Changes in Hyperkalemia Management After Online CME

During a poster session at the NKF 2022 Spring Clinical Meetings, Amy Larkin and colleagues reported on an assessment of the effect of online education designed to initiate changes in clinical practice related to management of hyperkalemia in order to enable and/or optimize use of renin-angiotensin-aldosterone system (RAAS) inhibitors. The poster was titled Impact of Online CME on Planned and Actual Practice Changes Related to Hyperkalemia Management.

The CME activity included a 30-minute online video roundtable panel discussion among three experts in the role of potassium binders in enabling use of RAAS inhibitors and mineralocorticoid receptor antagonist in patients with various comorbidities. A survey administered immediately following the education activity was used to assess the impact of the activity on performance outcomes. The survey also identified planned changes in clinician practice as a result of participation in the CME activity

Eight weeks after completion of the activity, participants were contacted to assess self-reported actual changes in practice. The activity launched October 6, 2020, and data were collected through April 30, 2021.

The survey immediately following the online education activity was completed by a total of 275 clinicians (91 nephrologists, 75 cardiologists, and 109 nurse practitioners/physicians assistants [NPs/PAs]). Nineteen percent of the nephrologists, 8% of the cardiologists, and 4% of the NPs/PAs were treating more than 100 patients per month taking RAAS inhibitors.

Of the overall responding cohort, 91% indicated an average of 3.2 planned practice changes each. When re-engaged with the follow-up survey, 28 participants responded (12 nephrologists, 6 cardiologists, and 10 NPs/PAs). Of those, 86% reported an average of 3.9 changes in practice as a result of the CME activity.

The practice changes included: (1) consider a loop diuretic to increase potassium clearance and enhance volume management (67% nephrologists, 83% cardiologists, 50% NPs/PAs); (2) review medications, diet, and over-the-counter medications to identify factors contributing to hyperkalemia (58% nephrologists, 83% cardiologists, 70% NAs/PAs); (3) control hyperkalemia with a novel potassium binder to optimize dose of RAAS inhibitor (58% nephrologists, 33% cardiologists, 50% NPs/PAs); (4) use of patiromer in patients on spironolactone to maintain normokalaemia and allow for spironolactone continuation of dose uptitration per the PEARL-HF study (58% nephrologists, 33% cardiologists, 40% NPs/ PAs).

In summary, the authors said, “The outcomes gathered in this assessment provide compelling evidence that participation in a 30-minute online video discussion among three experts prompted both planned and actual changes in practice to provide belter hyperkalemia management to their patients.”

Source: Larkin A, Blatherwick D, Boutsalis G. Impact of online CME on planned and actual practice changes related to hyperkalemia management. Abstract of a poster presented at the National Kidney Foundation Spring Clinical Meetings 2022 (Abstract #294), Boston, Massachusetts, April 6-10, 2022.