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Hyperkalemia in chronic kidney disease patients with and without heart failure: an Italian economic modelling study
Ewa Stawowczyk1, Thomas Ward2,3, Ernesto Paoletti4
1Health Economics and Outcomes Research Ltd, Cardiff, UK. ewa.stawowczyk@heor.co.uk.
Insights
Patiromer therapy in chronic kidney disease (CKD) patients with hyperkalemia (HK) improves quality of life and enables renin-angiotensin-aldosterone system inhibitor (RAASi) use. This cost-effective treatment reduces adverse events and hospitalizations in Italy.
Area of Science:
- Nephrology
- Cardiology
- Health Economics
Background:
- Hyperkalemia (HK) is common in chronic kidney disease (CKD), often linked to comorbidities and renin-angiotensin-aldosterone system inhibitor (RAASi) use.
- Standard care for HK in CKD may require RAASi dose reduction or discontinuation, negatively impacting cardiorenal outcomes.
- This study assesses the cost-effectiveness of patiromer for HK in CKD patients, with or without heart failure (HF), in Italy.
Purpose of the Study:
- To evaluate the cost-effectiveness of patiromer compared to standard of care (SoC) for managing hyperkalemia in CKD patients.
- To analyze the impact of patiromer on clinical events, quality-adjusted life years (QALYs), and RAASi treatment adherence.
- To conduct subgroup analyses in CKD patients with and without heart failure (HF).
Main Methods:
- A lifetime Markov cohort model (OPAL-HK) was utilized to simulate clinical and economic outcomes.
- The model compared patiromer therapy against SoC, considering the effects of HK and RAASi use.
- Key outcomes included clinical events, number needed to treat (NNT), and incremental cost-effectiveness ratio (ICER), with subgroup analyses for HF presence.
Main Results:
- Patiromer yielded an incremental cost-effectiveness ratio (ICER) of €24,004, with an associated QALY gain of 0.194.
- Patiromer treatment prevented 275 moderate/severe HK events, 54 major adverse cardiovascular events, and facilitated RAASi therapy maintenance (246 discontinuations avoided, 213 up-titrations/restarts).
- QALY gains were higher in CKD patients without HF (0.267) compared to those with HF (0.092); patiromer was more effective in preventing events in CKD patients with HF.
Conclusions:
- Patiromer demonstrates value by improving QALYs in CKD patients with and without HF in Italy.
- Patiromer effectively prevents HK events, supports the continuation of RAASi therapy, and reduces the risk of cardiovascular events.
- The findings support patiromer as a beneficial treatment option for HK in CKD patients, offering improved outcomes and enabling optimal RAASi management.
Background:
Hyperkalemia (HK) is frequently present in chronic kidney disease (CKD). Risk factors for HK among CKD patients include comorbidities and renin-angiotensin-aldosterone system inhibitor (RAASi) treatment. Current standard of care (SoC) often necessitates RAASi down-titration or discontinuation, resulting in poorer cardiorenal outcomes, hospitalization and mortality. This study evaluates the cost-effectiveness of patiromer for HK in CKD patients with and without heart failure (HF) in an Italian setting.
Methods:
A lifetime Markov cohort model was developed based on OPAL-HK to assess the health economic impact of patiromer therapy in comparison to SoC after accounting for the effects of HK and RAASi use on clinical events. Outcomes included accumulated clinical events, number needed to treat (NNT) and the incremental cost-effectiveness ratio (ICER). Subgroup analysis was conducted in CKD patients with and without HF.
Results:
Patiromer was associated with an incremental discounted cost of €4,660 and 0.194 quality adjusted life years (QALYs), yielding an ICER of €24,004. Per 1000 patients, patiromer treatment prevented 275 moderate/severe HK events, 54 major adverse cardiovascular event, 246 RAASi discontinuation and 213 RAASi up-titration/restart. Subgroup analysis showed patiromer was more effective in preventing clinical events in CKD patients with HF compared to those without; QALY gains were greater in CKD patients without HF versus those with HF (0.267 versus 0.092, respectively). Scenario analysis and sensitivity analysis results support base-case conclusions.
Conclusion:
Patiromer is associated with QALY gains in CKD patients with and without HF compared to SoC in Italy. Patiromer prevented HK events, enabled RAASi therapy maintenance and reduced cardiovascular event risk.
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