| アブストラクト | KEY POINTS: Hyperkalemia (HK) is associated with increased comorbidity burden in patients with CKD. Reducing serum potassium levels after HK episodes helps continuation of renin-angiotensin-aldosterone system inhibitor treatment. In Japan, HK treatment pathways are more heterogeneous and potassium binders are more commonly prescribed compared with the United Kingdom. BACKGROUND: This analysis used retrospective data from the DISCOVER CKD observational study (NCT04034992) to describe the burden of and treatment pathways for hyperkalemia (HK) in patients with CKD. METHODS: Data were extracted from the following databases: UK Clinical Practice Research Datalink (2008-2019) and Japan Medical Data Vision (2008-2017). Patients with CKD (two eGFR measures <75 ml/min per 1.73 m(2) recorded >/=90 days apart) and HK (at least two serum potassium [sK(+)] measures >5.0 mmol/L) were compared with patients without HK (sK(+) <5.0 mmol/L); HK index event was the second sK(+) measurement. Outcomes included baseline characteristics and treatment pathways for key medications (renin-angiotensin-aldosterone system inhibitors [RAASi], diuretics and potassium [K(+)] binders). RESULTS: In the UK Clinical Practice Research Datalink, 37,713 patients with HK and 142,703 patients without HK were included for analysis (HK prevalence 20.9%). In the Japan Medical Data Vision, 5924 patients with HK and 74,272 patients without HK were included for analysis (HK prevalence 7.4%). In both databases, median eGFR was lower and comorbidities such as hypertension, heart failure, type 2 diabetes, and AKI were more prevalent among patients with versus without HK, and most patients were taking RAASi at the time of HK index. Treatment pathways were more heterogeneous in Japan; <0.2% of patients with CKD and HK in the United Kingdom initiated K(+) binders within 3 months of HK index versus 18.7% in Japan. The proportions of patients with CKD and HK who stopped treatment with diuretics, K(+) binders, and RAASi during follow-up were 48.7%, 76.5%, and 50.6%, respectively, in the United Kingdom, and 22.9%, 53.6%, and 29.2%, respectively, in Japan. CONCLUSIONS: HK was associated with increased comorbidity burden in patients with CKD. Variations in treatment pathways between the United Kingdom and Japan reflect the previous lack of a standardized approach to HK management in CKD. |
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| 投稿者 | Fishbane, Steven; Carrero, Juan-Jesus; Kumar, Supriya; Kanda, Eiichiro; Hedman, Katarina; Ofori-Asenso, Richard; Kashihara, Naoki; Kosiborod, Mikhail N; Lainscak, Mitja; Pollock, Carol; Stenvinkel, Peter; Wheeler, David C; Pecoits-Filho, Roberto |
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| 組織名 | Division of Nephrology, Zucker School of Medicine at Hofstra/Northwell, Great;Neck, New York.;Department of Medical Epidemiology and Biostatistics, Karolinska Institutet,;Stockholm, Sweden.;Real World Data Science, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg,;Maryland.;Kawasaki Medical School, Kurashiki, Japan.;Late Cardiovascular, Renal, Metabolism, BioPharmaceuticals R&D, AstraZeneca,;Molndal, Sweden.;Biopharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom.;Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City,;Kansas City, Missouri.;Division of Cardiology, Faculty of Medicine, General Hospital Murska Sobota,;University of Ljubljana, Ljubljana, Slovenia.;Kolling Institute, Royal North Shore Hospital, University of Sydney, Sydney, New;South Wales, Australia.;Department of Renal Medicine M99, Karolinska University Hospital, Stockholm,;Sweden.;Department of Renal Medicine, University College London, London, United Kingdom.;School of Medicine, Pontifical Catholic University of Parana, Curitiba, Brazil.;Arbor Research Collaborative for Health, Ann Arbor, Michigan. |
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