Prevalence and economic burden of hyperkalemia in the United States Medicare population

Abstract

Objective: To estimate the prevalence and economic burden of hyperkalemia in the United States (US) Medicare population.

Methods: Patients were selected from a 5% random sample of Medicare beneficiaries (01 January 2010–31 December 2014) to estimate the prevalence and economic burden of hyperkalemia. The prevalence for each calendar year was calculated as the number of patients with hyperkalemia divided by the total number of eligible patients per year. To estimate the economic burden of hyperkalemia, patients with hyperkalemia (cases) were matched 1:1 to patients without hyperkalemia (controls) on age group, chronic kidney disease [CKD] stage, dialysis treatment, and heart failure. The incremental 30-day and 1-year resource utilization and costs (2016 USD) associated with hyperkalemia were estimated.

Results: The estimated prevalence of hyperkalemia was 2.6–2.7% in the overall population and 8.9–9.3% among patients with CKD and/or heart failure. Patients with hyperkalemia had higher 1-year rates of inpatient admissions (1.28 vs. 0.44), outpatient visits (30.48 vs. 23.88), emergency department visits (2.01 vs. 1.17), and skilled nursing facility admissions (0.36 vs. 0.11) than the matched controls (all p < .001). Patients with hyperkalemia incurred on average $7208 higher 30-day costs ($8894 vs. $1685) and $19,348 higher 1-year costs ($34,362 vs. $15,013) than controls (both p < .001). Among patients with CKD and/or heart failure, the 30-day and 1-year total cost differences between cohorts were $7726 ($9906 vs. $2180) and $21,577 ($41,416 vs. $19,839), respectively (both p < .001).

Conclusions: Hyperkalemia had an estimated prevalence of 2.6–2.7% in the Medicare population and was associated with markedly high healthcare costs.

Keywords:

• Hyperkalemia
• economic burden
• prevalence
• Medicare
• chronic kidney disease
• heart failure

Transparency

Declaration of funding

This work was supported by AstraZeneca.

Declaration of financial/other relationships

JMW was an employee of AstraZeneca at the time of the study and owns stock/stock options. FM, KAB, AD, YW, JZ, and EQW are employees of Analysis Group Inc., which has received consultancy fees from AstraZeneca. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

FM: Study design, result interpretation, overseeing the conduct of analysis, manuscript drafting, review and revision; KAB: Study design, result interpretation, overseeing the conduct of analysis, manuscript drafting, review, and revision; JMW: Study design, result interpretation, and manuscript review and revision; AD: Data analysis, manuscript drafting, review and revision; YW: Data analysis, manuscript drafting, review and revision; JZ: Data analysis, result interpretation, manuscript drafting, review and revision; EQW: Study design, result interpretation, overseeing the conduct of analysis, manuscript drafting, review and revision. A peer reviewer discloses receiving honoraria from Relypsa from 2014 to 2015. Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose.

Acknowledgements

Manuscript drafts were prepared with the assistance of Shelley Batts, PhD, a professional medical writer employed by Analysis Group, Inc., Boston, MA. This study, including the manuscript preparation service, was funded by AstraZeneca.

Previous presentations

Portions of this research were presented at the 2017 ASN Kidney Week, which took place October 31-November 5 in New Orleans, LA, USA.

Data availability statement

This study used a 5% random sample of the Medicare claims database provided by the Centers for Medicare & Medicaid Services to Analysis Group, Inc. and is not publically available. For information regarding access to the data used in this study please visit https://www.resdac.org.

Compliance with ethics of experimentation

This study followed the principles of the Declaration of Helsinki; institutional board review was not required for this study.