ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on Twitter

Kidney Week

Abstract: FR-PO310

Changes in Nephrologists’ Understanding and Management of Hyperkalemia from 2015 to 2018

Session Information

Category: Fluid and Electrolytes

  • 902 Fluid and Electrolytes: Clinical


  • Larkin, Amy, Medscape Education, Nicholasville, Kentucky, United States
  • Blatherwick, Donald, Medscape, Medford, New Jersey, United States
  • Marshall, Teresa S., Medscape, Medford, New Jersey, United States
  • Boutsalis, George, Medscape, Medford, New Jersey, United States

Identifying clinical gaps related to hyperkalemia and its management can inform the development of tools to advance best practices for nephrologists


Medscape conducted surveys in 2015, 2016, and 2018. The first two were CME-accredited activities consisting of 25 multiple choice, knowledge- and case-based questions aboout hyperkalemia assessment and management. These online surveys were available without compensation or fee. The third online, 14-question, survey was incentivized for nephrologists with monetary compensation for completion. In all surveys, respondents’ confidentiality was maintained and responses were de-identified and aggregated prior to analyses. Data collection occurred in 9/22 - 11/22/2015, 11/21 – 12/21/2016, and 4/20 – 4/26/2018.


Participation by nephrologists: 394 in 2015, 131 in 2016, and 50 in 2018
Significant Changes:
Competence related to management of hyperkalemia rose significantly (P =.018) from 44% in 2016 to 66% in 2018*
Competence regarding clinical use of potassium binders grew significantly (P <.001), from 63% to 92% (2016 to 2018, respectively)
Nephrologists who reported being very confident increased significantly (P =.04), from 35% to 45% to 60% (2015, 2016, and 2018, respectively)*

Modest Changes:

Hyperkalemia risk assessment understanding grew (58% to 72%, P =.083) as well as recognition of strategies to minimize hyperkalemia risk with RAAS inhibitors (25% to 30%, P =.381) from 2016 – 2018*
Knowledge of the mechanism of action of patiromer trended upward each year, 46% to 50% to 56% (2015, 2016, and 2018 respectively, P=.377) *

Ongoing Gap:
Confusion remains around the mechanism of action of ZS9, 49% (2015), 39% (2016), and 44% 2018, P =.046)*
Understanding related to the physiology of hyperkalemia and potassium excretion remains low (55% vs 54%, P - .885) from 2015 to 2018*

* results indicate a need for further education


These surveys demonstrate some improvement in clinical knowledge, competence, and confidence by nephrologists related to hyperkalemia from 2015 to 2018, as well as continued gaps that need to be addressed to improve patient care. Future education in the area of hyperkalemia should focus on improving risk assessment for hyperkalemia, understanding available treatment options, management of hyperkalemia, and also reinforce important points to further increase confidence.