Cost‐analysis of persistent hyperkalaemia in non‐dialysis chronic kidney disease patients under nephrology care in Italy

Abstract

Aim In patients with chronic kidney disease (CKD), hyperkalaemia (HK) (potassium level ≥ 5.0 mEq/L) is associated with poor clinical outcomes. This study provides novel insights by comparing management costs of CKD patients with normokalaemia vs those with persistent HK regularly followed in renal clinics in Italy. Methods To this aim, a Markov model over life‐time horizon was developed. Time to end‐stage renal disease (ESRD) and time to death in CKD patients were derived from an observational multi‐centre database including 1665 patients with non‐dialysis CKD stage 1‐5 under nephrology care in Italy (15 years follow‐up). Resource use for CKD and HK management was obtained from the observational database, KDIGO international guidelines, and clinical expert opinion. Results Results showed that patients with normokalaemia vs persistent HK brought an average per patient lifetime cost‐saving of €16 059 besides delayed onset of ESRD by 2.29 years and increased survival by 1.79 years with increment in total survival and dialysis‐free survival in normokalaemia that decreased from early to advanced disease. Cost‐saving related to normokalaemia increased at more advanced CKD; however, it was already evident at early stage (3388.97€ at stage 1‐3a). OWSA confirmed cost‐saving associated with normokalaemia across all parameter variations. Discussion and conclusion This model is the first to simulate the impact of HK in non‐dialysis CKD patients on economic and clinical outcomes using real‐world data from nephrology clinics. In these patients, persistent HK results into higher lifetime costs, besides poorer clinical outcomes, that are evident since the early stages of CKD. Maintaining normokalaemia should therefore be of main concern in CKD treatment planning to improve long‐term economic and clinical outcomes.

Current Management of Hyperkalemia in Non-Dialysis CKD: Longitudinal Study of Patients Receiving Stable Nephrology Care

“…Similar data have been shown in 2164 patients at discharge after decompensated heart failure [3]. Furthermore, the cost of providing care for patients with even moderate HK is double the cost of care for those whose potassium levels are normal [4,5].…”

Management of Chronic Hyperkalemia in Patients With Chronic Kidney Disease: An Old Problem With News Options

“…Compensatory mechanisms may help improving tolerance to hyperkalemia in patients with CKD and a J-shaped correlation was found between serum potassium and overall mortality risk in non-dialysis patients (16). Moreover, new onset or persistence of mild-to-moderate hyperkalemia (potassium 5.0-6.0 mmol/L) during 12 months of observation significantly increased by 30% the risk of End Stage Renal Disease (ESRD) (4,17,18). It has been suggested that CKD patients adapt to elevated potassium concentrations through modifications in gastrointestinal secretions which may favor intracellular potassium storage, or by increasing insulinmediated intracellular potassium uptake in splanchnic and peripheral muscle tissues (19).…”

Hyperkalemia in chronic kidney disease patients with and without heart failure: an Italian economic modelling study

“…Authors reported that HK was frequent in patients with CKD and/or HF and was associated with decreased RAASi use compared to patients with normokalemia. Furthermore, an Italian observational study assessed outcomes and determinants of HK in 2,446 CKD patients across 46 nephrology clinics, and found that HK (mild to moderate) was prevalent amongst 37% of CKD patients with an associated risk of ESRD progression [ 16 ]. These studies highlight the unmet need for better treatment options for HK in CKD patients with and without HF in Italy.…”

“…Healthcare utilization for HK management was primarily derived from Italian guidelines [ 17 ] and multicenter prospective observational studies in non-dialysis [ 16 , 25 ] and dialysis patients [ 28 ]. RAASi use was based on OPAL-HK [ 20 ] and dose optimization was aligned with technology appraisal guidance from National Institute for Health and Care Excellence (NICE) for sodium zirconium cyclosilicate in treating HK [ 29 ].…”