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Initial and Recurrent Hyperkalemia Events in Patients With CKD in Older Adults: A Population-Based Cohort Study

Authors
  • Sriperumbuduri, Sriram1, 2
  • McArthur, Eric2, 3
  • Hundemer, Gregory L.1, 2
  • Canney, Mark1, 2
  • Tangri, Navdeep4, 5
  • Leon, Silvia J.4
  • Bota, Sara2, 3
  • Bugeja, Ann1, 2
  • Akbari, Ayub1, 2
  • Knoll, Greg1, 2
  • Sood, Manish M.1, 2
  • 1 Department of Medicine, University of Ottawa, ON, Canada
  • 2 Ottawa Hospital Research Institute, ON, Canada
  • 3 International Council for the Exploration of the Sea, Ottawa, ON, Canada
  • 4 Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, MB, Canada
  • 5 Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba. Winnipeg, Canada
Type
Published Article
Journal
Canadian Journal of Kidney Health and Disease
Publisher
SAGE Publications
Publication Date
May 27, 2021
Volume
8
Identifiers
DOI: 10.1177/20543581211017408
PMID: 34104453
PMCID: PMC8165829
Source
PubMed Central
Keywords
Disciplines
  • Original Clinical Research Quantitative
License
Unknown

Abstract

Background: The risk of hyperkalemia is elevated in chronic kidney disease (CKD); however, the initial and recurrent risk among older individuals is less clear. Objectives: We set out to examine the initial and 1-year recurrent risk of hyperkalemia by level of kidney function (estimated glomerular filtration rate, eGFR) in older adults (≥66 years old). Design: Population-based, retrospective cohort study Settings: Ontario, Canada Participants: 905 167 individuals (≥66 years old) from 2008 to 2015. Measurements: Serum potassium values Methods: Individuals were stratified by eGFR (≥90, 60-89, 30-59, 15-29 mL/min/1.73 m2) and examined for the risk of incident hyperkalemia (K ≥ 5.5 mEq/L) using adjusted Cox proportional hazards models. The 1-year risk of recurrent hyperkalemia was examined using multivariable Andersen-Gill models. Results: Among a population of 905 167 individuals (15% eGFR ≥ 90, 58% eGFR 60-89, 25% eGFR 30-59, 3% eGFR 15-29) with a potassium measurement, there were a total of 18 979 (2.1%) individuals with hyperkalemia identified. The event rate (per 1000 person-years) and adjusted hazard ratio (HR) of hyperkalemia was inversely associated with eGFR (mL/min; eGFR >90 mL/min: 8.8, referent, 60-89 mL/min: 11.8 HR 1.41; eGFR 30-59: 39.8, HR 4.37; eGFR 15-29: 133.6, 13.65) and with an increasing urine albumin-to-creatinine ratio (ACR, mg/mmol; ACR< 3: 14, referent, ACR 3-30: 35.1, HR 1.98; ACR >30: 93.7, 4.71). The 1-year event rate and adjusted risk of recurrent hyperkalemia was similarly inversely associated with eGFR (eGFR ≥ 90: 10.1, referent, eGFR 60-89: 14.4, HR 1.47; eGFR 30-59: 54.8, HR 4.90; eGFR 15-29: 208.0, HR 12.98). Among individuals with a baseline eGFR of 30 to 59 and 15 to 29, 0.9 and 3.8% had greater than 2 hyperkalemia events. The relative risk of initial and recurrent hyperkalemia was marginally higher with RAAS blockade. Roughly 1 in 4 individuals with hyperkalemia required hospitalization the day of or within 30 days after their hyperkalemia event. Limitations: Limited to individuals aged 66 years and above. Conclusions: Patients with low eGFR are at a high risk of initial and recurrent hyperkalemia. Trial registration: N/A

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