemia (K+ levels ≥5.5mmol/L) is a severe ion imbalance that occurs in patients who have heart failure (HF) with reduced ejection fraction (HFrEF) and increases the risk of ventricular fibrillation. Given that there are no estimates on the number of patients with this complication, the aim of this study was to estimate the prevalence and incidence of hyperkalemia in patients with HFrEF in Spain. Material and methodsBased on a systematic literature search and through a meta-analysis, we calculated an HFrEF prevalence of ≤40% in the European and U.S. population. Based on another systematic literature search, we calculated the prevalence of hyperkalemia in patients with HF and its annual incidence rate. Considering the previous values and the Spanish population pyramid in 2016, we estimated the number of individuals with HFrEF who currently have hyperkalemia and those who develop it each year in Spain. ResultsApproximately 17,100 (10,000 men and 7100 women) of the 508,000 patients with HFrEF in Spain have hyperkalemia. Furthermore, approximately 14,900 patients with HFrEF (9500 men and 5400 women) develop hyperkalemia each year. ConclusionsApproximately 1 of every 30 patients with HFrEF has plasma potassium values >5.5mmol/L.

Prevalencia e incidencia de hiperpotasemia en población española con insuficiencia cardiaca con fracción de eyección deprimida: revisión sistemática y relevancia poblacional

Background and objectivesHyperkalaemia (K+ levels≥5.5mmol/L) is a severe ion imbalance that occurs in patients who have heart failure (HF) with reduced ejection fraction (HFrEF) and increases the risk of ventricular fibrillation. Given that there are no estimates on the number of patients with this complication, the aim of this study was to estimate the prevalence and incidence of hyperkalaemia in patients with HFrEF in Spain. Material and methodsBased on a systematic literature search and through a meta-analysis, we calculated an HFrEF prevalence of ≤40% in the European and U.S. population. Based on another systematic literature search, we calculated the prevalence of hyperkalaemia in patients with HF and its annual incidence rate. Considering the previous values and the Spanish population pyramid in 2016, we estimated the number of individuals with HFrEF who currently have hyperkalaemia and those who develop it each year in Spain. ResultsApproximately 17,100 (10,000 men and 7100 women) of the 508,000 patients with HFrEF in Spain have hyperkalaemia. Furthermore, approximately 14,900 patients with HFrEF (9500 men and 5400 women) develop hyperkalaemia each year. ConclusionsApproximately 1 of every 30 patients with HFrEF has plasma potassium values >5.5 mmol/L.

Impact of hyperkalaemia definition on incidence assessment: implications for epidemiological research based on a large cohort study in newly diagnosed heart failure patients in primary care.

BackgroundVarious definitions of hyperkalaemia have been used in clinical research, and data from routine clinical practice on its incidence are sparse. We aimed to establish the incidence of hyperkalaemia in patients with newly diagnosed heart failure in the UK general population using different definitions for the condition.MethodsWe conducted a large retrospective cohort study using data from The Health Improvement Network primary care database. Patients with newly diagnosed heart failure (N = 19,194) were identified and followed until the first occurrence of hyperkalaemia. Different serum potassium (K+) thresholds were evaluated as possible definitions for hyperkalaemia, and incidence rates (IRs) calculated using a final operational definition both overall and among patient sub-groups.ResultsIRs of hyperkalaemia ranged from 0.92–7.93 per 100 person-years according to the definition. Based on considerable differences in the serum K+ normal range used between practices, 2176 (11.3 %) individuals were identified with a record of hyperkalaemia using our operational definition of a proportional increase of ≥10 % above the upper bound of the normal range: IR 2.90 per 100 person-years (95 % CI 2.78–3.02) over a mean follow-up of 3.91 years. Incidence rates were higher in older patients, and in those with diabetes or renal impairment.ConclusionsHyperkalaemia is a common finding in heart failure patients in primary care, but its incidence can vary nearly ten-fold depending on its definition. Since assessment of hyperkalaemia risk is essential for therapeutic decision making in heart failure patients, this finding warrants consideration in future epidemiological studies.

Effects of 8,000 IU aXa long-term prophylaxis with certoparin on the incidence of hyperkalemia in patients with coronary heart disease – a post-hoc analysis of the PARAT trial

BackgroundHyperkalemia is an infrequent but potentially serious complication of low molecular weight heparin (LMWH) use. While there are a number of trials comparing LMWH to unfractionated heparin (UFH) there is no comparison of the risk with LMWH versus placebo. Aim of the present post-hoc analysis of the PARAT trial was the description of serum potassium levels with certoparin compared to placebo.ResultsPARAT was a double-blind, placebo-controlled, randomized trial in patients with coronary artery disease receiving either 8,000 I.U. aXa per day or placebo. Serum potassium was monitored at baseline and at scheduled follow-up visits at 2 and 4–6 weeks and 3 and 4–6 months. Statistical evaluation included paired, two sided t-test for each of the treatment groups to compare baseline and follow-up values. A total of 117 patients (59 certoparin, 58 placebo) were included with a mean age of 59 years and 84.6% male gender. There was a statistically significant increase in serum potassium at two weeks after discharge compared to baseline (p < 0.001) in either group which remained elevated throughout the three months treatment phase. Differences between treatment groups were not statistically significant. After treatment discontinuation at the three months’ visit serum potassium returned to normal values (p = n.s. vs. baseline) in both groups. Overall 12 out of 59 patients receiving certoparin (20.3%) and 11 out of 58 patients receiving placebo (19.0%) experienced hyperkalemia based on threshold of >5.0 mmol/l at any time during the observation.ConclusionsWe conclude that there is no incremental risk of hyperkalemia with certoparin up to 8,000 I.U. aXa per day versus placebo in patients with coronary artery disease. The increase in serum potassium values in either group calls for clinical surveillance and the consideration of further risk factors predisposing to hyperkalemia.

Evaluation of the incidence of hyperkalemia in patients prescribed spironolactone for the treatment of resistant hypertension

Evaluation of the incidence of hyperkalemia in patients prescribed spironolactone for the treatment of resistant hypertension

RISK OF HYPERKALEMIA ASSOCIATED WITH THE USE OF BLOCKERS OF THE RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM IN THE TREATMENT OF HEART FAILURE: A REVIEW

Heart failure (HF) is the leading cause of hospitalizations for cardiovascular diseases in Brazil. Hyperkalemia is an important adverse effect of therapy for HF. Several factors affect the incidence of hyperkalemia in patients treated for HF, as well as the presence of comorbidities and the use of associated medications. The aim of this study is to gather new evidence regarding the risk of hyperkalemia in patients treated for HF. The well-established therapy for HF involves drugs that may lead to hyperkalemia as inhibitors of angiotensin converting enzyme blockers, angiotensin II receptor blockers, aldosterone receptor blockers and direct renin inhibitors. The high incidence of HF in elderly patients with comorbidities such as diabetes mellitus and renal insufficiency increases the risk of hyperkalemia. Anti-inflammatory drugs, trimethoprim-sulfamethoxazole and heparin may aggravate the situation. Conclusion: Given the risk of hyperkalemia in patients undergoing treatment for HF, cautious monitoring of renal function and serum potassium should be performed.

679 Use of spironolactone and incidence of severe hyperkalemia in patients enrolled in a heart failure programme

679 Use of spironolactone and incidence of severe hyperkalemia in patients enrolled in a heart failure programme