Abstract: FR-PO353
Consequences of Not Maximizing Renin-Angiotensin System Inhibition Due to Hyperkalemia
Session Information
- Hypertension, CVD, and the Kidneys: Epidemiology
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Hickey, Cecelia L., University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin, United States
- Dopp, John M., University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin, United States
- Meyer, Jodi, William S. Middleton VA Hospital, Madison, Wisconsin, United States
- Maursetter, Laura J., University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
Background
Until March, 2024, potassium binders within the Veterans Health Administration were non-formulary with criteria for use that limited prescribing to persistent moderate-severe hyperkalemia (at least two K values ≥ 5.5 mEq/L). Thus, patients with mild hyperkalemia were at risk of repeated hyperkalemia and dose-reductions or discontinuation of angiotensin converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB). We sought to determine if patients with persistent mild hyperkalemia experienced subsequent hyperkalemia and if ACE-I/ARB use was affected in adult Veteran’s Affairs (VA) patients with difficult-to-control hypertension and chronic kidney disease (CKD).
Methods
Retrospective chart review was performed for patients in a VA renal hypertension clinic who had at least two potassium values ≥ 5.1 but less than 5.5 mEq/L (mild hyperkalemia) documented in the VA electronic health record. Serum creatinine, proteinuria, and ACE-I/ARB use were recorded from the medical record at the time of the second potassium value between 5.1 and 5.49 mEq/L and at the patient’s most recent follow-up visit. Longitudinal hyperkalemia events (K ≥ 5.1 mEq/L) were recorded for all patients.
Results
In patients with persistent mild hyperkalemia (n=54), serum creatinine increased from 2.15±0.1 to 3.01±0.28 mg/dL (mean±SEM) and 2 (1-3) (median and interquartile range) hyperkalemia episodes occurred in the time between their second high K value and their most recent follow-up (median 5 years). At time of their second high K value, 89% of patients were taking an ACE-I/ARB. At the most recent follow-up, 48% of patients taking ACE-I/ARB had their ACE-I/ARB dose reduced or discontinued. In addition, urinary protein to creatinine ratio increased by 546±474 mg/g.
Conclusion
Adult VA patients with CKD, hypertension, and mild hyperkalemia are at risk of subsequent hyperkalemia episodes, worsening of kidney function, and worsening proteinuria. Importantly, approximately half of patients with mild hyperkalemia had de-escalation of renoprotective medications. With the removal of VA formulary restrictions for potassium binders, patients with mild hyperkalemia should be candidates for initiation of potassium binder therapy and optimization of ACE-I/ARB therapy to delay progression of kidney disease.