Hyperkalemia in the elderly

Perazella, Mark A.; Mahnensmith, Rex L.

doi:10.1046/j.1525-1497.1997.07128.x

Cited by 98 publications

(36 citation statements)

References 90 publications

(215 reference statements)

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“…5,6 High pre-dialysis serum potassium (SK) is recognized as a risk factor for sudden death and all-cause mortality in HD patients. 7,8 Potassium has the potential to move freely across the dialyzer membrane during the HD session, typically being transferred from a patient’s blood into the dialysate.…”

Section: Introductionmentioning

confidence: 99%

Dialysate Potassium, Serum Potassium, Mortality, and Arrhythmia Events in Hemodialysis: Results From the Dialysis Outcomes and Practice Patterns Study (DOPPS)

Karaboyas

Zee

Brunelli

et al. 2017

American Journal of Kidney Diseases

142

158

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Background Sudden death is a leading cause of death in patients on maintenance hemodialysis (HD). During HD sessions, the gradient between serum and dialysate levels results in rapid electrolytes shifts, which may contribute to arrhythmias and sudden death. Controversies exist on the optimal electrolyte concentration in the dialysate; specifically, it is unclear whether patient outcomes differ among those treated with dialysate potassium (DK) concentration of 3 mEq/L compared to 2 mEq/L. Study Design Prospective cohort study Setting & Participants 55,183 patients from 20 countries in the Dialysis Outcomes and Practice Patterns Study phases 1–5 (1996–2015). Predictor DK at study entry. Outcomes Cox regression was used to estimate the association between DK and both all-cause mortality and an arrhythmia composite outcome (arrhythmia-related hospitalization or sudden death), adjusting for potential confounders. Results During a median follow-up of 16.5 months, 24% of patients died and 7% had an arrhythmia composite outcome. No meaningful difference in clinical outcomes were observed for patients treated with DK 3 vs. 2 mEq/L; the adjusted hazard ratio (95% CI) was 0.96 (0.91, 1.01) for mortality and 0.98 (0.88, 1.08) for the arrhythmia composite. Results were similar across pre-dialysis serum potassium (SK) levels. As in prior studies, higher SK was associated with adverse outcomes. However, DK only had minimal impact on SK measured pre-dialysis (+0.09 mEq/L SK per 1 mEq/L DK; 95% CI: 0.05, 0.14). Limitations Data were not available on delivered (vs. prescribed) DK and post-dialysis SK; possible unmeasured confounding. Conclusions In combination, these results suggest that approaches other than altering DK concentration (e.g., education on dietary K sources, prescription of K-binding medications) may merit further attention to reduce risks associated with high SK.

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Section: Introductionmentioning

confidence: 99%

Dialysate Potassium, Serum Potassium, Mortality, and Arrhythmia Events in Hemodialysis: Results From the Dialysis Outcomes and Practice Patterns Study (DOPPS)

Karaboyas

Zee

Brunelli

et al. 2017

American Journal of Kidney Diseases

142

158

View full text Add to dashboard Cite

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“…This homeostasis plays a critical role in maintaining cellular resting membrane potential and neuromuscular function and is essential for normal activity of muscles, nerves, and the heart [3]. Hyperkalemia, resulting from an imbalance in K + homeostasis, is defined as a serum K + level of greater than 5.0 mEq/L and is further classified as mild, moderate, or severe [4,5]. It has been reported that drug therapy and impaired renal function are the main factors predisposing to the development of hyperkalemia [6-8].…”

Section: Introductionmentioning

confidence: 99%

Severe hyperkalemia requiring hospitalization: predictors of mortality

et al. 2012

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IntroductionSevere hyperkalemia, with potassium (K+) levels ≥ 6.5 mEq/L, is a potentially life-threatening electrolyte imbalance. For prompt and effective treatment, it is important to know its risk factors, clinical manifestations, and predictors of mortality.MethodsAn observational cohort study was performed at 2 medical centers. A total of 923 consecutive Korean patients were analyzed. All were 19 years of age or older and were hospitalized with severe hyperkalemia between August 2007 and July 2010; the diagnosis of severe hyperkalemia was made either at the time of admission to the hospital or during the period of hospitalization. Demographic and baseline clinical characteristics at the time of hyperkalemia diagnosis were assessed, and clinical outcomes such as in-hospital mortality were reviewed, using the institutions' electronic medical record systems.ResultsChronic kidney disease (CKD) was the most common underlying medical condition, and the most common precipitating factor of hyperkalemia was metabolic acidosis. Emergent admission was indicated in 68.6% of patients, 36.7% had electrocardiogram findings typical of hyperkalemia, 24.5% had multi-organ failure (MOF) at the time of hyperkalemia diagnosis, and 20.3% were diagnosed with severe hyperkalemia at the time of cardiac arrest. The in-hospital mortality rate was 30.7%; the rate was strongly correlated with the difference between serum K+ levels at admission and at their highest point, and with severe medical conditions such as malignancy, infection, and bleeding. Furthermore, a higher in-hospital mortality rate was significantly associated with the presence of cardiac arrest and/or MOF at the time of diagnosis, emergent admission, and intensive care unit treatment during hospitalization. More importantly, acute kidney injury (AKI) in patients with normal baseline renal function was a strong predictor of mortality, compared with AKI superimposed on CKD.ConclusionsSevere hyperkalemia occurs in various medical conditions; the precipitating factors are similarly diverse. The mortality rate is especially high in patients with severe underlying disease, coexisting medical conditions, and those with normal baseline renal function.

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“…Hyperkalemia is a serious and potentially life-threatening electrolyte disorder that follows from a number of underlying abnormalities in potassium homeostasis [2]. It is recognized by the elevation of serum potassium above its upper normal level.…”

Section: Introductionmentioning

confidence: 99%