Management of Hyperkalaemia - KDIGO

[Pages:60]Management of Hyperkalaemia:

KDIGO More Than Just Avoiding Bananas

Prof Simon D Roger MD FRACP Director, Renal Research, Dept of Nephrology

Gosford, Australia

Today's talk......

n Who is at risk? Incidence and recurrence n Hyperkalemia and mortality

KDIGO n Impact of hyperkalemia on healthcare resource utilization, hospital visits and emergency department visits n Treatment options

n What about the foods? n Sub-optimal RAASi and MRA therapy due to fear of hyperkalemia n What is on the horizon to lower potassium?

n Unmet needs in hyperkalemic CKD patients: How would you manage the patient?

Hyperkalaemia is prevalent in specific patient populations, such as CKD and heart failure and those prescribed key drug classes

CKD

Chronic heart failure

KDIKGO (frequency 40?50%)29

(frequency up to 50%)62

+

Diabetes mellitus (frequency up to

15%)69

Resistant hypertension (frequency up to 20%a)70,71

aAmong patients prescribed add-on MRA treatment CKD, chronic kidney disease; HF, heart failure; MRA, mineralocorticoid receptor antagonist

High potassium risk increases with CKD severity

Odds ratio of K+ 5.5 mEq/L

14

12

11.00

10

8 6

KDIGO5.91

4

2

1.00

0

No CKD (reference)

2.24 CKD stage 3

CKD stage 4

CKD stage 5

CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; high K, hyperkalaemia Einhorn LM, et al. Arch Intern Med 2009;169:1156?1162

High potassium is associated with increased morbidity and mortality

? As serum K+ levels deviate from normal levels, rates of morbidity (including MACE) and mortality increase1?5

Morbidity and mortality

KDIGO 3.5 mEq/L NORMNOOKRAMLAALEMIA 5.0 mEq/L PotaKs+sium

HypHoykpaloaKemia

HypheirgkhalKemia

Morbidity and mortality

CV, cardiovascular; high K, hyperkalaemia; HypoK, hypokalaemia; MACE, major adverse cardiovascular events 1. Luo J, et al. Clin J Am Soc Nephrol 2016;11:90?100; 2. McMahon GM, et al. Intensive Care Med 2012;38:1834?1842; 3. Hayes J, et al. Nephron Clin Pract 2012;120:c8?c16; 4. An JN, et al. Crit Care 2012;16:R225; 5. Goyal A, et al. JAMA 2012;307:157?164

Recent studies confirm high serum K+ levels are associated with increased risk of mortality and MACE in CKD

2.5

2.07

2.0

1.5

1.0

0.5

0.0

K+ levels and risk of mortality

K+ levels and risk of MACE

1.26 1.02

2.4

2.23 2.2

KDIGO2.0

1.8

1.6

1.40

1.29

1.4

1.02

1.2

1.09 1.01

1.0

1.00

0.8

0.6

0.4

0.2

0.0

1.01 1.00

1.31 1.17

Adjusted IRR Adjusted IRR

Serum K+ (mEq/L)

Serum K+ (mEq/L)

CKD, chronic kidney disease; CPRD, Clinical Practice Research Datalink; HES, hospital episode statistics; IRR, incident risk ratio; MACE, major adverse cardiovascular events

Adapted from Qin L, et al. Presented at ERA-EDTA, Madrid; 3rd?6th June 2017; Oral presentation MO067

Today's talk......

n Who is at risk? Incidence and recurrence n Hyperkalemia and mortality

KDIGO n Impact of hyperkalemia on healthcare resource utilization, hospital visits and emergency department visits n Treatment options

n What about the foods? n Sub-optimal RAASi and MRA therapy due to fear of hyperkalemia n What is on the horizon to lower potassium?

n Unmet needs in hyperkalemic CKD patients: How would you manage the patient?

% of patients at risk of acute hospitalisation

CKD patients with a hyperkalemic event are at higher risk of hospitalisation

Risk of acute hospitalisation

After vs before risk ratio (95% CI): 1.72 (1.69, 1.74)

Patients with a hyperkalemic event Time-matched comparison cohort without a hyperkalemic event

100

? CKD patients with hyperkalemia were

80 60

KDIGO Risk ratio: 1.72

at higher risk of acute hospitalisation after an hyperkalemic event compared with the control group without

hyperkalemia

40

? The risk for the comparison cohort

remained relatively unchanged over

20

the same time period

0

6 months before a

6 months after

hyperkalemic event hyperkalemic event

CKD, chronic kidney disease; Adapted from Thomsen RW, et al. Presented at ERA-EDTA, Madrid, 3rd?6th June 2017; Oral presentation MO066

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