Category: Professional Posters
Purpose: Hyperkalemia (HK) may result from altered potassium homeostasis and lead to life-threatening arrythmias and sudden cardiac death. Vulnerable patients include those with chronic kidney disease, heart failure (HF), diabetes (DM), and hypertension (HTN). Optimal treatment includes renin-angiotensin-aldosterone system inhibitors (RAASi), which further increase HK risk that results in dose lowering or discontinuation despite evidence demonstrating end organ and mortality benefits in such groups. Patients on submaximum doses or who discontinue RAASi have worse outcomes than patients on maximum doses. We describe retrospective analyses of RAASi and other medications in a representative population within a large integrated health system.
Methods: This study included adults with at least 2 non-urgent or emergency department encounters at least two years apart and a non-spurious potassium measurement between 1/1/2003 and 12/3/2018 (N=1,208,815). Patients were stratified as no-HK (never having a K > 5.0) (n=1,046,966; 87%) or HK (n=161,849; 13%), and further characterized by HK severity as mild (>5.0 to 5.5), moderate (>5.5 to 6.4) or severe (>6.4).
Results: The HK group was significantly older, more likely male, had cardiovascular risk factors, and on baseline medications that affect serum potassium (sK) (p<0.0001, each). Baseline diagnoses in the HK group included: HTN (63%), DM (33%), HF (20%), and renal insufficiency (16%). Severity of HK inversely correlated with renal function. Labs were reported on average 2.4+2.9 days after the highest reported sK, and 1.3+2.5 days after a severe HK episode.
At baseline and after HK episode, medications with potential to induce HK were used frequently in both groups although consistently greater in the HK group. Potassium supplement use in HK patients was double that in the no-HK group, and occurred in nearly half of patients with severe HK.
RAASi use was more common in the HK group at baseline and after HK episode. After HK episode, RAASi use trended in opposite manners for the no-HK and HK groups: angiotensin-converting-enzyme inhibitor and angiotensin receptor blocker use increased in the no-HK group and decreased in the HK group, whereas mineralocorticoid receptor antagonist use decreased in the no-HK group and increased in the HK group.
Chronic comorbidities were common in the HK population with a mean Charlson Comorbidity Index of 3.53+2.77.
Conclusion: HK occurs relatively frequently in a population with complex comorbidities, and with frequent confounders that increase HK risk. Follow-up patterns indicate even severe HK is addressed non-urgently. Concurrent use of potassium-confounding medications was relatively common after HK episodes whereas use of RAASi declined in a population with comorbid disease that would likely benefit from ongoing RAASi treatment. Analyses warrant further consideration of approaches to optimally and chronically manage HK while maintaining RAASi.