Monitoring Potassium in Hemodialysis Patients

Due to elevated levels of potassium, patients with kidney failure requiring dialysis are at high risk for hyperkalemia, a complication associated with increased morbidity and mortality. Interventions designed for early detection of hyperkalemic events may aid in prevention of those adverse outcomes and their associated costs.

Ryan J. Bamforth and colleagues at the Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada, performed a cost-utility analysis comparing the use of a real-time potassium monitoring device in patients on hemodialysis with usual care. Results of the analysis were reported during a poster session at the American Society of Nephrology Kidney Week 2022 in a poster titled Cost-Utility of Real-Time Potassium Monitoring in Hemodialysis Patients.

The researchers developed a decision analytic microsimulation model from the perspective of the United States health care payer. Outcomes included were the monthly break-even cost per patient of the proposed intervention and the incremental cost-effectiveness ratio comparing the use of the real-time potassium monitoring device with usual care. Included costs were those associated with hyperkalemic events (emergency department and hospitalization specific) and dialysis.

Utilities for patients on dialysis were developed using utility estimates from a systematic review and meta-analysis. In the intervention scenario, a reduction in hyperkalemic events of 25% was used as a baseline effectiveness estimate, with a range between 10% and 50% considered in sensitivity analyses.

In the base case scenario, threshold analysis revealed a monthly break-even cost of $689.56 US dollars per patient. In the microsimulation model, the intervention provided 0.04 additional quality-adjusted life-years. Thus, at any price point equal to or below the break-even cost the intervention was dominant compared with usual care. In effectiveness estimates of a reduction of hyperkalemic events between 10% and 50%, the monthly break-even cost ranged from $265.36 to $1387.90 US dollars respectively.

“Implementing a real-time potassium monitoring device in hemodialysis patients to prevent hyperkalemic events has the potential for cost savings and increased quality of life from the perspective of the United States health care payer,” the researchers said.

Source: Bamforth R, Ferguson TRW, Komenda P. Cost-utility of real-time potassium monitoring in hemodialysis patients. FR-PO542. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2022; November 4, 2022; Orlando, Florida.