Association of Serum Potassium with All-Cause Mortality in Patients with and without Heart Failure, Chronic Kidney Disease, and/or Diabetes

Abstract

and highest in the combined cohort 29.7%. Higher mortality rates were noted in those aged ≥ 65 vs. 50-64 years. In an adjusted model, all-cause mortality was significantly elevated for every 0.1 mEq/L change in potassium <4.0 mEq/L and ≥ 5.0 mEq/L. Diuretics and renin-angiotensin-aldosterone system inhibitors were related to hypokalemia and hyperkalemia respectively. Conclusion: Mortality risk progressively increased with dyskalemia and was differentially greater in those with HF, CKD, or DM.

Serum potassium and clinical outcomes in heart failure patients: results of risk calculations in 21 334 patients in the UK

“…2 Adjusted IRRs estimated in our study illustrated the association between serum potassium concentrations outside 4.0-5.0 mmol/L and an increased risk of mortality among incident HF patients. This may imply that our results are more generalizable to other countries and health care systems, compared with those founded on relatively short-term, claims-based data sets.…”

“…[8][9][10] At present, the clinical burden of hypokalaemia and hyperkalaemia among European HF patients, and relationships between serum potassium and adverse clinical outcomes in this population, is not well characterized. 2 Using primary care data obtained from the Clinical Practice Research Datalink (CPRD), 15,16 this study developed risk equations to describe associations between serum potassium and the incidence of death, major adverse cardiac events (MACE), and RAASi discontinuation, in a UK cohort of newly diagnosed HF patients. 2 Using primary care data obtained from the Clinical Practice Research Datalink (CPRD), 15,16 this study developed risk equations to describe associations between serum potassium and the incidence of death, major adverse cardiac events (MACE), and RAASi discontinuation, in a UK cohort of newly diagnosed HF patients.…”

“…1 Both hypokalaemia and hyperkalaemia are considered burdensome electrolyte imbalances, associated with increased mortality and morbidity. [2][3][4] As a consequence of renal insufficiency, patients with heart failure (HF) are at increased risk of hyperkalaemia, and medications routinely prescribed for management of HF are known to further affect serum potassium levels. 5 In particular, combination therapy with renin-angiotensinaldosterone system inhibitor (RAASi) and/or mineralocorticoid receptor antagonist (MRA) agents, while recommended to reduce the incidence of hospitalization, 5 may further increase the risk of hyperkalaemia in this already-vulnerable population.…”

Real or Perceived: Hyperkalemia Is a Major Deterrent for Renin-Angiotensin Aldosterone System Inhibition in Heart Failure

“…Collins et al[8] have recently demonstrated in a nationwide electronic medical record ( n = 1,716,141 with ≥2 potassium values) that the presence of HF appears to considerably elevate the fatal risks of hyperkalemia in patients treated with RAAS inhibitors. They found that all-cause mortality was 25.7% at potassium values of 4.0–<5.0 mEq/L and 45.5% at >5.0 mEq/L.…”

Hyperkalaemia in diabetes: a silent risk predicting poor outcomes

“…This study by Thomsen et al confirms previous smaller studies and hospital-based data identifying the same people at risk for hyperkalaemia. Moreover, a recent analysis of data on >900 000 people from a different database suggests that hyperkalaemia should be redefined among those with chronic kidney disease and diabetes and especially those with chronic kidney disease, heart failure and diabetes [10]. In that analysis, cardiovascular mortality was significantly higher when serum potassium level was >5 mmol/l, with a relative risk of 4.09 among those stage 3b chronic kidney disease, whereas diabetes alone without chronic kidney disease had a much lower relative risk, albeit elevated [10].…”