#1395 Management of CKD patients and HK, as its main complication: degree of adoption of the multi-society consensus on CKD and HK in Spain
Authors: Alvaro Carlos , Andrés Ana , Garcia María , Fernandez Nicolás , Tomás Laura , Diez Andrea , Jimenez Alberto , Prieto Roberto , Ollero David , Moreno Juan , Villarroel Aida , Izarra Aitziber 
Published: May 2024

Abstract

Background and Aims
The high incidence, morbidity and mortality of Chronic Kidney Disease (CKD) makes it a public health problem, due to the difficulties in its early detection and management. Hyperkalemia (HK) is a common complication of CKD, also associated with high morbidity and mortality, impacting on the management of patients with CKD and leading sometimes to deoptimization of their treatment.
It has been shown that the development of multidisciplinary consensus contributes to improving patient management. With this objective, the multi-society consensus documents –Information and consensus document for the detection and management of chronic kidney disease (2022)- and –Recommendations for the management of hyperkalemia in the emergency department (2022)- have been published.
The aim of this study is to analyze the degree of adoption of the recommendations of both consensus in clinical practice in Spain, in order to identify potential areas of improvement in the management of CKD patients with HK.

Method
This study is based on the perceptions obtained through the discussion on the applicability of the national consensus documents for the management of CKD and HK. To this end, two medical education programs focused on CKD and HK, respectively, were carried out to discuss the applicability of both consensuses. In total, 41 meetings were held (14 from ERC and 27 from HK) from April 2022 to April 2023, involving a total of 542 healthcare professionals (HCPs) (nephrologists and emergency physicians). The main hypothesis was that neither the consensuses are being followed regularly in Spanish clinical practice. All responses were coded numerically, and a national mean was created based on the meeting means.

Results
The majority of nephrologists who participated in the discussion of the consensus analysis consider that CKD is underdiagnosed (77%), and that the detection of albuminuria is not routinely performed in Primary Care (PC) (72%). Furthermore, half of the nephrologists point out that referrals from PC do not meet the recommended criteria. In relation to treatment, almost 90% of nephrologists would follow the recommendations for the use of RAASi (renin angiotensin aldosterone system inhibitors) and Dapagliflozin very frequently. Regarding HK (a complication of CKD), 42% of HCPs considered that 30-40% of patients with CKD and/or HF suffered a second episode of HK. In relation to its management, only 21% of HCPs considered that the recommendations to maintain treatment with RAASis were followed. Of those who modified it, more than 50% did not consider reintroducing it or considered it little. 33% of HCPs did not show willingness to use the new antihyperkalemia treatments upon discharge. 50% of the participants said they did not have access to them. Regarding follow-up, 54% considered that it should be done by PC specialists.

Conclusion
The recommendations specified in the CKD and HK management consensuses are being applied less than desired in Spanish clinical practice. Especially highlighting the lack of detection of albuminuria and non-compliance with the referral criteria in patients with CKD, which is consistent with the high underdiagnosis described in Spain. Furthermore, the recommendation of not to modifying the RAASi treatment for the management of HK is not regularly adopted, despite of its impact on the morbidity and mortality of these patients. This information could help to guide future interventions that aim to improve the diagnosis and management of patients with CKD and/or HK.