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The value of maintaining normokalaemia and enabling RAASi therapy in chronic kidney disease
Llandough Hosp, Diabet Resource Ctr, Cardiff, S Glam, Wales.
AstraZeneca, Global Hlth Econ, Cambridge, England.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Renal Medicine.
Hlth Econ & Outcomes Res Ltd, Cardiff, S Glam, Wales.
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2019 (English)In: BMC Nephrology, ISSN 1471-2369, E-ISSN 1471-2369, Vol. 20, article id 31Article in journal (Refereed) Published
Abstract [en]

Background

People with chronic kidney disease (CKD) are at an increased risk of developing hyperkalaemia due to their declining kidney function. In addition, these patients are often required to reduce or discontinue guideline-recommended renin-angiotensin-aldosterone system inhibitor (RAASi) therapy due to increased risk of hyperkalaemia. This original research developed a model to quantify the health and economic benefits of maintaining normokalaemia and enabling optimal RAASi therapy in patients with CKD.

Methods

A patient-level simulation model was designed to fully characterise the natural history of CKD over a lifetime horizon, and predict the associations between serum potassium levels, RAASi use and long-term outcomes based on published literature. The clinical and economic benefits of maintaining sustained potassium levels and therefore avoiding RAASi discontinuation in CKD patients were demonstrated using illustrative, sensitivity and scenario analyses.

Results

Internal and external validation exercises confirmed the predictive capability of the model. Sustained potassium management and ongoing RAASi therapy were associated with longer life expectancy (+ 2.36 years), delayed onset of end stage renal disease (+ 5.4 years), quality-adjusted life-year gains (+ 1.02 QALYs), cost savings (£3135) and associated net monetary benefit (£23,446 at £20,000 per QALY gained) compared to an absence of RAASi to prevent hyperkalaemia.

Conclusion

This model represents a novel approach to predicting the long-term benefits of maintaining normokalaemia and enabling optimal RAASi therapy in patients with CKD, irrespective of the strategy used to achieve this target, which may support decision making in healthcare.

Place, publisher, year, edition, pages
2019. Vol. 20, article id 31
Keywords [en]
Chronic kidney disease, Potassium, Hyperkalaemia, Renin-angiotensin-aldosterone system inhibitor, Economic modelling
National Category
Urology and Nephrology
Identifiers
URN: urn:nbn:se:uu:diva-377338DOI: 10.1186/s12882-019-1228-yISI: 000457382600004PubMedID: 30704421OAI: oai:DiVA.org:uu-377338DiVA, id: diva2:1291499
Funder
AstraZenecaAvailable from: 2019-02-25 Created: 2019-02-25 Last updated: 2019-02-25Bibliographically approved

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