by Kristen Monaco, Senior Staff Writer, MedPage Today April 14, 2023
AUSTIN, Texas -- Dietary counseling alone wasn't cutting it for patients with chronic kidney disease (CKD) experiencing recurrent hyperkalemia, according to real-word data from the REVOLUTIONIZE I study. CAS No. 206996-60-3)
Within 1 month of medical nutrition therapy (MNT) involving a low-potassium diet (typically less than 3 g per day), hyperkalemia recurred in 37.4% of patients with stage 3-4 CKD, reported Christopher Rowan, PhD, of COHRDATA in San Clemente, California, and colleagues.
This percentage grew over time in the months following a low-potassium diet, affecting more than half of these patients by month 4:
Within 6 months of receiving MNT, these patients had an average of 2.6 episodes of hyperkalemia recurrence, according to the poster presented at the National Kidney Foundation Spring Clinical Meeting.
"The results from this study show recurrent hyperkalemia is both very common and serious," said co-investigator Jamie Dwyer, MD, of University of Utah Health in Salt Lake City, adding that the condition is associated with "increased healthcare costs, admission/readmission risk, and mortality risk."
"A multi-modal and aggressive management plan, perhaps including both MNT and pharmacotherapy, may be needed to improve clinical outcomes for patients with hyperkalemia and CKD," he told MedPage Today. "It would be prudent to closely manage patients who have hyperkalemia and CKD -- especially if MNT is selected as the primary treatment modality. To maintain normal potassium and mitigate recurrent hyperkalemia episodes, we might also consider drug therapies like potassium binders."
Some of these potassium binders include patiromer (Veltassa), which was FDA approved in 2015, and sodium zirconium cyclosilicate (Lokelma), approved in 2018.
The time lapse between each hyperkalemia episode only shrunk, too. While these patients had an average of 45 days to their first episode of recurrence, this dropped to 35 days for the second recurrence, 29 days to the third recurrence, and 27 days to the fourth recurrence.
For the index hyperkalemia event, the average serum potassium level was 5.50 mmol/L. By the first recurrence, potassium levels were an average of 5.42 mmol/L. Levels were an average of 5.40 mmol/L, 5.48 mmol/L, and 5.45 mmol/L, respectively, on the second, third, and fourth recurrences.
"For patients with a hyperkalemia recurrence ... only a small mean reduction in serum potassium concentration (less than 0.1 mmol/L reduction) was observed following MNT," Dwyer pointed out, adding how surprising it was to see just how quick the time from MNT to recurrence was.
He said it was also surprising to find the high levels of inpatient admission rates, despite the utilization of MNT. A total of 13.7% of patients had hyperkalemia-related admission while 63.5% were admitted for any cause.
The 6-month retrospective, observational study included 2,048 patients whose electronic health records were pulled from 53 healthcare organizations across the U.S. All patients were adults with CKD stages 3-4: 26% had stage 3A (estimated glomerular filtration rate [eGFR] 45-59), 32.1% had stage 3B (eGFR 30-44), and 41.9% had stage 4 (eGFR 15-29).
All received MNT and had a serum potassium level over 5.0 mmol/L within 30 days prior to therapy.
About 60% were male, 61% white, 29% Black, and 89% resided in the Northeast. The majority of patients had comorbid "complicated" diabetes and congestive heart failure. A total of 71% were on a loop diuretic and 44% on a renin-angiotensin-aldosterone system inhibitor.
Most (59%) had mildly elevated serum potassium at baseline -- over 5.0 but below 5.5 mmol/L. About 28% had moderately elevated levels (5.5 to under 6.0), 8.3% had severe (6.0 to under 6.5), and 4.4% had levels of 6.5 or higher.
Kristen Monaco is a senior staff writer, focusing on endocrinology, psychiatry, and nephrology news. Based out of the New York City office, she’s worked at the company since 2015.
The study was funded by AstraZeneca.
Dwyer reported no disclosures; co-authors reported ties with industry, including employment with AstraZeneca.
Source Reference: Rowan CG, et al "Recurrence of hyperkalemia following dietary counseling: REVOLUTIONIZE I real-world evidence study" NKF 2023; Poster #296.
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