Weir MR, et al. Am J Manag Care. The OPAL-HK study demonstrated that patiromer significantly decreased potassium levels in patients with hyperkalemia and CKD who took RAASi compared to placebo (mean decrease of -1.01 ± 0.03 mEq/L from baseline). Robert D. Toto (2019) Patiromer and maintenance of RAASi therapy in hyperkalemic medicare patients, Journal of Drug Assessment, 8:sup1, 2-2, DOI: 10.1080/21556660.2019.1658287 To limit the risk of hyperkalemia in this vulnerable population, doctors should closely monitor potassium levels and prescribe a potassium binder when hyperkalemic events occur. 2015; www.ajmc.com/journals/supplement/2015/a577_nov15_hyperkalemia/a577_nov15_hyperkalemia. How to optimise RAASi therapy in patients with hyperkalaemia HFA webinar Thursday, 19 March 2020 from 18:00 to 19:00 CET Mortality [ Time Frame: 12 months ] Additionally, he is an Associate Editor of the International Textbook of Cardiology. The frequency of dose changes and drug discontinuations is not well understood; nor are the subsequent implications in terms of … Its use is strongly recommended in clinical guidelines for the treatment of HF with reduced ejection fraction, and CKD 1,2 . More recently, a post-hoc subgroup analysis of the AMETHYST-DN study in diabetic kidney disease patients aged 75 years or older was reported at the American Diabetes Association 79th Scientific Sessions. At 6 months post-index, RAASi continuation rates were 87%, 72% and 57% and dose-reduction rates were 11%, 11% and 9% in the patiromer, SPS and non-treatment cohorts, respectively. Looking for the definition of RAASI? www.ajmc.com/journals/supplement/2015/a577_nov15_hyperkalemia/a577_nov15_hyperkalemia. Novel agents, such as patiromer, have the potential to shift the treatment paradigm in the management of hyperkalemia caused by RAASi and may provide clinicians with a new strategy to improve patient outcomes. 1. Enabling and optimizing Renin-Angiotensin-Aldosterone-System inhibitors (RAASi) therapy in cardio-renal patients by controlling potassium levels session at Heart Failure 2017 - … Thus, a significant challenge for the optimal management of patients at high cardiovascular risk is that treatment with RAASi therapy may bring significant risk of hyperkalemia. 7. Often overlooked and recurrent, hyperkalemia impacts approximately three million Americans — with most of them reporting no symptoms. In fact, diabetic kidney disease carries one of the highest risk for cardiovascular diseases, such as stroke, heart failure or myocardial infarction. These kidney-sparing and life-saving medications, though, are also among the most common causes of hyperkalemia, or high potassium levels in the blood. If a patient experiences a hyperkalemic event (serum potassium level >5.0 mEq/L), which occurs in up to 30% of cases, then the clinician is faced with the difficult decision of reducing or discontinuing RASi therapy to bring potassium levels back down to a safer range (4.6 to 5.0 mEq/L). Renin-angiotensin-aldosterone system inhibitor (RAASi) therapy has been shown to improve outcomes among patients with congestive heart failure, diabetes, or renal dysfunction. If left untreated, it can have potentially lethal consequences, including abnormal heart rhythms and sudden death. Eur Heart J. Healio.com. RAASi therapy has been shown to improve cardiovascular and renal outcomes and is proven to prolong survival and reduce hospitalisation. However, RAASi medications are also linked to an increased risk of hyperkalemia, and in some cases up to 30% of patients on RAASi therapy develop the condition.3,4 Therefore, RAASi therapy is often modified or discontinued once a patient experiences a hyperkalemic event. Proportion of patients continuing of RAASi therapy after initial episodes of hyperkalaemia at 3 months and 12 months. Heart Assoc. Close monitoring of glomerular filtration rate (GFR) and blood pressure can help provide earlier diagnosis in these high-risk patients. With worldwide rates of diabetes continuing to climb, the prevalence of diabetic kidney disease is anticipated to increase in tandem, along with kidney failure. Greene SJ. Combined with RASi therapeutics, which inhibit potassium excretion by the kidneys, older patients with diabetic kidney disease are 50% more likely to develop hyperkalemia than the general population and should have their serum potassium levels closed monitored every two to four weeks. McCullough PA. Nephron 2018;doi:10.1159/000485645. The management of hyperkalemia in patients taking RAASi therapies is challenging. The most common risk factors for hyperkalemia are reduced kidney function and treatment with renin-angiotensin-aldosterone system inhibitor (RAASi) therapy. He served on the Cardio-renal Advisory Board of the FDA and to CMS. Since RAASi therapy reduces mortality and morbidity in patients with cardiovascular disease steps should, when hyperkalaemia develops, be considered to lower K + level and enable patients to continue their RAASi therapy. The renin–angiotensin–aldosterone system (RAAS) plays a key role in the regulation of blood volume, blood pressure, and cardiovascular function.1 Modification of the RAAS through the use of RAAS inhibitors (RAASi), such as angiotensin‐converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and mineralocorticoid receptor antagonists (MRAs), is an important therapeutic option for the treatment of numerous cardiorenal conditions, reducing progression of chronic kidney disease (… Dunn JD. 1 Studies have shown that hyperkalaemia is associated with poor clinical outcomes in HF patients with hypertension who are being treated with hypertensive drugs including: 2,3 Patiromer is the first sodium-free, non-absorbed potassium (K+) … Current Medical Research and Opinion. Find out what is the full meaning of RAASI on Abbreviations.com! Among these cohorts, we evaluated RAASi continuation and dose reductions within 1-, 3- and 6-month time frames. Primary care physicians will be the first line of defense in quickly identifying them based on their patient history and lab results, as well as be able to start them early on life-saving RAASi therapies. Raasi, also known as Mantra, is a South Indian actress who has acted in Telugu, Tamil, and Kannada movies. What are the real-world factors that influence RAASi treatment decisions in patients with HF who have or are at risk for hyperkalemia? The use of such measures are especially important in those patients with the most to gain from RAASi therapy. Epstein M et al. Help us guide you to the right place. Down-regulation of RAASi therapy is a common strategy in the chronic management of hyperkalaemia but studies show that sub-maximum doses or discontinuation is associated with poor outcomes. The aggressiveness of therapy for hyperkalemia is directly related to the rapidity with which the condition has developed, the absolute level of serum potassium, and the evidence of toxicity. RAASi therapy is being refined. RAASi therapy can increase the risk of hyperkalemia, and physicians may decide to reduce the dose or discontinue RAASi therapy following hyperkalemia. Film career. 2008;doi:10.1161/CIRCULATIONAHA.108.807917. Desai NR, et al. 2018;doi:10.1016/j.jacc.2018.04.070. Diabetes, both type 1 and type 2, is the leading cause of chronic kidney disease (CKD) as well as end-stage renal disease (ESRD, or kidney failure). RAASi therapy benefit and challenges in cardio-renal patients Session: Enabling and optimising RAASi therapy for cardio-renal patients by controlling potassium levels Lisbon 2017 Dürrenmatt Hall 14. He was a co-principal investigator on the NIH Clinical Research training grant for clinical research (K30) (1999-2004). SPS was first approved by the FDA for the treatment of hyperkalemia in 1958 and has been used in the long-term management of hyperkalemia. People with chronic kidney disease (CKD) are at an increased risk of developing hyperkalaemia due to their declining kidney function. N Engl J Med. 2017;doi:10.15420/cfr.2017.2.1. The faster the rise in the potassium level, the higher it has reached, and the greater the evidence of cardiotoxicity, the more aggressive therapy should be. In the PEARL-HF study of heart failure patients with previously documented hyperkalemia or CKD, patiromer significantly lowered serum potassium levels with a difference between groups of −0.45 mEq/L; a lower incidence of hyperkalemia (7.3% patiromer vs. 24.5% placebo); and a greater proportion of patients on spironolactone 50 mg/day (91% patiromer vs. 74% placebo). Nihar Desai, MD, MPH, is assistant professor of medicine (cardiology) and in the Institution for Social and Policy Studies, Yale School of Medicine in New Haven, Connecticut. 8. More importantly, through the 52 weeks, the majority of these patients maintained RASi therapy. With the elderly population in the United States estimated to double to 71 million by 2030, clinicians will begin caring for sicker patients living with age-related illnesses and multiple comorbidities, including diabetic kidney disease. In particular, data from the ESC HF registry reveal that RAASi were frequently underdosed because of persistent and consistent hyperkalemia and/or worsening renal function. In the PARADIGM-HF trial, 2 sacubitril/valsartan (an angiotensin receptor blocker combined with a neprilysin inhibitor), when used concomitantly with an MRA, resulted in lower hyperkalaemia rates when compared to the concomitant use of enalapril and an MRA. Due to this significantly elevated risk, older patients with diabetic kidney disease can become challenging to treat for clinicians. Betts KA, et al. Speaker Lars Lund 2011;doi:10.1093/eurheartj/ehq502. recommended renin-angiotensin-aldosterone system inhibitor (RAASi) therapy due to increased risk of hyperkalaemia. 12. These therapeutics are indicated to slow the progression of diabetic kidney disease, as well as to reduce the risk of death from cardiovascular events. Disclosure: Desai reports he is a consultant for Relypsa Pharmaceuticals. Am J Manag Care. Lainscak M. Cardiac Failure Review. These patients are also at risk for the development of hyperkalemia (HK), often leading to down-titration and/or discontinuation of RAASi therapy. The value of maintaining normokalaemia and enabling RAASi therapy in chronic kidney disease | springermedizin.de Skip to main content 2. Hyperkalemia and renin-angiotensin aldosterone system inhibitor therapy in chronic kidney disease: A general practice-based, observational study. He is the Editor or Co-Editor of 21 books as well as the new 3rd edition of Hypertension: A Companion to Braunwald’s The Heart. This 3D mechanism of action video will explore how serum potassium levels rise due to disruptions in the renin-angiotensin-aldosterone system and the mechanisms of novel potassium binders to combat this condition. Data presented at the Kidney Week in 2018 further expand our understanding of the potential role of patiromer in patients on RAASi therapy. Large clinical trials have shown the critical value of RAASi therapy, demonstrating that risk of death was lowered with RAASi therapy, and discontinuing RAASi therapies or administering them at a suboptimal dose was associated with a higher death rate.4,5 Despite these benefits, RAASi therapies are closely linked to increased potassium concentrations, and ultimately to hyperkalemia, which is common in patients at risk for CKD and/or heart failure.6. Breakthrough therapy: Anti-inflammatory drug can affect important CV outcomes 5' education - Aug. 27, 2017 - ESC 2017, Barcelona, Spain Clinical implications of inhibiting inflammation as risk factor for progression of CVD Due to this, it becomes imperative that these patients are diagnosed and provided aggressive intervention as early as possible to prevent or delay the progression of the disease and associated comorbidities, such as hypertension. The study, evaluating one of the potassium-binding polymers, patiromer, found that the medication significantly reduced and maintained serum potassium levels to ≤5.0 Eq/L in this difficult-to-manage patient population. Circulation. All rights reserved. I reside in the United States Visit the US site J Am Coll Cardiol. 10. 'Renin Angiotensin Aldosterone System Inhibitors' is one option -- get in to view more @ The Web's largest and most authoritative acronyms and abbreviations resource. This piece reflects his views, not necessarily those of the publication. Edner M et al. People with chronic kidney disease (CKD) are at an increased risk of developing hyperkalaemia due to their declining kidney function. Tell us what you think about Hyperkalemia is a serious condition that commonly affects those with heart failure. However, newer non-absorbable potassium binders have recently emerged for the long-term treatment and management of adults with hyperkalemia to enable concurrent RASi therapy. 4. He chaired the first National Kidney Foundation Consensus report on blood pressure and impact on renal disease progression (2000). These therapeutics are indicated to slow the progression of diabetic kidney disease, as well as to reduce the risk of death from cardiovascular events. Pitt B, et al. Patiromer and maintenance of RAASi therapy in hyperkalemic Medicare patients. Despite evidence and guideline recommendations, renin-angiotensin-aldosterone system inhibitor (RAASi) therapy tends to be used suboptimally among patients with heart failure (HF), particularly in patients with chronic kidney disease (CKD). 9. 2015; www.ncbi.nlm.nih.gov/pubmed/26619183. Clin Nephrol. Please select one of the below options! In turn, this may lead to a greater threat of heart failure and cardiovascular-related death. To achieve this ambitious goal, the order includes a proposed change in the way Medicare providers are paid to incentivize the prevention of disease progression to kidney failure. Once GFR is reduced to levels below 60 ml/min and/or high blood pressure or albuminuria above 300 mg is detected in patients with diabetes, guidelines typically recommend immediately prescribing renin-angiotensin system inhibitors (RASi), such as angiotensin receptor blockers (ARBs), or angiotensin-converting-enzyme (ACE) inhibitors. We will need additional studies to clarify these findings, and to further elucidate how clinicians can keep patients on RAASi therapies to maximize the renal and cardiovascular protective effects of the therapies. 6. Poster presented at: ASN Kidney Week; Oct. 27, 2018. Across the Veltassa ® clinical trial program, over 99 percent of participants were also taking RAASi therapy. 13. 3. Healthcare professionals and researchers interested in responding to this piece or contributing to MD Magazine® can reach the editorial staff here. He has published over 800 peer-reviewed articles and book chapters in the areas of diabetic kidney disease, hypertension and progression of nephropathy. Unfortunately, their use increases the risk for developing hyperkalemia, which can lead to underuse or discontinuation of RAASi therapy. Hagan AE. RAASi therapies are life-saving medications for patients with heart failure and other chronic conditions. These drugs bind with potassium, decreasing the amount available for absorption in the gastrointestinal tract, thereby enabling the use and continuation of RASi therapy in patients living with kidney disease. Postgrad Med J. HFrEF patients at higher risk of developing hyperkalemia present comorbidities such as CKD, diabetes, and use of dual or triple therapy including RAASi and concurrent HF therapy. Reinitiate RAASi therapy once any concurrent condition contributing to changes in K + is under control AND serum K + has decreased to <5.0 mEq/L or to within patient’s usual range (whichever is higher) Reintroduce RAASi agents one at a time with monitoring of kidney function and electrolytes: European Society of Cardiology 1: 4.5-5.0 b In 1958, the US Food and Drug Administration (FDA) approved a potassium-binding polymer, sodium polystyrene sulfonate (SPS), for the treatment of hyperkalemia in patients. George Bakris, MD, outlines the difficulties clinicians face when treating diabetic kidney disease in an aging population. Comprehensive Hypertension Center at the University of Chicago Medicine. 2001;doi:10.1136/pmj.77.914.759. Rastegar A, et al. Get the latest news and education delivered to your inbox, Receive an email when new articles are posted on, Please provide your email address to receive an email when new articles are posted on. 2015;doi:10.1056/NEJMoa1410853. These kidney-sparing and life-saving medications, though, are also among the most common causes of hyperkalemia, or high potassium levels in the blood. *1. ... First Patient Treated in DIAMOND Study to Evaluate if Veltassa Improves Outcomes by Enabling Long-Term Use of Essential RAASi Therapy. In an effort to make a dent in the fight against kidney disease, the US Federal Government recently issued an executive order that seeks to lower the number of new kidney failure cases by 25 percent by 2030. RAASi therapy benefit and challenges in cardio-renal patients. 14 Of note, a substantial proportion of patients receiving RAASi therapy have their therapy … All rights reserved. Desai A. RAASi, renin-angiotensin-aldosterone system inhibitors. Session Enabling and optimizing Renin-Angiotensin-Aldosterone-System inhibitors (RAASi) therapy in cardio-renal patients by controlling potassium levels . After watching the videos on RAASi and hyperkalemia in cardiorenal disease, the learner should be able to: Explain the challenge of following guideline recommended (dose of) RAASi therapy in cardiorenal patients; Recall the association between serum potassium levels and outcomes; Describe determinants and prevalence of hyperkalemia in HF 13 Hyperkalemia is more often observed when RAASi are administered in combination than when administered individually. 2015; doi:10.1093/eurheartj/ehv268. Current guidelines advise that heart failure patients who develop hyperkalemia reduce RAASi dosage or discontinue therapy.7 While this strategy addresses the immediate negative effects of hyperkalemia, discontinuing or reducing RAASi therapy exposes the patient to poorer clinical outcomes and to increased health care costs, such as hospitalizations due to cardiovascular issues and cardiovascular mortality.8 Moreover, recent data from the Change the Management of Patients with Heart Failure registry show there is substantial underuse of guideline-directed RAASi therapy.9 As such, there is a significant unmet need for novel therapeutic options for the chronic management of patients at risk for hyperkalemia. Real-world evidence and clinical trial data suggest that patients with hyperkalemia treated with potassium binders are significantly more likely to stay on RAASi therapy. She is credited as Raasi in Telugu, Kannada movies and Manthra in Tamil movies. © 2020 MJH Life Sciences™ and HCPLive. In the United States, there are more than 3 million patients living with hyperkalemia, yet this recurrent condition is often overlooked, even though it can cause abnormal heart rhythms and sudden death.1,2 People at highest risk for hyperkalemia include patients with chronic kidney disease, diabetes and heart failure — three common clinical conditions. References: Epstein M et … Disclaimer: Some of Dr. Bakris’ research has been supported by Relypsa, Inc. Dr. Bakris is a tenured Professor of Medicine and Director of the Am. Hospitalisations [ Time Frame: 12 months ] Number and causes (all cause, cardiovascular or HF) of hospitalisations at 12 months. COVID-19, ACE2 and RAASi - a scientific perspective Lecture 1 out of 3 10' education - May 14, 2020 - Prof. Jan Danser, PhD - Erasmus MC, Rotterdam, The Netherlands RAASI is listed in the World's largest and most authoritative dictionary database of abbreviations and acronyms. Older patients are particularly predisposed to developing hyperkalemia due to the combination of age-associated reductions in kidney function, poorly controlled diabetes, heart failure and high blood pressure, which can either impact their bodies’ ability to eliminate excess potassium or cause too much potassium to be released into the bloodstream. Doing so will enable their older patients to continue to reap the cardiorenal protective benefits of RASi therapies, and will improve overall patient outcomes. Rather than reduce or eliminate a patient’s RAASi therapy, one clinical alternative is to add a potassium‐binding polymer, such as sodium polystyrene sulfonate (SPS). 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