Feyissa GD. Letter to the Editor: Enhancing renin-angiotensin-aldosterone system inhibitors utilization through patiromer adherence - real-world insights for nephrology practice. World J Nephrol 2026; 15(3): 119286 [DOI: 10.5527/wjn.119286]
Corresponding Author of This Article
Gemechu Dereje Feyissa, Assistant Professor, Department of Public Health, Faculty of Health Sciences, Rift Valley University, Hangatu District, Dabe Sub-City, Adama 1715, Oromīa, Ethiopia. gemechudereje80@gmail.com
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Urology & Nephrology
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letter
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Feyissa GD. Letter to the Editor: Enhancing renin-angiotensin-aldosterone system inhibitors utilization through patiromer adherence - real-world insights for nephrology practice. World J Nephrol 2026; 15(3): 119286 [DOI: 10.5527/wjn.119286]
World J Nephrol. Sep 25, 2026; 15(3): 119286 Published online Sep 25, 2026. doi: 10.5527/wjn.119286
Letter to the Editor: Enhancing renin-angiotensin-aldosterone system inhibitors utilization through patiromer adherence - real-world insights for nephrology practice
Gemechu Dereje Feyissa
Gemechu Dereje Feyissa, Department of Public Health, Faculty of Health Sciences, Rift Valley University, Adama 1715, Oromīa, Ethiopia
Author contributions: Feyissa GD conceptualized the topic, its clinical relevance, and structure; Feyissa GD conducted the literature review and evidence synthesis; Feyissa GD interpreted data from the cohort study; Feyissa GD drafted all sections; Feyissa GD revised for accuracy, clarity, and flow; Feyissa GD approved the final version, and assumes accountability for the work’s integrity.
AI contribution statement: AI-assisted tools were used for language editing and grammar refinement. The entirety of the manuscript's intellectual content, analysis, and clinical interpretation was written and synthesized by me. No portion of the manuscript was generated by AI. AI tools were utilized exclusively for language polishing and grammatical refinement to improve clarity and readability. No AI tool was used for data analysis or to generate any original scientific text. The study design, synthesis of the findings, and the interpretation of results were conducted entirely by me without AI involvement. There are no AI-generated images in this manuscript. I hope this clarifies the nature of the assistance received.
Conflict-of-interest statement: The author declares that there are no conflicts of interest related to this work.
Corresponding author: Gemechu Dereje Feyissa, Assistant Professor, Department of Public Health, Faculty of Health Sciences, Rift Valley University, Hangatu District, Dabe Sub-City, Adama 1715, Oromīa, Ethiopia. gemechudereje80@gmail.com
Received: January 23, 2026 Revised: January 30, 2026 Accepted: February 25, 2026 Published online: September 25, 2026 Processing time: 202 Days and 9.1 Hours
Abstract
I read with interest the retrospective cohort study by Kleinman et al published in World Journal of Nephrology. Renin-angiotensin-aldosterone system inhibitors (RAASi) anchor therapy for chronic kidney disease, heart failure, and hypertension, but hyperkalemia often curtails optimal use. This letter synthesizes a retrospective cohort of 13447 patiromer users, where approximately 25% high adherers [proportion of days covered (PDC) ≥ 80%] showed approximately 10% greater RAASi utilization (days’ supply and PDC) across angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and mineralocorticoid receptor antagonists vs lower adherers. Findings echo OPAL-HK, reinforce Kidney Disease: Improving Global Outcomes 2021 binder prioritization, and urge adherence strategies to sustain guideline therapy, cut hospitalizations, and integrate with SGLT2i/finerenone.
Core Tip: Among 13447 real-world patiromer users, high adherence [proportion of days covered (PDC) ≥ 80%] drove approximately 10% higher renin-angiotensin-aldosterone system inhibitors utilization. Prioritize chronic patiromer (Kidney Disease: Improving Global Outcomes 2021/OPAL-HK), monitor PDC, use multidisciplinary support to overcome barriers, and combine with SGLT2i/finerenone for renal/cardiovascular protection.
