BURDEN OF HYPERKALEMIA AND RISK FACTORS IN CHRONIC KIDNEY DISEASE AND HEART FAILURE: INSIGHTS FROM ICAREME GLOBAL REGISTRY

Hyperkalemia (HK; serum potassium [K⁺] >5.0 mmol/L) is a clinically significant complication in chronic kidney disease (CKD) or heart failure (HF). It is associated with adverse outcomes and often prompts down‑titration or discontinuation of renin-angiotensin-aldosterone system inhibitors (RAASi), thereby compromising guideline-directed medical therapy (GDMT) and optimal disease management. Contemporary global real‑world evidence on HK burden, risk factors, and management practices remain limited. Leveraging data from iCaReMe Global Registry (NCT03549754), we conducted an analysis across the Middle East and Africa (MEA), Latin America (LATAM), and Asia‑Pacific (APAC) to estimate HK prevalence and characterize associated risk factors in CKD and HF.

Cross-sectional observational study including baseline data of adults with CKD or HF enrolled in iCaReMe Global Registry from 28 countries across APAC, LATAM and MEA region. Demographic and clinical characteristics, HK prevalence, and treatment patterns were summarized descriptively. HK risk factors were analyzed using stepwise logistic regression.

A total of 8,968 participants (mean age 59±14.0 years; 56.5% male) were included; 5,964 (71.8%) individuals presented with CKD (mean estimated glomerular filtration rate [eGFR] 37±25.6 mL/min/1.73 m²) and 4,107 (50.3%) with HF (mean left ventricular ejection fraction 40±14.0%). Hypertension was prevalent in 78.9%, and type 2 diabetes mellitus in 57.7% of the study population. Serum K+ data, available for 6,741 (75.2%) subjects, showed a mean of 4.5±0.65 mmol/L and an overall HK prevalence of 18.2% (22.5% in CKD and 11.8% in HF patients). Overall, 60.7% of the participants received angiotensin-converting enzyme inhibitors (ACEi)/angiotensin II receptor blockers (ARB)/angiotensin receptor-neprilysin inhibitors (ARNI), 30.7% were on sodium-glucose co-transporter 2 inhibitors, 30.3% on loop diuretics, and 22.2% received mineralocorticoid receptor antagonists (MRA). Patients with HK (mean K+, 5.5±0.44 mmol/L) exhibited decreased kidney function (mean eGFR 30±23.7 vs 51±30.8 mL/min/1.73 m²), more advanced CKD stages (78.1% vs 46.3% G3b-G5 stage) and lower use of ACE/ARB/ARNI (55.1% vs 62.7%) and MRA (12.7% vs 24.5%) compared to non-HK patients (mean K+=4.3±0.46 mmol/L). Only 9.2% of subjects with HK were on anti-HK therapies, with 39.4% receiving potassium binders. (Table 1)

Serum K+ levels had a significant negative correlation with eGFR (r=−0.3, p<.0001) and linear regression further showed significant associations of history of CKD (β=0.21; SE=0.046; p<.0001) with increased K+ levels. Multivariate analysis identified RAASi use (odds ratio [OR], 1.7; 95% CI, 1.33–2.05; p<.0001) and serum creatinine levels (mg/dL) (OR, 1.1; 95% CI, 1.01−1.12; p=0.0144) as independently associated with HK. (Figure 1)

Our study offers a unique perspective on the global characteristics and management of individuals with CKD and HF in real-world settings, revealing a significant HK burden. Our findings highlight a critical barrier to care, as HK limits the use of GDMT, with suboptimal adoption of cardio-renal protective agents and minimal utilization of anti-HK therapies like potassium binders, even in patients with established HK. These data emphasize an urgent need to prioritize strategies that mitigate HK, enabling optimal therapeutic care and improving patient outcomes across diverse global populations.