{"id":"9098f972e08b","type":"article","url":"https://hartvaat.nl/2026/06/26/sglt2-remmers-kunnen-hyperkaliemie-gerelateerd-stoppen-van-raas-remmers-voorkome/","title":"SGLT2-remmers kunnen hyperkaliëmie-gerelateerd stoppen van RAAS-remmers voorkomen bij MRA-gebruik","title_en":"Sodium-Glucose Co-Transporter 2 Inhibitors and Hyperkalemia-Related Discontinuation of Renin-Angiotensin-Aldosterone System Inhibitors During Mineralocorticoid Receptor Antagonist Therapy: A Real-World Cohort Study.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"Pharmacy (Basel, Switzerland)","doi":"10.3390/pharmacy14040091","source_url":"https://doi.org/10.3390/pharmacy14040091","authors":["Abdullah Hashim Almalki","Nourah Abdulaziz Alorainan","Muhjah Abdulhakim Bukhari","Fahad Ali Dokhaikh","Salma Mohamed Abbas Quqandi","Reyan Hatem Merdad","Laila Fahad Sadagah"],"significance":5,"published":"2026-08-06","source_date":"2026-06-26","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/sglt2-remmers-farmacologie/","https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/"],"congress":"","summary_en":"In a retrospective cohort of 905 patients, adding a mineralocorticoid receptor antagonist (MRA) to RAAS inhibition doubled the risk of hyperkalemia. However, co-prescription of an SGLT2 inhibitor neutralized the association between MRA use and hyperkalemia-driven RAAS inhibitor discontinuation: discontinuation rates increased more than fivefold without an SGLT2 inhibitor, but remained low in those receiving one. This real-world data suggests that SGLT2 inhibitors may help preserve RAASi and MRA therapy in patients prone to hyperkalemia, supporting their early integration in cardiorenal management.","created":"2026-07-30T01:20:27Z","updated":"2026-08-10T10:36:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"In een retrospectieve cohortstudie onder 905 patiënten bleek de toevoeging van een mineralocorticoidreceptorantagonist (MRA) aan RAAS-remming de kans op hyperkaliëmie te verdubbelen. Co-prescriptie van een SGLT2-remmer neutraliseerde echter de associatie tussen MRA-gebruik en hyperkaliëmie-gerelateerd stoppen van RAAS-remmers: zonder SGLT2-remmer nam het stoppercentage met meer dan vijf toe, terwijl dit bij gebruikers van een SGLT2-remmer niet significant hoger was. Voor cardiologen en internisten betekent dit dat SGLT2-remmers niet alleen cardiorenale bescherming bieden, maar mogelijk ook helpen om RAAS-remming en MRA-therapie vol te houden bij patiënten met een verhoogd kaliumrisico.","abstract_original":"Background: Hyperkalemia (HK) is a common complication of renin-angiotensin-aldosterone system inhibitor (RAASi) therapy, and the risk is often increased by concomitant use of a mineralocorticoid receptor antagonist (MRA). The effect of SGLT2i co-prescription on this risk in routine clinical practice remains incompletely understood. Methods: This is a secondary analysis of a published retrospective cohort of 905 adult RAASi users attending outpatient clinics at King Abdulaziz Medical City, Jeddah, Saudi Arabia (IRB: NRJ22J/279/11), followed for a median of 28 months. Patients were classified as RAASi alone (n = 723) or RAASi plus MRA (n = 182). Beta-blockers and digoxin were excluded from the exposure definition. Effect modification by SGLT2i was assessed using logistic regression with a multiplicative interaction term. Results: MRA addition was associated with significantly higher rates of any HK (48.4% vs. 28.9%; RR 1.67, 95% CI 1.38-2.02, p < 0.001) and moderate-to-severe HK (13.7% vs. 6.9%; RR 1.99, 95% CI 1.26-3.12, p = 0.003). Overall, RAASi discontinuation rates were similar between groups. SGLT2i co-prescription significantly modified the association between MRA use and HK-driven RAASi discontinuation (interaction p = 0.004): among patients without SGLT2i, MRA addition was associated with a more than 5-fold increase in HK-driven discontinuation (21.1% vs. 4.1%; RR 5.11, p = 0.001), whereas no significant excess risk was observed among SGLT2i users (1.8% vs. 4.2%; RR 0.44, 95% CI 0.12-1.57, p = 0.190), although this subgroup estimate was imprecise. CKD (aOR 2.16, 95% CI 1.56-2.99) and age ≥ 75 years (aOR 1.64, 95% CI 1.04-2.58) were the strongest independent predictors of HK. Conclusions: MRA addition to RAASi substantially increases HK burden, and SGLT2i co-prescription appears to protect against HK-driven RAASi discontinuation in combined RAASi-MRA-treated patients. In patients with established indications for SGLT2i, co-prescription may confer the additional benefit of preserving RAASi continuity in the setting of MRA combination therapy."}