Hyperkalemia: Room for Improvement?

Background: Patiromer and sodium zirconium ciclosilicate mitigate the risk of RASi-associated hyperkalemia, avoiding decreasing or stopping its dose. Our aim was to evaluate how physicians from different specialties treat hyperkalemia. Methods: A survey with different items related to the prevalence of hyperkalemia, severity assessment, and acute and chronic treatment was coducted among physicians in one hospital. Results: 68 surveys were included: 51.5% women, age 37.1±10.6 years. Medical specialties enrolled were 38.2% Nephrologists, 14.3% internal medicine, 14.3% GPs, and 33.2% other. Among all the surveys, 43.2% assess 5 or more patients per month with hyperkalemia, of which 17.6±8.3% are moderate and 8.1±6.1% are severe. Although 92.6% of the surveyed identify peaked T waves as a sign of severity, 26.5% acknowledge not requesting an ECG in all patients. In acute hyperkalemia:100% adjust treatment according to the patient's blood glucose and 96.6% to the acid-base status; 86.2% prescribe diuretics and 69% use new binders, although 51% are unaware of their financing conditions in Spain. The use of new binders has reduced the use of diuretics in 31% of respondents. After correcting a mild hyperkalemia, only 50% of physicians recommend analytical review, within a time frame of 30(15-90) days. After correcting a moderate hyperkalemia, 88.2% recommend review and within a time: 30(15-30) days, p=0.006. After severe hyperkalemia is corrected, 98.5% recommend analytical review, significantly earlier, within 10(4-30) days (p<0.001). In chronic hyperkalemia, 16.2% of physicians discontinue treatment with RASi and 52.9% reduce their dose. Although 42.6% always recommend a low-potassium diet and 47.1% do so sometimes, 26.5% of surveyed are unaware of culinary techniques to reduce potassium and 33.8% are unaware of hidden potassium sources (such as sodium-free salt) When starting a RASi/MRA in a patient with normal renal function, 67.6% recommend analytical review to assess potassium and it is recommended within 30(15-90) days. If initiated in a patient with renal disease, 88.2% recommend review, significantly earlier within 30(15-30) days, (p=0.004). Conclusion: The management of hyperkalemia is adequate in our area although there is room for improvement. Strategies to improve the maintenance of cardio-nephro-protective treatment are essential.