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An international Delphi consensus regarding best practice recommendations for hyperkalaemia across the cardiorenal spectrum

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Version 2 2023-12-21, 11:40
Version 1 2022-07-08, 12:40
journal contribution
posted on 2022-07-08, 12:40 authored by James O Burton, Andrew JS Coats, Csaba P Kovesdy, Biff F Palmer, Ileana L Piña, Giuseppe Rosano, Manish M Sood, Shelley Zieroth

Aims

Renin-angiotensin-aldosterone system inhibitors (RAASi) are guideline recommended therapy for individuals with cardiorenal disease. They are associated with increased risk of hyperkalaemia, a common and life-threatening disorder for this population. RAASi-induced hyperkalaemia therapy often leads to dose reduction or discontinuation, reducing cardiorenal protection. Guideline recommendations differ between specialities for the clinical management of hyperkalaemia. Using a modified Delphi method, we developed consensus recommendations for optimal management of hyperkalaemia in adults with cardiorenal disease.


Methods and results

An international steering group of cardiologists and nephrologists developed 39 statements regarding hyperkalaemia care, including risk factors and risk stratification, prevention, correction, and cross-specialty coordination. Consensus was determined by agreement on an online questionnaire administered to cardiorenal specialists across Europe and North America. The threshold for consensus agreement was established a priori by the steering group at 67%. Across November 2021, 520 responses were received from Canada (n = 50), France (n = 50), Germany (n = 54), Italy (n = 58), Spain (n = 57), the UK (n = 49), and the U.S. (n = 202); 268 from cardiologists and 252 from nephrologists. Twenty-nine statements attained very high agreement (≥ 90%) and 10 attained high agreement (≥ 67–< 90%), with strong alignment between cardiologists and nephrologists.


Conclusion

A high degree of consensus regarding hyperkalaemia evaluation and management exists among healthcare professionals. Based on high levels of agreement, the steering group derived six key recommendations for hyperkalaemia prevention and management in people with cardiorenal disease. Future studies examining the quality of hyperkalaemia care delivery are required.

History

Author affiliation

Department of Cardiovascular Sciences, University of Leicester

Version

  • AM (Accepted Manuscript)

Published in

European Journal of Heart Failure

Publisher

Wiley

issn

1388-9842

eissn

1879-0844

Acceptance date

2022-07-05

Copyright date

2022

Available date

2023-07-05

Publisher DOI

Notes

https://doi.org/10.1002/ejhf.2612

Language

en

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