The Frequency of Hyperkalemia and Its Significance in Chronic Kidney Disease

Abstract

Background Hyperkalemia is a potential threat to patient safety in chronic kidney disease (CKD). This study determined the incidence of hyperkalemia in CKD and whether it is associated with excess mortality. Methods This retrospective analysis of a national cohort comprised of 2,103,422 records from 245,808 veterans with at least one hospitalization and at least one inpatient or outpatient serum potassium record during fiscal year 2005. CKD and treatment with ACE-I and/or ARBs (RAAS blockers) were the key predictors of hyperkalemia. Death within one day of a hyperkalemic event was the principal outcome. Results Of the 66,529 hyperkalemic events (3.2% of records), more occurred inpatient (34937 (52.7%)) versus outpatient (31322 (47.3%)). The adjusted rate of hyperkalemia was higher in patients with CKD than without CKD among individuals treated with RAAS blockers (7.67 vs. 2.30 per 100 patient months, p<0.0001) and those without RAAS blocker treatment (8.22 vs. 1.77 per 100 patient months, p<0.0001). The adjusted odds (OR) of death with a moderate (K+≥ 5.5 and < 6.0mg/dl) and severe (K+≥ 6.0 mg/dl) hyperkalemic event was highest with no CKD (OR: 10.32, 31.64, respectively), versus Stage 3 (5.35, 19.52), Stage 4 (OR: 5.73, 11.56), or Stage 5 CKD (OR: 2.31, 8.02) with all p<0.0001 versus normokalemia and no CKD. Conclusion The risk of hyperkalemia is increased with CKD, and its occurrence increases the odds of mortality within one day of the event. These findings underscore the importance of this metabolic disturbance as a threat to patient safety in CKD.

Remote Usability Testing and Satisfaction with a Mobile Health Medication Inquiry System in CKD

“…Individuals with CKD, often characterized by low disease awareness, limited health literacy, and frequent interactions with the health care system (17,18), are at high risk of adverse safety events related to their care, such as drug-related problems. This opens potential to introduce tailored digital tools to this population as patient-initiated safeguards (7,(19)(20)(21)(22). Mobile technologies, such as cellular telephones, provide instant access to information that previously was not promptly available to patients.…”

Predictors of Outcome in Patients Presenting with Moderate to Severe Hyperkalemia

“…Frequent causes of hyperkalemia include Renin-angiotensin-aldosterone inhibitors, potassium sparing diuretics and high dietary potassium intake relative to residual renal function. Acute conditions such as rhabdomyolysis, extensive burns and extracellular shift of potassium caused by the metabolic acidosis of acute kidney injury may also cause sudden and severe rise in serum potassium level [5,6,14]. Patients with chronic kidney disease present a special problem because of frequent development of electrolyte imbalance and simultaneous presence of high anion gap acidosis and sometimes sepsis.…”

“…Moreover, very high level of serum potassium seems to have less deleterious effect when compared to K level of 6.0-6.9 mEq/dl, One of the possible explanations in patients with chronic renal insufficiency is the compensatory response to chronic hyperkalemia, in which the body eventually develops a new steady state potassium level that is often higher than normal range. This observation has led to the practice of treatment of moderate hyperkalemia in the outpatient setting [6,11]. However, when acidosis causes potassium to shift into extracellular space, the treatment is directed to the correction of underlying cause and acid-base balance than just normalization of serum potassium level.…”

“…Its prevalence and clinical impact in critically ill Emergency Department (ED) patients is not fully discovered yet but it is thought to occur in 1-10% of patients admitted to the hospital [5]. Majority of the patients have underlying end-stage renal disease, which causes decreased excretion of dietary potassium, chronic asymptomatic, hyperkalemia, or metabolic acidosis induced extracellular shift of potassium leading to acute hyperkalemia [6][7][8]. Although the condition is associated with a variety of clinical presentations, EKG manifestations of hyperkalemia are generally progressive and proportional to the serum K+ and ventricular arrhythmias may be the first EKG finding of hyperkalemia.…”

Long-term Mortality Outcomes of Hyperkalemic Patients in the Emergency Department Setting: A Case Control Study

“…Hyperkalemia is a potentially lethal electrolyte disorder present in 3.2% of inpatients in a large case series [1]. The increasing prevalence of chronic kidney disease (CKD), end stage renal disease (ESRD), diabetes mellitus (DM), use of angiotensin converting enzyme inhibitors (ACEi) [2] and aldosterone blockers will continue to escalate the burden of hyperkalemia [3,4].…”