Real-World Epidemiology of Potassium Derangements Among Chronic Cardiovascular, Metabolic and Renal Conditions: A Population-Based Analysis

Abstract

Background

The aims of the present analysis are to estimate the prevalence of five key chronic cardiovascular, metabolic and renal conditions at the population level, the prevalence of renin–angiotensin–aldosterone system inhibitor (RAASI) medication use and the magnitude of potassium (K⁺) derangements among RAASI users.

Methods and Results

We used data from more than 375,000 individuals, 55 years of age or older, included in the population-based healthcare database of the Catalan Institute of Health between 2015 and 2017. The conditions of interest were chronic heart failure (CHF), chronic kidney disease (CKD), diabetes mellitus, ischemic heart disease and hypertension. RAASI medications included angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, mineralocorticoid receptor antagonists (MRAs) and renin inhibitors. Hyperkalemia was defined as K⁺ levels >5.0 mEq/L and hypokalemia as K⁺ <3.5 mEq/L. The prevalence of chronic cardiovascular, metabolic and renal conditions was high, and particularly that of hypertension (prevalence ranging from 48.2% to 48.9%). The use of at least one RAASI medication was almost ubiquitous in these patients (75.2–77.3%). Among RAASI users, the frequency of K⁺ derangements, mainly of hyperkalemia, was very noticeable (12% overall), particularly in patients with CKD or CHF, elderly individuals and users of MRAs. Hypokalemia was less frequent (1%).

Conclusion

The high prevalence of K⁺ derangements, and particularly hyperkalemia, among RAASI users highlights the real-world relevance of K⁺ derangements, and the importance of close monitoring and management of K⁺ levels in routine clinical practice. This is likely to benefit a large number of patients, particularly those at higher risk.

Keywords:

• chronic heart failure
• chronic kidney disease
• heart failure
• hyperkalemia
• hypertension
• potassium

Abbreviations

ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin II receptor blocker; ARNI, angiotensin II receptor blocker neprilysin inhibitor; ATC, Anatomical Therapeutic Chemical (coding system); CCS, Clinical Classifications Software; CHF, chronic heart failure; CKD, chronic kidney disease; DM, diabetes mellitus; HTN, hypertension; ICD-9-CM, International Classification of Diseases, 9th Revision, Clinical Modification; ICD-10, International Classification of Diseases, 10th Revision; ICS, Catalan Institute of Health (Institut Catala de Salut); IHD, ischemic heart disease; K⁺, potassium; MetroSud, Metropolitana Sud healthcare area; MRA, mineralocorticoid receptor antagonist; RAAS, renin–angiotensin–aldosterone system; RAASI, RAAS inhibitor; RI, renin inhibitor.

Declaration of Authorship

All authors listed take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

Disclosure

Josep Comin-Colet had received speaker fees from Vifor Pharma. The authors report no other potential conflicts of interest for this work.

Additional information

Funding

The present study was funded by an unrestricted research grant from Vifor Pharma.