Previous studies have examined the role of medical nutrition therapy (MNT) in progression of chronic kidney disease (CDK). However, according to Christopher G. Rowan, PhD, and colleagues, there are few data available on the relationship between MNT and hyperkalemia.
The researchers conducted a retrospective data analysis in a cohort of adults with stage 3-4 CKD and hyperkalemia (diagnosis of hyperkalemia and serum potassium >5.0 mmol/L) who received MNT from January 1, 2019, to August 31, 2022. Results were reported during a poster session at the National Kidney Foundation Spring Clinical Meetings 2023 in a poster titled Recurrence of Hyperkalemia Following Dietary Counseling, REVOLUTIONIZE I Real-World Evidence Study.
The study utilized electronic health record data from TriNetX Dataworks, USA. To focus on patients who received MNT as first-line therapy, those who were treated with oral antihyperkalemia therapy (potassium binder) within 6 months prior to MNT were excluded. Follow-up was censored at the first of 6 months following initiation of MNT, initiation of outpatient therapy with an oral antihyperkalemia therapy, death, or the end date (August 31, 2022).
The researchers analyzed the percentage of patients who had a hyperkalemic event at 0-1, 0-2, 0-3, 0-4, 0-5, and 0-6 months following MNT. Using the Chi-square test, during each analysis interval the observed percentage of patients with a recurrence of hyperkalemia was calculated and compared with 50% (the a priori estimated hyperkalemia recurrence rate).
The final study cohort included 773 patients. Six months following initiation of MNT, 69% of the cohort (n=532) were uncensored and included in the analysis. Median age at baseline was 70 years, median serum potassium level was 5.4 mmol/L, 59% of the cohort had stage 3 CKD, 41% had stage 4 CKD, 45% were women, 77% were White, and 14% were Black.
The percentages of recurrence of hyperkalemia during the prespecified intervals of 0-1, 0-2, 0-3, 0-4, 0-5, and 0-6 months were: 32.1% (P<.001); 39.0% (P<.001); 44.9% (P=.076); 49.3% (P=.814); 52.8% (P=.367); and 56.0% (P=.049), respectively.
In summary, the authors said, “Within 1 month following MNT nearly one-third of patients had a hyperkalemia recurrence. By 6 months, the majority of patients (56%) had a hyperkalemia recurrence (P=.049). To maintain normokalemia and prevent hyperkalemia recurrence among CKD patients, clinicians may augment MNT with a novel oral antihyperkalemia therapy. Additional research is warranted to elucidate these findings.”
Source: Rowan CG, Agiro A, Chan A, et al. Recurrence of hyperkalemia following dietary counseling, REVOLUTIONIZE I real-world evidence study. Poster #296. Abstract of a poster presented at the National Kidney Foundation Spring Clinical Meetings 2023; April 11-15, 2023; Austin, Texas.