#3068 POTASSIUM LEVELS AND EGFR DO NOT PREDICT SEVERE HYPERKALEMIA FOLLOWING SPIRONOLACTONE INTRODUCTION IN PATIENTS WITH CKD AT HIGH RISK OF HYPERKALEMIA

Abstract Background and Aims Mineralocorticoid receptor antagonists (MRA) reduce blood pressure, albuminuria the rate of disease progression in patients with chronic kidney (CKD) albuminuria. Despite these apparent benefits, only a very small fraction CKD are treated an MRA. This may part be due to fear hyperkalemia (HK), which most severe cases can cause life-threatening arrythmias. Indeed, international guidelines previous studies have excluded believed at high risk HK from treatment MRA including pre-existing serum potassium. To examine if fact predicted by baseline potassium levels or eGFR, we performed clinical study testing effect introducing spironolactone on plasma (P-K) closely monitored, high-risk other studies. Secondly, analyzed eGFR Method We included 25-60 ml/min/1.73 m2 maximal tolerated RAAS-blockade (ACEi ARB) history least two HK-episodes (P-K > 4.5mmol/l) within 24 months prior inclusion. Following dietary counselling avoidance potassium-rich foods, was initiated 25 mg daily. If as defined decline < 30%, P-K ≤ 5.5mmol/l absence hypotension, dose increased 50 after weeks. Total follow-up four weeks measuring P-K, pressure spot urine albumin creatinine ratio. Results were compared using paired t-test. In post-hoc analysis, grouped based occurrence 5.5mmol/l) not, characteristics change unpaired Linear regression model used test association between vs. eGFR. Fifty-eight mean age 65 years. Forty-seven males 23 had diabetes. Forty-eight reached mg. introduction, declined 39 34ml/min/1.73 (p<0.001) reduced median 1276mg/g 654 mg/g (49%; 95%CI: 44 – 54%) no significant pressure. Mean 0.5mmol/l (95% CI 0.3 - 0.7mmol/l) 4.7mmol/l 5.2mmol/l. Seventeen developed briefly admitted 6.2mmol/l. Importantly, there difference nor that when those did not (4.70 vs 4.67 mmol/L, p = 0.83 36.2 40.1 m2, 0,13). Furthermore, correlate maximum (Figure 1) significantly 2). Conclusion Short-term leads similar reductions low-risk cohorts. With counseling, 30% will develop 4 Importantly contrary common belief, neither associated development HK. Thus, excluding solely is appropriate. Instead, believe empirical approach counseling close monitoring should used.