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The value of maintaining normokalaemia and enabling RAASi therapy in chronic kidney disease
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) thera...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357372/ https://www.ncbi.nlm.nih.gov/pubmed/30704421 http://dx.doi.org/10.1186/s12882-019-1228-y |
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author | Evans, Marc Palaka, Eirini Furuland, Hans Bennett, Hayley Linde, Cecilia Qin, Lei McEwan, Phil Bakhai, Ameet |
author_facet | Evans, Marc Palaka, Eirini Furuland, Hans Bennett, Hayley Linde, Cecilia Qin, Lei McEwan, Phil Bakhai, Ameet |
author_sort | Evans, Marc |
collection | PubMed |
description | 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12882-019-1228-y) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-6357372 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-63573722019-02-07 The value of maintaining normokalaemia and enabling RAASi therapy in chronic kidney disease Evans, Marc Palaka, Eirini Furuland, Hans Bennett, Hayley Linde, Cecilia Qin, Lei McEwan, Phil Bakhai, Ameet BMC Nephrol Research Article 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12882-019-1228-y) contains supplementary material, which is available to authorized users. BioMed Central 2019-01-31 /pmc/articles/PMC6357372/ /pubmed/30704421 http://dx.doi.org/10.1186/s12882-019-1228-y Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Evans, Marc Palaka, Eirini Furuland, Hans Bennett, Hayley Linde, Cecilia Qin, Lei McEwan, Phil Bakhai, Ameet The value of maintaining normokalaemia and enabling RAASi therapy in chronic kidney disease |
title | The value of maintaining normokalaemia and enabling RAASi therapy in chronic kidney disease |
title_full | The value of maintaining normokalaemia and enabling RAASi therapy in chronic kidney disease |
title_fullStr | The value of maintaining normokalaemia and enabling RAASi therapy in chronic kidney disease |
title_full_unstemmed | The value of maintaining normokalaemia and enabling RAASi therapy in chronic kidney disease |
title_short | The value of maintaining normokalaemia and enabling RAASi therapy in chronic kidney disease |
title_sort | value of maintaining normokalaemia and enabling raasi therapy in chronic kidney disease |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357372/ https://www.ncbi.nlm.nih.gov/pubmed/30704421 http://dx.doi.org/10.1186/s12882-019-1228-y |
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