Preserving RAASi: hyperkalaemia qualitative analysis

According to the PLOS One qualitative study (Gimenez-Stamminger et al., published 30 July 2026), Spanish nephrologists prioritised preserving RAASi drugs and used a stepwise approach combining diet, diuretics, bicarbonate, and potassium binders to avoid RAASi discontinuation.

• 12 nephrologists were interviewed in October 2025 and the sample included clinicians from six autonomous communities, as reported in the PLOS One paper (published 30 July 2026).
• Interviews averaged 53 minutes and produced 30 final codes organised into 15 sub-themes and five overarching themes, according to the PLOS One methods section.
• In the PLOS One results, participants described newer binders (patiromer and sodium zirconium cyclosilicate) as better tolerated than traditional resins, supporting RAASi continuity; usage in the prior 12 months was split 50% patiromer and 50% SZC among participants.
• Clinicians reported system-level barriers such as prior authorisation (_visado_) and fragmented cross-specialty communication, a finding documented in the PLOS One discussion.
• Direct clinician quote from the PLOS One interviews: "I structure the management in a stepped way: first line, diet and diuretics; second line, bicarbonate or binders; third line, reduction or suspension of drugs that increase potassium, as a last resort." (Participant ID05, quoted in PLOS One).

The PLOS One study interviewed 12 practising nephrologists in October 2025 to characterise real-world hyperkalaemia management and RAASi decision-making in Spain, as described in Gimenez-Stamminger et al. (published 30 July 2026).

According to the PLOS One methods, researchers used semi-structured interviews conducted in Spanish, transcribed verbatim, and analysed with ATLAS.ti using a codebook-based thematic analysis; the team iteratively refined 30 codes into 15 sub-themes and five themes.

According to the PLOS One results, the five themes were: (1) stepwise clinical algorithms to preserve RAASi, (2) newer potassium binders (patiromer and SZC) viewed as better tolerated than traditional resins, (3) system-level access and communication barriers such as _visado_, (4) the central role of nursing and patient education, and (5) the unmeasured impact on patients’ daily functioning and health-related quality of life (HRQoL).

When the PLOS One paper referenced guidelines, it cited KDIGO and European Society of Cardiology recommendations; for example, KDIGO guidance was used to contextualise RAASi preservation (see KDIGO guidance https://doi.org/10.1016/j.kint.2023.10.018).

Answer: The PLOS One study shows that a codebook-based thematic approach can surface implementation barriers and clinician reasoning that quantitative datasets miss.

According to the PLOS One methods and results, purposive sampling across regions and iterative codebook refinement produced transferable themes about access (_visado_), multidisciplinary communication, and HRQoL gaps that are directly actionable for policy and implementation research.

For qualitative researchers, the PLOS One workflow, semi-structured interviewing, verbatim transcription, team double-coding of an initial subset, iterative codebook refinement, and ATLAS.ti-assisted coding, provides a replicable blueprint for studying clinical decision-making.

For clinical quality teams, the PLOS One findings imply three operational priorities: streamline prior authorisation for newer binders, embed nursing-led education pathways, and routinely measure HRQoL using validated patient-reported outcome measures.

The PLOS One qualitative study (Gimenez-Stamminger et al., published 30 July 2026) shows that nephrologists in Spain prioritise RAASi preservation, view newer potassium binders as practice-changing, and face system-level access and coordination barriers that reduce guideline-concordant care.

For qualitative researchers, reproducing that study's codebook workflow yields actionable themes that can inform policy and implementation studies; for implementation teams, measuring HRQoL and streamlining access are immediate priorities.

If you run interview-based projects and want to scale secure transcription, codebook development, and AI-assisted synthesis, consider a platform that mirrors the PLOS One analytic steps.

Next step: Try Evidano for free to import interviews, run codebook-based thematic analysis, and produce reproducible outputs suitable for publication and policy translation.