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Inpatient management and post-discharge outcomes of hyperkalemia
Jill Davis1, Rubeen Israni1, Fan Mu2
1AstraZeneca, Wilmington, Delaware, USA.
Insights
Inpatient hyperkalemia management is common, with most patients achieving normal potassium levels. However, high rates of death, readmission, and recurrence highlight the need for improved care strategies.
Area of Science:
- Nephrology
- Internal Medicine
- Clinical Research
Background:
- Hyperkalemia is frequently managed in hospitals, but real-world data on its inpatient treatment and outcomes are scarce.
- Understanding current management practices and post-discharge results is crucial for improving patient care.
Purpose of the Study:
- To characterize the inpatient management of hyperkalemia.
- To describe post-discharge outcomes, including recurrence and readmission rates.
- To compare these outcomes across different severity levels of hyperkalemia.
Main Methods:
- Analysis of electronic medical records from US adult patients (2012-2018) with inpatient hyperkalemia (potassium >5.0mEq/L).
- Comparison of patient characteristics, treatments, monitoring, and post-discharge events (recurrence, readmission) for mild, moderate, and severe hyperkalemia.
- Categorization of hyperkalemia severity based on serum potassium levels: mild (>5.0-5.5mEq/L), moderate (>5.5-6.0mEq/L), and severe (>6.0mEq/L).
Main Results:
- Of 21,793 patients, 69.2% had mild, 19.0% moderate, and 11.8% severe hyperkalemia.
- Common treatments included temporizing agents, diuretics, and sodium-polystyrene sulfonate; potassium binders were rarely used at discharge.
- Inpatient mortality was 12.3% (mild) to 19.5% (severe); 30-day hyperkalemia recurrence ranged from 13.3% to 18.4%; 30-day readmission rates were around 20% across all severities.
Conclusions:
- Inpatient hyperkalemia treatment frequently normalizes potassium levels but is associated with significant inpatient mortality.
- Hyperkalemia recurrence and hospital readmission within 30 days post-discharge are common, irrespective of initial severity.
- Further research is needed to develop strategies for reducing mortality, readmissions, and recurrence in hospitalized hyperkalemia patients.
Objectives:
Patients with hyperkalemia are commonly treated in the inpatient setting; however, real-world evidence is limited. The purpose of this study was to describe the inpatient management and post-discharge outcomes among patients with hyperkalemia.
Methods:
Electronic medical record data (2012-2018) were used to analyze US adult patients with an inpatient stay with hyperkalemia (≥1 potassium value >5.0mEq/L). Patient characteristics, treatments, and monitoring six months prior to and during the inpatient stay, and hyperkalemia recurrence and inpatient readmissions post-discharge were summarized and compared among patients with mild (>5.0-5.5mEq/L), moderate (>5.5-6.0), and severe (>6.0) hyperkalemia.
Results:
Of the 21,793 patients, 69.2% had mild, 19.0% had moderate, and 11.8% had severe hyperkalemia during inpatient care. The most common inpatient treatments were temporizing agents (mild: 28.9%; moderate: 46.0%; severe: 73.0%), diuretics (32.7%; 37.1%; 34.6%), and sodium-polystyrene sulfonate (11.7%; 27.8%; 45.3%). Almost no patients (0.1%) received a potassium binder at discharge. Most patients (86.8%) had their potassium levels return to ≤5.0mEq/L during the inpatient stay. Death during the inpatient stay occurred in 12.3% of mild, 15.5% of moderate, and 19.5% of severe hyperkalemic patients. Within 30 days of discharge, hyperkalemia recurred in 13.3%, 15.4%, and 18.4% of patients with mild, moderate, and severe hyperkalemia, respectively. Additionally, 19.7%, 21.5%, and 19.6% of patients were readmitted to inpatient care within 30 days post-discharge.
Conclusion:
Among patients with hyperkalemia in the inpatient setting, treatment and normalization of serum potassium levels were common. However, death, readmission, and hyperkalemia recurrence were also fairly common across all cohorts. Future studies examining measures to reduce inpatient death, readmission, and hyperkalemia recurrence among patients with hyperkalemia in inpatient care are warranted.
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