Establishing Cross-Specialty Expert Consensus on the Optimal Management of Hyperkalemia in Patients With Heart Failure and Chronic Kidney Disease.

Background: Patients with both heart failure (HF) and chronic kidney disease (CKD) are often treated with renin-angiotensin-aldosterone system inhibitors (RAASi), but these drugs can cause hyperkalemia, which may lead to their reduction or discontinuation, resulting in the loss of their beneficial effects. Approaches to managing RAASi-induced hyperkalemia are discordant, so in this study we aimed to establish a cross-specialty consensus on the optimal approach to managing hyperkalemia in patients with HF and CKD.

Methods And Results: The study used a modified Delphi methodology. A steering committee of Japanese cardiologists and nephrologists drafted 26 consensus statements, which were used to create a survey, distributed across Japan. A total of 250 responses were received. Consensus, defined as 75% agreement, was achieved for 21/26 (81%) statements. Respondents agreed on the importance of effective hyperkalemia management based on serum potassium levels and supported the use of potassium binders (PBs), particularly novel PBs such as sodium zirconium cyclosilicate, to treat hyperkalemia while maintaining RAASi therapy. However, when potassium levels exceed 6.0 mEq/L, reduction or discontinuation of RAASi may be considered based on individual risk factors.

Conclusions: This consensus provides proposals that may help support the optimal management of RAASi-induced hyperkalemia in Japanese patients with HF and CKD. It highlights the importance of treating hyperkalemia alongside optimal RAASi therapy.