#3433 Burden of disease and management of hyperkalemia in patients with type 2 diabetes mellitus and chronic kidney disease managed at Spanish endocrinology services

Abstract Background and Aims Chronic kidney disease (CKD) is a global public health problem with a high impact on morbidity and mortality. Diabetes is the one of the leading causes of CKD, and up to 40% of patients with type 2 diabetes mellitus (T2D) have CKD. Despite patients with metabolic diseases are mainly managed by Endocrinology units, there are currently no studies describing the burden associated to the loss of kidney function and the risk of developing hyperkalemia in these patients. The ENDO_CKD study aimed to describe and characterize the prevalence, associated burden and management of hyperkalemia in patients with T2D and CKD managed by Endocrinologists in Spain. Method This was a retrospective observational study using data from the TELOTRON database in Spain. Adult patients with T2D (diagnosis code or at least one HbA1c value ≥6.5% or prescription of any antidiabetic drug) and CKD (diagnosis code or lab criteria for CKD diagnosis (one eGFR value < 60 ml/min/1.73 m2 and/or one UACR value ≥30 mg/g)) with at least one visit to the endocrinology services between January 2013–November 2023 were included. Hyperkalemia was defined as per diagnosis code and/or with potassium laboratory values >5 mmol/L. Baseline characteristics, treatments, and hyperkalemia management were analyzed. Results A total of 8,017 patients were identified, mean age 70.7 (SD 11.8) years, 45.2% female, mean BMI 31.8 (SD 6.5) kg/m², mean eGFR 61.9 (SD 24.6) mL/min/1.73 m², median UACR 53.5 (IQ 25.0–146.2) mg/g, and median Charlson index 4.0 (IQ 2.0–5.0). These patients were highly comorbid (81.6% hypertension; 77.8% hyperlipidemia; 45.6% obesity; 21.4% heart failure) and had a high use of drugs (96.1% glucose-lowering; 83.5% lipid-lowering; 80.6% RAASi; 63.7% SGLTi2; 43.1% beta-blocker). Among them, 26.4% (2116) had an event of hyperkalemia, yet only 29.7% (628) were formally diagnosed and 12.6% (267) received treatment with potassium binders (Table 1). Conclusion Hyperkalemia is a prevalent condition but remains underdiagnosed and undertreated in patients with CKD and T2D managed in Spanish endocrinology services, despite guideline recommendations to achieve optimal cardio-renal-metabolic therapy. Over 70% of hyperkalemia cases are not formally identified, and more than 85% of patients do not receive appropriate treatment. Our findings underscore the need for early detection and management of hyperkalemia in these high-risk patients.