Hyperkalemia: A Cause of Non-adherence to Renin- Angiotensin-Aldosterone System Inhibitors in Chronic Kidney Disease: A Retrospective Study

Abstract

Introduction: There is increasing awareness of non-adherence to renin-angiotensin- aldosterone system inhibitors (RAASi) in chronic kidney disease (CKD). This study aimed to evaluate the incidence of hyperkalemic adult CKD patients who were prescribed RAASi and to determine variations in pharmacological interventions to uncover reasons for non-adherence to RAASi treatment. Methods: The incidence of hyperkalemia and non-adherence to RAASi [angiotensin-converting enzyme inhibitor (ACEi)/angiotensin II receptor blockers (ARBs)] in CKD patients was examined among 471 patients over the age of 18 years who had estimated-glomerular filtration rate (e-GFR) measurements and were diagnosed with CKD between stages 1 and 5. Hyperkalemia was defined as serum potassium (K+) ≥5 mmol/L. The number of hyperkalemic patients not reaching the target dose, hyperkalemia as a reason for not reaching the target dose, patients receiving sodium polystyrene sulfonate patients discontinuing ACEi/ARBs, having a decreased dose of ACEi/ARBs, or treated with the addition or increasing dose of diuretics were compared between the hyperkalemia groups. Results: Hyperkalemia was detected in 29.1% of the patients (n=137), being mild in 21.7%, moderate in 6.2%, and severe in 1.3%. The main finding was that the frequency of patients not reaching the target dose of ACEi/ARBs treatment due to hyperkalemia, hypotension, or e-GFR increase higher than 30% was dramatically higher among patients having moderate/severe hyperkalemia (p<0.0001). In 12.41% of hyperkalemic patients, hyperkalemia was cited as the cause for not achieving the target dosage of ACEi/ARB therapy. 25.71% of these patients discontinued ACEi/ARBS treatment, 14.29% had decreased dose of this treatment, and 11.43% had increased dose of diuretics or newly prescribed diuretics. However, none of the patients with mild hyperkalemia experienced these events during treatment. Conclusion: These findings suggest that serum K+ concentration may be related to major adverse clinical outcomes and affect the type of pharmacological intervention in CKD, resulting in ACEi-ARB discontinuation and halting to reach the target dose.

Keywords

• chronic kidney disease
• hyperkalemia
• renin-angiotensin-aldosterone system inhibitors