Observational studyJournal of internal medicine2026
Potassium binders and continuation of renin-angiotensin system inhibitors/mineralocorticoid receptor antagonist in chronic kidney disease and heart failure (the DEMONSTRATE database).
Observational study in Journal of internal medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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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.
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Who cites it
1 citing paper in PubMed.
- Impact of the Four Pillars on Electrolyte Derangements during State-of-the-Art Therapy for Diabetic Kidney Disease.Electrolyte & blood pressure : E & BP · 2026Review
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Authors and funding
7 authors.
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No grant is acknowledged in the PubMed record.
Abstract
introductionHyperkalaemia is a serious complication in patients with chronic kidney disease (CKD) and heart failure (HF), often leading to the discontinuation of renin-angiotensin-aldosterone system inhibitors (RAASi; renin-angiotensin system inhibitors [RASi] and mineralocorticoid receptor antagonists [MRAs]) despite their cardiorenal benefits. Although potassium binders, especially second-generation potassium binders, reduce the risk of hyperkalaemia in clinical trials, real-world evidence on whether they enable RAASi continuation and influence clinical outcomes remains scarce.
methodsThis observational, population-based cohort study used Swedish healthcare data from the DEMONSTRATE database to identify adults with non-dialysis (ND) CKD and/or HF who initiated potassium binders (2018-2022). Patients were stratified by potassium binder generation. RASi and MRA treatment changes were assessed at 6 months, and clinical outcomes (all-cause mortality, hospitalization and three-point major adverse cardiovascular events [3P-MACE]) were evaluated over a 3-year follow-up using propensity-score-weighted Kaplan-Meier analyses.
resultsOf 7913 potassium binder episodes (6232 patients), 7.1% used second-generation binders. These episodes were associated with increased RAASi persistence at 6 months: 76.9% and 57.5% of second-generation users maintained RASi and MRA therapy, respectively, compared with 66.4% and 47.8% in the first-generation group. Patients who maintained RASi had lower observed all-cause mortality and hospitalization rates, but no difference in incidence of 3P-MACE was found.
conclusionSecond-generation potassium binders were associated with higher RAASi persistence than first-generation binders. RASi persistence was associated with lower observed rates of all-cause mortality and hospitalization, with no clear differences in 3P-MACE. These findings suggest that potassium binders may enable sustained RAASi use in patients with ND-CKD and/or HF.
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