OBJECTIVES: Patients with heart failure (HF) or chronic kidney disease (CKD) are particularly susceptible to hyperkalemia (HK). Moreover, associations between HK and increased risks of mortality, morbidity, hospitalisation, and down-titration or discontinuation of renin-angiotensin-aldosterone system inhibitors are well-characterised in these populations. Using a novel lifetime simulation model, this study aimed to quantify the impact of recurrent and severe HK events on life expectancy (LE) and quality-adjusted life expectancy (QALE) in patients with HF or CKD.

METHODS: A lifetime patient-level simulation model was developed, which utilised published evidence to model HF and CKD progression via changes in New York Heart Association (NYHA) class and estimated glomerular filtration rate (eGFR), respectively. Published risk equations were applied to characterise associations between serum potassium (K⁺) and health economic outcomes. The impact of experiencing one HK event per year (defined as K++).

RESULTS: In HF patients with maintained normokalaemia, estimated LE and QALE were 6.84 and 3.97 years, compared to 10.56 and 6.13 years in CKD patients, respectively. Among HF patients, the incidence of HK (K^{++++ CONCLUSIONS: Predictions generated by this lifetime simulation model highlight the negative impact of recurrent and severe HK on LE and QALE in patients with HF or CKD. Strategies to optimise serum K+ management in these patients may improve both length and quality of life.}