Abstract 11709: High Rates of Hyperkalemia Recurrence After Medical Nutrition Therapy in Patients With Heart Failure: REVOLUTIONIZE I Real-World Evidence Study

Introduction: Medical nutrition therapy (MNT) slows chronic kidney disease (CKD) progression but its effect on serum potassium (K ⁺ ) and hyperkalemia (HK) recurrence in patients with heart failure (HF) and comorbid CKD is unclear. REVOLUTIONIZE I is a real-world study of HK recurrence in patients who received MNT after experiencing HK.

Aims: This analysis aims to describe HK recurrence in a subgroup of patients with HF and comorbid CKD in the REVOLUTIONIZE I study.

Methods: Patients aged ≥18 years with HF and stage 3/4 CKD who received MNT within 30 days after a serum K ⁺ value of >5.0 mEq (1/1/2019 to 10/31/22) were identified from TriNetX Dataworks de-identified electronic health records data. Patients were excluded if they received outpatient K ⁺ binder therapy within 6 months before the index date (MNT date + 7 days). Patients were censored at the first of: 6 months post-index, outpatient K ⁺ binder therapy initiation, death, or 10/31/22. HK recurrence was calculated for 1-6-month intervals post-index and compared with the estimated a priori HK recurrence rate (50%) by Chi-square test.

Results: The HF subgroup included 1179 patients. Of 861 patients with ≥6 months’ follow-up, 485 (56.3%) had ≥1 HK recurrence ( Figure ), with a mean ± SD of 2.6 ± 2.2 recurrences (range 1-14). Time between HK recurrences decreased with each recurrence, from a mean of 42 days for the first recurrence to 35 days for the second and <30 days for additional recurrences.

Conclusions: This real-world study showed that HK is a chronic, recurrent condition for the majority of patients with HF and comorbid CKD, despite the use of medical nutrition therapy. There is unmet need to consider long-term anti-HK therapy with newer K ⁺ binders to reduce HK recurrence in this patient population.