Trevisan M, et al. - In real-world settings, the frequency of mineralocorticoid receptor antagonist (MRA)-associated hyperkalemia and the extent of subsequent MRA discontinuation was assessed. All Stockholm citizens initiating MRA therapy between 2007–2010 were examined. Hyperkalemia was a very common occurrence in real-world adults initiating MRA therapy, and was frequently followed by therapy interruption, particularly among those with chronic kidney disease (CKD). Factors related to increased hyperkalemia risk were CKD, older age, male sex, heart failure, peripheral vascular disease, diabetes and concomitant use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers and diuretics. After hyperkalemia, MRA discontinuation and reduction in the prescribed dose was reported for 47% and 10% patients, respectively. Discontinuation rates were noted to be higher after moderate/severe (K⁺ > 5.5 mmol/L) and early in therapy (<3 months from initiation) hyperkalemias.