Heart Failure

Shifting Perceptions of Hyperkalemia in Care of Patients with Heart Failure

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]

Ravi Dhingra, MD, MPH, FACC, FAHA
Ravi Dhingra, MD, MPH, FACC, FAHA

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 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

  1. 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.
  2. Kanda E, et al. Clinical impact of suboptimal RAASi therapy following an episode of hyperkalemia. BMC Nephrol. 2023;24(1):18.
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