Advances in therapyApr 30, 2024

Return of High Blood Potassium After Diet Treatment in Patients with Moderate to Severe Chronic Kidney Disease

Circadian Biology Weekly Brief ↗PubMed ↗DOI ↗OA ↗

Updated Mar 28, 2026

Abstract

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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Return of High Blood Potassium After Diet Treatment in Patients with Moderate to Severe Chronic Kidney Disease

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