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Hyperkalemia burden and treatment patterns in Chinese patients on hemodialysis: final analysis of a prospective
Haijiao Jin1, Renhua Lu1, Lihong Zhang2
1Department of Nephrology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights
Hyperkalemia (HK) is common in Chinese hemodialysis (HD) patients, with over 75% experiencing recurrence. Potassium binder use was very low, highlighting a gap in HK management for end-stage renal disease (ESRD).
Area of Science:
- Nephrology
- Internal Medicine
- Cardiology
Background:
- Patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) face a significant risk of hyperkalemia (HK), a condition linked to cardiac arrhythmias and sudden death.
- Limited data exists on the prevalence and management of HK in the Chinese HD population, necessitating further investigation into this critical health issue.
Purpose of the Study:
- To assess the treatment modalities, recurrence rates, and overall prevalence of hyperkalemia (HK) among patients with end-stage renal disease (ESRD) on hemodialysis (HD) in China.
- To identify gaps in current HK management strategies within this patient cohort.
Main Methods:
- A prospective cohort study involving 600 adult patients with ESRD on HD was conducted across 15 centers in China from May 2021 to July 2022.
- Data collection focused on the incidence and recurrence of HK over a 6-month period, alongside an analysis of prescribed treatment modalities, including potassium binders.
Main Results:
- A high prevalence of HK was observed, with 75.5% of patients experiencing at least one episode over 6 months, and a substantial recurrence rate of 78.6% among those affected.
- Despite the high recurrence, the utilization of potassium binders was notably low, with only 5.3% of patients with HK receiving these treatments.
- Specific potassium binders used included sodium polystyrene sulfonate (1.5%), calcium polystyrene sulfonate (2.9%), and sodium zirconium cyclosilicate (1.3%).
Conclusions:
- Hyperkalemia (HK) represents a chronic challenge for hemodialysis (HD) patients, underscoring the need for sustained and effective potassium management strategies.
- The low prescription rate of potassium binders in this Chinese HD population suggests a significant unmet need and potential for improved therapeutic interventions to manage HK.
Objectives:
Patients with end-stage renal disease (ESRD) on hemodialysis (HD) are at risk for hyperkalemia (HK), associated with cardiac arrhythmia and sudden death. Data on the burden of HK and management techniques among HD patients in China are still scarce. This study assessed the treatment modalities, recurrence, and prevalence of HK in Chinese HD patients.
Methods:
In this prospective cohort study conducted from May 2021 to July 2022, patients aged ≥18 years who had ESRD and were on HD were enrolled from 15 centers in China (up to 6 months).
Results:
Overall, 600 patients were enrolled. At the baseline visit, mean (± standard deviation) urea reduction ratio was 68.0% ± 9.70 and Kt/V was 1.45 ± 0.496. Over 6 months, 453 (75.5%) patients experienced HK, of whom 356 (78.6%) recurred. Within 1, 2, 3, 4, 5, and 6 months, 203 (44.8%), 262 (57.8%), 300 (66.2%), 326 (72.0%), 347 (76.6%), and 356 (78.6%) patients had at least one HK recurrence event, respectively. The proportions of patients with ≥1, 2, 3, 4, 5, or 6 HK recurrence events were 356 (78.6%), 306 (67.5%), 250 (55.2%), 208 (45.9%), 161 (35.5%), and 110 (24.3%), respectively. Among the 453 patients who experienced HK, only 24 (5.3%) were treated with potassium binders: seven (1.5%) with sodium polystyrene sulfonate, 13 (2.9%) with calcium polystyrene sulfonate, and six (1.3%) with sodium zirconium cyclosilicate.
Conclusion:
Since HK is a chronic illness, long-term care is necessary. Patients on HD should have effective potassium management on non-dialysis days, yet our real-world population rarely used potassium binders.
Trial Registration:
ClinicalTrials.gov Identifier NCT04799067.
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