{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T20:08:50Z","timestamp":1787947730483,"version":"build-2784847793"},"reference-count":35,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern Med"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Hyperkalaemia is a serious complication in patients with chronic kidney disease (CKD) and heart failure (HF), often leading to the discontinuation of renin\u2013angiotensin\u2013aldosterone system inhibitors (RAASi; renin\u2010angiotensin system inhibitors [RASi] and mineralocorticoid receptor antagonists [MRAs]) despite their cardiorenal benefits. Although potassium binders, especially second\u2010generation potassium binders, reduce the risk of hyperkalaemia in clinical trials, real\u2010world evidence on whether they enable RAASi continuation and influence clinical outcomes remains scarce.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This observational, population\u2010based cohort study used Swedish healthcare data from the DEMONSTRATE database to identify adults with non\u2010dialysis (ND) CKD and\/or HF who initiated potassium binders (2018\u20132022). Patients were stratified by potassium binder generation. RASi and MRA treatment changes were assessed at 6 months, and clinical outcomes (all\u2010cause mortality, hospitalization and three\u2010point major adverse cardiovascular events [3P\u2010MACE]) were evaluated over a 3\u2010year follow\u2010up using propensity\u2010score\u2010weighted Kaplan\u2013Meier analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 7913 potassium binder episodes (6232 patients), 7.1% used second\u2010generation binders. These episodes were associated with increased RAASi persistence at 6 months: 76.9% and 57.5% of second\u2010generation users maintained RASi and MRA therapy, respectively, compared with 66.4% and 47.8% in the first\u2010generation group. Patients who maintained RASi had lower observed all\u2010cause mortality and hospitalization rates, but no difference in incidence of 3P\u2010MACE was found.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Second\u2010generation potassium binders were associated with higher RAASi persistence than first\u2010generation binders. RASi persistence was associated with lower observed rates of all\u2010cause mortality and hospitalization, with no clear differences in 3P\u2010MACE. These findings suggest that potassium binders may enable sustained RAASi use in patients with ND\u2010CKD and\/or HF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/joim.70087","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T09:36:51Z","timestamp":1774517811000},"page":"179-192","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Potassium binders and continuation of renin\u2013angiotensin system inhibitors\/mineralocorticoid receptor antagonist in chronic kidney disease and heart failure (the DEMONSTRATE database)"],"prefix":"10.1111","volume":"300","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9001-614X","authenticated-orcid":false,"given":"Hans","family":"Furuland","sequence":"first","affiliation":[{"name":"Department of Medical Sciences, Renal Medicine Uppsala University Hospital  Uppsala 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