Key result
Reducing RAASi treatment after hyperkalaemia was associated with a greater increase in hospitalized days per person-year compared to maintaining treatment (Sweden: 18.2 vs 9.4; Japan: 17.9 vs 8.5).
Why the study?
Hyperkalaemia is a barrier to optimal RAASi treatment in patients with CKD and/or HF, but the association between hyperkalaemia-related RAASi reduction and subsequent hospitalized days was unclear.
Does reducing RAASi treatment after a hyperkalaemia episode increase hospitalized days in patients with CKD and/or HF?
Cohort (n=28,613)
Yes
Does reducing RAASi treatment after a hyperkalaemia episode increase hospitalized days in patients with CKD and/or HF?
Reducing RAASi therapy following a hyperkalaemia episode in patients with CKD or HF is associated with significantly more hospitalized days and fewer days alive and out of hospital compared to maintaining therapy.
This is the authors' abstract. We don't add key points for this paper.
BACKGROUND: Hyperkalaemia is a barrier to achieving optimal, guideline-directed treatment with renin-angiotensin-aldosterone system inhibitors (RAASis) in patients with chronic kidney disease (CKD) and/or heart failure (HF). This study describes the association between hyperkalaemia-related RAASi treatment reduction and the number of hospitalized days in patients with CKD and/or HF in Sweden and Japan. METHODS: Using data from health registers and hospital medical records, patients with CKD and/or HF currently receiving RAASis who experienced an index hyperkalaemia episode were identified and categorized as having maintained or reduced RAASi treatment post-index; propensity score matching (1:1) was applied to balance the groups in terms of baseline characteristics. Changes in the number of all-cause, CKD- and HF-related hospitalized days per patient-year during 6 months pre- versus post-index and the number of days alive and out of hospital (DAOH) during 6 months post-index were described. RESULTS: Overall, 20 824 and 7789 patients were included from Sweden and Japan, respectively, 42% and 38% of whom reduced their RAASi treatment after the index hyperkalaemia episode. During the 6 months post-index, all-cause hospitalization increased by 18.2 days [95% confidence interval (CI) 17.0-19.2] per person-year in Sweden and 17.9 days (95% CI 17.4-18.5) per person-year in Japan among patients with reduced RAASi treatment compared with increases of 9.4 days (95% CI 8.6-10.4) and 8.5 days (95% CI 8.0-9.0) per person-year, respectively, among patients with maintained RAASi treatment. The mean DAOH was 121.5 [standard deviation (SD) 75.0] in Sweden and 141.7 (SD 54.5) in Japan among patients with reduced RAASi treatment compared with 154.0 (SD 51.3) and 157.5 (SD 31.6), respectively, among patients with maintained RAASi treatment. CONCLUSION: Patients whose RAASi treatment was reduced after a hyperkalaemia episode had more hospitalized days and fewer DAOH compared with patients whose RAASi treatment was maintained.
Reducing RAASi after hyperkalemia may increase hospitalization burden; leaves open whether maintenance improves outcomes in CKD/HF.
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Svensson et al. (2024) conducted a cohort in Chronic kidney disease and/or heart failure with hyperkalaemia (n=28,613). Reduced RAASi treatment vs. Maintained RAASi treatment was evaluated on Increase in all-cause hospitalized days per person-year (Sweden cohort). Reducing RAASi treatment after hyperkalaemia was associated with a greater increase in hospitalized days per person-year compared to maintaining treatment (Sweden: 18.2 vs 9.4; Japan: 17.9 vs 8.5).
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