POTENTIAL CONSEQUENCES OF RECURRENT HYPERKALEMIA

Recurrent hyperkalemia can result in ER visits and hospitalizations1

Decreased renal excretion of potassium is commonly caused by progressive kidney decline, comorbid disease (eg, CKD, heart failure), and the use of certain medications to treat the underlying disease. These factors exacerbate hyperkalemia, therefore many patients face the risk of recurrent hyperkalemia.2-5

There are no guidelines that support the appropriate treatment setting for patients who develop hyperkalemia. The decision whether to treat in the clinic setting, the ER, or whether to admit to the hospital is based on clinical judgment, taking into account a number of factors.1,6

For patients, who have already had a hyperkalemic episode, it may be worthwhile to explore a different strategy that approaches the management of recurrent hyperkalemia through the maintenance of normokalemia on an on-going basis.7

Clinical data mine: Explore patient types most at risk for developing hyperkalemia

(Click on any link below to expand and view clinical evidence)

AS LEVELS OF K+ ELEVATE, SO DO THE RISK AND SEVERITY OF CLINICAL CONSEQUENCES:

Healthcare Cost and Utilization Project: Emergency room visits and hospitalizations related to hyperkalemia

Although hyperkalemia may be diagnosed in the ambulatory setting, the lack of management options may result in referrals to the emergency department. In 2011, there were 66,989 ED visits with a primary diagnosis of hyperkalemia.1

2011 ED Visits—Primary Diagnosis of Hyperkalemia1
Chart showing total number of emergency department visits due to hyperkalemia: 66,989 ED visits with 33,999 admitted among all patients and 45,828 ED visits with 24,023 admitted among Medicare members. Adapted from Healthcare Cost and Utilization Project.

Additionally, patients presenting with hyperkalemia in the ED are often admitted to the hospital for treatment. In 2011, over 40,000 patients were hospitalized with hyperkalemia as a primary diagnosis. Meanwhile, in 2012, hospitalizations with a primary diagnosis of hyperkalemia had increased by over 300% from 1993.1

2011 Hospitalizations—Primary Diagnosis of Hyperkalemia1
Chart showing number of hospitalization occurrences among hyperkalemia patients:  41,039 with 11,681 discharged to another hospital, institution, or home healthcare among all patients and 28,840 with 9600 discharged to another hospital, institution, or home healthcare among Medicare members.

Collins et al: CKD patients with hyperkalemia show a significant increase in mortality

A study evaluated the risk of mortality in patients with pre-dialysis CKD stage 3-5. De-identified medical records (2007-2012) of patients with at least 2 serum potassium readings were pulled from a large database and mortality was evaluated through hospital discharge records and Social Security registry information. Results indicated that the risk of mortality is significantly higher in patients with serum potassium levels above 5.0 mEq/L, including levels considered within the usual normal laboratory range, 3.7-5.2 mEq/L. Additionally, this trend was magnified in each stage of advanced kidney disease.8

Adjusted mortality in hyperkalemia patients with CKD 3-5 vs Controls8
Chart showing adjusted mortality in hyperkalemia patients with Chronic Kidney Disease 3-5 vs controls.

Pitt et al: Patients with hyperkalemia show a significant increase in mortality

Hyperkalemia significantly increases the risk of mortality in patients with certain comorbidities.6

A study evaluated the risk of mortality in patients with pre-dialysis CKD stage 3-5. De-identified medical records (2007-2012) of patients with at least 2 serum potassium readings were pulled from a large database and mortality was evaluated through hospital discharge records and Social Security registry information. The results indicated that patients with certain comorbid illnesses (CKD stage 3-5; heart failure; diabetes; cardiovascular disease; or hypertension) show consistently higher index serum potassium levels compared to control patients. Furthermore, the risk of mortality is significantly higher in patients aged ≥65 years vs patients aged 45-64 years.6

Adjusted mortality rates in hyperkalemic patients with or without comorbidities6
Chart showing adjusted mortality rates in hyperkalemic patients with or without comorbidities.

RRI-CKD Cohort Study: Hyperkalemia was associated with CV events

A study examining the relationship between serum potassium and mortality in patients with CKD, defined as an eGFR <60 mL/min, showed that hyperkalemia, at serum potassium levels >5.5, is associated with a significant increase in mortality or any cardiovascular event. This was defined as CAD, cerebrovascular disease, or PVD, and related events requiring hospitalization or revascularization.9

Hyperkalemia associated with CV events and mortality in patients
with CKD9
This line graph shows the relationship between hyperkalemic events and CV events, including death. As serum potassium levels rise above 5.5 mEq/L, there is a significant increase in the composite of death or any cardiovascular event.

Reproduced with permission from Korgaonkar S, Tilea A, Gillespie BW, et al. Serum potassium and outcomes in CKD: insights from the RRI-CKD Cohort Study. Clin J Am Soc Nephrol. 2010;5(5):762-769.