Estimated Number Needed to Treat to Avoid a First Hospitalization by Maintaining Instead of Reducing Renin-Angiotensin-Aldosterone System Inhibitor (RAASi) Therapy after Hyperkalemia
2024

Keeping RAASi Therapy After High Potassium Levels Can Prevent Hospitalization

Sample size: 40059 publication 10 minutes Evidence: moderate

Author Information

Author(s): Maria K. Svensson, Michael Fischereder, Paul R. Kalra, Ignacio José Sánchez Lázaro, Eva Lesén, Stefan Franzén, Alaster Allum, Thomas Cars, Nils Kossack, Philipp Breitbart, David Arroyo

Primary Institution: Uppsala University, Uppsala, Sweden

Hypothesis

Can maintaining RAASi therapy after a hyperkalemia episode reduce hospitalization rates?

Conclusion

Maintaining RAASi therapy after a hyperkalemia episode may help avoid hospitalizations.

Supporting Evidence

  • Reducing RAASi therapy after hyperkalemia increases hospitalization risk.
  • 25 patients need to maintain RAASi therapy to avoid one hospitalization.
  • Patients with CKD and/or HF were studied across four European countries.
  • RAASi therapy is often reduced after hyperkalemia, leading to worse outcomes.
  • Maintaining RAASi therapy aligns with clinical guidelines.

Takeaway

If patients keep taking their heart and kidney medicine after having high potassium levels, they might not have to go to the hospital as much.

Methodology

The study used health care registers and claims data from four European countries to compare hospitalization risks between patients who reduced versus maintained RAASi therapy after hyperkalemia.

Potential Biases

Some residual confounding may remain due to the observational nature of the study.

Limitations

The study may have underestimated hospitalization risk by excluding patients with less follow-up time, potentially leading to a healthier sample.

Participant Demographics

Patients were mostly elderly, with a mean age of 75.7 to 78.6 years, and included both men and women with CKD and/or HF.

Statistical Information

P-Value

4.1%

Confidence Interval

95% CI, 2.8 to 5.3

Statistical Significance

p<0.05

Digital Object Identifier (DOI)

10.34067/KID.0000000000000561

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