Payer Information

Examining the Clinical and Economic Impact
of Hyperkalemia Management

Hyperkalemia prevalence and risk factors

Hyperkalemia is often an asymptomatic condition and is associated with clinical and economic consequences. While definitions vary, hyperkalemia is usually defined as serum potassium (K+) concentration >5.0 mEq/L and severe hyperkalemia is defined as >6.0 mEq/L.1,2

Hyperkalemia can pose serious risks that include ventricular arrhythmias* and sudden cardiac death.3-5 It may go unnoticed until it reaches unsafe levels that require immediate treatment in the hospital setting.4,5 The chronic risk for hyperkalemia in patients with chronic kidney disease (CKD) and heart failure can result in emergency department (ED) visits, hospitalizations, and increased costs.6

*
Of most concern with hyperkalemia is the impairment of cardiac conduction, which can result in ventricular fibrillation or cardiac arrest.

(Tap any link below to expand and view clinical evidence.) (Click on any link below to expand and view clinical evidence.)

Hyperkalemia is often a silent condition associated with clinical and economic consequences

Hyperkalemia prevalence in managed care settings

Hyperkalemia is disproportionately prevalent among Medicare‑aged patients with CKD and heart failure. Among these patients, the prevalence of hyperkalemia increases as kidney function continues to decline.7

  • Prevalence increased from 23.5% to 47.7% in CKD stages 3 to 4
  • Prevalence was 47.3% for CKD stages 3 and 4 with heart failure
5-Year database prevalence of hyperkalemia,
control population vs. CKD* stages 3a, 3b, 4 in patients ≥657
5-Year database prevalence of hyperkalemia, control population vs. CKD stages 3a, 3b, 4 in patients ≥65
5-Year database prevalence of hyperkalemia, control population vs. CKD* stages 3-4 + heart failure in patients ≥657
5-Year database prevalence of hyperkalemia, control population vs. CKD stages 3-4 + heart failure in patients ≥65

Adapted from Humedica, Cambridge, MA, an analysis of 1.63 million persons age 65+ years with potassium values on 2 dates (2007‑2012), with >1 serum K+ value between 2.5 mEq/L and 10 mEq/L during 2008‑2012.7

*
Control population comprised of patients ≥65 without CKD stages 2‑5, heart failure, diabetes, end‑stage renal disease (ESRD) or acute kidney injury.
Hyperkalemia defined as highest reported potassium value ≥5.1 in 2008‑2012.
P<0.0001.

Consequences of hyperkalemia

Limited options to manage the chronic risk for hyperkalemia in patients with CKD and heart failure may lead to increased ED visits.6

Although hyperkalemia may be diagnosed in the ambulatory setting, the lack of management options may result in referrals to the ED. There were ~67,000 ED visits with a primary diagnosis of hyperkalemia in 2011 and ~69% were covered under Medicare.6*

  • 52% of Medicare members treated in the ED for hyperkalemia were admitted to the hospital
2011 ED VISITS - PRIMARY DIAGNOSIS OF HYPERKALEMIA6
2011 ED VISITS - PRIMARY DIAGNOSIS OF HYPERKALEMIA

Patients presenting with hyperkalemia in the ED are often admitted to the hospital for treatment.6

In 2011, over 40,000 patients were hospitalized with hyperkalemia as a primary diagnosis.6* Of the 40,000, nearly 29,000 were Medicare members who had an average length of stay (LOS) of 3.2 days with mean charges of $24,085/stay.6

  • One-third of patients were discharged to another short term hospital, institution, or home healthcare
  • In 2011, the estimated total annual hospital charges for Medicare admissions with hyperkalemia as a primary diagnosis were ~$697 million
2011 HOSPITALIZATIONS - PRIMARY DIAGNOSIS OF HYPERKALEMIA6
2011 HOSPITALIZATIONS - PRIMARY DIAGNOSIS OF HYPERKALEMIA
*
Outcomes for ICD-9-CM principal diagnosis code 276.7 Hyperpotassemia.
Includes Medicare, Medicaid, private insurance, uninsured, and other.

Hyperkalemia payer resources

Poster presented at the International Society For Pharmacoeconomics and Outcomes Research (ISPOR) 20th Annual International Meeting.

A poster presented at the ISPOR 20th Annual International Meeting demonstrated key insights on hyperkalemia's prevalence in patients with cardiorenal comorbidities.8

"Hyperkalemia is prevalent in patients with cardiorenal comorbidities"8

  • An analysis of over 1.6 million patients found that hyperkalemia was more prevalent in patients with each measured comorbidity compared to patients without comorbidities
  • Patients with diabetes mellitus, heart failure, CKD stages 3–4 and combinations of these conditions were 2.5 to 5.6 times more likely to experience hyperkalemia than patients without any of these conditions
  • Findings confirmed that as patient morbidity increases, either through declining renal function and/or the development of concomitant disease, the prevalence of hyperkalemia increases
Download the full poster from ISPOR's
20th Annual International Meeting

Science & Innovation Theater* presentation from the Academy of Managed Care Pharmacy's (AMCP) 27th Annual Meeting & Expo.

This presentation discusses the association of hyperkalemia with increased risk of mortality and its prevalence in patients with cardiorenal disorders including CKD and heart failure. Key topics include:

  • Definition, prevalence, and risk of hyperkalemia
  • How can hyperkalemia be a barrier to implementing
    guideline‑recommended therapies?
  • Current management approaches for hyperkalemia
Download the full Science & Innovation Theater* presentation from AMCP’s
27th Annual Meeting & Expo
*
Science & Innovation Theaters are developed outside of the official continuing pharmacy education program at AMCP’s 27th Annual Meeting & Expo. Science & Innovation Theaters do not offer continuing pharmacy education credit. The content of this Science & Innovation Theater and the opinions expressed by the presenters are those of the sponsor and/or presenters and not necessarily those of the Academy of Managed Care Pharmacy.

“Novel Approaches to Understanding Risks and Management of Hyperkalemia” Webinar presentation from AMCP

This webinar presentation covers key information on the challenges of hyperkalemia management. Hyperkalemia is prevalent among older populations and associated with increased mortality in patients with CKD and/or heart failure. The presentation’s main objectives are to:

  • Review the definition, prevalence, and risk of hyperkalemia
  • Understand how hyperkalemia can be a barrier to implementing guideline-recommended therapies for CKD and/or heart failure
  • Describe current management approaches for managing hyperkalemia
Download the full “Novel Approaches to Understanding Risks and Management of Hyperkalemia” webinar presentation from AMCP