Patient Profiles: Elena

CKD PATIENT

How would you manage Elena’s dangerously elevated K⁺ levels?

Insulin and Dextrose

Calcium gluconate

Furosemide

Potassium binder

I suddenly felt exhausted, I started to experience horrible muscle cramps. The scariest part was that my heart was pounding very hard. At that moment I called an ambulance.”

CKD patient

5-year database of hyperkalemia prevalence, stratified
by patient comorbidities²

CKD PATIENT

What was actually done?

Elena was administered 15 mL calcium gluconate 10% as a slow IV injection followed with insulin 10 units in 50 mL of 50% dextrose and nebulized salbutamol 20 mg
Irbesartan treatment was immediately stopped
Potassium levels went down to 5.1 mEq/L
Discharged from the emergency department

Is Elena still at risk of hyperkalemia?

Because treatment with irbesartan was stopped

Yes

Because of her pre-existing comorbidities

CKD PATIENT

Is Elena being adequately managed for her kidney condition?

Yes

What do the guidelines say?

The latest 2021 KDIGO Guidelines recommends newer oral K⁺ binders as a treatment option to control hyperkalemia in patients with CKD receiving RAASi therapy⁷

Practice Point 3.2.4: Hyperkalemia associated with the use of RAASi can be often managed by measures to reduce the serum K⁺ levels rather than decreasing the dose or stopping RAASi⁷

In CKD patients receiving RAASi who develop hyperkalemia, the latter can be controlled with newer oral potassium binders in many patients, with the effect that RAASi can be continued at the recommended dose.^’’7

2021 KDIGO Guidelines

Can Veltassa® enable Elena to re-introduce Irbesartan while controlling her K⁺ levels long-term?

Learn more about the use of irbesartan in CKD patients through the OPAL-HK trial

How can Elena re-start irbesartan and control her K⁺ long-term?

CKD PATIENT

How would you manage Elena’s dangerously elevated K⁺ levels?

EMERGENCY TREATMENT

INTERMEDIATE CARE

Protect the myocardium from the negative effects of severe hyperkalemia¹

Calcium gluconate

Fast, but temporary redistribution of K⁺ to avoid immediate consequences of hyperkalemia¹

Insulin + dextrose
ß₂-adrenergic receptor agonists
Sodium bicarbonate
(intermediate care)*

Fast, but temporary redistribution of K⁺ to avoid immediate consequences of hyperkalemia¹

Potassium binders
Loop diuretics
Dialysis

EMERGENCY TREATMENT

Protect the myocardium from the negative effects of severe hyperkalemia¹

Calcium gluconate

Fast, but temporary redistribution of K⁺ to avoid immediate consequences of hyperkalemia¹

Insulin + dextrose
ß₂-adrenergic receptor agonists
Sodium bicarbonate
(intermediate care)*

INTERMEDIATE CARE

Fast, but temporary redistribution of K⁺ to avoid immediate consequences of hyperkalemia¹

Potassium binders
Loop diuretics
Dialysis

Adapted from Dunn JD et al, 2015.

Assess outcome

CKD patient

5-year database of hyperkalemia prevalence, stratified
by patient comorbidities²

CKD PATIENT

What was actually done?

Elena was administered 15 mL calcium gluconate 10% as a slow IV injection followed with insulin 10 units in 50 mL of 50% dextrose and nebulized salbutamol 20 mg
Irbesartan treatment was immediately stopped
Potassium levels went down to 5.1 mEq/L
Discharged from the emergency department

Is Elena still at risk of hyperkalemia?

Because treatment with irbesartan was stopped

Yes

Because of her pre-existing comorbidities

CKD PATIENT

Is Elena being adequately managed for her kidney condition?

Yes

What do the guidelines say?

The latest 2021 KDIGO Guidelines recommends newer oral K⁺ binders as a treatment option to control hyperkalemia in patients with CKD receiving RAASi therapy⁷

Practice Point 3.2.4: Hyperkalemia associated with the use of RAASi can be often managed by measures to reduce the serum K⁺ levels rather than decreasing the dose or stopping RAASi⁷

In CKD patients receiving RAASi who develop hyperkalemia, the latter can be controlled with newer oral potassium binders in many patients, with the effect that RAASi can be continued at the recommended dose.^’’7

2021 KDIGO Guidelines

Can Veltassa® enable Elena to re-introduce Irbesartan while controlling her K⁺ levels long-term?

Learn more about the use of irbesartan in CKD patients through the OPAL-HK trial

How can Elena re-start irbesartan and control her K⁺ long-term?

CKD PATIENT

How would you manage Elena’s dangerously elevated K⁺ levels?

Prevalence of hyperkalemia and risk of recurrence increase as severity and number of comorbidities increase^1,3,4

Prevalence

~50%

of patients with CKD stage 3–4 and HF may be at risk of elevated serum K⁺ levels (vs. 8.5% in comparison group over 5 years)²

Recurrence

~50%

of patients with CKD with hyperkalemia had 2 or more recurrences within 1 year³*^†

Show data

Therapeutic challenge

CKD patient

5-year database of hyperkalemia prevalence, stratified
by patient comorbidities²

CKD PATIENT

What was actually done?

Elena was administered 15 mL calcium gluconate 10% as a slow IV injection followed with insulin 10 units in 50 mL of 50% dextrose and nebulized salbutamol 20 mg
Irbesartan treatment was immediately stopped
Potassium levels went down to 5.1 mEq/L
Discharged from the emergency department

Is Elena still at risk of hyperkalemia?

Because treatment with irbesartan was stopped

Yes

Because of her pre-existing comorbidities

CKD PATIENT

Is Elena being adequately managed for her kidney condition?

Yes

What do the guidelines say?

The latest 2021 KDIGO Guidelines recommends newer oral K⁺ binders as a treatment option to control hyperkalemia in patients with CKD receiving RAASi therapy⁷

Practice Point 3.2.4: Hyperkalemia associated with the use of RAASi can be often managed by measures to reduce the serum K⁺ levels rather than decreasing the dose or stopping RAASi⁷

In CKD patients receiving RAASi who develop hyperkalemia, the latter can be controlled with newer oral potassium binders in many patients, with the effect that RAASi can be continued at the recommended dose.^’’7

2021 KDIGO Guidelines

Can Veltassa® enable Elena to re-introduce Irbesartan while controlling her K⁺ levels long-term?

Learn more about the use of irbesartan in CKD patients through the OPAL-HK trial

12.06.20

Elena’s condition has worsened following irbesartan discontinuation

Physical examination

Pitting oedema of the legs to the level of knees

Concomitant medications

Amlodipine: 10 mg
Irbesartan: 150 mg
Saxagliptin: 2.5 mg
Hydrochlorthiazide: 25 mg

Clinical findings

Creatinine: 1.5 mg/dL
eGFR: 35 mL/min/1.73m²
Proteinuria: A2 A3
HbA1c: 6.4%
Potassium: 5.1 5.5 mEq/L
BP: 100/60 148/100 mm Hg
Heart rate: 65 beats/min
ECG: b.o.

How can Elena re-start irbesartan and control her K⁺ long-term?

Would it have been appropriate to re-initiate irbesartan at discharge from the emergency department?

I feel tired almost everyday and I have noticed that my ankles are very swollen, making it quite difficult to walk around. My biggest concern are the occasional surges in blood pressure I’ve been getting, followed by terrible headaches.”

CKD patient

5-year database of hyperkalemia prevalence, stratified
by patient comorbidities²

CKD PATIENT

What was actually done?

Elena was administered 15 mL calcium gluconate 10% as a slow IV injection followed with insulin 10 units in 50 mL of 50% dextrose and nebulized salbutamol 20 mg
Irbesartan treatment was immediately stopped
Potassium levels went down to 5.1 mEq/L
Discharged from the emergency department

Is Elena still at risk of hyperkalemia?

Because treatment with irbesartan was stopped

Yes

Because of her pre-existing comorbidities

CKD PATIENT

Is Elena being adequately managed for her kidney condition?

Yes

What do the guidelines say?

The latest 2021 KDIGO Guidelines recommends newer oral K⁺ binders as a treatment option to control hyperkalemia in patients with CKD receiving RAASi therapy⁷

Practice Point 3.2.4: Hyperkalemia associated with the use of RAASi can be often managed by measures to reduce the serum K⁺ levels rather than decreasing the dose or stopping RAASi⁷

In CKD patients receiving RAASi who develop hyperkalemia, the latter can be controlled with newer oral potassium binders in many patients, with the effect that RAASi can be continued at the recommended dose.^’’7

2021 KDIGO Guidelines

Can Veltassa® enable Elena to re-introduce Irbesartan while controlling her K⁺ levels long-term?

Learn more about the use of irbesartan in CKD patients through the OPAL-HK trial

CKD PATIENT

Re-introducing RAASi could make Elena’s future look brighter

RENAAL and IDNT studies showed reduced risk of a primary composite endpoint of a doubling of the baseline serum creatinine concentration, development of end-stage kidney disease, or death in diabetic nephropathy with RAASi vs placebo.^5,6

How can Elena re-start irbesartan and control her K⁺ long-term?

How can Elena re-start irbesartan and control her K⁺ long-term?

CKD patient

5-year database of hyperkalemia prevalence, stratified
by patient comorbidities²

CKD PATIENT

What was actually done?

Elena was administered 15 mL calcium gluconate 10% as a slow IV injection followed with insulin 10 units in 50 mL of 50% dextrose and nebulized salbutamol 20 mg
Irbesartan treatment was immediately stopped
Potassium levels went down to 5.1 mEq/L
Discharged from the emergency department

Is Elena still at risk of hyperkalemia?

Because treatment with irbesartan was stopped

Yes

Because of her pre-existing comorbidities

CKD PATIENT

Is Elena being adequately managed for her kidney condition?

Yes

What do the guidelines say?

The latest 2021 KDIGO Guidelines recommends newer oral K⁺ binders as a treatment option to control hyperkalemia in patients with CKD receiving RAASi therapy⁷

Practice Point 3.2.4: Hyperkalemia associated with the use of RAASi can be often managed by measures to reduce the serum K⁺ levels rather than decreasing the dose or stopping RAASi⁷

In CKD patients receiving RAASi who develop hyperkalemia, the latter can be controlled with newer oral potassium binders in many patients, with the effect that RAASi can be continued at the recommended dose.^’’7

2021 KDIGO Guidelines

Can Veltassa® enable Elena to re-introduce Irbesartan while controlling her K⁺ levels long-term?

Learn more about the use of irbesartan in CKD patients through the OPAL-HK trial