Hyperkalemia, a condition of elevated serum potassium, arises from disturbances to potassium homeostasis within the body. Among key populations, including patients with kidney disorders and/or HF, hyperkalemia persists and requires frequent treatment in order to mitigate associated morbidity and mortality risks. Until recently, physicians had limited tools to deal with chronic hyperkalemia and were forced to rely on dialysis (an intensive procedure inappropriate for many patients), loop diuretics, and SPS (Kayexalate; a potassium binder associated with significant side-effects). The emergence of patiromer (Veltassa) and the anticipated approval of zirconium cyclosilicate (ZS-9)  have already started altering treatment dynamics within the market. This content explores how current treatment practices may be influenced by these new treatment tools and investigates the key factors that influence prescribing.

Questions Answered:

  • How will prescribing of hyperkalemia therapies change one year from now? What will drive these changes?
  • Among physicians prescribing a potassium binder—what serum potassium value is the binder initiated? How long is the patient on the binder? What pharmacologic therapy was the patient receiving prior to binder use?
  • What are the major drivers and obstacles of potassium binder use? What lessons can be applied to recently launched Veltassa and the emerging agent ZS-9?

Table of contents

  • Hyperkalemia - Current Treatment - Detailed, Expanded Analysis Hyperkalemia (US)
    • Key Updates
      • November 2017
    • Introduction to Current Treatment for Hyperkalemia
      • Key Findings
      • Summary Figures
        • Percentage of Chronic Kidney Disease Patients with Chronic Hyperkalemia: Nephrologists
        • Treatment Duration with Potassium Binders
        • Satisfaction with Hyperkalemia Treatment: Nephrologists
      • Introduction to Current Treatment and Medical Practice for Hyperkalemia
      • Drugs Included in This Study of Current Treatment of Hyperkalemia
    • Physician Prescribing Practices
      • Key Findings
      • Patient Characteristics
        • Nephrologists Report 40% of Patients with Hyperkalemia Receive Dialysis
        • Etiology of Hyperkalemia
        • Percentage of Chronic Kidney Disease Patients with Chronic Hyperkalemia: Nephrologists
        • Percentage of Patients with Hyperkalemia Receiving Dialysis vs. Nondialysis: Nephrologists
        • Percentage of Chronic Heart Failure Patients with Chronic Hyperkalemia: Cardiologists
        • Chronic Heart Failure Patients by Glomerular Filtration Rate: Cardiologists
        • Hyperkalemia by Disease Severity
      • Treatment Practices
        • Physicians Report Different Treatment Practices Among Acute and Chronic Hyperkalemia Patients
        • Cardiologists Initiate Drug Treatment Faster Than Nephrologists
        • Days to Treatment Start
        • Potassium Level at Treatment Start for Binders
        • Renin Angiotensin Aldosterone System Inhibitors Frequently Halted Due to Hyperkalemia
        • Renin Angiotensin Aldosterone System Inhibitor Treatment Modification in Chronic Kidney Disease Patients with Hyperkalemia - Nephrologists
        • Renin Angiotensin Aldosterone System Inhibitor Treatment Modification in Heart Failure Patients with Hyperkalemia - Cardiologists
        • Cardiologists Prescribe Fewer Potassium Binders in Their Chronic Hyperkalemia Patients Than Nephrologists
        • Patient Share for Hyperkalemia Treatments: Cardiologists
        • Patient Share for Hyperkalemia Treatments: Nephrologists
        • Patient Share of Potassium Binders Among Chronic Kidney Disease Nondialysis and Dialysis Patients
        • Chronic Kidney Disease Patients Receive Patiromer for an Average 36 Days
        • Treatment Duration with Potassium Binders
        • One-Third of Patients with Hyperkalemia Receive Only Nonpharmacological Treatment
        • Pharmacological Versus Nonpharmacological Treatment Approaches
        • Factors Influencing Dialysis Initiation for Hyperkalemia Treatment
        • Potassium Binder Prescribing Varies by Line of Therapy
        • The Majority of Hyperkalemia Patients Managed on the First Line
        • Patient Share by Line of Therapy
        • Recurring Hyperkalemia Drives Progression Between Lines of Therapy
        • Cause of Progression Between Lines of Therapy
        • Hyperkalemia Treatment Practices Depend on Line of Therapy
        • Product Patient Share by Line of Therapy: Cardiologists
        • Product Patient Share by Line of Therapy: Nephrologists
        • Longer Treatment Duration for Patiromer Compared with Sodium Polystyrene Sulfonate Observed
        • Sodium Polystyrene Sulfonate Treatment Duration by Line of Therapy
        • Patiromer Treatment Duration by Line of Therapy
      • Persistency and Compliance
        • Compliance with Therapies Used in Hyperkalemia
        • Hyperkalemia Therapy Compliance
      • Sequencing of Treatment
        • Over One-Third of Patients Receiving Patiromer Are Treatment-Naive
        • Sequencing of Treatment with Sodium Polystyrene Sulfonate
        • Sequencing of Treatment with Patiromer
      • Recent/Anticipated Changes in Brand Use/Treatment Approach
        • Emergence of New Potassium Binders Alters Anticipated Treatment Practices One Year from Now
        • Future Patient Share in Hyperkalemia: Cardiologists
        • Future Patient Share in Hyperkalemia: Nephrologists
        • Future Use of Zirconium Cyclosilicate: Cardiologists
        • Future Use of Zirconium Cyclosilicate: Nephrologists
    • Physician Insight on Medical Practice
      • Key Findings
      • Drivers of Treatment Selection
        • Potassium Severity Influences Treatment Selection for Hyperkalemia
        • Discomfort with Potassium Binders Helps Drive Hyperkalemia Patient Referrals to Nephrologists
        • Cardiologist Patient Referrals to Nephrologists for Hyperkalemia
        • Reasons for Cardiologist Patient Referrals for Hyperkalemia
        • Nephrologist Patient Referrals to Cardiologists for Hyperkalemia
        • Reasons for Nephrologist Patient Referrals for Hyperkalemia
        • Guideline Use in Hyperkalemia
        • Different Factors Drive Cardiologist and Nephrologist Prescribing Decisions
        • Satisfaction with Hyperkalemia Treatment: Cardiologists
        • Satisfaction with Hyperkalemia Treatment: Nephrologists
        • Drivers of Sodium Polystyrene Sulfonate Prescribing: Cardiologists
        • Drivers of Sodium Polystyrene Sulfonate Prescribing: Nephrologists
        • Drivers of Patiromer Prescribing: Cardiologists
        • Drivers of Patiromer Prescribing: Nephrologists
        • Cost and Access are Major Impediments to Patiromer Use
        • Obstacles to Prescribing Sodium Polystyrene Sulfonate: Cardiologists
        • Obstacles to Prescribing Sodium Polystyrene Sulfonate: Nephrologists
        • Obstacles to Prescribing Patiromer: Cardiologists
        • Obstacles to Prescribing Patiromer: Nephrologists
        • Tolerability, Cost, and Hyperkalemia Resolution Lead to Treatment Discontinuation
        • Patient Share After Potassium Binder Use: Cardiologists
        • Patient Share After Potassium Binder Use: Nephrologists
        • Reasons for Hyperkalemia Treatment Discontinuation
        • Reasons for Treatment Switching: Cardiologists
        • Reasons for Treatment Switching: Nephrologists
    • Methodology
      • Primary Market Research Methodology
      • Average Number of Chronic Kidney Disease Patients with Hyperkalemia
      • Average Number of Heart Failure Patients with Hyperkalemia
    • Appendix
      • Key Abbreviations
      • Bibliography
      • Primary Market Research
        • Treatment Location of Incident Hyperkalemia
        • Average Number of Kidney Transplant Patients
        • Level of Familiarity with Patiromer
        • Potassium Measurement for Dialysis Patients
        • Concomitant Drug Use Among Hyperkalemia Patients: Cardiologists
        • Concomitant Drug Use Among Hyperkalemia Patients: Nephrologists
        • Familiarity with Emerging Therapies: Cardiologists
        • Familiarity with Emerging Therapies: Nephrologists
        • Counter-Ion Preference for Potassium-Binding Therapies

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.