The Frequency of Hyperkalemia and Its Significance in Chronic Kidney Disease
2009/06/22 by Lisa M. Einhorn, Min Zhan, Van Doren Hsu +5 · 31 citations
Medicine · Nursing · #Potassium and Related Disorders #Dialysis and Renal Disease Management #Magnesium in Health and Disease
paper · doi:10.1001/archinternmed.2009.132
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 2 103 422 records from 245 808 veterans with at least 1 hospitalization and at least 1 inpatient or outpatient serum potassium record during the fiscal year 2005. Chronic kidney disease and treatment with angiotensin-converting enzyme inhibitors and/or angiotensin II receptor blockers (blockers of the renin-angiotensin-aldosterone system [RAAS]) were the key predictors of hyperkalemia. Death within 1 day of a hyperkalemic event was the principal outcome. RESULTS: Of the 66 259 hyperkalemic events (3.2% of records), more occurred as inpatient events (n = 34 937 [52.7%]) than as outpatient events (n = 31 322 [47.3%]). The adjusted rate of hyperkalemia was higher in patients with CKD than in those without CKD among individuals treated with RAAS blockers (7.67 vs 2.30 per 100 patient-months; P < .001) and those without RAAS blocker treatment (8.22 vs 1.77 per 100 patient-months; P < .001). The adjusted odds ratio (OR) of death with a moderate (potassium, >or=5.5 and <6.0 mEq/L [to convert to mmol/L, multiply by 1.0]) and severe (potassium, >or=6.0 mEq/L) hyperkalemic event was highest with no CKD (OR, 10.32 and 31.64, respectively) vs stage 3 (OR, 5.35 and 19.52, respectively), stage 4 (OR, 5.73 and 11.56, respectively), or stage 5 (OR, 2.31 and 8.02, respectively) CKD, with all P < .001 vs normokalemia and no CKD. CONCLUSIONS: The risk of hyperkalemia is increased with CKD, and its occurrence increases the odds of mortality within 1 day of the event. These findings underscore the importance of this metabolic disturbance as a threat to patient safety in CKD.
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- 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension
- 2025 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline for the Primary Care Management of Chronic Kidney Disease
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- Chronic kidney disease and end-stage renal disease in the elderly population: current prevalence, future projections, and clinical significance. [europepmc]
- Increased serum potassium affects renal outcomes: a post hoc analysis of the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) trial. [europepmc]
- Evaluation of the efficacy and safety of RLY5016, a polymeric potassium binder, in a double-blind, placebo-controlled study in patients with chronic heart failure (the PEARL-HF) trial. [europepmc]
- Prevalence and factors associated with hyperkalemia in predialysis patients followed in a low-clearance clinic. [europepmc]
- Serum Potassium, End-Stage Renal Disease and Mortality in Chronic Kidney Disease. [europepmc]
- Urinary Sodium and Potassium Excretion and CKD Progression. [europepmc]
- Association between Serum Potassium and Outcomes in Patients with Reduced Kidney Function. [europepmc]
- Randomized Clinical Trial of Sodium Polystyrene Sulfonate for the Treatment of Mild Hyperkalemia in CKD. [europepmc]
- Mechanism of Action and Pharmacology of Patiromer, a Nonabsorbed Cross-Linked Polymer That Lowers Serum Potassium Concentration in Patients With Hyperkalemia. [europepmc]
- Nutrient Non-equivalence: Does Restricting High-Potassium Plant Foods Help to Prevent Hyperkalemia in Hemodialysis Patients? [europepmc]
- Antihypertensive Medications and the Prevalence of Hyperkalemia in a Large Health System. [europepmc]
- Updates in hyperkalemia: Outcomes and therapeutic strategies. [europepmc]
- Potassium Sensing by Renal Distal Tubules Requires Kir4.1. [europepmc]
- Electrophysiology of Hypokalemia and Hyperkalemia. [europepmc]
- How Dangerous Is Hyperkalemia? [europepmc]
- An integrative review of the methodology and findings regarding dietary adherence in end stage kidney disease. [europepmc]
- Potassium Homeostasis, Oxidative Stress, and Human Disease. [europepmc]
- Serum potassium and adverse outcomes across the range of kidney function: a CKD Prognosis Consortium meta-analysis. [europepmc]
- Medication Safety Principles and Practice in CKD. [europepmc]
- Serum potassium and clinical outcomes in heart failure patients: results of risk calculations in 21 334 patients in the UK. [europepmc]
- Development and Validation of a Deep-Learning Model to Screen for Hyperkalemia From the Electrocardiogram. [europepmc]
- Sodium Zirconium Cyclosilicate among Individuals with Hyperkalemia: A 12-Month Phase 3 Study. [europepmc]
- Risk of Hospitalization for Serious Adverse Gastrointestinal Events Associated With Sodium Polystyrene Sulfonate Use in Patients of Advanced Age. [europepmc]
- Hyperkalemia in Real-World Patients Under Continuous Medical Care in Japan. [europepmc]
- Roxadustat for Treating Anemia in Patients with CKD Not on Dialysis: Results from a Randomized Phase 3 Study. [europepmc]
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