Hyperkalemia and Use of Raas Inhibitors in Stage 3-5 Chronic Kidney Disease Non-Dialysis Patients: a Single-Center Experience

Abstract

Objectives: Despite the risk of hyperkalemia, renin angiotensin aldosterone system inhibitors (RAASi) are widely used in chronic kidney disease (CKD) because of their positive effects on mortality. In this study, we aimed to investigate the frequency of hyperkalemia, the use of RAASi, and potassium binders in Stage 3-5 CKD non-dialysis patients. Methods: In this cross-sectional study, non-dialysis patients with Stage 3-5 CKD were recruited and evaluated at two visits with a 3-month interval. The use of RAASi and potassium-lowering therapy of the patients were followed up. Pres- ence of hyperkalemia at both visits was defined as persistent hyperkalemia. Results: A total of 182 patients were included in the study. The mean serum potassium was 4.8±0.5 mmol/L, and the prevalence of hyperkalemia was 27.5%. Serum potassium level was similar between CKD groups. RAASi use was sig- nificantly higher in CKD Stages 3a and 3b than the other groups (p<0.001). Potassium binder use was highest in CKD Stage 5. Despite persistent hyperkalemia, most of the patients continued to use the RAASi. Potassium binder use was also high to tolerate hyperkalemia. Conclusion: Our study reveals that RAASi continues to be used in daily practice even in cases of persistent hyperkale- mia due to its positive effects.