Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2019 Mar 7;14(3):e0213192.
doi: 10.1371/journal.pone.0213192. eCollection 2019.

Hyperkalemia and renin-angiotensin aldosterone system inhibitor therapy in chronic kidney disease: A general practice-based, observational study

Min Jun  1 , Meg J Jardine  1 , Vlado Perkovic  1 , Quentin Pilard  1 , Laurent Billot  1 , Anthony Rodgers  1 , Kris Rogers  1 , Martin Gallagher  1
Affiliations
Observational Study

Hyperkalemia and renin-angiotensin aldosterone system inhibitor therapy in chronic kidney disease: A general practice-based, observational study

Min Jun et al. PLoS One. .

Abstract

Data on hyperkalemia frequency among chronic kidney disease (CKD) patients receiving renin-angiotensin aldosterone system inhibitors (RAASis) and its impact on subsequent RAASi treatment are limited. This population-based cohort study sought to assess the incidence of clinically significant hyperkalemia among adult CKD patients who were prescribed a RAASi and the proportion of patients with RAASi medication change after experiencing incident hyperkalemia. We conducted a retrospective, population-based cohort study (1 January 2013-30 June 2017) using Australian national general practice data from the NPS MedicineWise's MedicineInsight program. The study included adults aged ≥18 years who received ≥1 RAASi prescription during the study period and had CKD (estimated glomerular filtration rate [eGFR] <60 ml/min/1.73m2). Study outcomes included incident clinically significant hyperkalemia (serum potassium >6 mmol/L or a record of hyperkalemia diagnosis) and among patients who experienced incident hyperkalemia, the proportion who had RAASi medication changes (cessation or dose reduction during the 210-day period after the incident hyperkalemia event). Among 20,184 CKD patients with a median follow-up of 3.9 years, 1,992 (9.9%) patients experienced an episode of hyperkalemia. The overall incidence rate was 3.1 (95% CI: 2.9-3.2) per 100 person-years. Rates progressively increased with worsening eGFR (e.g. 3.5-fold increase in patients with eGFR <15 vs. 45-59 ml/min/1.73m2). Among patients who experienced incident hyperkalemia, 46.6% had changes made to their RAASi treatment regimen following the first occurrence of hyperkalemia (discontinuation: 36.6% and dose reduction: 10.0%). In this analysis of adult RAASi users with CKD, hyperkalemia and subsequent RAASi treatment changes were common. Further assessment of strategies for hyperkalemia management and optimal RAASi use among people with CKD are warranted.

PubMed Disclaimer

Conflict of interest statement

This study was funded by AstraZeneca Proprietary Limited and commissioned by VentureWise (a wholly owned commercial subsidiary of NPS MedicineWise). MJ reports no conflicts of interest. MJJ is responsible for research projects that have received unrestricted funding from Gambro, Baxter, CSL, Amgen, Eli Lilly, and Merck; has served on advisory boards sponsored by Akebia, Baxter and Boehringer Ingelheim, spoken at scientific meetings sponsored by Janssen, Amgen and Roche; with any consultancy, honoraria or travel support paid to her institution. VP has participated in advisory boards for both Relypsa and AstraZeneca and has received honoraria and consultation fees from Tricida, Novartis, Amgen, Janssen, GlaxoSmithKline, Astellas, Boeringer Ingelheim, Baxter, Mitsubishi Tanabe, Retrophin, Merck, Abbvie, Novo Nordisk, AstraZeneca, Gilead, Durect, Servier, Eli Lilly, Relypsa, Pharmalink, Bayer, Bristol-Myers Squibb and Tufts, with payments paid to his institution. MG reports receiving honoraria from Shire and Amgen for speaking at scientific meetings. QP, LB, AR and KR report no conflicts of interest. Reported competing interests do not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Identification of the study cohort.
Fig 2
Fig 2. Unadjusted and adjusted* incidence rate of hyperkalemia according to eGFR category.
Fig 3
Fig 3. Subgroup analysis assessing hyperkalemia incidence according to baseline patient characteristics.
See this image and copyright information in PMC

References

    1. Lv J, Ehteshami P, Sarnak MJ, Tighiouart H, Jun M, Ninomiya T, et al.: Effects of intensive blood pressure lowering on the progression of chronic kidney disease: a systematic review and meta-analysis. CMAJ 185: 949–957, 2013. 10.1503/cmaj.121468 - DOI - PMC - PubMed
    1. Ninomiya T, Perkovic V, Turnbull F, Neal B, Barzi F, Cass A, et al.: Blood pressure lowering and major cardiovascular events in people with and without chronic kidney disease: meta-analysis of randomised controlled trials. BMJ 347: f5680, 2013. 10.1136/bmj.f5680 - DOI - PMC - PubMed
    1. Weir MR, Rolfe M. Potassium homeostasis and renin-angiotensin-aldosterone system inhibitors. Clin J Am Soc Nephrol 5: 531–548, 2010. 10.2215/CJN.07821109 - DOI - PubMed
    1. Fried LF, Emanuele N, Zhang JH, Brophy M, Connor TA, Duckworth W, et al.: Combined angiotensin inhibition for the treatment of diabetic nephropathy. N Engl J Med 369: 1892–1903, 2013. 10.1056/NEJMoa1303154 - DOI - PubMed
    1. Mathialahan T, Maclennan KA, Sandle LN, Verbeke C, Sandle GI: Enhanced large intestinal potassium permeability in end-stage renal disease. J Pathol 206: 46–51, 2005. 10.1002/path.1750 - DOI - PubMed

Publication types

MeSH terms

Substances