Treatment Strategies in Incident and Recurrent Hyperkalemia: Insights from the TRACK Study

Little is known about the implementation of guideline recommendations and healthcare provider decision-making when managing hyperkalemia. We aimed to address these knowledge gaps and better understand hyperkalemia management in routine clinical care and the baseline characteristics and longitudinal (12-month) clinical variables of participants with hyperkalemia. This was an observational, prospective, longitudinal, cohort study including adults with recent (≤ 21 days of enrollment) hyperkalemia (serum potassium [K+] > 5.0 mmol/L) during standard of care, across Germany, Italy, Spain, the UK, and the USA from July 2022 to December 2024. Primary and secondary data were collected from participants’ medical records and their respective healthcare providers. Healthcare providers’ hyperkalemia management decisions, treatment rationale, and expectations were measured overall, by incident versus recurrent cases, and by hyperkalemia severity. In total, 1330 participants with hyperkalemia were included (458 incident, 870 recurrent). The most common treatment rationale for index hyperkalemia was ease of treatment (41.4%). Overall, 80.9% of participants received conservative treatment (no hyperkalemia treatment, monitoring K+ levels, or a low K+ diet; incident hyperkalemia 76.9%, recurrent hyperkalemia 83.2%). K+ binder use was low (10.8%) but increased with hyperkalemia severity (mild, 6.6%; moderate, 17.0%; severe 20.0%). Renin–angiotensin–aldosterone system inhibitors were stopped/reduced in < 5% of participants. Over 12 months, 71.7% of participants achieved normokalemia at any timepoint (incident 65.7%, recurrent 74.8%). Among participants with normokalemia at 9 months (incident, n = 125; recurrent, n = 294), the probability of hyperkalemia recurrence at 12 months was lower in the incident than in the recurrent group (14.5% vs 39.3%; crude odds ratio 0.26 [95% confidence interval 0.13–0.53]). Guideline recommendations for incident and recurrent hyperkalemia were inconsistently implemented in clinical practice, as demonstrated by a conservative approach to treatment. Unmet hyperkalemia treatment goals and recurrent hyperkalemia were common. Individuals with chronic kidney disease and/or heart failure have an increased risk of hyperkalemia, a condition caused by elevated blood potassium levels that can impair cardiac function. Additionally, some medications used to treat chronic kidney disease and heart failure conditions can further increase potassium levels. The TRACK study assessed how healthcare providers (HCPs) in five countries treated adults who had a recent first-time episode (incident) or recurring episodes (recurrent) of hyperkalemia in routine clinical practice. Researchers reviewed the medical records of participants with incident or recurrent hyperkalemia and collected data from HCPs over 12 months to document treatment decisions, reasons for those choices, and outcomes. Data were analyzed to identify patterns over time. The researchers found that HCPs did not consistently follow guidelines when treating patients with hyperkalemia. HCPs tended to use conservative treatment approaches, including monitoring blood potassium levels and advising a low-potassium diet, and few patients were given specialized treatments such as potassium binder medication, which helps lower potassium levels. ‘Ease of treatment’ was the most common reason HCPs gave for their treatment choice. Many patients returned to normal potassium levels, but it was common for them to have recurrences of hyperkalemia. The findings show inconsistent use of clinical guidelines by HCPs in everyday clinical practice and a conservative approach to treating hyperkalemia. A more proactive care approach and closer adherence to clinical guidelines could reduce hyperkalemia recurrence and improve patient outcomes.