Associations between serum potassium and adverse clinical outcomes: A systematic literature review

Palaka, Eirini; Grandy, Susan; Darlington, Oliver; McEwan, Phil; Doornewaard, Alexander van

doi:10.1111/ijcp.13421

Cited by 42 publications

(50 citation statements)

References 22 publications

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“…There is no international consensus as to what constitutes false hyperkalaemia. 18 The definition of true hyperkalaemia as initial serum potassium of >5.5 mmol/L and a repeat potassium within 8 days of >5.5 mmol/L was used to aid clinical interpretation and relevant actions in managing these patients according to their risk profile. While there is a certain degree of measurement uncertainty to each serum potassium processed, this error will be present in all samples, and clinicians will still need to trust each potassium result published as-is, and manage patients based on guidelines.…”

Section: Impact Of False Hyperkalaemiamentioning

confidence: 99%

Prevalence and factors associated with false hyperkalaemia in Asians in primary care: a cross-sectional study (the Unlysed Hyperkalaemia- the Unseen Burden (UHUB) study)

Boo

Koh

et al. 2020

BMJ Open

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Serum potassium is part of routine laboratory tests done for patients with hypertension or diabetes mellitus in primary care. Those found to have raised potassium (K>5.5 mmol/L) are recalled for repeat potassium in emergency departments or primary care clinics. Repeat potassium are often normal (≤5.5 mmo/L), that is, false hyperkalaemia. Haemolysis is known to cause false hyperkalaemia. We postulated that unlysed false hyperkalamia was prevalent and was associated with factors such as delayed processing time.ObjectiveWe aimed to determine the prevalence of unlysed false hyperkalaemia and the factors associated with false-and-true-hyperkalaemia.SettingOutpatients in a cluster of public primary care clinics (polyclinics) in Singapore.ParticipantsAll patients of any ethnicity aged ≥21 with serum potassium test done.MethodsElectronic health records of index patients with potassium >5.5 mmol/L and its corresponding laboratory processing time in seven local polyclinics were reviewed between August 2015 and August 2017. Haemolysed specimens and patients on sodium polystyrene sulfonate (SPS) suspension were excluded. If repeat potassium level was ≤5.5 mmol/L within 8 days, the case was defined as false hyperkalaemia. The proportion of such patients was computed to determine its prevalence. Linear and logistic regressions were used to identify the associated factors.ResultsThe study population comprised of 3014 index cases, of which 1575 had repeat potassium tests without preceding SPS. 86.4% (1362/1575) of them had potassium ≤5.5 mmol/L. The average processing time among specimens with potassium ≥6.0 mmol/L was 50 min longer, compared with those with potassium <5.1 mmol/L. Risk factors significantly associated with false hyperkalaemia included estimated glomerular filtration rate (eGFR) (60–89 mL/min/1.73 m2, OR=3.25, p<0.001;>90 mL/min/1.73 m2, OR=3.77, p<0.001) and delayed laboratory processing time (beta coefficient 0.001, p<0.001).ConclusionThe prevalence of false hyperkalaemia was 86.4%. Recommendation to repeat potassium tests may target those with eGFR<60ml/min/1.73m2.

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Section: Impact Of False Hyperkalaemiamentioning

confidence: 99%

Prevalence and factors associated with false hyperkalaemia in Asians in primary care: a cross-sectional study (the Unlysed Hyperkalaemia- the Unseen Burden (UHUB) study)

Boo

Koh

et al. 2020

BMJ Open

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“…The relationship between hyperkalemia and prognosis has not been fully clarified (Table 1) since some data suggest an association with risk of hospitalization and death (Aldahl et al, 2017;Jain et al, 2012;Palaka et al, 2019), while others do not (Zannad et al, 2011). The aforementioned Danish study indicates that hyperkalemia increases the risk of mortality up to three times, in addition to a high frequency of hospitalizations.…”

Section: Incidence Of Hyperkalemia and Prognostic Rolementioning

confidence: 99%

Hyperkalemia in heart failure: current treatment and new therapeutic perspectives

Minà

Ajello

Gesaro

et al. 2020

Reviews in Cardiovascular Medicine

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“…Dyskalaemia, either hyperkalaemia or hypokalaemia, may lead to muscular weakness and cardiac arrhythmias and is associated with increased hospitalisation and mortality. [1][2][3] Besides its life-threatening influences, patients with dyskalaemia might unduly discontinue administration of certain medications that bear benefits on clinical outcomes, such as ACE inhibitors (ACEI) and diuretics. 4 5 It is clinically important to characterise the epidemiology of dyskalaemia in the general population.…”

Section: Introductionmentioning

confidence: 99%

Normal range of serum potassium, prevalence of dyskalaemia and associated factors in Chinese older adults: a cross-sectional study

et al. 2020

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ObjectiveTo investigate the normal range of serum potassium, the prevalence of dyskalaemia and the associated factors in Chinese older adults.DesignA cross-sectional study conducted from September 2017 to March 2018.SettingForty-eight community elderly care facilities in four regions in northern China.ParticipantsA total of 1266 (308 apparently healthy and 958 unhealthy) participants 55 years or older and with fasting serum potassium measured.Main outcome measures and methodsSerum potassium <3.5 mEq/L and >5.5 mEq/L (guidelines definition) and <2.5th and >97.5th percentiles of the distribution among healthy participants (our study definition) were both used to define hypokalaemia and hyperkalaemia, respectively. Multivariable generalised estimating equation models were used to adjust for clustering effect in the analyses of factors associated with risk of dyskalaemia and with variations in serum potassium.ResultsThe study participants had a mean age of 70 (8.8) years. Among apparently healthy participants, the 2.5th and 97.5th percentiles of serum potassium distribution were 3.7 mEq/L and 5.3 mEq/L, respectively. Using the study definition, the prevalence of hyperkalaemia was 4.3% (95% CI 3.2% to 5.4%) and of hypokalaemia was 4.0% (95% CI 2.9% to 5.1%). Multivariable analyses showed that risk of hyperkalaemia was associated with unhealthy conditions (OR=2.21; 95% CI 1.17 to 4.18); risk of hypokalaemia was associated with unhealthy conditions (OR=2.56; 95% CI 1.05 to 6.23), older age (OR=1.70 per 10-year increase; 95% CI 1.04 to 2.79) and region (OR=16.87; 95% CI 6.41 to 44.38); and higher serum potassium was associated with male gender (mean difference (MD)=0.12; 95% CI 0.05 to 0.19) and estimated glomerular filtration rate <60 mL/min/1.73 m2 (MD=0.29; 95% CI 0.12 to 0.46). Using the guidelines definition, hyperkalaemia accounted for 2.7% (1.8%, 3.6%) and hypokalaemia 1.8% (1.1%, 2.5%). Analyses of the associated factors showed similar trends.ConclusionsThe study suggested a narrower normal range of serum potassium for defining dyskalaemia, which was common in older Chinese and more prevalent in unhealthy ones.Trial registration numberNCT03290716; Pre-results.

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Associations between serum potassium and adverse clinical outcomes: A systematic literature review

Cited by 42 publications

References 22 publications

Prevalence and factors associated with false hyperkalaemia in Asians in primary care: a cross-sectional study (the Unlysed Hyperkalaemia- the Unseen Burden (UHUB) study)

Prevalence and factors associated with false hyperkalaemia in Asians in primary care: a cross-sectional study (the Unlysed Hyperkalaemia- the Unseen Burden (UHUB) study)

Hyperkalemia in heart failure: current treatment and new therapeutic perspectives

Normal range of serum potassium, prevalence of dyskalaemia and associated factors in Chinese older adults: a cross-sectional study

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