Paolo Cogliati

Management of hyperkalaemia in the Italian clinical practice: impact of diverse potassium binders on outcomes and costs in patients with chronic kidney disease and heart failure

Introduction Hyperkalemia is a common and clinically relevant condition in patients with chronic kidney disease (CKD)
and heart failure (HF), often limiting optimal use of renin–angiotensin–aldosterone system inhibitors (RAASi).
Methods This real-world study evaluated adherence, clinical outcomes, and healthcare costs among Italian patients initiating
patiromer, sodium zirconium cyclosilicate (SZC), or sodium polystyrene sulfonate (SPS) between January 2022 and
June 2024.
Results Administrative data covering about 10% of the Italian population identified 1953 patients: 249 on patiromer, 387 on
SZC, and 1317 on SPS. After full matching, 67.5% of patiromer patients were adherent at 6 months, compared with 20.4%
for SZC and 0.5% for SPS (p < 0.001). Over the total follow-up, adherence remained higher with patiromer (42.5% vs 13.4% and 0.5%). During the first 6 months, HF-related hospitalization rates were lower with patiromer versus SZC (5.4 vs 12.8 events per 100 person-years; p = 0.079), becoming significant over overall follow-up (5.3 vs 15.7; p = 0.003). Composite HF outcomes at 6 months were also lower with patiromer compared with SZC (5.3 vs 17.4; p = 0.012) and SPS (3.4 vs 24.8; p = 0.005). At 12 months, total healthcare costs were significantly lower with patiromer than with SZC and SPS (€5645 vs €8500 and €4736 vs €6234; p < 0.001). Overall, patiromer use was associated with better adherence, fewer HF-related events, and reduced healthcare expenditure. Conclusions These findings suggest a patiromer potential role for sustained potassium binder therapy in supporting RAASi optimization and improving clinical management in routine practice, but confirmation through direct comparative prospective randomized trials is needed