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Recommendations for Managing Hyperkalaemia

Case Study:

Aligned recommendations for managing hyperkalaemia across the cardiorenal spectrum


The Client

Our client is a world leader in treatments supporting nephrology and cardiology patients. They commissioned us to help develop consensus recommendations on the optimal management of hyperkalaemia in the cardiorenal patient using a modified Delphi method. This organisation are a manufacturer of a novel treatment for hyperkalaemia.

Therapy Area

Hyperkalaemia is a potentially life-threatening elevation in blood potassium levels that is particularly common amongst patients with cardiorenal comorbidities (e.g. heart failure and chronic kidney disease). Renin angiotensin aldosterone system inhibitors (RAASi) are a mainstay of treatment for cardiorenal patients but are associated with an increased risk of hyperkalaemia. When hyperkalaemia presents, RAASi therapy is often dose reduced or discontinued with subsequent loss of the cardiorenal protection those agents confer.


Opinion exists that RAASi doses should be maintained / increased while the risk or occurrence of hyperkalaemia should be managed with appropriate treatment. Guideline recommendations across cardiology and nephrology specialities vary and leads to variation in clinical practice. This coupled with the fact that cardiologists and nephrologists generally work independently means that best practice is unclear.



Working with the client from mid 2021, we identified the opportunity to implement a Delphi consensus that was designed to:

  • Align perspectives from cardiologists & nephrologists on recommendations for clinical best practice today
  • Help support appropriate updates to future guidelines

Our Process

Step 1

A multi-disciplinary group of experts specialising in cardiology and nephrology from across Europe and North America were facilitated to pinpoint the challenges related to the management and treatment of hyperkalaemia in the cardiorenal patient, and then define a set of statements that described ‘ideal’ practice

Step 2

A structured online survey was developed and disseminated across other cardiorenal specialists across Europe and North America. The online survey tested the strength of agreement that existed in relation to the statements developed.

Step 3

A subsequent facilitated review of the full dataset by the steering group led to the development of a core set of recommendations that reflected the results achieved.  These were focused on the prevention and management of hyperkalaemia in cardiorenal patients.

Step 4

A manuscript capable of peer-reviewed publication was developed and authored by the steering group. Triducive supported submission to the European Journal of Heart Failure for peer review.

Outcomes & Observations



responses achieved from cardiorenal specialists across Europe, US and Canada.


clear recommendations which inform potential improvements to the management of hyperkalaemia in cardiorenal patients

Published in a high impact peer-reviewed journal which supports credibility and citation of subsequent materials

Provided a strong platform for the client team to engage with key stakeholders to support updates to guidelines

Following submission, the manuscript was accepted and subsequently published in mid-2022 in a journal with an impact factor of 17. The study has already been cited in other research (within 1 month of publication) and one National guideline organisation has already initiated a program to redefine its approach. The client have since worked with Triducive to develop campaign activities to build further on this and to drive awareness of the recommended best practice for the prevention and management of hyperkalaemia in cardiorenal patients. Activities include:

  • Clinical meeting materials
  • Congress communications
  • Digital communication campaign assets including an innovative video abstract

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