Recurrent Hyperkalemia in Renin-Angiotensin-Aldosterone System Inhibitor (RAASi) Treatment

Bolanos, Jonathan A.; Seliger, Stephen L.

doi:10.2215/cjn.00950121

Cited by 3 publications

(1 citation statement)

References 9 publications

(13 reference statements)

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“…Hence, the long half-life of RAASi treatment, together with the short duration of the AMBER trial, most likely allowed patients who discontinued treatment to prolong the effects of RAASi therapy in the short term [37]. More recently, the long-term effects of patiromer on clinical outcomes in patients with HF, such as MACE and cardiovascular-related mortality, are being investigated in the phase IIIb DIAMOND clinical trial [85]. Initial results suggest that patients are able to maintain long-term potassium control, with a reduction in HK and prolonged optimised RAASi use [86].…”

Section: Discussionmentioning

confidence: 99%

The Cost Effectiveness of Patiromer for the Treatment of Hyperkalaemia in Patients with Chronic Kidney Disease with and without Heart Failure in Ireland

Ward

Brown

Lewis

et al. 2022

PharmacoEconomics Open

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Background and ObjectiveHyperkalaemia can be a life-threatening condition, particularly in patients with advanced chronic kidney disease with and without heart failure. Renin-angiotensin-aldosterone system inhibitor therapy offers cardiorenal protection in chronic kidney disease and heart failure; however, it may also cause hyperkalaemia subsequently resulting in down-titration or discontinuation of treatment. Hence, there is an unmet need for hyperkalaemia treatment in patients with chronic kidney disease with and without heart failure to enable renin-angiotensin-aldosterone system inhibitor use in this patient population. In this study, we develop a de novo disease progression and cost-effectiveness model to evaluate the clinical and economic outcomes associated with the use of patiromer for the treatment of hyperkalaemia in patients with chronic kidney disease with and without heart failure. Methods A Markov model was developed using data from the OPAL-HK trial to assess the health economic impact of patiromer therapy in comparison to standard of care in controlling hyperkalaemia in patients with advanced chronic kidney disease with and without heart failure in the Irish setting. The model was designed to predict the natural history of chronic kidney disease and heart failure and quantify the costs and benefits associated with the use of patiromer for hyperkalaemia management over a lifetime horizon from a payer perspective. Results Treatment with patiromer was associated with an increase in discounted life-years (8.62 vs 8.37) and an increase in discounted quality-adjusted life-years (6.15 vs 5.95). Incremental discounted costs were predicted at €4979 per patient, with an incremental cost-effectiveness ratio of €25,719 per quality-adjusted life-year gained. Patients remained taking patiromer treatment for an average of 7.7 months, with treatment associated with reductions in the overall clinical event incidence and a delay in chronic kidney disease progression. Furthermore, patiromer was associated with lower overall rates of hospitalisation, major adverse cardiovascular events, dialysis, renin-angiotensin-aldosterone system inhibitor discontinuation episodes and renin-angiotensin-aldosterone system inhibitor down-titration episodes. At a willingness-to-pay threshold of €45,000 per quality-adjusted life-year in Ireland, treatment with patiromer was estimated to have a 100% chance of cost effectiveness compared with standard of care. Conclusions This study has demonstrated an economic case for the reimbursement of patiromer for the treatment of hyperkalaemia in patients with chronic kidney disease with and without heart failure in Ireland. Patiromer was estimated to improve life expectancy and quality-adjusted life expectancy, whilst incurring marginal additional costs when compared with current standard of care. Results are predominantly attributed to the ability of patiromer to enable the continuation of renin-angiotensin-aldosterone system inhibitor treatment whilst also reducing potassium levels.

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Section: Discussionmentioning

confidence: 99%

The Cost Effectiveness of Patiromer for the Treatment of Hyperkalaemia in Patients with Chronic Kidney Disease with and without Heart Failure in Ireland

Ward

Brown

Lewis

et al. 2022

PharmacoEconomics Open

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Design and cohort characteristics of TRACK, a prospective study of hyperkalaemia management decision-making

Hsia,

Shivappa,

Bakhai

et al. 2024

Clinical Kidney Journal

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Background Guideline-recommended hyperkalemia management includes dietary potassium (K+) restriction, bicarbonate correction, diuretics, and K+ binders with dose reduction of renin-angiotensin-aldosterone system inhibitors as a last resort. The extent to which these recommendations are implemented is uncertain as real-world data on hyperkalaemia management are limited. The Tracking Treatment Pathways in Adult Patients With Hyperkalemia (TRACK) study is a multinational, prospective, longitudinal study that is being conducted to address this knowledge gap. We report the design and baseline cohort characteristics of this real-world study of hyperkalaemia management decision-making. Methods This study enrolled participants within 21 days of an episode of hyperkalaemia in 4 European countries (United Kingdom, Spain, Germany, Italy) and the United States. During 12-month follow up, data collected will include participant and healthcare provider characteristics (specialty and practice setting), hyperkalaemia treatment objectives and strategies, rationale for management decisions and indicators of response, and patient-reported perceptions of their hyperkalaemia treatment. Results The enrolled cohort includes 1330 participants, mean age 68 years, of whom 31% were women. At baseline, 6% reported heart failure, 55% chronic kidney disease, 29% both and 9% neither. Most participants (57%) were taking an angiotensin converting enzyme inhibitor, angiotensin receptor blocker or angiotensin receptor/neprilysin inhibitor at baseline. Mineralocorticoid receptor antagonist use was lower (14%). Conclusions The prospective TRACK study will shed light on practitioners’ hyperkalaemia management decision-making and assess the impact of their decisions on hyperkalaemia recurrence. Understanding practitioners’ underlying thought processes will facilitate efforts to improve hyperkalaemia management. Clinicaltrials.gov NCT05408039

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Care of Adults with Advanced Chronic Kidney Disease

Shrestha,

Haq,

Malhotra

et al. 2024

JCM

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Chronic kidney disease (CKD) impacts over 10% of the global population. Adults with CKD face significant morbidity and mortality. As kidney disease progresses, the risk of adverse outcomes increases. Here, we present an overview of strategies to care for adults with advanced CKD (stage 4–5 CKD, not receiving kidney replacement therapy). We aim to guide clinicians through several aspects of CKD care, ranging from recommended laboratory assessments to interdisciplinary support for patients as they plan for kidney replacement therapy (dialysis, transplantation, or conservative management). We incorporate considerations of health equity and person-centered care, empowering clinicians to deliver high-quality care to people with CKD.

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Recurrent Hyperkalemia in Renin-Angiotensin-Aldosterone System Inhibitor (RAASi) Treatment

Cited by 3 publications

References 9 publications

The Cost Effectiveness of Patiromer for the Treatment of Hyperkalaemia in Patients with Chronic Kidney Disease with and without Heart Failure in Ireland

The Cost Effectiveness of Patiromer for the Treatment of Hyperkalaemia in Patients with Chronic Kidney Disease with and without Heart Failure in Ireland

Design and cohort characteristics of TRACK, a prospective study of hyperkalaemia management decision-making

Care of Adults with Advanced Chronic Kidney Disease

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