Serum potassium abnormalities, renin-angiotensin-aldosterone system inhibitor discontinuation, and clinical outcomes...

Area of Science:

• Cardiology
• Nephrology
• Pharmacology

Background:

• Renin-angiotensin-aldosterone system inhibitors (RAASIs) are vital for managing chronic cardiovascular diseases.
• Hyperkalemia is a common side effect of RAASIs, often leading to treatment cessation.
• The clinical impact of hyperkalemia-induced RAASI modifications remains unclear.

Purpose of the Study:

• To investigate the association between hyperkalemia, RAASI management, and clinical outcomes in older adults.
• To determine the prevalence of hyperkalemia and subsequent RAASI down-titration.
• To identify factors influencing RAASI dose adjustments following hyperkalemia.

Main Methods:

• Retrospective cohort study utilizing two large healthcare databases.
• Inclusion of 77,089 individuals aged 55+ prescribed RAASIs between 2015-2017 in Southern Barcelona.
• Analysis of serum potassium levels, RAASI management, and clinical outcomes, with adjustments for confounders.

Main Results:

• The one-year prevalence of hyperkalemia (K+ >5.0 mmol/L) was 17.8%.
• RAASIs were down-titrated in 16.1% of patients experiencing hyperkalemia.
• Down-titration of RAASIs post-hyperkalemia was linked to increased hospitalization (aHR 1.16) and mortality (aHR 1.60).

Conclusions:

• Hyperkalemia significantly increases the likelihood of discontinuing RAASIs.
• Down-titration of RAASIs following hyperkalemia is independently associated with adverse outcomes, including mortality.
• Preventing hyperkalemia is crucial to maintain RAASI therapy and improve patient outcomes.