#2546 Hyperkalaemia prevalence and risk factors in chronic kidney disease and heart failure: insights from iCaReMe Registry Latin America Cohort

Abstract Background and Aims Hyperkalaemia (HK) is a common and serious electrolyte imbalance characterized by serum potassium >5.0 mmol/L, frequently observed in chronic kidney disease (CKD) and heart failure (HF). It poses a major therapeutic challenge, as its occurrence is closely linked to the use of renin-angiotensin-aldosterone system inhibitors (RAASi), essential treatments for slowing CKD progression and improving HF outcomes. In Latin America (LATAM), increasing rates of CKD and HF highlight an urgent need to better understand HK and its management. However, data on HK prevalence and associated factors in this region remain scarce. Using iCaReMe Global Registry (NCT03549754) data, our study examines the prevalence, risk factors, and clinical context of HK in CKD and HF patients across LATAM, aiming to address key gaps for evidence-based care. Method Adult CKD and HF people from 6 LATAM countries (Argentina, Brazil, Costa Rica, Ecuador, Mexico, Peru) were included in this cross-sectional analysis. The study examined HK prevalence, patient demographics, clinical features, and treatment patterns (reported as frequencies and percentages). Risk factors for HK were identified using stepwise logistic regression. Results A total of 1,721 subjects (mean age, 61.6 ± 14.4 years; 52.5% male) were analysed. CKD was present in 61.0% of participants (mean estimated glomerular filtration rate [eGFR], 33.3 ± 23.1 mL/min/1.73 m²), HF in 47.0% (mean left ventricular ejection fraction, 43.8 ± 15.8%), type 2 diabetes mellitus in 53.2% and 73.0% had HTN. The mean serum potassium (K⁺) was 4.6 ± 0.7 mmol/L with an overall HK prevalence of 24.2% including 18.5% in HF and 27.5% in CKD. Medications included angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers/angiotensin receptor-neprilysin inhibitors (80.7%), sodium-glucose co-transporter 2 inhibitors (39.1%), loop diuretics (27.1%) and mineralocorticoid receptor antagonists (MRA; 26.7%). Individuals with HK (mean K⁺: 5.5 ± 0.5 mmol/L) showed lower kidney function, more severe CKD stages (G3b-G5, 88.4% vs 68.5%), and reduced MRA use (25.8% vs 33.4%) compared to those without HK (mean K⁺: 4.4 ± 0.4 mmol/L). Only 8.9% of patients with HK received anti-HK therapies, among them, potassium binders were used in 15% of patients. Multivariate analysis identified a significant association between HK and MRA use (odds ratio, 2.1; 95% CI, 1.09–4.19; P < 0.0276). Conclusion Our findings highlight the substantial prevalence of HK in patients with HF and CKD in the LATAM region, particularly in advanced CKD. The association of HK with MRA use underscores the challenge of optimising guideline-based therapies while managing HK risks. Despite the need for effective HK management, anti-HK therapies, including potassium binders, remain low. Region-specific strategies to improve HK management and ensure optimal RAASi use are essential to improve patients’ outcomes in this high-risk population.