PMU71 - ESTIMATING THE CLINICAL AND ECONOMIC BURDEN OF ADDITIONAL HOSPITALISATION ASSOCIATED WITH HYPERKALAEMIA AND RAASI THERAPY MANAGEMENT: A MODELLING STUDY IN PATIENTS WITH CHRONIC KIDNEY DISEASE OR HEART FAILURE

Abstract

Associations between hyperkalaemia (HK) and mortality and morbidity in patients with chronic kidney disease (CKD) or heart failure (HF) are well-characterised in the literature. Furthermore, normalising and stabilising serum potassium (K+) may require additional hospital-based care and/or down-titration or discontinuation of renin-angiotensin-aldosterone system inhibitor (RAASi) therapy, consequently increasing hospital length of stay (LOS). This study aimed to quantify the impact of HK management on patient LOS. A lifetime patient-level simulation modelled disease progression via New York Heart Association (NYHA) class or estimated glomerular filtration rate (eGFR) in HF and CKD patients respectively; and related K+ to patient outcomes. Two hypothetical scenarios were evaluated: sustained normokalaemia (NK) versus NK with the possibility of HK. Hospital LOS required to normalise K+ was varied as per published literature (2–6 days), with an additional 0–5 days assumed for RAASi dose adjustments. Published costs for an inpatient day (UK, 2017) were applied to LOS and discounted at 3.5% annually. In CKD and HF patients (aged 65 years; eGFR 50 mL/min/1.73m2 or NYHA II) with NK and the possibility of HK, 4.3 and 1.7 HK events (defined as K+ >5.5 mmol/L) were predicted per patient over a lifetime, respectively. Relative to sustained NK, the incidence of HK required an additional LOS of 8.5–25.6 and 3.5–10.5 days in CKD and HF patients; and necessitated RAASi dose adjustments on 1.6 and 1.1 occasions, respectively. Taken together, incremental LOS associated with HK ranged from 8.5–33.6 and 3.5–16.0 days in CKD and HF patients; corresponding to incremental costs of £5,333–£21,271 and £2,290–£10,591, respectively. HK was estimated to increase hospital LOS and associated costs in patients with CKD or HF. Increased healthcare resource utilisation may be alleviated by efficient K+ management strategies to avoid HK and consequent RAASi dose adjustments.