Hyperkalemia-Related RAASi Reduction and Estimated Number Needed to Treat to Avoid a First Hospitalization by Maintaining RAASi

What is it about?

Renin-angiotensin-aldosterone system inhibitors (RAASis) are a group of medicines used to treat certain long-term diseases of the kidney (chronic kidney disease [CKD]) and of the heart (heart failure [HF]). However, these medicines can increase potassium levels in the blood. A high level of potassium in the blood is known as hyperkalemia, which, if very high and not treated, can lead to hospitalization and, in very severe cases, death. Doctors often lower the dose or stop RAASi medication altogether if a patient gets hyperkalemia. However, stopping or lowering the dose of RAASi treatment can make the patient’s underlying CKD and/or HF worsen. This research aimed to understand what happens if the RAASi dose is reduced after patients develop hyperkalemia compared with continuing with the same RAASi dose. Researchers used medical records from Germany, Spain, Sweden, and the UK to find patients with CKD and/or HF who had hyperkalemia while on RAASi therapy. The researchers compared patients who had their RAASi treatment reduced after hyperkalemia with patients who maintained the same RAASi dose after hyperkalemia, specifically looking at how many patients ended up in hospital over the next 6 months.

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Photo by Marcelo Leal on Unsplash

Photo by Marcelo Leal on Unsplash

Why is it important?

The results showed that patients with reduced RAASi treatment after experiencing hyperkalemia had a higher risk of being hospitalized within 6 months than those who maintained the same RAASi dose after hyperkalemia. On average, one hospitalization could be avoided for every 25 patients who kept their RAASi dose the same instead of reducing it. This shows that it is important for doctors to follow guidelines and to encourage patients to keep taking their RAASi at the optimal dose, even after hyperkalemia, to potentially reduce the risk of a hospital admission.