Barriers to guideline mandated renin-angiotensin inhibitor use: focus on hyperkalaemia

Area of Science:

• Nephrology
• Cardiology
• Endocrinology

Background:

• Hyperkalaemia is a common complication in patients with chronic diseases, particularly heart failure (HF), chronic kidney disease (CKD), and diabetes mellitus (DM).
• Renin-angiotensin-aldosterone system inhibitors (RAASi) are vital for managing these conditions but can increase hyperkalaemia risk.
• Hyperkalaemia frequently leads to reduced RAASi dosage or discontinuation, compromising patient care.

Purpose of the Study:

• To review current hyperkalaemia management strategies in patients with chronic diseases.
• To explore barriers to optimal RAASi prescribing in high-risk populations.
• To identify the unmet need for effective hyperkalaemia management in patients on RAASi therapy.

Main Methods:

• Literature review of current guidelines and clinical practices.
• Analysis of factors contributing to hyperkalaemia in chronic disease states.
• Exploration of challenges in RAASi therapy adherence and management.

Main Results:

• Patients with HF, CKD, and DM using RAASi are at high risk for hyperkalaemia.
• Hyperkalaemia often necessitates RAASi dose reduction or cessation, impacting treatment efficacy.
• Current management options may not adequately address recurrent hyperkalaemia in this population.

Conclusions:

• Effective hyperkalaemia management is essential for maintaining RAASi therapy in chronic disease patients.
• Barriers to guideline-adherent RAASi use must be addressed.
• There is a significant need for novel therapeutic agents to manage hyperkalaemia in patients on RAASi.