A Portuguese Modified Delphi Consensus on Quality Standards for Hyperkalemia Management in Portugal
DOI:
https://doi.org/10.71749/pkj.158Keywords:
Angiotensin‑Converting Enzyme Inhibitors, Chelating Agents, Delphi Technique, Heart Failure, Hyperkalemia, Patient Care Team, Polyamines, Polymers, Potassium, Quality of Life, Renal Insufficiency, Chronic, SilicatesAbstract
Hyperkalemia (HK) is common in chronic kidney disease, heart failure, and other cardiovascular-kidney-metabolic (CKM) conditions, often impacting the use of guideline-directed medical therapies (GDMT). Despite scientific guidelines and available treatments, healthcare organization and care delivery also influence treatment patterns and quality of care for patients with HK.
This study aimed to develop consensus-based recommendations for HK management in Portugal, focusing on care organization, clinical practice, and treatment access, through a process that included regional multidisciplinary in-person meetings followed by a single-round modified Delphi panel. Afterwards, a focus group defined twenty-eight recommendations across three domains: A) healthcare organization and care pathways, B) clinical practice and therapeutic strategies, and C) access to potassium (K+) binders. The online questionnaire was distributed to nephrologists (NE), cardiologists (CA), internists (IM), and hospital pharmacists (PH).
Ninety-nine participants completed the survey (IM: 38.4% NE: 30.3% CA: 25.3% PH: 6.0%). Following a single Delphi round, all statements achieved high agreement (≥89%), with four unanimously approved. In domain A, structured care pathways, early clinical reassessment, and patient education were considered important. In domain B, panelists recognized the importance of integrated risk assessment, maintaining GDMT, and using new K+ binders in acute and chronic HK. In domain C, agreement was highest, with full consensus on ensuring treatment continuity and simplifying administrative procedures delaying therapy initiation.
The need for standardized approaches, improved multidisciplinary coordination, and preventive HK management in Portugal was consistently supported. This national consensus provides a framework for developing quality standards to improve patient outcomes and promote consistent HK care across Portuguese healthcare settings.
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Data Availability Statement
The data generated and analyzed during the current study are not publicly available due to confidentiality agreements and the nature of the Delphi process.
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Copyright (c) 2026 Ana Natário, Irene Marques, Marco Mendes, Cátia Oliveira, João Porto, Ana Paula Silva, Joana Paixão, Paulo Araújo, Rodrigo Leão, Luís Rodrigues, Renata Carvalho, Hugo Diniz
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