Hyperkalemia due to RAASi is best managed by stopping the drugs

RAASi are commonly prescribed in patients with Chronic Kidney Disease and a common complication of these drugs is hyperkalemia. Hyperkalemia is the increase of serum potassium levels. These drugs block the interaction of aldosterone with its receptors and reduce renal potassium excretion. The management of RAASi–related hyperkalemia to reduce the risk of recurrence is not known. With this background, a group of investigators from the University of Ottawa carried out a retrospective cohort among the Canadian population to examine the risk of hyperkalemia recurrence on the basis of outpatient pharmacologic changes following an episode of RAASi-related hyperkalemia.

49,571 patients who developed hyperkalemia while on RAASi therapy, with a median age of 79 years, were included in the study. The following groups were observed: no intervention, RAASi discontinuation, RAASi dose decrease, new diuretic, diuretic dose increase, or sodium polystyrene sulfonate within 30 days. The primary outcome was hyperkalemia recurrence, with secondary outcomes of cardiovascular events and all-cause mortality within 1 year.

The study revealed the following findings:

Among patients who received a pharmacologic intervention (23% of the cohort), RAASi discontinuation was the most commonly prescribed strategy (74%), followed by RAASi decrease (15%), diuretic increase (7%), new diuretic (3%), and sodium polystyrene sulfonate (1%).

Incidence of recurrent hyperkalemia was lower with RAASi discontinuation, whereas there was no difference with RAASi dose decrease, new diuretic, or diuretic increase. A higher incidence of recurrence was noted with sodium polystyrene sulfonate.

RAASi discontinuation was not associated with a higher risk of 1-year cardiovascular events, or all-cause, compared with no intervention.

Since the study was observational, causation between the study interventions and outcome measures could not be established.

"Among older adults with RAASi-related hyperkalemia, RAASi discontinuation is associated with the lowest risk of recurrent hyperkalemia, with no apparent increase in short-term risks for cardiovascular events or all-cause mortality," the investigators, led by Manish M. Sood, concluded.

Reference:

Study titled, "Ambulatory Treatments for RAAS Inhibitor–Related Hyperkalemia and the 1-Year Risk of Recurrence," published in the Clinical Journal of American Society of Nephrology.

DOI: https://doi.org/10.2215/CJN.12990820