Managing RAAS-Inhibitor-Associated Hyperkalemia in Patients with CKD – A Balancing Act

Authors:
Michelle A. Fravel, PharmD, BCPS

Reviewers:
Zachary Hovis, PharmD, BCACP
Stuart T Haines, PharmD, BCACP

Citation:
Leon SJ, Whitlock R, Rigatto C, et al. Hyperkalemia-related discontinuation of renin-angiotensin-aldosterone system inhibitors and clinical outcomes in CKD: a population-based cohort study. Am J Kidney Dis 2022; 80 (2): 164-173.

The Problem

It is well established that renin-angiotensin-aldosterone system (RAAS) inhibitors, namely angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), slow the progression of kidney decline and development of cardiovascular complications in patients with chronic kidney disease (CKD).¹ Unfortunately, hyperkalemia is a common electrolyte disorder in patients with CKD that can be exacerbated by RAAS inhibitors. While hyperkalemia poses potential risks to patients with CKD, the potentially negative impact of discontinuing RAAS inhibitor therapy on long-term renal and cardiovascular outcomes in CKD patients is unclear.