The Cost of Hyperkalemia in the United States

Betts, Keith A.; Woolley, J. Michael; Mu, Fan; Xiang, Cheryl; Tang, Wenxi; Wu, Eric Q.

doi:10.1016/j.ekir.2017.11.003

Cited by 55 publications

(70 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The management of HK is a major yet unmet need in the Nephrology setting, in spite of the negative impact of this alteration on patient prognosis and the obvious high costs of hospitalization and dialysis [ 104 ].…”

Section: Discussionmentioning

confidence: 99%

Management of hyperkalemia in patients with kidney disease: a position paper endorsed by the Italian Society of Nephrology

Bianchi

Aucella

Nicola³

et al. 2019

J Nephrol

View full text Add to dashboard Cite

Hyperkalemia (HK) is the most common electrolyte disturbance observed in patients with kidney disease, particularly in those in whom diabetes and heart failure are present or are on treatment with renin-angiotensin-aldosterone system inhibitors (RAASIs). HK is recognised as a major risk of potentially life threatening cardiac arrhythmic complications. When an acute reduction of renal function manifests, both in patients with chronic kidney disease (CKD) and in those with previously normal renal function, HK is the main indication for the execution of urgent medical treatment and the recourse to extracorporeal replacement therapies. In patients with end-stage renal disease, the presence of HK not responsive to medical therapy is an indication at the beginning of chronic renal replacement therapy. HK can also be associated indirectly with the progression of CKD, because the finding of high potassium values leads to withdrawal of treatment with RAASIs, which constitute the first choice nephro-protective treatment. It is therefore essential to identify patients at risk of developing HK, and to implement therapeutic interventions aimed at preventing and treating this dangerous complication of kidney disease. Current strategies aimed at the prevention and treatment of HK are still unsatisfactory, as evidenced by the relatively high prevalence of HK also in patients under stable nephrology care, and even in the ideal setting of randomized clinical trials where optimal treatment and monitoring are mandatory. This position paper will review the main therapeutic interventions to be implemented for the prevention, detection and treatment of HK in patients with CKD on conservative care, in those on dialysis, in patients in whom renal disease is associated with diabetes, heart failure, resistant hypertension and who are on treatment with RAASIs, and finally in those presenting with severe acute HK.

show abstract

Section: Discussionmentioning

confidence: 99%

Management of hyperkalemia in patients with kidney disease: a position paper endorsed by the Italian Society of Nephrology

Bianchi

Aucella

Nicola³

et al. 2019

J Nephrol

View full text Add to dashboard Cite

show abstract

“…8,9 When considering this future perspective, attaining a cost analysis of HK is preliminary and functional to the best implementation of the new anti-hyperkaliaemic agents. Few studies have evidenced that HK is a costly event; these studies were however based on retrospective analyses in unselected populations either derived from commercial or insurance databases [10][11][12] or from databases covering primary and secondary care. 13 Conversely, it is essential to gain this information in CKD patients under nephrology care for two major reasons: first, these referred CKD patients profoundly differ from general CKD population in terms of prognosis and management [14][15][16][17][18][19] ; second, a larger use of the new K binders is obviously expected in renal clinics that are the reference of care for high-risk CKD patients.…”

mentioning

confidence: 99%

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

Provenzano

Francesco²,

Iannazzo³

et al. 2020

Int J Clin Pract

View full text Add to dashboard Cite

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.

show abstract

“…Nevertheless, consistent with clinical trial findings, 21 the present study demonstrates that patients continuously exposed to patiromer for 6 months also had high RAASi continuation rates. In an observational study of patients with HK, [26] the 1-year hospital admission and ED visit rates were 0.44 and 0.86, respectively. These were consistent with the baseline (ie, 6 months pre-index) rates in the present study, though substantially higher than the observed hospital admission and ED visit rates following 6 months of CE to patiromer (0.17 admission rate; 0.40 ED rate) and SPS (0.23 admission rate; 0.64 ED rate).…”

Section: Discussionmentioning

confidence: 99%

Hyperkalemia treatment modalities: A descriptive observational study focused on medication and healthcare resource utilization

Desai

Rowan²,

Alvarez

et al. 2020

PLoS ONE

View full text Add to dashboard Cite

Renin-angiotensin-aldosterone system inhibitor (RAASi) therapy has been shown to improve outcomes among patients with congestive heart failure, diabetes, or renal dysfunction. These patients are also at risk for the development of hyperkalemia (HK), often leading to down-titration and/or discontinuation of RAASi therapy. Patiromer is the first sodium-free, non-absorbed potassium (K +) binder approved for the treatment of hyperkalemia (HK) in over 50 years. We described the association between use of K + binders (Patiromer and sodium polystyrene sulfonate [SPS]) and renin-angiotensin-aldosterone system inhibitor (RAASi), on healthcare resource utilization (HRU). The study population consisted of Medicare Advantage patients with HK (K + � 5.0 mmol/L) in Optum's Clinformatics ® Data Mart between 1/1/2016-12/31/2017. Patiromer and (SPS) initiators, and HK patients not exposed to a K + binder (NoKb) were included. The index date was the date of the first K + binder dispensing or HK diagnosis. Outcomes assessed at 6 months post-index were: (1) K + binder utilization, (2) RAASi continuation, and (3) HRU (pre-vs post-index). HRU change was analyzed using McNemar's statistical test. Study cohorts included 610 (patiromer), 5556 (SPS), and 21,282 (NoKb) patients. Overall baseline patient characteristics were: mean age 75 years; female 49%, low-income subsidy 29%, chronic kidney disease 48% (63% for patiromer cohort), and congestive heart failure 29%. At 6 months post-index, 28% (patiromer) and 2% (SPS) remained continuously exposed to the index K + binder. RAASi continued for 78% (patiromer), 57% (SPS), and 57% (NoKb). The difference (pre-vs postindex) in hospitalized patients was:-9.4% (patiromer; P<0.05),-7.2% (SPS), and +16.8% (NoKb; P<0.001). Disparate K + binder utilization patterns were observed. The majority of patiromer patients continued RAASi therapy while the percentage of SPS patients that continued RAASi therapy was lower, overlapping CIs were observed. Following continuous

show abstract

The Cost of Hyperkalemia in the United States

Cited by 55 publications

References 24 publications

Management of hyperkalemia in patients with kidney disease: a position paper endorsed by the Italian Society of Nephrology

Management of hyperkalemia in patients with kidney disease: a position paper endorsed by the Italian Society of Nephrology

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

Hyperkalemia treatment modalities: A descriptive observational study focused on medication and healthcare resource utilization

Contact Info

Product

Resources

About