The effect of renin-angiotensin system blockades on renal protection in chronic kidney disease patients with hyperkalemia

Abstract

Background: Renin-angiotensin system (RAS) blockades are widely used in patients with chronic kidney disease (CKD), however, hyperkalemia as an adverse effect remains an obstacle in this population. It is not clear whether maintenance of RAS blockade is beneficial in CKD patients with elevated potassium levels. The aim of this study was to determine the effects of RAS blockade maintenance on renal protection in CKD patients with hyperkalemia occurred during treatment with RAS blockade.Methods: CKD III or IV patients, who were prescribed with RAS blockers and accompanied with hyperkalemia, were included. The study population was divided into two groups based on maintenance or withdrawal of RAS blocker. Renal outcomes (doubling creatinine or progression to ESRD) and incidence of hyperkalemia were compared between the two groups.Results:Out of 258 subjects who were developed hyperkalemia during the treatment with RAS blockers, 150 (58.1%) patients continued RAS blockades, while RAS blockades were discontinued for more than 3 months in the remaining 108 patients. Renal event-free survival was significantly higher in the maintenance group compared to the withdrawal group (p=0.04). Cox proportional hazard ratio for renal outcomes was 1.35 (95% CI; 1.08-1.92, p=0.04) in the withdrawal group compared to the maintenance group. In addition, prognostic significance was much greater in subgroup of patients with urine protein to creatinine ratio above 1.0 mg/mg (p=0.02). However, the incidence of hyperkalemia and hyperkalemia-related hospitalization or mortality during the follow up period did not differ between the two groups. Conclusion: This study demonstrated that the maintenance of RAS blockade is beneficial for preservation of renal function and relatively tolerable in CKD patients with hyperkalemia occurred during treatment with RAS blockade.