Furuland Hans, Larsson Anders Olof, Bjellerup Per, Uhde Milica, Cars Thomas, Almstedt Matilda, Svensson Maria K
Department of Medical Sciences, Renal Medicine, Uppsala University Hospital, Akademiska Sjukhuset, Entrance 40, Floor 5, Uppsala, SE, 751 85, Sweden.
Department of Medical Sciences, Clinical Chemistry, Uppsala University Hospital, Uppsala, Sweden.
BMC Nephrol. 2025 Apr 28;26(1):213. doi: 10.1186/s12882-025-04146-8.
Potassium binders mitigate hyperkalemia, allowing patients to maintain their renin-angiotensin-aldosterone-system inhibitor (RAASi) treatment. This study characterized patients treated with first- or second-generation potassium binders, usage patterns and their effectiveness in reducing potassium levels, and changes in RAASi treatment in a Swedish population-based study.
A National Cohort included patients who had record of a treatment episode with a first-generation or second-generation potassium binder between 2018 and 2022. A Mid-Sweden Cohort included patients from the National Cohort who also had a record of a potassium measurement within the 60 days prior to beginning potassium binder treatment. Comorbidities, prior medication use, persistence with potassium binder treatment, subsequent changes in potassium levels and RAASi treatment were evaluated. Persistence was analyzed using the Kaplan-Meier estimator and changes in potassium levels were assessed using linear mixed-effects models.
23,892 treatment episodes involving 14,235 patients (mean age 70 years, 33% women) were followed in the National Cohort, and 4860 episodes involving 3179 patients (mean age 72 years, 34% women) in the Mid-Sweden Cohort. Patients treated with second-generation potassium binders had more comorbidities and higher median persistence with treatment compared to those on first-generation potassium binders, 112.5 (95% CI:112.5-117.5) vs. 87.5 (95% CI: 87.5-87.5) days in the National Cohort; 165.5 (95% CI: 121.0-198.0) vs. 97.6 (95% CI: 87.5-110.0) days in the Mid-Sweden Cohort. Both first- and second-generation potassium binders reduced potassium levels from baseline by day 15, 5.7 [95% CI: 4.5-6.8] mmol/L to 4.7 [95% CI: 3.6-5.9] mmol/L and 5.5 (95% CI: 4.3-6.7) mmol/L to 4.9 (95% CI: 3.8-6.1) mmol/L, respectively. Dose reduction or discontinuation of renin-angiotensin system inhibitors (RASi) or mineralocorticoid receptor antagonists (MRAs) was found in 31.4% and 47.7%, respectively, within 120 days of initiating therapy.
Both potassium binders effectively reduced potassium levels, but frequent discontinuation or dose reduction of RAASi therapy were still observed during this period. The adjustments of RAASi therapy, despite the achievement of normokalemia within 15 days, may be premature and warrants careful reconsideration to ensure optimal patient outcomes.
钾结合剂可减轻高钾血症，使患者能够维持肾素 - 血管紧张素 - 醛固酮系统抑制剂（RAASi）治疗。在一项基于瑞典人群的研究中，本研究对接受第一代或第二代钾结合剂治疗的患者进行了特征分析、使用模式及其降低血钾水平的有效性分析，以及RAASi治疗的变化情况分析。
全国队列纳入了2018年至2022年间有第一代或第二代钾结合剂治疗记录的患者。瑞典中部队列纳入了全国队列中在开始钾结合剂治疗前60天内也有血钾测量记录的患者。评估了合并症、既往用药情况、钾结合剂治疗的持续性、随后血钾水平的变化以及RAASi治疗情况。使用Kaplan - Meier估计器分析持续性，使用线性混合效应模型评估血钾水平的变化。
全国队列随访了涉及14235名患者（平均年龄70岁，33%为女性）的23892次治疗记录，瑞典中部队列随访了涉及3179名患者（平均年龄72岁，34%为女性）的4860次治疗记录。与接受第一代钾结合剂治疗的患者相比，接受第二代钾结合剂治疗的患者合并症更多，治疗的中位持续时间更长，在全国队列中分别为112.5（95%CI：112.5 - 117.5）天和87.5（95%CI：87.5 - 87.5）天；在瑞典中部队列中分别为165.5（95%CI：121.0 - 198.0）天和97.6（95%CI：87.5 - 110.0）天。第一代和第二代钾结合剂均使血钾水平在第15天时从基线分别降低，从5.7[95%CI：4.5 - 6.8]mmol/L降至4.7[95%CI：3.6 - 5.9]mmol/L和从5.5（95%CI：4.3 - 6.7）mmol/L降至4.9（95%CI：3.8 - 6.1）mmol/L。在开始治疗的120天内，分别有31.4%和47.7%的患者减少了肾素 - 血管紧张素系统抑制剂（RASi）或盐皮质激素受体拮抗剂（MRA）的剂量或停药。
两种钾结合剂均有效降低了血钾水平，但在此期间仍观察到RAASi治疗频繁停药或减量。尽管在15天内实现了血钾正常，但RAASi治疗的调整可能为时过早，需要仔细重新考虑以确保患者获得最佳预后。
