Development and outcomes of hyperkalemia in hospitalized patients: potential implications for care

Link to article at PubMed

Am Heart J. 2021 Jul 19:S0002-8703(21)00185-X. doi: 10.1016/j.ahj.2021.07.006. Online ahead of print.


INTRODUCTION: While severe hyperkalemia is commonly encountered, its manifestation in hospitalized patients and related outcomes are unclear. We aimed to examine development of hyperkalemia in hospitalized patients and associated outcomes.

METHODS: Data from a county hospital electronic health record were used to assess all inpatient admissions, 2012-2016, for non-dialysis-dependent patients with ≥1 K value for development of hyperkalemia. Unadjusted odds ratios (ORs) were calculated for associations of the maximum K value with in-hospital mortality and adjusted ORs were calculated for death associated with hyperkalemia.

RESULTS: In 47,018 individual patient hospitalizations, 1.3% had a maximum K ≥6.0 mEq/L and 4.2% <3.5 mEq/L. Fifth and 95th percentiles for maximum K values were 3.5 and 5.3 mEq/L. For high-K patients with a prior K value, the mean (SD) of the immediate pre-maximum K value was 5.0±1.0 mEq/L, and the mean difference in K values (immediate pre-maximum to maximum) was 1.5±1.1 mEq/L; mean duration between these two K tests was 10.7±14.9 hours. Compared with maximum K values 3.5-4.0 mEq/L, ORs for death were 37.1 (95% confidence intervals, 25.8-53.3) for K 6.0-<6.5, 88.6 (56.8-138.2) for K ≥7.0, and 18.9 (4.3-82.2) for K <3.0 mEq/L. In adjusted models, the OR for death for K ≥6.0 mEq/L was 4.9 (3.7-6.4).

DISCUSSION/CONCLUSION: Peak K values ≥6.0 mEq/L were associated with mortality. Values tended to increase rapidly, limiting opportunities for detection and treatment. Systems-based approaches to detect life-threatening hyperkalemia should be studied.

PMID:34293294 | DOI:10.1016/j.ahj.2021.07.006

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