#3185 Insights into the adoption of consensus guidelines for hyperkalemia management in Spain: a national, multicenter, descriptive analysis

Abstract Background and Aims Hyperkalemia is a recurrent, life-threatening electrolyte imbalance requiring rapid intervention. The latest Spanish Consensus Document on the Management of Hyperkalemia published in 2023 outlined recommendations for improving its management. In this analysis, we assessed the perception of nephrologists and other specialists who manage this condition as regards the adoption of these guidelines in Spain. Method A national, multicenter, descriptive analysis was conducted with nephrologists and specialists in cardiology, internal medicine, and geriatrics involved in hyperkalemia management. Participants were presented with eight questions evaluating clinical practices based on the recommendations of the Consensus Document, divided into the categories of 'knowledge' and 'management'. These questions were discussed at 27 medical meetings held in Spain between November 2023 and December 2024. Results A total of 122 nephrologists and 186 professionals from the aforementioned specialties participated. Almost three-quarters of nephrologists (73.2%) and 72.3% of the other specialists declared adequate knowledge of hyperkalemia classification. Nevertheless, only 30.3% of nephrologists and 21.9% of the others reported a second episode of hyperkalemia in 30%–40% of patients with heart failure and/or chronic kidney disease. Regarding management, 70.8% of nephrologists and 70.4% of the other specialists prioritized adding potassium binders for mild hyperkalemia when the patient is receiving optimal therapy, and 90.8% of nephrologists and 70.8% of the other specialists participating in this analysis considered using new antihyperkalemic agents at discharge to prevent recurrence. However, only 25.7% of nephrologists and 22.3% of the other specialists agreed with the recommendation to maintain renin-angiotensin-aldosterone system inhibitor (RAASi) treatment with no adjustments. Despite this, 79.8% of nephrologists and 84.8% of the others perceived that the recommendation to reintroduce it upon discharge was considered by clinicians. Regarding treatment initiation, 15.7% of nephrologists and 14.6% of the other specialties reported that they start antihyperkalemic agents at potassium levels of 5–5.5 mEq/L. Additionally, only 17.9% of nephrologists and 20.7% of the other clinicians indicated adherence to the recommendation not to discontinue antihyperkalemic treatment once normokalemia is reached. Finally, 32.5% of nephrologists and 18.4% of the others lacked access to new antihyperkalemic agents, and 35.2% of nephrologists and 55.9% of the other specialists had no access to updated management protocols. Conclusion There is a high level of awareness regarding the consensus document on the management of hyperkalemia. However, notable gaps remain in the implementation of key recommendations, particularly regarding RAASi therapy and the use of antihyperkalemic agents. Encouragingly, there is a gradual shift towards improved management practices, such as having a RAASi reintroduction or titration plan. Standardizing and optimizing hyperkalemia management has the potential to significantly improve patient cardiorenal outcomes while reducing healthcare costs. The authors presented this communication on behalf of AstraZeneca Medical team involved in ‘Aktuando Juntos’ program. *Medical team: Almorin Andres, Maria; Alvaro Alonso, Carlos; Bernat Gomez, Rebeca; Fuertes Martin, Rocio; Garcia Diaz, Alejandro Jose; González Amado, MariSierra; Gonzalez Bogaz, Irene: Izarra, Aitziber; Jerico Zapatero, Sara; Martinon Martinez, Jose Maria; Montáns Redondo, Borja; Morales Estévez, Salvador; Pardo Martinez-Quintanilla, Cristina; Pastor Beades, Noemi; Pastor Moya, Ana Belen; Prieto, Roberto; Saiz Lou, Elena Maria; Sierra Urueña, Yanik; Silvestre Miralles, Diana; Villarroel Vargas, Aida.