Background Hyperkalemia is common in chronic kidney disease (CKD) and chronic heart failure (CHF), often leading to treatment dilemmas regarding renin– angiotensin–aldosterone system (RAAS) inhibitors. Although potassium binders and dietary restrictions are central to chronic management, their quality-of-life (QOL) impact remains insufficiently described. This study aimed to characterize real-world treatment patterns and evaluate treatment impact on QOL.

Methods We analyzed baseline data from a prospective cohort in Japanese nephrology and cardiology outpatient clinics. Participants were adults with CKD (≥ stage G3) or CHF (New York Heart Association class II–IV) who initiated potassium binders within 6 months. Clinical data, serum potassium values, and patient-reported outcomes (generic QOL, disease/treatment-specific QOL, and adherence measures) were obtained at enrollment.

Results Among 347 patients, the median age was 75 years, and 74% were male; 93% had CKD. At enrollment, 300 patients were receiving potassium binders, and 59% were prescribed a RAAS inhibitor. Dietary therapy was implemented in 29%. Physical scores of generic QOL were lower than population norms, whereas mental scores were comparable. Treatment-specific QOL scores indicated that potassium binders had a smaller impact on QOL than dietary therapy. Adherence to potassium binders was high.

Conclusions Concurrent use of RAAS inhibitors and potassium binders was common, suggesting that binders may support RAAS inhibitor continuation. Potassium binders showed less perceived impact than dietary restrictions, indicating that pharmacologic potassium control may be acceptable to patients managing multiple lifestyle limitations. These findings highlight the role of potassium binders in maintaining both RAAS inhibitor therapy and QOL.

Employment: Tadateru Hamada, Ryotaro Ide, and Masayoshi Takeda (AstraZeneca K.K.), Consultancies: Yosuke Yamamoto (Nippon Shinyaku Co.), Honoraria: Ken-ei Sada (AstraZeneca K.K.), Yugo Shibagaki (AstraZeneca K.K., Otsuka Pharma Co., and Kyowa Kirin Co.), Hajime Yamazaki (Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma, Kowa Company Limited, AstraZeneca K.K., and Takeda Pharmaceutical Company Limited.), Yosuke Yamamoto (Sun Pharma, Asahi Kasei Pharma, Toray Industries, Inc., and Ono Pharmaceutical Co., Ltd.), Unrelated to the submitted work, consultation fees for Hajime Yamazaki and Shinichi Fukuhara were paid to Kyoto University under contracts with Takeda Pharmaceutical Co., Ltd. and Magmitt Pharmaceutical Co., Ltd.

This study was funded by AstraZeneca K.K.

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Ethics committees listed below gave ethical approval for this work: Azumino Red Cross Hospital Ethics Committee, Ethics Committee of Kasugai Municipal Hospital, Komatsu Ishikawa Central Hospital Ethics Committee, Non-Profit Organization MINS Research Ethics Committee, Hiroshima City Hiroshima Citizens Hospital Ethics Review Committee, Saga Memorial Hospital Ethics Committee, Ethics Committee on Epidemiological and its related Studies, Sakuragaoka Campus, Kagoshima University, Clinical Ethics Committee of New Tokyo Hospital, Nagaoka Chuo General Hospital Ethics Committee, The Research Ethics Review Committee of NHO Nagoya Medical Center, The Ethics Review Committee of Toyama City General Hospital.

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