Hyperkalemia Burden and Treatment Pathways in Patients with CKD: Findings From the DISCOVER CKD Retrospective Cohort

Abstract

Key Points:

1. Hyperkalemia (HK) is associated with increased comorbidity burden in patients with CKD.

2. Reducing serum potassium levels after HK episodes helps continuation of renin-angiotensin-aldosterone system inhibitor treatment.

3. In Japan, HK treatment pathways are more heterogeneous and potassium binders are more commonly prescribed compared with the United Kingdom.

Background: This analysis used retrospective data from the DISCOVER CKD observational study (NCT04034992) to describe the burden of and treatment pathways for hyperkalemia (HK) in patients with CKD.

Methods: Data were extracted from the following databases: UK Clinical Practice Research Datalink (2008–2019) and Japan Medical Data Vision (2008–2017). Patients with CKD (two eGFR measures <75 ml/min per 1.73 m² recorded ≥90 days apart) and HK (at least two serum potassium [sK⁺] measures >5.0 mmol/L) were compared with patients without HK (sK⁺ <5.0 mmol/L); HK index event was the second sK⁺ measurement. Outcomes included baseline characteristics and treatment pathways for key medications (renin-angiotensin-aldosterone system inhibitors [RAASi], diuretics and potassium [K⁺] binders).

Results: In the UK Clinical Practice Research Datalink, 37,713 patients with HK and 142,703 patients without HK were included for analysis (HK prevalence 20.9%). In the Japan Medical Data Vision, 5924 patients with HK and 74,272 patients without HK were included for analysis (HK prevalence 7.4%). In both databases, median eGFR was lower and comorbidities such as hypertension, heart failure, type 2 diabetes, and AKI were more prevalent among patients with versus without HK, and most patients were taking RAASi at the time of HK index. Treatment pathways were more heterogeneous in Japan; <0.2% of patients with CKD and HK in the United Kingdom initiated K⁺ binders within 3 months of HK index versus 18.7% in Japan. The proportions of patients with CKD and HK who stopped treatment with diuretics, K⁺ binders, and RAASi during follow-up were 48.7%, 76.5%, and 50.6%, respectively, in the United Kingdom, and 22.9%, 53.6%, and 29.2%, respectively, in Japan.

Conclusions: HK was associated with increased comorbidity burden in patients with CKD. Variations in treatment pathways between the United Kingdom and Japan reflect the previous lack of a standardized approach to HK management in CKD.