Título

WHAT CHARACTERIZES THE PATIENTS WHO DEVELOP REPEATED OR PERSISTENT HYPERKALAEMIA? A POPULATION-BASED LABORATORY STUDY OF POTASSIUM TRAJECTORIES IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Introdução

Hyperkalaemia (HK) (defined as blood potassium (K+) >5.0 mmol/L) is common among patients with chronic kidney disease (CKD) and associated with adverse outcomes and increased costs. Little is currently known about what characterizes patients who experience repeated and persistent HK.

Material e Método

Laboratory study of patients with established CKD in the total population (1.8 million inhabitants) of Northern Denmark, 2000-2012. For all CKD patients who experienced a first incident HK event, we examined K+ trajectories over the following 6 months. We described patient characteristics associated with persistent (≥2 consecutive K+ tests >5.0 mmol/L with maximum 1 normal K+ test in between) and repeated HK (≥2 K+ tests >5.0 mmol/L separated by ≥2 normal K+ tests).

Resultados

Of 157,283 patients with CKD (median age 73 years, 59% females), 28% (n=43,845) experienced a subsequent HK event. During 6 months after first HK, 29% had died, 45% had no additional high K+ test, while 26% (n=11,390) fell into a persistent or repeated HK pattern. FIGURE 1 shows K+ trajectories for the 11,390 HK patients with either persistent HK (A: 2 high K+ tests, n=3,936; B: 3 high tests, n= 1,236; C: ≥4 high tests, n=974) or repeated HK (D, n=5,244). Important baseline predictors for developing persistent or repeated HK (e.g. trajectory C) included eGFR (prevalence ratio (PR)=2.40 (95% CI 1.91-3.01) for eGFR <15), severity of first HK event (PR=3.98 (95% CI 3.05-5.18) for K+ 6.0-6.5 mmol/L), and treatment with ACE-inhibitors (PR=1.32 (95% CI 1.23-1.41)) or spironolactone (PR=1.59 (95% CI 1.43-1.78)).

Discussão e Conclusões

Repeated HK and persistently elevated K+ levels are common in CKD patients and are preceded by readily identifiable clinical predictors for the populations at highest risk.

Palavras Chave

Chronic kidney disease; Heart failure epidemiology; hyperkalaemia; potassium