Hyperkalemia Increases Risk of Mortality and Hospitalization, finds study
Hyperkalemia is a common but potentially life-threatening electrolyte disturbance in patients with chronic kidney disease (CKD), heart failure, diabetes or hypertension. A recent study suggests that hyperkalemia independently increase the risk of mortality, cardiovascular events, hospitalizations, and ICU admissions. The study findings were published in the Kidney International Reports on March 16, 2021.
The potential immediate adverse consequences of acute hyperkalemia are well described in the literature. However, the long-term outcomes associated with hyperkalemia remain poorly described. Although several observational studies have demonstrated the association between hyperkalemia and excess mortality, few studies have explored other important clinical outcomes. Therefore, Dr Navdeep Tangri and his colleagues conducted a study to evaluate the association between hyperkalemia and mortality, cardiovascular events, hospitalizations, and intensive care unit (ICU) admissions.
In this retrospective cohort study, the researchers used administrative databases in Manitoba, Canada and identified 93,667 patients with de novo hyperkalemia (serum potassium ≥ 5.0 mmol/l). They performed propensity score matching among patients with de novo hyperkalemia and patients who were nonhyperkalemic. Using multivariate Cox proportional hazards regression models, adjusted for patient characteristics they assessed the association between hyperkalemia and normokalemia and mortality. The researchers also assessed cardiovascular events, hospitalizations, and ICU admissions. They further performed a sensitivity analysis with hyperkalemia defined as serum potassium ≥ 5.5 mmol/l.
Key findings of the study were:
- Among 93,667 patients, the researchers noted that 36% had diabetes mellitus (DM), 28% had CKD, and 21% had heart failure (HF).
- In the propensity score-matched sample of 177,082 individuals, they found that hyperkalemia was associated with an increased risk for
◊ All-cause mortality (hazard ratio [HR] 1.15),
◊ Cardiovascular events (HR 1.20 ),
◊ Short-term mortality (odds ratio [OR] 1.29),
◊ Hospitalizations (OR 1.71), and
◊ ICU admissions (OR 3.48).
- They noted that the findings remained unchanged when a threshold of serum potassium ≥ 5.5 mmol/l was used.
The authors concluded, "hyperkalemia was an independent risk factor for all-cause mortality, cardiovascular events, hospitalizations, and ICU admissions. This finding expands our understanding of important clinical outcomes associated with hyperkalemia."
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