In a cohort of 2048 patients with stage 3-4 chronic kidney disease, 56.0% experienced at least one recurrence of during a 6-month follow-up.
Patients with hyperkalemia had a mean of 2.6 recurrences during the follow-up period.
37.4% of patients had at least one recurrence within the first month after .
The mean time to the first hyperkalemia recurrence was 45 days, with shorter intervals between subsequent episodes.
Hyperkalemia-related hospitalizations occurred in 13.7% of patients, while 1.5% had emergency department visits.
Results were consistent across subgroups, including those with heart failure and those on specific hypertension medications.
Simplified
INTRODUCTION: The REVOLUTIONIZE I study aimed to characterize the relationships between (MNT) and recurrence in patients with stage 3-4 chronic kidney disease (CKD) and hyperkalemia who received MNT in real-world clinical practice.
METHODS: This observational cohort study used de-identified electronic health record data from patients aged ≥ 18 years with stage 3-4 CKD who received MNT between January 2019 and October 2022 and had hyperkalemia (serum potassium > 5.0 mmol/L) within 30 days before MNT. Patients were followed for 6 months or until the first censoring event (death, prescription of outpatient potassium binder, or study end). The primary outcome was the percentage of patients with ≥ 1 hyperkalemia recurrence during follow-up. Secondary outcomes included the number of hyperkalemia recurrences per patient, time to each recurrence, and hyperkalemia-related healthcare resource utilization. Exploratory outcomes included all-cause healthcare resource utilization and mortality.
RESULTS: The final cohort comprised 2048 patients; 1503 (73.4%) patients remained uncensored after 6 months. During the 6-month follow-up period, 56.0% of patients had ≥ 1 hyperkalemia recurrence and 37.4% had ≥ 1 recurrence within the first month. Patients with ≥ 1 hyperkalemia recurrence during follow-up had a mean ± standard deviation (SD) of 2.6 ± 2.2 recurrences. The mean ± SD time to first hyperkalemia recurrence was 45 ± 46 days; the time between recurrences decreased with subsequent episodes. Hyperkalemia-related hospitalizations and emergency department visits were recorded for 13.7% and 1.5% of patients, respectively. Sensitivity analyses showed that results were consistent across patient subgroups, including those with comorbid heart failure and patients receiving renin-angiotensin-aldosterone system inhibitor therapy at baseline.
CONCLUSION: Most patients with stage 3-4 CKD had hyperkalemia recurrence, and MNT alone was inadequate to prevent recurrence. These patients may require additional long-term treatment, such as novel potassium binders, to maintain normokalemia and prevent hyperkalemia recurrence following MNT. Infographic available for this article. INFOGRAPHIC.
Key numbers
56.0%
Recurrence Rate
Percentage of patients with at least one recurrence during follow-up.
2.6
Mean Recurrences
Average number of recurrences per patient during the follow-up.
13.7%
Hospitalization Rate
Percentage of patients requiring -related hospitalizations.
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Christopher G. Rowan was paid by TriNetX, LLC as an observational scientist to design and execute this study and is a paid consultant for Harvard Pilgrim Health Care Institute and Puma Biotech. Abiy Agiro, Ellen Colman, and Pooja Desai are employees and stockholders of AstraZeneca. K. Arnold Chan and Katie White are employees of TriNetX, LLC. The study described in this manuscript was conducted as part of their employment responsibilities at TriNetX, LLC. The authors were compensated by TriNetX, LLC for their contributions to the design, data collection, analysis, and interpretation of the study findings presented herein. The funding for this study was provided by AstraZeneca. Jamie P. Dwyer has acted as a scientific consultant for AstraZeneca and received fees from AstraZeneca for the conduct of this study; has received fees from Sanofi and CSL Behring as part of a steering committee; has received fees from Novo Nordisk for outcome adjudication for a clinical trial; has received fees from Boehringer Ingelheim and Lilly for study design; and has received personal fees from Bayer, CinCor, Caladrius Biosciences, Inversago, GlaxoSmithKline LLC, and ProKidney.
