Treatment Strategies in Incident and Recurrent Hyperkalemia: Insights from the TRACK Study

Little is known about the implementation of guideline recommendations and healthcare provider decision-making when managing hyperkalemia. We aimed to address these knowledge gaps and better understand hyperkalemia management in routine clinical care and the baseline characteristics and longitudinal (12-month) clinical variables of participants with hyperkalemia.

This was an observational, prospective, longitudinal, cohort study including adults with recent (≤ 21 days of enrollment) hyperkalemia (serum potassium [K⁺] > 5.0 mmol/L) during standard of care, across Germany, Italy, Spain, the UK, and the USA from July 2022 to December 2024. Primary and secondary data were collected from participants' medical records and their respective healthcare providers. Healthcare providers' hyperkalemia management decisions, treatment rationale, and expectations were measured overall, by incident versus recurrent cases, and by hyperkalemia severity.

In total, 1330 participants with hyperkalemia were included (458 incident, 870 recurrent). The most common treatment rationale for index hyperkalemia was ease of treatment (41.4%). Overall, 80.9% of participants received conservative treatment (no hyperkalemia treatment, monitoring K⁺ levels, or a low K⁺ diet; incident hyperkalemia 76.9%, recurrent hyperkalemia 83.2%). K⁺ binder use was low (10.8%) but increased with hyperkalemia severity (mild, 6.6%; moderate, 17.0%; severe 20.0%). Renin-angiotensin-aldosterone system inhibitors were stopped/reduced in < 5% of participants. Over 12 months, 71.7% of participants achieved normokalemia at any timepoint (incident 65.7%, recurrent 74.8%). Among participants with normokalemia at 9 months (incident, n = 125; recurrent, n = 294), the probability of hyperkalemia recurrence at 12 months was lower in the incident than in the recurrent group (14.5% vs 39.3%; crude odds ratio 0.26 [95% confidence interval 0.13-0.53]).

Guideline recommendations for incident and recurrent hyperkalemia were inconsistently implemented in clinical practice, as demonstrated by a conservative approach to treatment. Unmet hyperkalemia treatment goals and recurrent hyperkalemia were common.