Healthcare resource utilization and costs associated with hyperkalemia in a large managed care population

Abstract

Background Hyperkalemia is a serious metabolic condition and can lead to life-threatening cardiac arrhythmias and sudden death. Guideline-directed medications that affect the renin-angiotensin-aldosterone axis can increase serum potassium and may limit their use. Hyperkalemia has been shown to drive healthcare resource utilization (HRU) and costs for patients with cardiorenal conditions. Objectives To describe hyperkalemic patient characteristics and quantify patient HRU and costs relative to normokalemic patients from a large US health plan. Methods A retrospective cohort study that identified and evaluated a hyperkalemic patient population from a large administrative claims database. The observation period was 1 January 2015 to 31 May 2018, with a 1-year follow-up period after the index date (the earliest service/claim with evidence of hyperkalemia). Primary patient outcomes included inpatient admissions, emergency department (ED) visits, primary care physician (PCP)/specialist visits, length of stay (LOS) and associated medical and pharmacy costs. This hyperkalemic cohort was stratified by renin-angiotensin-aldosterone system inhibitor (RAASi) utilization and chronic kidney disease (CKD) stage for the economic analysis. Key findings 86,129 adult patients with hyperkalemia were evaluated in the study cohort (median age: 69 years). There were more males [45,155 (52%)], with the majority of patients located in the Southern United States [45,541 (51%)] and a 70/30 split of Medicare to a commercial health plan. Most patients had CKD, hypertension and hyperlipidemia; ≥80% of the patients had ≥4 comorbidities. Over 40% of patients were not receiving RAASi therapy, and potassium binder use was low (<5%). Patients using optimal-dose RAASi with proportion of days covered ≥80% were observed to have the lowest HRU for inpatient admissions, ED and PCP visits and LOS days. Conclusions Hyperkalemia is associated with substantial HRU and costs. The development of a quality improvement program structured around the management of hyperkalemia in individuals with heart failure, diabetes and/or CKD may be necessary.

A Predictive Model for Progression of Chronic Kidney Disease to Kidney Failure Using a Large Administrative Claims Database

“…Ongoing studies will evaluate whether novel potassium binders, such as patiromer or sodium zirconium cyclosilicate, 36–39 may offer additional benefits to those with high risk of both CKD progression and HK. 8 …”

“…Ongoing studies will evaluate whether novel potassium binders, such as patiromer or sodium zirconium cyclosilicate, [36][37][38][39] may offer additional benefits to those with high risk of both CKD progression and HK. 8 Despite the dissemination of clinical practice guidelines on kidney disease and DM, 40,41 more than one-third of new ESRD patients receive little or no pre-ESRD nephrology care. 18 To accelerate the improvement of the quality and 40,41 Our model provides good discriminating performance and adequate calibration: AUROC was 0.844; the numbers of predicted vs observed individuals with kidney failure were well matched in the highest probability deciles; and a cutoff of the top 20% scores…”

“… 27 The comorbid HK was identified using previous described method. 8 , 25 Medications taken during the BY were extracted from the National Drug Codes of dispensed medications and categorized by drug class as: angiotensin II receptor blocker (ARB), angiotensin-converting enzyme inhibitors (ACEi), beta-blocker, calcineurin inhibitor, direct renin inhibitors (DRI), mineralocorticoid receptor antagonist (MRA), nonsteroidal anti-inflammatory drug (NSAID), or potassium-sparing diuretic (see specific generic drug names and their drug class in Sharma et al). 25 Among the aforementioned, RAAS inhibitors (RAASi) included ACEi, ARB, MRA, and DRI.…”

“…1 We recently reported similar results in CKD patients with hyperkalemia (HK), who utilize more healthcare resources than CKD patients without HK, leading to more than double the healthcare costs. 8 …”

“…1 We recently reported similar results in CKD patients with hyperkalemia (HK), who utilize more healthcare resources than CKD patients without HK, leading to more than double the healthcare costs. 8 Earlier diagnosis and evidence-based management of CKD are key to slowing its progression and preventing the complications of advanced disease. 9 The renin-angiotensin -aldosterone system (RAAS) blockade plays a pivotal role in delaying, and perhaps halting, kidney failure in most types of CKD.…”