Quality of life in hyperkalemia: baseline analysis of a cohort study of management of hyperkalemia in patients with chronic kidney disease or heart failure in Japan.

Abstract

Background: Hyperkalemia is common in chronic kidney disease (CKD) and chronic heart failure (CHF), often leading to treatment dilemmas regarding renin-angiotensin-aldosterone system (RAAS) inhibitors. Although potassium binders and dietary restrictions are central to chronic management, their quality-of-life (QOL) impact remains insufficiently described. This study aimed to characterize real-world treatment patterns and evaluate treatment impact on QOL.

Methods: We analyzed baseline data from a prospective cohort in Japanese nephrology and cardiology outpatient clinics. Participants were adults with CKD (≥ stage G3) or CHF (New York Heart Association class II-IV) who initiated potassium binders within 6 months. Clinical data, serum potassium values, and patient-reported outcomes (generic QOL, disease/treatment-specific QOL, and adherence measures) were obtained at enrollment.

Results: Among 347 patients, the median age was 75 years, and 74% were male; 93% had CKD. At enrollment, 59% were prescribed a RAAS inhibitor. Dietary therapy was implemented in 29%. Physical scores of generic QOL were lower than population norms, whereas mental scores were comparable. Treatment-specific QOL scores suggested that potassium binders may have had a relatively small impact on QOL compared with dietary therapy. Adherence to potassium binders was high.

Conclusions: Concurrent use of RAAS inhibitors and potassium binders was common, consistent with a role for binders in supporting RAAS inhibitor continuation. Potassium binders showed little perceived impact, indicating that pharmacologic potassium control may be acceptable to patients managing multiple lifestyle limitations.

Study registration: The study was registered with ClinicalTrials.gov (NCT05297409).