Letter to the Editor: Enhancing renin-angiotensin-aldosterone system inhibitors utilization through patiromer adherence - real-world insights for nephrology practice.

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.