Impact of ACEi/ARB discontinuation after an episode of hyperkalemia in patients with chronic kidney disease. A population-based cohort study
Bibliographic record
Abstract
Background: Angiotensin-converting-enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) are recommended in diabetic and proteinuric nondiabetic chronic kidney disease (CKD). However, therapy with ACEi/ARBs is associated with an increased risk of hyperkalemia. For the management of chronic hyperkalemia, physicians are faced with the important clinical decision of whether to discontinue ACEi/ARBs or continue them despite a risk of hyperkalemia reoccurring. The aim of this study is to evaluate the effect of discontinuing ACEi/ARBs after an episode of hyperkalemia in patients with CKD. Methods: We performed a retrospective cohort study using administrative health data from Manitoba, Canada. All adults (≥ 18 years old) with an episode of de novo hyperkalemia (defined as serum potassium ≥ 5.5 mmol/L) and CKD who were current ACEi/ARB users at the time of their hyperkalemia episode were included. We examined the association between ACEi/ARB exposure and study outcomes in patients with an episode of hyperkalemia using Cox proportional hazards regression models where our primary analysis assessed continuation of ACEi/ARB versus discontinuation as a time-dependent variable. In sensitivity analyses, this association was assessed using intention-to-treat, as well as dose reduction analyses. Results: In our cohort, 34,317 people who had an episode of hyperkalemia were identified, of which 8,534 had CKD and were current ACEi/ARB users at baseline. Ninety days after the episode of hyperkalemia, 7,203 surviving patients were included for analyses. In time-dependent analysis, ACEi/ARB discontinuation was associated with a more than 2-fold higher risk of both all-cause [hazard ratio (HR) 2.68, 95% CI: 2.48-2.89] and cardiovascular mortality [HR 2.42, 95% CI 2.10-2.77]. Intention to treat analyses showed similar results. Suboptimal dose use was associated with increased all-cause mortality (adjusted HR 1.21, 95% CI 1.10-1.33) compared to maximal daily dose. Conclusion: ACEi/ARB discontinuation was associated with a more than 2-fold higher rate of all-cause mortality, compared with patients who continued ACEi/ARB. Patients on suboptimal doses had worse outcomes compared to those receiving a maximal daily dose.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".