Hyperkalemia is an important complication of chronic kidney disease (CKD) and end-stage renal disease (ESRD) with significant impacts on morbidity and mortality. Management of hyperkalemia is dependent on both patient symptoms and the elevation of serum potassium levels, and it typically involve potassium binders to control potassium levels in the body. These potassium binders have a significant side-effect profile; therefore, tolerable and effective treatments are needed. This content provides an in-depth examination of the different treatment and prescribing practices for hyperkalemia within Europe and offers insights for companies seeking to enter this market.

Table of contents

  • Hyperkalemia - Current Treatment - Detailed, Expanded Analysis Hyperkalemia (EU5)
    • Physician Prescribing Practices
      • Patients with Chronic Kidney Disease Often Have Severe and Recurrent Hyperkalemia
      • Patient Characteristics
        • Nephrologists Manage More Patients with Recurrent Hyperkalemia Than Cardiologists
        • Causes of Hyperkalemia
        • Experience Treating Hyperkalemia
        • Hyperkalemia by Chronic Kidney Disease Stages 1-5
        • Percentage of Chronic Heart Failure Patients with Hyperkalemia by Glomerular Filtration Rate
        • Percentage of Hyperkalemia Patients by Level of Disease Severity
        • Percentage of Hyperkalemia Patients with Cardiac Arrest by Severity
        • Percentage of Hyperkalemia Patients Receiving 12-Lead Electrocardiogram
        • Percentage of Patients with Recurring Hyperkalemia by Severity Level: Cardiologists
        • Percentage of Patients with Recurring Hyperkalemia by Severity: Nephrologists
      • Treatment Practices
        • Surveyed Physicians Reported Varied Treatment Approaches for Hyperkalemia by Country
        • Physicians Report Delaying Treatment in Patients with Mild Hyperkalemia
        • Percentage of Patients with a Delay in Treatment Initiation
        • Average Potassium Level at Time of Potassium-Binding Agent Initiation
        • Renin-Aldosterone-Angiotensin-System Inhibitors Are More Likely to Be Stopped in Hyperkalemia Patients Not on Dialysis
        • Treatment Location of Incident Hyperkalemia by Disease Severity
        • Treatment with Renin-Aldosterone-Angiotensin-System Inhibitors in Hyperkalemia Patients: Nondialysis
        • Treatment with Renin-Aldosterone-Angiotensin-System Inhibitors in Hyperkalemia Patients: Dialysis
        • Treatment with Renin-Aldosterone-Angiotensin-System Inhibitors in Hyperkalemia Patients: Chronic Heart Failure
        • 75% of French Patients with Hyperkalemia Receive a Potassium Binder
        • Patient Share of Emergency Treatment for Severe Hyperkalemia
        • Patient Share of Non-Emergency Treatment for Mild, Moderate, and Severe Hyperkalemia
        • Low Treatment Duration on Potassium Binders Reported by Physicians in the United Kingdom
        • Average Number of Days Hyperkalemia Patients Receive Potassium-Ion Exchange Agents
        • Dialysis Is a Common Nonpharmacological Approach to Treating Hyperkalemia
        • Percentage of Hyperkalemia Patients Receiving Pharmacological Versus Nonpharmacological Treatment
        • Situations Prompting Use of Dialysis to Treat Hyperkalemia
        • The Majority of Patients with Hyperkalemia Are Treated in the First-Line Setting
        • The Majority of Patients with Recurrent Hyperkalemia Are Still On First-Line Therapy
        • Line of Therapy for Patients with Recurring Hyperkalemia
        • Drivers of Progression Between Lines of Therapy Vary by Country
        • Reasons for Progression to Next Line of Therapy in Patients with Recurring Hyperkalemia
        • Potassium Binders Maintain High Patient Share in the First, Second, and Third Line
        • Patient Share of First-Line Treatments for Recurring Hyperkalemia
        • Patient Share of Second-Line Treatments for Recurring Hyperkalemia
        • Patient Share of Third-Line Treatments for Recurring Hyperkalemia
        • Potassium Binder Duration of Use Tends to Increase Across Line of Therapy
        • Treatment Duration of Potassium Binders by Line of Therapy
        • Many Patients with Severe Hyperkalemia Also Receive Potassium Binders
        • Patient Share for Other Therapies for Hyperkalemia and Renal Insufficiency
      • Persistency and Compliance
        • Severe Patients Are Slightly More Compliant with Their Potassium Binder Treatment
        • Potassium Binder Adherence by Severity of Hyperkalemia
      • Sequencing of Treatment
        • Less Than One-Third of Patients with Mild Hyperkalemia Receiving a Potassium Binder Are Treatment-Naive
        • Prior Treatment for Hyperkalemia Patients Currently Receiving a Potassium Binder
      • Recent/Anticipated Changes in Brand Usage/Treatment Approach
        • Physicians Anticipate Changes in Hyperkalemia Treatment Approaches Over the Next Year as New Binders Hit the Market
        • Anticipated Treatment Patient Share for Mild Hyperkalemia
        • Anticipated Treatment Patient Share for Moderate Hyperkalemia
        • Anticipated Treatment Patient Share for Severe Hyperkalemia
    • Physician Insight on Medical Practice
      • Tolerability and Efficacy Drive Treatment Selection
      • Drivers of Treatment Selection
        • Varying Factors Influence Nephrologists and Cardiologist to Prescribe Potassium Binders
        • U.K. Physicians Report Low Satisfaction with Potassium Binders
        • Referral of Chronic Heart Failure Patients with Hyperkalemia from Cardiologists to Nephrologists
        • Drivers of Cardiologist Referrals of Hyperkalemia Patients to Nephrologists
        • Referral of Chronic Kidney Disease Patients with Hyperkalemia from Nephrologists to Cardiologists
        • Guidelines and Protocols Used to Advise Hyperkalemia Management
        • Level of Satisfaction with Current Treatment Options for Hyperkalemia: France
        • Level of Satisfaction with Current Treatment Options for Hyperkalemia: Germany
        • Level of Satisfaction with Current Treatment Options for Hyperkalemia: Italy
        • Level of Satisfaction with Current Treatment Options for Hyperkalemia: Spain
        • Level of Satisfaction with Current Treatment Options for Hyperkalemia: United Kingdom
        • Physician Ranking of Factors That Influence Use of Potassium Binders to Treat Hyperkalemia
        • Clinical Scenarios Benefitting Use of Emerging Potassium Binders
        • ECG Abnormalities Drive Potassium Binder Use by a Subset of Surveyed Physicians
        • Ranked Drivers of Potassium Binder Use for Non-Emergency Treatment of Hyperkalemia
        • Ranked Drivers of Potassium Binder Use for Emergency Treatment of Hyperkalemia
        • Ranked Drivers for IV Calcium Use for Emergency Treatment of Hyperkalemia
        • Ranked Drivers for IV Insulin-Glucose Use for Emergency Treatment of Hyperkalemia
        • Tolerability Impedes Potassium Binder Use
        • Obstacles to Potassium Binder Use in Non-Emergency Treatment for Hyperkalemia
        • Obstacles to Potassium Binder Use in Emergency Treatment for Hyperkalemia
        • Obstacles to IV Calcium Use for Emergency Treatment of Hyperkalemia
        • Obstacles to IV Insulin-Glucose Use for Emergency Treatment of Hyperkalemia
        • Failure to Control Hyperkalemia Drives Switching
        • Reasons for Switching Hyperkalemia Treatments/Approaches
        • Tolerability Impedes Potassium Binder Prescribing
        • Ranked Reasons for Not Using Potassium Binders as Non-Emergency Treatment for Mild Hyperkalemia
        • Ranked Reasons for Not Using Potassium Binders as Non-Emergency Treatment for Moderate Hyperkalemia
        • Ranked Reasons for Not Using Potassium Binders as Non-Emergency Treatment for Severe Hyperkalemia
      • Face-to-Face Product Detailing Effectiveness
        • Sales Representatives for Emerging Calcium- and Sodium-Based Binders Get an Early Start in Europe
        • Surveyed Physicians Reported Contact by Patiromer and Sodium Zirconium Cyclosilicate Sales Representatives
        • Sales Representative Frequency of Visits for Emerging Potassium Binders
        • Sales Representative Satisfaction Scores are Similar
        • Sales Representatives' Knowledge of Hyperkalemia
        • Sales Representatives' Knowledge of the Agent
        • Sales Representatives' Overall Effectiveness in Bringing Value to My Practice
        • Sales Representatives for Emerging Potassium Binders Promote Efficacy
        • Key Message Presented by Sales Representatives During Visit for Emerging Potassium Binders
    • Methodology
      • Primary Market Research Methodology
      • Physician Specialty
      • Length of Time as a Practicing Physician
      • Average Number of Chronic Kidney Disease Patients with Hyperkalemia Per Year: Nephrologists
      • Average Number of Chronic Heart Failure Patients with Hyperkalemia per Year: Cardiologists
      • Primary Practice Location: Nephrologists and Cardiologists
    • Appendix
      • Primary Market Research
        • Symptoms of Hyperkalemia
        • Ranked ECG Abnormalities Among Hyperkalemia Patients
        • Percentage of Chronic Kidney Disease Patients with Hyperkalemia with Chronic Heart Failure
        • Percentage of Hyperkalemia Patients Receiving Emergency Versus Non-Emergency Treatment
        • Administration Route of Potassium-Ion Exchange Resins
        • Product Profile: Veltassa (patiromer)
        • Product Profile: ZS-9 (sodium zirconium cyclosilicate)
        • Familiarity with Emerging Therapies
        • Preference for Counter-Ion Used in Potassium Binding
      • Key Abbreviations Related to Hyperkalemia
      • Brands, Marketers, and Generic Availability of Key Therapies for Hyperkalemia, by Market
      • Hyperkalemia Bibliography

Author(s): Caitlin Koris, MSPH

Caitlin Koris, MSPH, is a business insights analyst on the cardiovascular, metabolic, and renal disorders team at Decision Resources Group. She has developed expertise in chronic kidney disease and related disorders such as bone and mineral metabolism, renal anemia, hyperkalemia, diabetic nephropathy, and kidney transplant.

Prior to joining DRG, Caitlin was a clinical research monitor for oncology phase I and II trials. She obtained her M.S. in public health/health services research (MSPH) from Emory University, where she focused on pharmacoeconomics/outcomes research and healthcare policy. She has conducted research at the U.S. Centers for Disease Control and at the Food and Drug Administration.