By Ravi Dhingra, MD, MPH, FACC, FAHA
Sponsored By AstraZeneca
Despite improving outcomes in patients with heart failure[1], renin-angiotensin-aldosterone system inhibitor (RAASi) therapy is underutilized due to hyperkalemia (HK), often to the detriment of patients.[2]
An observational study[2] utilizing Optum’s de-identified Market Clarity Data from July 2019 to September 2021, evaluated the risk of progression to end-stage kidney disease (ESKD) and HF-related hospitalizations in 15,488 adult patients with chronic kidney disease (CKD) stage 3 or 4 and/or HF. Patients who experienced an index HK event (based on International Classification of Diseases codes) and had ≥1 filled RAASi prescription within 6 months before the index HK event were assessed. All RAASi classes were included.
- 33% of patients discontinued RAASi (no fill of a new prescription within 90 days), and 7% down-titrated (>25% reduction in dose) at least one RAASi following HK.[2]
- Risk of progression to ESKD and HF-related hospitalizations increased with RAASi discontinuation (adjusted hazard ratio [HR] 1.55; 95% confidence interval [CI] 1.38-1.75) and RAASi down-titration (adjusted HR 1.51; 95% CI 1.24-1.86) compared to patients who maintained or up-titrated RAASi at 6 months.[2]
- Key limitation: A higher proportion of patients who discontinued or down-titrated RAASi therapy had severe index HK episode (potassium [K+] ≥6.0 mEq/L) and higher use of mineralocorticoid receptor antagonist at baseline compared to patients who maintained or up-titrated RAASi.[2]
These data highlight the need to treat HK to allow for continuation of RAASi therapy in patients with HF.
Healthcare providers can consider a K+ binder to treat HK. Managing HK may enable treatment with RAASi in patients with HF.
- The 2022 American Heart Association (AHA)/American College of Cardiology (ACC)/Heart Failure Society of America (HFSA) Guideline for the Management of HF highlights that K+ binders have been shown to lower K+ levels. Managing HK may enable treatment with RAASi in patients with HF.[1]
The Takeaway
Providers should not let HK be a barrier to guideline-recommended RAASi therapy. A K+ binder can be considered to help treat HK in patients with HF. Managing HK may enable treatment with RAASi therapy.[1,2] Learn more about a novel K+ binder for the treatment of HK here.
References
- Heidenreich Paul A, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79(17):e263-e421.
- Kanda E, et al. Clinical impact of suboptimal RAASi therapy following an episode of hyperkalemia. BMC Nephrol. 2023;24(1):18.
