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Home » News » Nephrology » Hyperkalemia

Publish Date August 31, 2021


KIDNEY FAILURE RISK UP SUBSTANTIALLY WITH HYPERKALEMIA

Natasha Persaud

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Kidney failure risk was 17-fold higher among adults with than without
hyperkalemia who had a baseline estimated glomerular filtration rate of 60
mL/min/1.73 m2 or greater. Credit: Getty Images


Hyperkalemia is associated with poor long-term health outcomes, particularly
kidney failure, independent of established risk factors, a new study finds.

“Clinicians should note that even minor episodes of hyperkalaemia are
prognostically relevant, important to communicate, and worthy of consideration
in the planning of ongoing care, monitoring and expectations for future health,”
Simon Sawhney, MBChB, BScMedSci, PhD, and colleagues from Aberdeen Centre for
Health Data Sciences, University of Aberdeen in Grampian, UK, concluded in an
article published in the American Journal of Kidney Diseases.





Based on data from 302,630 adults in Grampian, UK, during 2012-2014, the annual
population incidence of hyperkalemia (defined as serum potassium 5.5 mmol/L or
greater) was 0.96 episodes per 100 person-years. The hyperkalemia incidence rate
doubled for each 10-year increase in age from age 40 years. Results showed
that 66.4% of episodes occurred in the community, 18.1% at hospital admission,
and 15.6% during initial hospitalization.





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Continue Reading




Adults with hyperkalemia had a 20- and 17-fold higher likelihood of concurrent
acute kidney injury (AKI) and stage 4 or 5 chronic kidney disease (estimated
glomerular filtration rate less than 30 mL/min/1.73 m2), respectively, compared
with those without hyperkalemia. They also had a 5-, 4-, and 4-fold higher
likelihood of heart failure, diabetes, and peripheral arterial disease,
respectively.

Hyperkalemia occurrence was associated with poor health outcomes over 5 years of
follow-up. Kidney failure risk was 17- and 2-fold higher among adults with than
without hyperkalemia who had a baseline eGFR of 60 or greater and less than 30
mL/min/1.73 m2, respectively. The risk for major adverse cardiac events (MACE;
defined as fatal or non-fatal myocardial infarction, heart failure or stroke)
was 1.8- and 1.4-fold higher with hyperkalemia at the respective levels of
kidney function. All-cause mortality risk was 2.3- and 1.5-fold higher,
respectively. Having both hyperkalemia and AKI was associated with higher
cumulative risks for MACE and death than having either condition alone.

“An increase in kidney failure after hyperkalemia among those with preserved
baseline kidney function is particularly notable and implies a mechanism of
reduced kidney reserve may be contributing to the poorer outcomes,” Dr Sawhney’s
team wrote. “Thus, ‘mild’ hyperkalemia is a novel predictor of lasting poor
health outcomes that is independent of conventional kidney excretory function
metrics.”

They added that hyperkalemia “should not be considered solely an acute or
transient problem, but a red flag indicator of diminished kidney reserve, and of
lasting future health risk.”

Reference

Mclean A, Nath M, Sawhney S. Population epidemiology of hyperkalemia: cardiac
and kidney long-term health outcomes. Am J Kidney Dis. Published online August
19, 2021. doi:10.1053/j.ajkd.2021.07.008


TOPICS:

Acute Kidney Injury Cardiovascular Disease Chronic Kidney Disease End-Stage
Renal Disease Epidemiology Heart Failure Hyperkalemia Myocardial Infarction
Renal Replacement Therapy Stroke


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