Why the study?
The study was conducted to capture expert opinion on hyperkalaemia management and form best practice recommendations for cardiorenal patients in Greece.
A Delphi consensus among Greek cardiologists and nephrologists highlights agreement on managing hyperkalaemia to maintain guideline-directed RAASi therapy in cardiorenal patients, utilizing novel potassium binders.
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Supports novel binders to sustain RAASi in hyperkalemic cardiorenal patients; extends expert consensus beyond prior guidelines.
The main purpose of this project was to capture experts' opinion on hyperkalaemia management and form best practice recommendations for cardiorenal patients in Greece. A steering committee of nephrologists and cardiologists developed 37 statements. An online questionnaire completed by 32 experts in cardiorenal management in Greece. Median score used to determine the level of agreement and disagreement index (DI) used to determine the level of consensus for each statement. Statements divided in four sectors: hyperkalaemia risk management, preventative measures, treatment and collaboration between specialties. The rate of the first round of the consensus was 94.6%. Median score was >7 for 36 of 37 statements and DI ≤ 1 for 35 of 37. Among other statements, consensus reached for recognizing levels K+ > 5.0 mEq/L as associated with elevated mortality risk; retaining renin-angiotensin-aldosterone system inhibitors (RAASi) on maximum recommended dose for cardiorenal patients; and using novel K+ binders to help enabling guideline-recommended doses of RAASi therapy. Cardiologists compared to nephrologists showed higher reluctance to discontinue down-titrate RAASi and MRA in patients with K+ levels above 5 mEq/L. Additionally, 88.9% of nephrologists and 71.4% of cardiologists agreed that cross-specialty alignment on a serum K+ concentration level (K > 5.5 mEq/L) is needed to initiate hyperkalaemia treatment. Both cardiologists and nephrologists showed disagreement with the statement on keeping titration in cardiorenal patients with K+ > 5.5 mEq/L or preserving fruit and vegetable consumption when moderate or severe hyperkalaemia exhibits. This Delphi project pointed out nephrologists' and cardiologists' agreement on hyperkalaemia management in cardiorenal patients; thus, it can help a cross-specialty optimal management of cardiorenal patients, with hyperkalaemia not being an obstacle for disease-optimizing therapy. Novel potassium binding agents can enable guideline-recommended doses of potassium-sparing medication.
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Chrysohoou et al. (2024) studied Hyperkalaemia in cardiorenal patients (n=32). Delphi consensus on hyperkalaemia management was evaluated on Level of agreement (median score) and disagreement index (DI) for 37 statements. A Delphi consensus of 32 Greek experts reached high agreement (median score >7 for 36 of 37 statements) on hyperkalaemia management, supporting novel potassium binders to maintain RAASi therapy.
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