Nephrology practice patterns show substantial variability in clinical management of hyperkalemia in nondialysis chronic kidney disease (CKD) patients, investigators reported virtually during the National Kidney Foundation 2020 Spring Clinical Meetings.

In 11 nephrology clinics across the US, 154 patients had mild hyperkalemia (5.2 to less than 5.5 mEq/L), 109 had moderate hyperkalemia (5.5 to 5.9 mEq/L), and 80 had severe hyperkalemia (more than 6.0 mEq/L) during the years of 2015 to 2019. Most patients (63% aged 60 to 79 years; 59% male; 68% white) had stage 3 or 4 CKD, 82% had hypertension, 51% diabetes, 8% congestive heart failure, and 37% proteinuria. Less than two-thirds were taking angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), 44% diuretics, and 7% aldosterone blocking agents.

Nephrologists prescribed a potassium binder to only 1 in 5 patients (22%) with no consistency by hyperkalemia severity, Adam Weinstein, MD, of Renal Physicians Association Registry Workgroup in Rockville, Maryland, and colleagues reported. Practice patterns also varied by region and setting (rural vs urban).

The study revealed no dominant treatment strategy. Nearly half of patients received dietary counseling, 29% had a repeat blood draw to recheck lab results, 27% started a medication, 17% stopped a medication, and 8% had a dose adjustment. In addition, 6% of patients were referred to the emergency department, 1% initiated dialysis, and less than 0.5% required an urgent office appointment. Yet, none of these steps were taken for 34% of patients.


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“There is an opportunity for standardization of [hyperkalemia] care at the provider and practice level,” Dr Weinstein’s team stated.

Disclosure: This clinical trial was supported by Relypsa. Please see the original reference for a full list of authors’ disclosures.

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Reference

Weinstein A, Alvarez PJ, Fogli JJ, et al. Multi-site nephrology practice chart review of hyperkalemia treatment patterns. Poster presented at the National Kidney Foundation 2020 live-virtual Spring Clinical Meetings, March 26-29, 2020. ePoster 334.