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Association between hyperkalemia, RAASi non-adherence and outcomes in chronic kidney disease
Antonio Santoro1, Valentina Perrone2, Elisa Giacomini2
1UOC Nephrology, Dialysis and Hypertension, Scuola di Specializzazione in Nefrologia, Università degli studi di Bologna, Policlinico S.Orsola-Malpighi, Azienda Ospedaliero-Universitaria, Via P. Palagi, 9, Bologna, Italy. antonio.santoro@unibo.it.
Insights
Hyperkalemia in chronic kidney disease (CKD) patients on RAAS inhibitors can lead to poor adherence. This non-adherence significantly increases the risk of cardiovascular events and mortality.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Hyperkalemia is a common complication in patients with chronic kidney disease (CKD) receiving renin-angiotensin-aldosterone-system inhibitors (RAASi).
- Sub-optimal adherence to RAASi therapy poses potential risks in this patient population.
Purpose of the Study:
- To investigate the association between sub-optimal adherence to RAASi and the risk of cardiovascular events and mortality in CKD patients experiencing hyperkalemia.
- To quantify the impact of hyperkalemia-induced RAASi non-adherence on patient outcomes.
Main Methods:
- An observational retrospective cohort study utilizing administrative and laboratory data from five Local Health Units.
- Inclusion criteria: adult CKD patients prescribed RAASi between 2010-2017.
- Evaluation of hyperkalemia episodes, RAASi adherence (Proportion of Days Covered < 80%), cardiovascular events, mortality, and dialysis inception.
Main Results:
- Hyperkalemia led to RAASi discontinuation in 21.8% and sub-optimal adherence in 33.6% of patients.
- Non-adherence to RAASi in hyperkalemia patients was linked to a 45% increased risk of cardiovascular events (HR 1.45, p<0.05).
- Non-adherent hyperkalemia patients faced a 126% higher risk of death compared to adherent patients (HR 2.26, p<0.001).
Conclusions:
- In CKD patients on RAASi, hyperkalemia onset frequently results in non-adherence to medication.
- This non-adherence is significantly associated with an elevated risk of adverse cardiovascular outcomes and mortality.
Background:
Hyperkalemia is relatively frequent in CKD patients treated with renin-angiotensin-aldosterone-system inhibitors (RAASi).
Aim:
The aim of the present study was to estimate the increased risk of cardiovascular events and mortality due to sub-optimal adherence to RAASi in CKD patients with hyperkalemia.
Methods:
An observational retrospective cohort study was conducted, based on administrative and laboratory databases of five Local Health Units. Adult patients discharged from the hospital with a diagnosis of CKD, who were prescribed RAASi between January 2010 and December 2017, were included. We evaluated the appearance of documented episodes of hyperkalemia, RAASi therapy adherence and the effects of these two variables on cardiovascular events, death and dialysis inception for study patients.
Results:
Of the 9241 selected patients, 4451 met all the criteria for study inclusion. Among them, 1071 had at least one documented episode of hyperkalemia, while 3380 did not. After propensity score matching based on several variables we obtained 2 groups of patients. The appearance of hyperkalemia caused treatment discontinuation in 21.8% of patients previously on RAASi therapy, and sub-optimal adherence (proportion of days covered < 80%) in 33.6% of them. Non-adherence to RAASi therapy among hyperkalemia patients was associated with a higher risk of cardiovascular events (hazard ratio [HR] 1.45, confidence interval [CI] 1.02-2.08; p < 0.05). Moreover, in non-adherent hyperkalemia patients, the risk of death increased by 126% (HR 2.26, CI 1.62-3.15; p < 0.001) compared with adherent patients.
Conclusions:
In a large cohort of CKD patients treated with RAASi, we observed that following hyperkalemia onset, non-adherence to RAASi medication can result in an increased risk of cardiovascular events and death.
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