Kidney Week

Abstract: FR-PO548

Cardiorenal and Mortality Outcomes Associated With Renin-Angiotensin-Aldosterone System Inhibitor (RAASi) Discontinuation After New-Onset Hyperkalemia

Session Information

• Fluid, Electrolyte, and Acid-Base Disorders: Clinical
  November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Fluid‚ Electrolyte‚ and Acid-Base Disorders

• 1002 Fluid‚ Electrolyte‚ and Acid-Base Disorders: Clinical

Authors

• An, Jaejin, Kaiser Permanente Southern California, Pasadena, California, United States

Jaejin An,

• Zhou, Hui, Kaiser Permanente Southern California, Pasadena, California, United States

Hui Zhou,

• Ni, Liang, Kaiser Permanente Southern California, Pasadena, California, United States

Liang Ni,

• Sim, John J., Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, United States

John J. Sim,

• Harrison, Teresa N., Kaiser Permanente Southern California, Pasadena, California, United States

Teresa N. Harrison,

• Ogun, Oluwaseye, Kaiser Permanente Southern California, Pasadena, California, United States

Oluwaseye Ogun,

• Wei, Rong, Kaiser Permanente Southern California, Pasadena, California, United States

Rong Wei,

• Agiro, Abiy, AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, United States

Abiy Agiro,

• Brahmbhatt, Yasmin G., AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, United States

Yasmin G. Brahmbhatt,

• Oluwatosin, Yemisi, AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, United States

Yemisi Oluwatosin,

• Schilling, Craig G., AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, United States

Craig G. Schilling,

Background

Discontinuation of RAASi is common after hyperkalemia. We evaluated the risk of cardiorenal outcomes and recurrence of hyperkalemia associated with RAASi discontinuation among patients with chronic kidney disease (CKD) and/or heart failure (HF).

Methods

We identified adults with hyperkalemia (potassium ≥5.0 mEq/L, index) and CKD and/or HF between 2016-2017 from Kaiser Permanente Southern California and followed them through 2019. We required patients to have no history of hyperkalemia and ≥2 fills of RAASi within 1 year prior to the index. We defined RAASi discontinuation as having ≥90-day gap in refills of ≥1 RAASi within 3 months after index. We used multivariable Cox proportional hazards models to evaluate the association between RAASi discontinuation and cardiovascular (CV) events (myocardial infarction, stroke, HF hospitalization) or all-cause mortality, and recurrence of hyperkalemia. Renal events (40% reduction in eGFR, dialysis, kidney transplant) or all-cause mortality were evaluated among patients with CKD.

Results

Of 7,875 patients (mean age 75 years, 91% CKD), 15% discontinued RAASi within 3 months after index. During the median 2 years of follow-up, 32% had a composite of CV/mortality (16% CV, 16% death) and 36% experienced hyperkalemia recurrence. Among those with CKD, 33% had a composite of renal/mortality. Patients who discontinued RAASi had a higher incidence of cardiorenal outcomes compared with those who continued RAASi (Table). RAASi discontinuation was associated with a higher risk of cardiorenal outcomes [adjusted hazard ratio (aHR) 1.20, 95%CI 1.09-1.33 for CV/mortality, aHR 1.20, 95%CI 1.07-1.34 for renal/mortality] and a lower risk of hyperkalemia recurrence [aHR 0.86, 95%CI 0.76-0.97].

Conclusion

RAASi discontinuation after hyperkalemia was associated with worsened cardiorenal and/or mortality outcomes, which underscores the benefits of continuing RAASi in CKD and/or HF.

Funding

• Commercial Support – AstraZeneca