Evidence map›Paper›PMID 36658531›Full record

Observational studyBMC nephrology2023

Clinical impact of suboptimal RAASi therapy following an episode of hyperkalemia.

Eiichiro Kanda, Anjay Rastogi, Toyoaki Murohara, Eva Lesén, Abiy Agiro, Matthew Arnold, Gengshi Chen, Toshitaka Yajima, Krister Järbrink, Charles V Pollack

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMC nephrology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 43 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
43citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

43 citing papers in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Eiichiro KandaDepartment of Medical Science, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan. kms.cds.kanda@gmail.com.
Anjay RastogiDepartment of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA.
Toyoaki MuroharaDepartment of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Eva LesénMedical & Payer Evidence, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.
Abiy AgiroUS Evidence, Medical Affairs, BioPharmaceuticals R&D, AstraZeneca, DE, Wilmington, USA.
Matthew ArnoldReal World Science and Digital, AstraZeneca, Cambridge, UK.
Gengshi ChenHealth Economics & Payer Evidence, AstraZeneca, Cambridge, UK.
Toshitaka YajimaCVRM TA, Medical Affairs, AstraZeneca, Tokyo, Japan.
Krister JärbrinkMedical & Payer Evidence, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.
Charles V PollackDepartment of Emergency Medicine, University of Mississippi School of Medicine, Jackson, MS, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundHyperkalemia (HK) is a barrier to optimization of renin-angiotensin-aldosterone system inhibitor (RAASi) therapy in heart failure (HF) and chronic kidney disease (CKD). We investigated cardiorenal risk associated with changes in RAASi regimen after an episode of HK in patients with HF and/or CKD.

methodsThis observational study utilized data from hospital records, claims, and health registers from the US (Optum's de-identified Market Clarity Data) and Japan (Medical Data Vision). Included patients had an index episode of HK between July 2019 and September 2021 (US), or May 2020 and September 2021 (Japan), with prior diagnosis of HF or CKD (stage 3 or 4), and RAASi use. Risk of a cardiorenal composite outcome (HF emergency visit, HF hospitalization, or progression to end-stage kidney disease) was determined in patients who discontinued RAASi, down-titrated their dose by > 25%, or maintained or up-titrated their dose following the HK episode.

resultsA total of 15,488 and 6020 patients were included from the US and Japan, respectively. Prior to the episode of HK, 59% (US) and 27% (Japan) of patients had achieved > 50% target RAASi dose. Following the episode of HK, 33% (US) and 32% (Japan) of patients did not fill a new RAASi prescription. Risk of the cardiorenal outcome at 6 months was higher in patients who discontinued or down-titrated versus maintained or up-titrated RAASi treatment both in the US (17.5, 18.3, and 10.6%; p <  0.001) and in Japan (19.7, 20.0, and 15.1%; p <  0.001).

conclusionHK-related RAASi discontinuation or down-titration was associated with higher risk of cardiorenal events versus maintained or up-titrated RAASi.

Indexed as

Angiotensin-Converting Enzyme InhibitorsHeart FailureHyperkalemiaRenal Insufficiency, ChronicAldosteroneAntihypertensive AgentsEnzyme InhibitorsHumansPotassiumRenin-Angiotensin SystemAldosteroneAngiotensin-Converting Enzyme InhibitorsAntihypertensive AgentsEnzyme InhibitorsPotassiumChronic kidney diseaseGuideline-directed medical therapyHeart failureHyperkalemiaPotassium binder

Identifiers

PMID36658531
PMCPMC9854063

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.