Hyperkalaemia and hypokalaemia outpatient management: a survey of 500 French general practitioners
Abstract Aims How general practitioners (GPs) manage dyskalaemia is currently unknown. This study aimed at describing GP practices regarding hypokalaemia or hyperkalaemia diagnosis and management in their outpatients. Methods and results A telephone survey was conducted among French GPs with a 20‐it...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-10-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.12834 |
| _version_ | 1819100579490693120 |
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| author | Laure Abensur Vuillaume Patrick Rossignol Zohra Lamiral Nicolas Girerd Jean‐Marc Boivin |
| author_facet | Laure Abensur Vuillaume Patrick Rossignol Zohra Lamiral Nicolas Girerd Jean‐Marc Boivin |
| author_sort | Laure Abensur Vuillaume |
| collection | DOAJ |
| description | Abstract Aims How general practitioners (GPs) manage dyskalaemia is currently unknown. This study aimed at describing GP practices regarding hypokalaemia or hyperkalaemia diagnosis and management in their outpatients. Methods and results A telephone survey was conducted among French GPs with a 20‐item questionnaire (16 closed‐ended questions and 12 open‐ended questions) regarding their usual management of hypokalaemia or hyperkalaemia patients, both broadly and more specifically in patients with heart failure and/or chronic kidney disease and/or in patients treated with angiotensin‐converting enzyme/angiotensin receptor blockers or mineralocorticoid receptor antagonists. We aimed to interview 500 GPs spread geographically throughout France. This descriptive survey results are presented as mean ± standard deviation (if normally distributed or as median and inter‐quartile range if the distribution was skewed). Categorical variables are expressed as frequencies and proportions (%). A total of 500 GPs participated in the study. Dyskalaemia thresholds (for diagnosis and intervention) and management patterns were highly heterogeneous. The mean ± SD (range) potassium level leading to ‘intervene’ was 5.32 ± 0.34 mmol/L (4.5–6.5) for hyperkalaemia and 3.23 ± 0.34 mmol/L (2.0–6.5) for hypokalaemia. Potassium levels leading to refer the patient to the emergency department (ED) were 6.14 ± 0.55 (4.5–10) and 2.69 ± 0.42 mmol/L (1–4), respectively. Potassium binders (51–65%) or potassium supplements (67–74%) were frequently used to manage hyperkalaemia or hypokalaemia. GPs uncommonly referred their dyskalaemic patients to cardiologists or nephrologists (or to the emergency department, if the latter was deemed necessary owing to the severity of the dyskalaemia). We identified an association between the close vicinity of GP office from an ED and ‘referring a heart failure patient’ (19.2% with ED vs. 8.6% without ED) and referring a heart failure and chronic kidney disease patient on mineralocorticoid receptor antagonist (16.7% with ED vs. 9.3% without ED). Although the majority (67%) of GPs had an electrocardiogram on hand, it was rarely used (14%) in dyskalaemic patients. Subgroup analyses considering gender, age of the participating GPs, and high‐income/low‐income regions did not identify specific patterns regarding the multidimensional aspect of dyskalaemia management. Conclusions Owing to the considerable heterogeneity of French GP practices toward dyskalaemia diagnosis and management approaches, there is a likely need to standardize (potentially enabled by therapeutic algorithms) practices. |
| first_indexed | 2024-12-22T01:05:01Z |
| format | Article |
| id | doaj.art-ff49eb33e85f4a4daf52946927f9f752 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-12-22T01:05:01Z |
| publishDate | 2020-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-ff49eb33e85f4a4daf52946927f9f7522022-12-21T18:44:07ZengWileyESC Heart Failure2055-58222020-10-01752042205010.1002/ehf2.12834Hyperkalaemia and hypokalaemia outpatient management: a survey of 500 French general practitionersLaure Abensur Vuillaume0Patrick Rossignol1Zohra Lamiral2Nicolas Girerd3Jean‐Marc Boivin4Université de Lorraine, Inserm, Centre d'Investigations Cliniques, Plurithématique 1433, and Inserm 1116 DCAC, CHRU, F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists) Nancy FranceUniversité de Lorraine, Inserm, Centre d'Investigations Cliniques, Plurithématique 1433, and Inserm 1116 DCAC, CHRU, F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists) Nancy FranceUniversité de Lorraine, Inserm, Centre d'Investigations Cliniques, Plurithématique 1433, and Inserm 1116 DCAC, CHRU, F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists) Nancy FranceUniversité de Lorraine, Inserm, Centre d'Investigations Cliniques, Plurithématique 1433, and Inserm 1116 DCAC, CHRU, F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists) Nancy FranceUniversité de Lorraine, Inserm, Centre d'Investigations Cliniques, Plurithématique 1433, and Inserm 1116 DCAC, CHRU, F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists) Nancy FranceAbstract Aims How general practitioners (GPs) manage dyskalaemia is currently unknown. This study aimed at describing GP practices regarding hypokalaemia or hyperkalaemia diagnosis and management in their outpatients. Methods and results A telephone survey was conducted among French GPs with a 20‐item questionnaire (16 closed‐ended questions and 12 open‐ended questions) regarding their usual management of hypokalaemia or hyperkalaemia patients, both broadly and more specifically in patients with heart failure and/or chronic kidney disease and/or in patients treated with angiotensin‐converting enzyme/angiotensin receptor blockers or mineralocorticoid receptor antagonists. We aimed to interview 500 GPs spread geographically throughout France. This descriptive survey results are presented as mean ± standard deviation (if normally distributed or as median and inter‐quartile range if the distribution was skewed). Categorical variables are expressed as frequencies and proportions (%). A total of 500 GPs participated in the study. Dyskalaemia thresholds (for diagnosis and intervention) and management patterns were highly heterogeneous. The mean ± SD (range) potassium level leading to ‘intervene’ was 5.32 ± 0.34 mmol/L (4.5–6.5) for hyperkalaemia and 3.23 ± 0.34 mmol/L (2.0–6.5) for hypokalaemia. Potassium levels leading to refer the patient to the emergency department (ED) were 6.14 ± 0.55 (4.5–10) and 2.69 ± 0.42 mmol/L (1–4), respectively. Potassium binders (51–65%) or potassium supplements (67–74%) were frequently used to manage hyperkalaemia or hypokalaemia. GPs uncommonly referred their dyskalaemic patients to cardiologists or nephrologists (or to the emergency department, if the latter was deemed necessary owing to the severity of the dyskalaemia). We identified an association between the close vicinity of GP office from an ED and ‘referring a heart failure patient’ (19.2% with ED vs. 8.6% without ED) and referring a heart failure and chronic kidney disease patient on mineralocorticoid receptor antagonist (16.7% with ED vs. 9.3% without ED). Although the majority (67%) of GPs had an electrocardiogram on hand, it was rarely used (14%) in dyskalaemic patients. Subgroup analyses considering gender, age of the participating GPs, and high‐income/low‐income regions did not identify specific patterns regarding the multidimensional aspect of dyskalaemia management. Conclusions Owing to the considerable heterogeneity of French GP practices toward dyskalaemia diagnosis and management approaches, there is a likely need to standardize (potentially enabled by therapeutic algorithms) practices.https://doi.org/10.1002/ehf2.12834General practitionersHyperkalaemiaHypokalaemiaHeart failureChronic kidney disease/ mineralocorticoid receptor antagonist |
| spellingShingle | Laure Abensur Vuillaume Patrick Rossignol Zohra Lamiral Nicolas Girerd Jean‐Marc Boivin Hyperkalaemia and hypokalaemia outpatient management: a survey of 500 French general practitioners ESC Heart Failure General practitioners Hyperkalaemia Hypokalaemia Heart failure Chronic kidney disease/ mineralocorticoid receptor antagonist |
| title | Hyperkalaemia and hypokalaemia outpatient management: a survey of 500 French general practitioners |
| title_full | Hyperkalaemia and hypokalaemia outpatient management: a survey of 500 French general practitioners |
| title_fullStr | Hyperkalaemia and hypokalaemia outpatient management: a survey of 500 French general practitioners |
| title_full_unstemmed | Hyperkalaemia and hypokalaemia outpatient management: a survey of 500 French general practitioners |
| title_short | Hyperkalaemia and hypokalaemia outpatient management: a survey of 500 French general practitioners |
| title_sort | hyperkalaemia and hypokalaemia outpatient management a survey of 500 french general practitioners |
| topic | General practitioners Hyperkalaemia Hypokalaemia Heart failure Chronic kidney disease/ mineralocorticoid receptor antagonist |
| url | https://doi.org/10.1002/ehf2.12834 |
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