{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T00:32:28Z","timestamp":1793320348452,"version":"4.5.0"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["RICORS2040"],"award-info":[{"award-number":["RICORS2040"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["RD24\/0004\/0028"],"award-info":[{"award-number":["RD24\/0004\/0028"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Uni\u00f3n Europea","award":["PI23\/001518"],"award-info":[{"award-number":["PI23\/001518"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hyperkalemia is a common complication in chronic kidney disease (CKD), requiring management to maintain cardiovascular benefits of renin\u2013angiotensin\u2013aldosterone system and mineralocorticoid receptors (RAASi\/MRA) therapy. This study evaluated hyperkalemia management and recurrence in CKD patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective, multicenter observational study was conducted across 15 hospitals, enrolling 429 patients with serum potassium &amp;gt; 5.5 mmol\/L. Patients were managed per usual practice, and data on recurrence, RAASi\/MRA changes, cardiovascular events, and renal function were collected over 2 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Cohort (mean age 71.5 years, 71.3% male, 88.6% hypertension, 55.9% diabetes) presented with mild, moderate (19.1%), and severe (3.7%) hyperkalemia. Post-event, dietary modifications increased by 39.9%, bicarbonate use by 7.9%, resin use by 2.6%, patiromer use by 10.9%, and sodium zirconium cyclosilicate (SZC) use by 24.6%. Modifications on RAA Si\/MRA therapy were as follows: angiotensin-converting enzyme inhibitors reduced in 12% and suspended in 6.8%; angiotensin II receptor blockers reduced in 5.49% and suspended in 7.32%; and MRA reduced in 12.73% and suspended in 21.82%. Recurrence occurred in 43.8%, with higher rates in patients with baseline estimated glomerular filtration rate &amp;lt;30 ml\/min (49.1% vs 38.8%, P = 0.03). Recurrent hyperkalemia was associated with faster eGFR decline (\u22122.4 ml\/min\/year, P &amp;lt; 0.001). Kaplan\u2013Meier analysis showed no differences in overall survival between patients with and without recurrence. The study found no significant difference between patiromer\/SZC and resins in efficacy (recurrence rates).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Integrating potassium binders into CKD therapeutic strategies may improve hyperkalemia management and allow sustained RAASi\/MRA use. Recurrence remains significant, impacting renal function, although causality is unclear. The mortality difference requires further study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/joneph\/aajag149","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T11:44:02Z","timestamp":1779882242000},"page":"1607-1615","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing hyperkalemia management in CKD: real-world nephrologist strategies and impact on patient outcomes"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9691-2546","authenticated-orcid":false,"given":"Mar\u00eda","family":"Marques","sequence":"first","affiliation":[{"name":"Nephrology Department, HU Puerta de Hierro-Majadahonda , Majadahonda ,","place":["Spain"]},{"name":"Medicine Department, Facultad Medicina, Universidad Aut\u00f3noma de Madrid , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4332-5759","authenticated-orcid":false,"given":"Paula","family":"L\u00f3pez-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Nephrology Department, HU Puerta de Hierro-Majadahonda , Majadahonda ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5824-6973","authenticated-orcid":false,"given":"Enrique","family":"Morales","sequence":"additional","affiliation":[{"name":"Nephrology Department, HU Doce de Octubre , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7364-557X","authenticated-orcid":false,"given":"M Auxiliadora","family":"Bajo","sequence":"additional","affiliation":[{"name":"Nephrology Department, HU La Princesa , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antolina","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Nephrology Department, HU Cl\u00ednico San Carlos , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milagros","family":"Fern\u00e1ndez Lucas","sequence":"additional","affiliation":[{"name":"Nephrology Department, HU Ram\u00f3n y Cajal , Madrid ,","place":["Spain"]},{"name":"Medicine Department, Universidad de Alcal\u00e1 , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicente","family":"Paraiso","sequence":"additional","affiliation":[{"name":"Nephrology Department, HU Henares , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Bucalo","sequence":"additional","affiliation":[{"name":"Nephrology Department, HU Guadalajara , Guadalajara ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yolanda","family":"Hernandez","sequence":"additional","affiliation":[{"name":"Nephrology Department, HU Infanta Sof\u00eda , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 C","family":"De La Flor","sequence":"additional","affiliation":[{"name":"Nephrology Department, HU G\u00f3mez Ulla , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maite","family":"Padr\u00f3n","sequence":"additional","affiliation":[{"name":"Nephrology Department, HU Toledo , Toledo ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanane","family":"Bouarich","sequence":"additional","affiliation":[{"name":"Nephrology Department, HU Pr\u00edncipe de Asturias , Alcal\u00e1 de Henares ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5655-5628","authenticated-orcid":false,"given":"Fabio","family":"Procaccini","sequence":"additional","affiliation":[{"name":"Nephrology Department, HU Infanta Leonor , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2663-7301","authenticated-orcid":false,"given":"Coraima","family":"Nava Chavez","sequence":"additional","affiliation":[{"name":"Nephrology Department, HU Gregorio Mara\u00f1\u00f3n , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Herrero","sequence":"additional","affiliation":[{"name":"Nephrology Department, HU Cl\u00ednico San Carlos , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Tornero","sequence":"additional","affiliation":[{"name":"Nephrology Department, HU Sureste , Arganda del Rey ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"2026102919565582800_aajag149-B1","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/j.kint.2019.09.018","article-title":"Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a kidney disease: improving global outcomes (KDIGO) controversies conference","volume":"97","author":"Clase","year":"2020","journal-title":"Kidney Int"},{"key":"2026102919565582800_aajag149-B2","doi-asserted-by":"publisher","first-page":"653634","DOI":"10.3389\/fmed.2021.653634","article-title":"Management of chronic hyperkalemia in patients with chronic kidney disease: an old problem with news options","volume":"8","author":"Morales","year":"2021","journal-title":"Front Med (Lausanne)"},{"key":"2026102919565582800_aajag149-B3","doi-asserted-by":"publisher","first-page":"762","DOI":"10.2215\/CJN.05850809","article-title":"Serum potassium and outcomes in CKD: insights from the RRI-CKD cohort study","volume":"5","author":"Korgaonkar","year":"2010","journal-title":"Clin J Am Soc Nephrol."},{"key":"2026102919565582800_aajag149-B4","doi-asserted-by":"publisher","first-page":"1535","DOI":"10.1093\/eurheartj\/ehy100","article-title":"Serum potassium and adverse outcomes across kidney function: a CKD prognosis consortium meta-analysis","volume":"39","author":"Kovesdy","year":"2018","journal-title":"Eur Heart J"},{"key":"2026102919565582800_aajag149-B5","doi-asserted-by":"publisher","first-page":"20543581211017408","DOI":"10.1177\/20543581211017408","article-title":"Initial and recurrent hyperkalemia events in patients with CKD in older adults: a population-based cohort study","volume":"8","author":"Sriperumbuduri","year":"2021","journal-title":"Can J Kidney Health Dis"},{"key":"2026102919565582800_aajag149-B6","doi-asserted-by":"publisher","first-page":"1698","DOI":"10.1002\/ejhf.2287","article-title":"Stopping mineralocorticoid receptor antagonists after hyperkalaemia: trial emulation in data from routine care","volume":"23","author":"Trevisan","year":"2021","journal-title":"Eur J Heart Fail"},{"key":"2026102919565582800_aajag149-B7","doi-asserted-by":"publisher","first-page":"1610","DOI":"10.1093\/ndt\/gfx312","article-title":"Elevated potassium levels in patients with chronic kidney disease: occurrence, risk factors and clinical outcomes-a Danish population-based cohort study","volume":"33","author":"Thomsen","year":"2018","journal-title":"Nephrol Dial Transplant"},{"key":"2026102919565582800_aajag149-B8","doi-asserted-by":"publisher","first-page":"3155","DOI":"10.1681\/ASN.2016121344","article-title":"How dangerous is hyperkalemia?","volume":"28","author":"Montford","year":"2017","journal-title":"J Am Soc Nephrol"},{"key":"2026102919565582800_aajag149-B9","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1016\/j.mayocp.2019.05.019","article-title":"Potassium binders for hyperkalemia in chronic kidney disease-diet, renin-angiotensin-aldosterone system inhibitor therapy, and hemodialysis","volume":"95","author":"Palmer","year":"2020","journal-title":"Mayo Clin Proc"},{"key":"2026102919565582800_aajag149-B10","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1056\/NEJMoa1410853","article-title":"Patiromer in patients with kidney disease and hyperkalemia receiving RAAS inhibitors","volume":"372","author":"Weir","year":"2015","journal-title":"N Engl J Med"},{"key":"2026102919565582800_aajag149-B11","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1056\/NEJMoa1411487","article-title":"Sodium zirconium cyclosilicate in hyperkalemia","volume":"372","author":"Packham","year":"2015","journal-title":"N Engl J Med"},{"key":"2026102919565582800_aajag149-B12","doi-asserted-by":"publisher","first-page":"2223","DOI":"10.1001\/jama.2014.15688","article-title":"Effect of sodium zirconium cyclosilicate on potassium lowering for 28 days among outpatients with hyperkalemia: the HARMONIZE randomized clinical trial","volume":"312","author":"Kosiborod","year":"2014","journal-title":"JAMA"},{"key":"2026102919565582800_aajag149-B13","doi-asserted-by":"publisher","first-page":"820","DOI":"10.1093\/eurheartj\/ehq502","article-title":"Evaluation of the efficacy and safety of RLY5016, a polymeric potassium binder, in a double-blind, placebo-controlled study in patients with chronic heart failure (the PEARL-HF) trial","volume":"32","author":"Pitt","year":"2011","journal-title":"Eur Heart J"},{"key":"2026102919565582800_aajag149-B14","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1001\/jama.2015.7446","article-title":"Effect of patiromer on serum potassium level in patients with hyperkalemia and diabetic kidney disease the AMETHYST-DN randomized clinical trial","volume":"314","author":"Bakris","year":"2015","journal-title":"JAMA"},{"key":"2026102919565582800_aajag149-B15","doi-asserted-by":"publisher","first-page":"2075","DOI":"10.1681\/ASN.2008111205","article-title":"Bicarbonate supplementation slows progression of CKD and improves nutritional status","volume":"20","author":"de Brito-Ashurst","year":"2009","journal-title":"J Am Soc Nephrol"},{"key":"2026102919565582800_aajag149-B16","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1038\/ki.2010.388","article-title":"Higher serum bicarbonate levels and renal outcomes","volume":"79","author":"Raphael","year":"2011","journal-title":"Kidney Int"},{"key":"2026102919565582800_aajag149-B17","doi-asserted-by":"publisher","first-page":"R225","DOI":"10.1186\/cc11872","article-title":"Severe hyperkalemia requiring hospitalization: predictors of mortality","volume":"16","author":"An","year":"2012","journal-title":"Crit Care"},{"key":"2026102919565582800_aajag149-B18","doi-asserted-by":"publisher","first-page":"1156","DOI":"10.1001\/archinternmed.2009.132","article-title":"The frequency of hyperkalemia and its significance in chronic kidney disease","volume":"169","author":"Einhorn","year":"2009","journal-title":"Arch Intern Med"},{"key":"2026102919565582800_aajag149-B19","doi-asserted-by":"publisher","first-page":"682","DOI":"10.1053\/j.ajkd.2019.03.427","article-title":"Physiology and pathophysiology of potassium homeostasis: core curriculum 2019","volume":"74","author":"Palmer","year":"2019","journal-title":"Am J Kidney Dis"},{"key":"2026102919565582800_aajag149-B20","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfaf127","article-title":"The burden of hyperkalemia in CKD","volume":"18","author":"Floege","year":"2025","journal-title":"Clin Kidney J"}],"container-title":["Journal of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/joneph\/article-pdf\/39\/8\/1607\/70650559\/aajag149.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/joneph\/article-pdf\/39\/8\/1607\/70650559\/aajag149.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:57:04Z","timestamp":1793318224000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/joneph\/article\/39\/8\/1607\/8761623"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,14]]},"references-count":20,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,14]]},"published-print":{"date-parts":[[2026,10,30]]}},"URL":"https:\/\/doi.org\/10.1093\/joneph\/aajag149","relation":{},"ISSN":["1121-8428","1724-6059"],"issn-type":[{"value":"1121-8428","type":"print"},{"value":"1724-6059","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,11]]},"published":{"date-parts":[[2026,8,14]]}}}