Risk–Benefit Balance of Renin–Angiotensin–Aldosterone Inhibitor Cessation in Heart Failure Patients with Hyperkalemia
Background: Whether to continue renin–angiotensin–aldosterone system inhibitor (RAASi) therapy in patients with hyperkalemia remains a clinical challenge, particularly in patients with heart failure (HF), where RAASis remain the cornerstone of treatment. We investigated the incidence of dose reducti...
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MDPI AG
2022-09-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/19/5828 |
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| author | Shun Kohsaka Suguru Okami Naru Morita Toshitaka Yajima |
| author_facet | Shun Kohsaka Suguru Okami Naru Morita Toshitaka Yajima |
| author_sort | Shun Kohsaka |
| collection | DOAJ |
| description | Background: Whether to continue renin–angiotensin–aldosterone system inhibitor (RAASi) therapy in patients with hyperkalemia remains a clinical challenge, particularly in patients with heart failure (HF), where RAASis remain the cornerstone of treatment. We investigated the incidence of dose reduction or the cessation of RAASis and evaluated the threshold of serum potassium at which cessation alters the risk–benefit balance. Methods: This retrospective analysis of a Japanese nationwide claims database investigated treatment patterns of RAASis over 12 months after the initial hyperkalemic episode. The incidences of the clinical outcomes of patients with RAASi (all ACEi/ARB/MRA) or MRA-only cessation (vs. non-cessation) were compared via propensity score-matched patients. A cubic spline regression analysis assessed the hazard of death resulting from treatment cessation vs. no cessation at each potassium level. Results: A total of 5059 hyperkalemic HF patients were identified; most received low to moderate doses of ACEis and ARBs (86.9% and 71.5%, respectively) and low doses of MRAs (76.2%). The RAASi and MRA cessation rates were 34.7% and 52.8% at 1 year post-diagnosis, while the dose reduction rates were 8.4% and 6.5%, respectively. During the mean follow-up of 2.8 years, patients who ceased RAASi or MRA therapies were at higher risk for adverse outcomes; cubic spline analysis found that serum potassium levels of <5.9 and <5.7 mmol/L conferred an increased mortality risk for RAASi and MRA cessation, respectively. Conclusions: Treatment cessation/dose reduction of RAASis are common among HF patients. The risks of RAASi/MRA cessation may outweigh the benefits in patients with mild to moderate hyperkalemia. |
| first_indexed | 2024-03-09T21:33:23Z |
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| language | English |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-6ed1edcf5c494aad82da9b0ef4ad36e02023-11-23T20:49:26ZengMDPI AGJournal of Clinical Medicine2077-03832022-09-011119582810.3390/jcm11195828Risk–Benefit Balance of Renin–Angiotensin–Aldosterone Inhibitor Cessation in Heart Failure Patients with HyperkalemiaShun Kohsaka0Suguru Okami1Naru Morita2Toshitaka Yajima3Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, JapanCardiovascular, Renal, and Metabolism, Medical Affairs, AstraZeneca K.K., Osaka 530-0011, JapanCardiovascular, Renal, and Metabolism, Medical Affairs, AstraZeneca K.K., Osaka 530-0011, JapanCardiovascular, Renal, and Metabolism, Medical Affairs, AstraZeneca K.K., Osaka 530-0011, JapanBackground: Whether to continue renin–angiotensin–aldosterone system inhibitor (RAASi) therapy in patients with hyperkalemia remains a clinical challenge, particularly in patients with heart failure (HF), where RAASis remain the cornerstone of treatment. We investigated the incidence of dose reduction or the cessation of RAASis and evaluated the threshold of serum potassium at which cessation alters the risk–benefit balance. Methods: This retrospective analysis of a Japanese nationwide claims database investigated treatment patterns of RAASis over 12 months after the initial hyperkalemic episode. The incidences of the clinical outcomes of patients with RAASi (all ACEi/ARB/MRA) or MRA-only cessation (vs. non-cessation) were compared via propensity score-matched patients. A cubic spline regression analysis assessed the hazard of death resulting from treatment cessation vs. no cessation at each potassium level. Results: A total of 5059 hyperkalemic HF patients were identified; most received low to moderate doses of ACEis and ARBs (86.9% and 71.5%, respectively) and low doses of MRAs (76.2%). The RAASi and MRA cessation rates were 34.7% and 52.8% at 1 year post-diagnosis, while the dose reduction rates were 8.4% and 6.5%, respectively. During the mean follow-up of 2.8 years, patients who ceased RAASi or MRA therapies were at higher risk for adverse outcomes; cubic spline analysis found that serum potassium levels of <5.9 and <5.7 mmol/L conferred an increased mortality risk for RAASi and MRA cessation, respectively. Conclusions: Treatment cessation/dose reduction of RAASis are common among HF patients. The risks of RAASi/MRA cessation may outweigh the benefits in patients with mild to moderate hyperkalemia.https://www.mdpi.com/2077-0383/11/19/5828heart failurehyperkalemiamineralocorticoid receptor antagonistsrenin–angiotensin–aldosterone system inhibitorsrisk–benefit |
| spellingShingle | Shun Kohsaka Suguru Okami Naru Morita Toshitaka Yajima Risk–Benefit Balance of Renin–Angiotensin–Aldosterone Inhibitor Cessation in Heart Failure Patients with Hyperkalemia Journal of Clinical Medicine heart failure hyperkalemia mineralocorticoid receptor antagonists renin–angiotensin–aldosterone system inhibitors risk–benefit |
| title | Risk–Benefit Balance of Renin–Angiotensin–Aldosterone Inhibitor Cessation in Heart Failure Patients with Hyperkalemia |
| title_full | Risk–Benefit Balance of Renin–Angiotensin–Aldosterone Inhibitor Cessation in Heart Failure Patients with Hyperkalemia |
| title_fullStr | Risk–Benefit Balance of Renin–Angiotensin–Aldosterone Inhibitor Cessation in Heart Failure Patients with Hyperkalemia |
| title_full_unstemmed | Risk–Benefit Balance of Renin–Angiotensin–Aldosterone Inhibitor Cessation in Heart Failure Patients with Hyperkalemia |
| title_short | Risk–Benefit Balance of Renin–Angiotensin–Aldosterone Inhibitor Cessation in Heart Failure Patients with Hyperkalemia |
| title_sort | risk benefit balance of renin angiotensin aldosterone inhibitor cessation in heart failure patients with hyperkalemia |
| topic | heart failure hyperkalemia mineralocorticoid receptor antagonists renin–angiotensin–aldosterone system inhibitors risk–benefit |
| url | https://www.mdpi.com/2077-0383/11/19/5828 |
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