Prognostic Impact of Mild Hypokalemia in Terms of Death and Stroke in the General Population—A Prospective Population Study

Mattsson, Nick; Nielsen, Olav Wendelboe; Johnson, Linda; Prescott, Eva; Schnohr, Peter; Jensen, Gorm; Køber, Lars; Sajadieh, Ahmad

doi:10.1016/j.amjmed.2017.09.026

Cited by 15 publications

(18 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another study performed on 5916 individuals from the general population found no significant associations between borderline hypokalemia (3.4-3.6 mmol/L) and risk of all-cause mortality, risk of stroke or risk of acute myocardial infarction [20]. Comparing the results of our study with this study is difficult due to major differences in study population, methodology and aim.…”

Section: Discussioncontrasting

confidence: 84%

“…First, our population was characterized by redemption of at least two antihypertensive drugs. Mattsson et al [20] enrolled participants from the general population, where 49.6% had high blood pressure at baseline, 13.9% were prescribed heart medication and 10.9% were treated with diuretics. In our population, we observed higher burden of cardiovascular disease and use of diuretics.…”

Section: Discussionmentioning

confidence: 99%

“…Second, our aim was to investigate the impact of correcting hypokalemia or borderline hypokalemia on short-term all-cause and cardiovascular mortality. In terms of mortality, Mattsson et al [20] followed participants from their fourth examination in 2001-2003 until November 2014 or death, having a median follow-up of 11.9 years (Q1-Q3: 11.4-12.5 years). As potassium is varying over time especially in patients with cardiovascular disease or treated with antihypertensive drugs, use of one potassium measurement to assess mortality over more than 10 years can provide results that are difficult to interpret.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of plasma potassium normalization on short-term mortality in patients with hypertension and hypokalemia or low normal potassium

Krogager

Søgaard

Torp‐Pedersen

et al. 2020

BMC Cardiovasc Disord

View full text Add to dashboard Cite

Background: Hypokalemia is common in patients treated with antihypertensive drugs, but the impact of correcting hypokalemia is insufficiently studied. We examined the consequences of hypokalemia and borderline hypokalemia correction in patients with hypertension. Methods: We identified 8976 patients with hypertension and plasma potassium concentrations ≤3.7 mmol/L within 100 days from combination antihypertensive therapy initiation. The first measurement between 6 and 100 days after the episode with potassium ≤3.7 mmol/L was retained. We investigated all-cause and cardiovascular mortality within 60-days from the second potassium measurement using Cox regression. Mortality was examined for seven predefined potassium intervals derived from the second measurement: 1.5-2.9 mmol/L (n = 271), 3.0-3.4 mmol/L (n = 1341), 3.5-3.7 (n = 1982) mmol/L, 3.8-4.0 mmol/L (n = 2398, reference), 4.1-4.6 mmol/L (n = 2498), 4.7-5.0 mmol/ L (n = 352) and 5.1-7.1 mmol/L (n = 134). Results: Multivariable analysis showed that potassium concentrations 1.5-2.9 mmol/L, 3.0-3.4 mmol/L, 4.7-5.0 mmol/L and 5.1-7.1 mmol/L were associated with increased all-cause mortality (HR 2.39, 95% CI 1.66-3.43; HR 1.36, 95% CI 1.04-1.78; HR 2.36, 95% CI 1.68-3.30 and HR 2.62, 95% CI 1.73-3.98, respectively). Potassium levels <3.0 and > 4.6 mmol/L were associated with increased cardiovascular mortality. The adjusted standardized 60-day mortality risks in the seven strata were: 11.7% (95% CI 8.3-15.0%), 7.1% (95% CI 5.8-8.5%), 6.4% (95% CI 5.3-7.5%), 5.4% (4.5-6.3%), 6.3% (5.4-7.2%), 11.6% (95% CI 8.7-14.6%) and 12.6% (95% CI 8.2-16.9%), respectively. Conclusions: Persistent hypokalemia was frequent and associated with increased all-cause and cardiovascular mortality. Increase in potassium to levels > 4.6 mmol/L in patients with initial hypokalemia or low normal potassium was associated with increased all-cause and cardiovascular mortality.

show abstract

Section: Discussioncontrasting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of plasma potassium normalization on short-term mortality in patients with hypertension and hypokalemia or low normal potassium

Krogager

Søgaard

Torp‐Pedersen

et al. 2020

BMC Cardiovasc Disord

View full text Add to dashboard Cite

show abstract

“…Serum potassium values were grouped into categories: <3.0, ≥3.0<3.5, ≥3.5<4.0, and a reference of ≥4.0≤5.0mEq/L. A one-sided threshold was chosen given previous evidence demonstrating a U-shaped event curve[7–9,19].…”

Section: Methodsmentioning

confidence: 99%

Association of hypokalemia with an increased risk for medically treated arrhythmias

et al. 2019

View full text Add to dashboard Cite

Background Potassium replenishment protocols are often employed across broad patient populations to prevent cardiac arrhythmias. Tailoring potassium thresholds to specific patient populations would reduce unnecessary tasks and cost. The objective of this retrospective cohort study was to determine the threshold at which hypokalemia increases the risk for medically treated arrhythmias in cardiac versus medical and surgical intensive care units. Methods Patients captured in the publicly available Philips eICU database were assessed for initiation of either intravenous amiodarone, adenosine, ibutilide, isoproterenol, or lidocaine as a surrogate for a clinically significant arrhythmia. A landmark time-to-event analysis was conducted to investigate the association of serum potassium values and time-marked administration of an antiarrhythmic drug. Analysis was adjusted for comorbidities, the use of vasopressor agents, diuretics, as well as age, gender and severity of illness. Results Among 20,665 admissions to cardiac intensive care units, 1,371 (6.6%) were treated with either amiodarone, adenosine, ibutilide, isoproterenol, or lidocaine. For potassium values of ≥3.0<3.5mEq/L, antiarrhythmic treatment occurred at an increased rate compared to a baseline of ≥4.0≤5.0mEq/L (HR 1.23, 95% CI 1.01–1.51; P = 0.04). For admissions to medical and surgical intensive care units, 2,100 of 69,714 patients (3.0%) were treated with either amiodarone, adenosine, ibutilide, isoproterenol, or lidocaine. Potassium values of ≥3.0<3.5mEq/L were also associated with an increased hazard of treatment (HR 1.26, 95% CI 1.09–1.45; P = 0.002). In both cohorts, worsening hypokalemia was associated with an increased risk of antiarrhythmic drug treatment. In neither cohort were there statistically significant differences for serum potassium values of ≥3.5<4.0 and a baseline of ≥4.0≤5.0mEq/L. The proportion of patients initiated on vasopressors or inotropes was over four-fold higher in those treated with one of the antiarrhythmic drugs in both cohorts. Conclusions Serum potassium levels <3.5mEq/L were associated with an increased hazard for treatment with specific antiarrhythmic drugs in a large cohort of patients admitted to both a cardiac as well as medical and surgical intensive care units. Potassium thresholds may be individualized further based on risk of relevant outcomes.

show abstract

“…Hypokalemia can be a life-threatening condition, due to its association with cardiac arrhythmias [2], stroke risk, and sudden death [3,4]. Patients diagnosed with coronary artery disease (CAD) are especially at high risk of hypokalemiainduced arrhythmias.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of hypokalemia in older persons: results from the PolSenior national survey

et al. 2021

View full text Add to dashboard Cite

Purpose Hypokalemia is one of the most common electrolyte disturbances in clinical practice. There are only a few epidemiological studies analyzing the occurrence of hypokalemia in older persons. The aim of the study was to determine the prevalence of hypokalemia in the Polish older population. Methods Serum potassium concentration was estimated in 4654 participants (2270 females and 2384 males, mean age 76.5 [11.0] years), who participated in the PolSenior study. Hypokalemia was defined as serum potassium concentration below 3.5 mmol/L. Hypokalemia was found in 39 participants (0.84%) and was significantly more frequent among females (28 females = 1.23% and 11 males = 0.46%; p = 0.003). The prevalence of hypokalemia was not related to age. Among 3303 participants suffering from arterial hypertension, 1093 were treated with potassium-losing diuretics. Results Hypokalemia was significantly more frequent among hypertensive than normotensive older participants (1.06 vs. 0.30% respectively; p = 0.007) and among hypertensive participants treated with potassium losing diuretics than ones untreated with these drugs (1.96 vs. 0.46% respectively; p < 0.001). In hypertensive participants, the prevalence of hypokalemia did not depend significantly on oral supplementation of potassium (1.92 and 0.98% respectively, NS). None of 81 participants using laxative agents presented hypokalemia. Conclusions This study demonstrates that: older age seems not to appear to be a significant risk factor of hypokalemia. Hypokalemia is more often found in the older hypertensive patients treated with potassium losing diuretics, and prevention of diuretic-induced hypokalemia with oral supplementation of potassium seems to be insufficient.

show abstract

Prognostic Impact of Mild Hypokalemia in Terms of Death and Stroke in the General Population—A Prospective Population Study

Cited by 15 publications

References 37 publications

Impact of plasma potassium normalization on short-term mortality in patients with hypertension and hypokalemia or low normal potassium

Impact of plasma potassium normalization on short-term mortality in patients with hypertension and hypokalemia or low normal potassium

Association of hypokalemia with an increased risk for medically treated arrhythmias

Prevalence of hypokalemia in older persons: results from the PolSenior national survey

Contact Info

Product

Resources

About