Patient and Clinician Perspectives on Hyperkalemia Management Under Cardio-Kidney-Protective Therapy: A Three-Stakeholder Cross-Sectional Survey.

Abstract

Background: Maintaining renin-angiotensin system inhibitor (RASi) and mineralocorticoid receptor antagonist (MRA) therapy in patients with hyperkalemia is now favored by contemporary guidelines, yet the perspectives of patients and clinicians on this shift have rarely been examined in parallel.

Methods: We conducted three parallel descriptive cross-sectional surveys in Korea between April and May 2026: a patient survey distributed through a kidney-disease patient community; a nephrologist survey; and a multispecialty physician survey. Patients, nephrology specialists, and multispecialty physicians were analyzed separately and in a combined nephrologist-versus-non-nephrologist comparison.

Results: A total of 125 patients, 82 nephrologists, and 255 multispecialty physicians completed the survey. Patient awareness of hyperkalemia was high (perceived risk, 3.97; 95% confidence interval, 3.84-4.10). More patients preferred potassium-lowering medication (68.8%) over strict dietary control (31.2%) for hyperkalemia management. Clinicians rated maintenance of RASi and MRA as 3.81 (3.72-3.90) and 3.47 (3.37-3.56), respectively; nephrologists rated maintenance as more important than non-nephrologists for both classes (p < 0.001 for RASi, p = 0.006 for MRA). For long-term outpatient hyperkalemia, nephrologists most often endorsed prescribing a potassium binder (68.2%), while non-nephrologists most often endorsed reducing or discontinuing the culprit drugs (55.5%).

Conclusion: Patients preferred to maintain cardio-kidney-protective therapy. A specialty gap in this preference was observed between nephrologists and non-nephrology clinicians, indicating a need to broaden clinician awareness of the full spectrum of hyperkalemia management options, including the more active use of potassium-lowering agents.