Impact of hyperkalemia?

Hyperkalemia is a serious medical
condition characterised by excessive
serum K+ levels.1

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HK is serious

HK and CKD

HK and HF

HK consequences

Hyperkalemia is a serious condition

Hyperkalemia is one of the most clinically important electrolyte abnormalities and is a serious
medical condition associated with increased mortality and high rates of hospitalisation.1–4

Elevated serum K+ is associated with an increase in all-cause
mortality in at-risk populations3

Medical records of 911,698 patients with and without HF, CKD and DM were assessed to
determine the relationship between K+ and all-cause mortality across an 18-month period.3

  • Risk of all-cause mortality was significantly higher following every
    0.1 mEq/L change in potassium <4.0 mEq/L and >5.0 mEq/L3

Hyperkalemia increases hospitalisation risk across patient populations5

In a retrospective cohort study of over 27,534 patients with hyperkalemia, the incidence
of hospitalisation within 12 months of a hyperkalemic event was assessed.5

The proportion of patients with incident hospitalisations per patient was more than 3 times
higher in patients with hyperkalemia compared to normokalemic patients.5

  • The proportion of patients with hyperkalemia and CKD requiring incident
    hospitalisations was nearly 3 times higher than CKD patients without hyperkalemia5
  • Similarly, the proportion of patients hospitalised with hyperkalemia and HF was
    more than 2 times higher than HF patients without hyperkalemia5

Emergency visits are significantly higher in patients with hyperkalemia5

Patients with HK and CKD

Patients with HK and CKD were 
5 times more likely to require
an emergency visit compared to
CKD patients without HK.5

Patients with HK and HF

Patients with HK and HF were nearly
4 times more likely to require an
emergency visit compared to HF
patients without HK.5

Hyperkalemia increases risk of all-cause
mortality across all CKD stages6

A large-scale meta-analysis was performed to determine the relationship between serum K+ levels
and the risk of all-cause mortality, CV mortality, and ESRD across all CKD stages.6

Hyperkalemia is associated with increased all-cause
mortality across all CKD stages6

  • Hyperkalemia was associated with an increased risk of all-cause mortality across all CKD stages6

Learn the clinical consequences of hyperkalemia in dialysis patients

Risk of CV mortality for pre-dialysis serum K+ concentrations

Adapted from Kovesdy et al. 2007.

Sudden cardiac arrest is one of the most common causes of death for patients on dialysis,7
and this is often associated with hyperkalemia and serum K+ fluctuations.8

  • Elevated pre-dialysis K+ levels were associated with a significantly higher risk of
    CV mortality in dialysis patients9

Hyperkalemia associated with higher risk
of all-cause mortality in HF10

Even a small increase in K+ levels may increase risk of mortality3

  • In a study evaluating the 16,116 serum K+ measurements taken from 2,164 patients with HF,
    a U-shaped association between serum K+ values and mortality was observed10
  • Analysis of serum K+ dynamics revealed that persistence of abnormal K+ levels was linked
    to a higher risk of mortality in comparison with patients who maintained or returned to
    normal values10

Adjusted survival probabilities associated with changes in potassium category

Hyperkalemia leads to suboptimal RAASi use11

Hyperkalemia is one of the main reasons for withholding RAASi treatment.11,12

  • ~50% of patients on maximum RAASi dose experiencing moderate-to-severe hyperkalemia had their
    dose reduced or stopped after a hyperkalemic event11
  • ~40% of patients on maximum RAASi dose experiencing mild hyperkalemia had their dose reduced or
    stopped after a hyperkalemic event11
 

Patients from a US database analysis

  

CKD patients

HF patients

Nearly half of patients on maximal RAASi dose have their treatment
reduced or stopped after a hyperkalemic event11

Discover more about the current treatment options
to manage hyperkalemia in selected patients

Learn more

Suboptimal RAASi use in CKD patients

Stopping or down-titrating RAASi therapy is associated with worse patient outcomes in CKD, including CKD
progression and progression to end-stage renal disease, as well as all-cause mortality.11

Mortality risk doubles when RAASi is reduced or stopped11

Adapted from Epstein et al. 2015.

  • The risk of mortality significantly increases following RAASi down-titration or discontinuation. For CKD
    patients on maximal RAASi dosage, the risk of mortality was significantly lower (9.8%) compared to
    patients on sub-maximal (20.3%) or who discontinued completely (22.4%)11

In a separate retrospective, observational study, 100,572 patients with new-onset CKD who
were prescribed RAASi therapy were monitored.13

MACE and mortality incidence stratified by RAASi dose in
patients with CKD (95% CI)

  • RAASi doses <50% of that recommended by the ESC guidelines were associated with consistently
    higher cumulative incidences of MACE and mortality compared with doses >50% in patients with CKD13

Physicians, therefore, are often faced with the dilemma of using RAASi and
accepting the risk of hyperkalemia or reducing/stopping RAASi and
accepting the risk of worse clinical outcomes.

Suboptimal RAASi use in HF patients

In a large Swedish study almost half of all patients discontinued MRA following an episode of hyperkalemia
within the first year of treatment,14 and in most patients, therapy was not reintroduced during the following
year. Discontinuation of concomitant ACEi/ARB use occurred in 23% of patients.14

Reducing RAASi increases mortality risk in HF patients11

Reducing or stopping RAASi is associated with an increased risk of mortality and morbidity,11,13
and an increased likelihood of hospitalisation in HF patients.15

Mortality risk doubles when RAASi is reduced or stopped11

Adapted from Epstein et al. 2015.

RAASi doses <50% of that recommended by ESC guidelines were associated with consistently higher cumulative
incidence of MACE and mortality compared with doses >50% in HF patients.13

MACE and mortality incidence stratified by RAASi dose
in patients with HF (95% CI)

The established relationship between reducing/stopping RAASi therapy and the
worse clinical outcomes present further challenges for physicians treating
patients with hyperkalemia on RAASi therapy.

Watch Professor Bohm describe the benefits, limitations and clinical considerations around RAASi therapy in heart failure

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Explore our patient profiles to
learn the considerations for
hyperkalemia treatment

Explore patient profiles

Discover more about the
importance of RAASi in
patients with CKD and HF

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