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Hyperkalemia and its treatment: real-world evidence and managed care considerations supporting use of potassium
Edgar Lerma1, Craig J Beavers2
1Department of Medicine, University of Illinois at Chicago, 335 Selborne Rd, Riverside, IL 60546.
Insights
Hyperkalemia affects millions of US adults, increasing risks for cardiovascular events and mortality. New potassium binders like sodium zirconium cyclosilicate (SZC) and patiromer offer effective treatment options, potentially reducing healthcare costs.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Hyperkalemia affects 3.7 million US adults, often linked to chronic kidney disease (CKD), heart failure (HF), and renin-angiotensin-aldosterone system inhibitors (RAASi).
- Recurrent hyperkalemia increases risks of major adverse cardiovascular events, hospitalization, mortality, and healthcare costs.
- Lifestyle modifications alone have shown limited success in managing chronic or recurrent hyperkalemia.
Purpose of the Study:
- To evaluate the role of potassium binders in managing hyperkalemia, particularly in patients with CKD and HF.
- To assess the efficacy, safety, and real-world outcomes associated with potassium binders, including sodium zirconium cyclosilicate (SZC), patiromer, and sodium polystyrene sulfonate (SPS).
Main Methods:
- Review of clinical trials, long-term extensions, and real-world evidence for SZC, patiromer, and SPS.
- Analysis of guideline recommendations for potassium binder use in CKD and HF patients.
- Examination of health economic data regarding hyperkalemia management and healthcare resource utilization.
Main Results:
- SZC and patiromer demonstrate safety and efficacy in clinical trials and are recommended for CKD patients; SZC and patiromer are also considered for HF patients.
- Real-world evidence links SZC and patiromer use to reduced healthcare costs and resource utilization.
- Potassium binders may enable optimization of RAASi therapy, improving management of comorbid conditions.
Conclusions:
- Potassium binders, particularly SZC and patiromer, represent crucial therapeutic options for managing hyperkalemia in at-risk populations.
- Proactive potassium control with binders can mitigate adverse cardiovascular outcomes and reduce healthcare expenditures.
- Managed care strategies incorporating routine potassium binder use can improve patient outcomes and support optimal medication management for CKD and HF.
Abstract:
An estimated 3.7 million adults in the United States have hyperkalemia. It commonly occurs in patients with chronic kidney disease (CKD) and/or heart failure (HF) and as a result of treatment with renin-angiotensin-aldosterone system inhibitors (RAASi), a class of medications recommended by professional guidelines for patients with CKD and those with HF. While lifestyle alterations have been previously recommended to control potassium levels for some patients with hyperkalemia, emerging evidence has shown a concerning pattern of chronicity and recurrence despite counseling to support lifestyle modifications. Real-world health outcomes among patients with hyperkalemia and recurrent episodes thereof have demonstrated higher risks of major adverse cardiovascular events, hospitalization, and mortality relative to patients with normokalemia. Similarly, real-world health economic studies have shown higher rates of health care resource utilization and higher medical costs. Together, these data hightlight the need for strategies that will restore patients' serum potassium levels to a normal range. Potassium binders are a pharmaceutical class indicated to treat hyperkalemia; sodium zirconium cyclosilicate (SZC), patiromer, and sodium polystyrene sulfonate (SPS) are guideline-recommended for patients with CKD, and the first 2 are considered potentially reasonable for patients with HF. Clinical trials and long-term open-label extensions studying SZC or patiromer support the safety and efficacy of these medications. Controlled clinical evidence supporting SPS's safety and efficacy is more limited, and its labeling also carries a warning for severe, potentially fatal gastrointestinal adverse events. Based on real-world evidence, use of SZC or patiromer has been associated with reduced medical costs and health care resource utilization, and some patients taking SZC or patiromer have been able to optimize doses of RAASi prescribed for other conditions. From a managed care perspective, proactive potassium control through routine use of potassium binders in patients with hyperkalemia may offer a means to reduce costly acute care while simultaneously supporting optimization of medications for comorbid conditions.
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