RWE shows risk of cutting RAASi medication in cardiorenal patients


A real-world evidence (RWE) study has shown the negative consequences of reducing or discontinuing renin-angiotensin-aldosterone system inhibitor (RAASi) medication in patients experiencing hyperkalaemia (HK).

One analysis from AstraZeneca’s ZORA study showed that discontinuation of RAASi treatment following a HK episode in cardiorenal patients with chronic kidney disease (CKD) and/or heart failure (HF) was still common in clinical practice in the US and Japan despite guidelines recommending maintained treatment.

In those patients who discontinued, re-initiation occurred within six months in only 10% to 15% of patients in the US and among 6% to 8% of patients in Japan.

In the small number who re-initiated RAASi, 17% to 37% of patients in the US and Japan respectively had their dose reduced by >25%.

A second analysis found that in cardiorenal patients living in Sweden and Japan, reduced RAASi treatment following a HK episode resulted in an increased number of all-cause hospital inpatient days by 18.2 days in Sweden and 17.9 days in Japan, six months after the HK event.

The increase in hospital days in patients who maintained their RAASi treatment, versus six months post the HK event, was 9.4 and 8.5 days in Sweden and Japan, respectively. Similar patterns were observed for CKD- and HF-related hospital inpatient days.

Anjay Rastogi, Clinical Chief of Nephrology, University of California Los Angeles (UCLA) Health, said: “These powerful real-world data show how common it is for hyperkalaemia to cause down-titration of guideline-recommended RAASi therapy in cardiorenal patients. Hyperkalaemia should not be a barrier to patients with chronic kidney disease or heart failure achieving guideline directed RAASi treatment, especially when there are treatment options, like potassium binders, which may better manage this chronic condition.”

The data were presented at the European Renal Association (ERA) 2023 Congress in Milan, Italy.

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