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Impact of Plasma Potassium Normalization on Short-Term Mortality in Patients With Hypertension and Hyperkalemia
Maria Lukács Krogager1, Peter Søgaard1, Christian Torp-Pedersen2,3
1Department of Cardiology Aalborg University Hospital Aalborg Denmark.
Insights
Correcting hyperkalemia (high potassium) in hypertension patients requires careful monitoring. Both overcorrection to low levels (<4.1 mmol/L) and high levels (>5.5 mmol/L) after an initial episode increase mortality risk.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- Hyperkalemia poses significant health risks, yet its management and the impact of correction are not well-understood.
- Understanding potassium level fluctuations after hyperkalemia is crucial for patient outcomes, especially in those with hypertension.
Purpose of the Study:
- To investigate the association between post-hyperkalemia potassium levels and mortality in patients with hypertension.
- To examine the risks associated with both under- and overcorrection of hyperkalemia following an initial high potassium episode.
Main Methods:
- Nationwide data analysis of 7620 hypertensive patients with initial hyperkalemia (potassium ≥4.7 mmol/L).
- Second potassium measurements were taken 6-100 days after the hyperkalemic episode.
- All-cause and cardiovascular mortality within 90 days of the second measurement were assessed using Cox regression analysis.
Main Results:
- Potassium levels >5.5 mmol/L after hyperkalemia were linked to a 2.27-fold increased mortality risk (HR, 2.27; 95% CI, 1.60-3.20).
- Potassium levels between 3.5-4.0 mmol/L were also associated with increased mortality risk (HRs 1.71 and 1.36, respectively).
- Potassium levels <4.1 mmol/L and >5.0 mmol/L were associated with increased cardiovascular mortality.
Conclusions:
- Overcorrection of hyperkalemia to levels <4.1 mmol/L is common and increases both all-cause and cardiovascular mortality.
- Sustained hyperkalemia (potassium >5.5 mmol/L) significantly elevates the risk of all-cause and cardiovascular mortality.
- Optimal potassium targets for hypertensive patients post-hyperkalemia require further investigation to balance risks.
Abstract:
Background Hyperkalemia can be harmful, but the effect of correcting hyperkalemia is sparsely studied. We used nationwide data to examine hyperkalemia follow-up in patients with hypertension. Methods and Results We identified 7620 patients with hypertension, who had the first plasma potassium measurement ≥4.7 mmol/L (hyperkalemia) within 100 days of combination antihypertensive therapy initiation. A second potassium was measured 6 to 100 days after the episode of hyperkalemia. All-cause mortality within 90 days of the second potassium measurement was assessed using Cox regression. Mortality was examined for 8 predefined potassium intervals derived from the second measurement: 2.2 to 2.9 mmol/L (n=37), 3.0 to 3.4 mmol/L (n=184), 3.5 to 3.7 mmol/L (n=325), 3.8 to 4.0 mmol/L (n=791), 4.1 to 4.6 mmol/L (n=3533, reference), 4.7 to 5.0 mmol/L (n=1786), 5.1 to 5.5 mmol/L (n=720), and 5.6 to 7.8 mmol/L (n=244). Ninety-day mortality in the 8 strata was 37.8%, 21.2%, 14.5%, 9.6%, 6.3%, 6.2%, 10.0%, and 16.4%, respectively. The multivariable analysis showed that patients with concentrations >5.5 mmol/L after an episode of hyperkalemia had increased mortality risk compared with the reference (hazard ratio [HR], 2.27; 95% CI, 1.60-3.20; P<0.001). Potassium intervals 3.5 to 3.7 mmol/L and 3.8 to 4.0 mmol/L were also associated with increased risk of death (HR, 1.71; 95% CI, 1.23-2.37; P<0.001; HR, 1.36; 95% CI, 1.04-1.76; P<0.001, respectively) compared with the reference group. We observed a trend toward increased risk of death within the interval 5.1 to 5.5 mmol/L (HR, 1.29; 95% CI, 0.98-1.69). Potassium concentrations <4.1 mmol/L and >5.0 mmol/L were associated with increased risk of cardiovascular death. Conclusions Overcorrection of hyperkalemia to levels <4.1 mmol/L was frequent and associated with increased all-cause and cardiovascular mortality. Potassium concentrations >5.5 mmol/L were also associated with an increased all-cause and cardiovascular mortality.
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