Progression Rates of Hyperkalemia Increase with CKD Stage

Researchers, led by Rubeen K. Israni, MD, recently conducted a study among people with mild hyperkalemia to identify the time to progression from mild hyperkalemia to moderate-to-severe or severe hyperkalemia. Results were reported during a poster session at Kidney Week 2019 in a poster titled Hyperkalemia Progression Rates among Patients with Mild Hyperkalemia.

The researchers examined data from electronic health records from the Research Action for Health Network (2012-2018). Eligible patients had a minimum of one mild hyperkalemia event, defined as serum potassium >5.0 and ≤5.5 mEq/L.  The index date was defined as the date of the first mild hyperkalemia event. Patients had to have a minimum of one additional serum potassium laboratory value during the study period (2 years post-index date).

Progression to moderate-to-severe hyperkalemia and to severe hyperkalemia was defined as the first occurrence of a serum potassium laboratory value >5.5 mEq/L and >6.0 mEq/L, respectively. Rates of progression over the study period for the overall study population were estimated using Kaplan-Meier analyses. Analyses were also performed among patient subgroups, including patients with and without chronic kidney disease (CKD stages 3-5), heart failure, hypertension, or type 2 diabetes.

The analysis included 35,369 patients with mild hyperkalemia. Mean age of the cohort was 65.6 years and 47.5% were women. At the end of the study period, 16.9% of patients progressed to moderate-to-severe hyperkalemia and 8.7% progressed to severe hyperkalemia. Among the subgroups, rates of hyperkalemia progression were higher in patients with CKD, heart failure, hypertension, and diabetes compared with patients without those conditions (all log-rank P<.001). As CKD stage progressed, there were significant increases in the rate of hyperkalemia progression (P<.001).

In conclusion, the researchers said, “A total of 16.9% of patients with mild hyperkalemia experienced hyperkalemia progression during the 2-year follow-up period. Hyperkalemia progression rates increased significantly with CKD stage and were also higher among those with heart failure, hypertension, or type 2 diabetes.”

Source: Israni RK, David J, Betts K, et al. Hyperkalemia progression rates among patients with mild hyperkalemia. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2019 (Abstract FR-PO648), November 8, 2019, Washington, DC.