OBJECTIVES

: Patients with Chronic Kidney Disease (CKD) taking Renin-Angiotensin-Aldosterone-System inhibitors (RAASi) are at high risk of hyperkalaemia (HK). HK can lead to RAASi treatment modification. RAASi discontinuation may lead to progression of CKD. National estimates of HK frequency and impact on CKD management are key to inform Health Authority decisions. Our objective was to describe RAASi treatment experiences and hospitalisation patterns following HK.

METHODS

: Retrospective cohort study of CKD (stage 3-4) patients (≥ 18 years old), registered in CPRD practices in England with Hospital Episode Statistic (HES) linkage. The study period was 1Jan2012-31Dec2016. CKD was defined by Read codes and lab test results. Patients had ≥ 12m data before first CKD record (index date); follow-up was until the earliest of: end of study period, last collection date, GP transfer out, death, or kidney transplant. Patients characteristics were summarized with descriptive statistics. Hospital length of stay (LOS) was estimated from HES linkage. RAASi treatment and discontinuation was defined from prescription records.

RESULTS

: There were 31,392 CKD patients, mostly stage 3 (n=29,779; 94.9%) in CPRD England; mean age was 74.8 years (±12.7 SD); 42.1% were male; hypertension was the most common comorbidity (n=15,646, 48.9%). 22,156 (70.6%) patients had HES linkage and 9,663 (43.6%) started RAASi after index date and 1,915 (19.8%) experienced HK thereafter. Most patients (66.1%) received an angiotensin-converting-enzyme inhibitor, while angiotensin receptor blockers or aldosterone antagonists were prescribed to 26.9% and 7.0% patients, respectively. There was a total of 4,171 unique hospital admissions, 17.1% (n=714) due to CKD and 30.0% (n=1,251) to cardiovascular related issues; the mean LOS were 9.9 and 9.4 days, respectively. In total 338 patients (17.7%) discontinued RAASi treatment.

CONCLUSIONS

: RAASi treatment discontinuation and lengthy average hospital stays were observed in CKD patients with HK history. These results highlight the need for HK treatment that will enable RAASi continuation.