The prevalence of predialysis hyperkalemia and associated characteristics among hemodialysis patients: The RE‐UTILIZE study

Abstract

Introduction: Hyperkalemia (HK), defined as serum potassium (K + ) >5.0 mEq/L, is an independent predictor of mortality in patients on maintenance hemodialysis (HD). This study investigated the annual prevalence of HK and examined patient characteristics potentially associated with a higher annual HK prevalence. Methods: This retrospective observational cohort study used Dialysis Outcomes and Practice Patterns Study (DOPPS) survey data from US patients undergoing in-center HD thrice weekly from 2018 to 2019. The primary endpoint was the proportion of patients with any predialysis HK (K + >5.0 mEq/L) within 1 year from the index date (date of DOPPS enrollment), using the first hyperkalemic K + value. Secondary endpoints were the proportion of patients with moderate-to-severe (K + >5.5 mEq/L) or severe (K + >6.0 mEq/L) HK. Findings: Overall, 9347 patients on HD were included in this analysis (58% male and 49% aged >66 years). Any predialysis HK (K + >5.0 mEq/L) occurred in 74% of patients within 1 year of the index date, 52% within 3 months, and 38% within 1 month. The annual prevalence of moderate-to-severe and severe HK was 43% and 17%, respectively. Recurrent HK (at least two K + >5.0 mEq/L within 1 year) occurred in 60% of patients, and 2.8% of patients were prescribed an oral K + binder. Multivariable logistic regression analysis showed younger age, female sex, Hispanic ethnicity, and renin-angiotensin-aldosterone system inhibitor use were significantly associated with a higher annual prevalence of any predialysis HK, while Black race, obesity, recent initiation of HD, and dialysate K + bath concentration ≥3 mEq/L were associated with a lower prevalence of HK.

A nomogram to predict hyperkalemia in patients with hemodialysis: a retrospective cohort study

“…In this study, the incidence of hyperkalemia was 39.65% in patients with hemodialysis. It was consistent with previous studies [ 6 , 25 ]. This study firstly developed a model for hyperkalemia prediction in patients with hemodialysis.…”

Hyperkalaemia prevalence and dialysis patterns in Chinese patients on haemodialysis: an interim analysis of a prospective cohort study (PRECEDE-K)

“…A prospective study in France showed that 73.8% of patients on HD had predialysis hyperkalaemia (sK > 5.1 mmol/L) over 2 years [ 11 ]. In a retrospective observational cohort of patients on HD in the United States (US), 74% experienced predialysis hyperkalaemia (sK > 5.0 mEq/L) within 1 year, 52% within 3 months, and 38% within 1 month [ 8 ]. Another US database study showed that the prevalence of sK ≥ 5.5 mEq/L the day after a LIDI was 2.0–2.4 times higher than that the day after a SIDI [ 12 ].…”

“…Hyperkalaemia, defined as elevated serum potassium (sK) levels, is a common complication among patients with ESRD, partly due to their diminished ability for renal potassium excretion [ 1 , 7 ]. Despite the removal of excess sK with HD treatment, 38–74% of patients with ESRD continued to have persistent hyperkalaemia during HD intervals [ 8 – 11 ]. Hyperkalaemia has been associated with adverse clinical outcomes, including significant arrhythmia, hospitalization, and all-cause mortality [ 10 , 12 – 15 ].…”