Table 3.

Consensus statements and levels of agreement displayed by country: correction of hyperkalaemia for at‐risk cardiorenal patients with the potassium‐lowering therapy (Topic C)

No.	Statement	Agreement (%)
		All	CA	DE	ES	FR	IT	UK	US
20	A reduction in emergency department visits and unplanned hospitalizations due to complications associated with hyperkalaemia should be a goal of good management	96	96	94	100	94	91	98	97
21	A goal for the management of high‐risk cardiorenal patients should be to utilize the maximum recommended dose of RAASi therapy	94	92	89	89	96	88	98	97
22	RAASi‐induced hyperkalaemia should not be considered intolerance until other strategies to reduce K+ have been exhausted	93	92	91	96	94	91	96	91
23	De‐escalation or discontinuation of RAASi therapy is associated with worse cardiovascular and renal outcomes in cardiorenal patients	94	92	91	96	94	84	100	95
24	Permanent discontinuation of a RAASi should only be considered as a last resort strategy for chronic hyperkalaemia	92	94	87	88	98	95	96	92
25	Hyperkalaemia should no longer be seen as a barrier to optimization of guideline‐directed therapy	88	88	93	91	96	88	82	87
26	Novel K+ binders enable guideline‐recommended RAASi dosing and the proven benefits that this brings to patients	92	90	91	89	90	95	94	93
27	Use of novel K+ binders in patients with mild hyperkalaemia can enable guideline‐recommended doses of RAASi therapy	94	90	93	98	94	100	92	94
28	RAASi use should not be de‐escalated or discontinued due to hyperkalaemia unless alternative measures of hyperkalaemia management have been optimized, including initiation of K+ binder therapy	92	94	94	95	92	91	90	91
29	Novel K+ binders can enable optimization of RAASi therapy in a similar way that antiemetics can enable optimization of chemotherapy	90	84	89	88	94	93	88	91
30	Novel K+ binders should not need to show mortality benefit; they enable RAASis, which have an already proven mortality benefit	82	86	74	79	86	86	86	80
31	The use of SPS should be avoided due to concerns with GI toxicity, low compliance due to poor palatability, and is only indicated in severely oliguric or anuric patients	77	60	69	68	66	86	92	82
32	SPS should not be used in the medium‐ or long‐term as it may cause severe GI side effects, including bowel necrosis	82	76	81	75	70	86	90	86

CA, Canada; DE, Germany; ES, Spain; FR, France; GI, gastrointestinal; IT, Italy; K⁺, potassium; RAASi, renin–angiotensin–aldosterone system inhibitor; SPS, sodium polystyrene sulfonate; UK, United Kingdom; US, United States of America.