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Published on: June 16, 2014
Initial and Recurrent Hyperkalemia Events in Patients With CKD in Older Adults: A Population-Based Cohort Study
Sriram Sriperumbuduri1,2, Eric McArthur2,3, Gregory L Hundemer1,2
1Department of Medicine, University of Ottawa, ON, Canada.
Insights
Older adults with chronic kidney disease (CKD) face a high risk of hyperkalemia, both initially and recurrently. Lower estimated glomerular filtration rate (eGFR) significantly increases this risk, highlighting the need for careful monitoring in this population.
Area of Science:
- Nephrology
- Geriatrics
- Cardiovascular Medicine
Background:
- Hyperkalemia risk is elevated in chronic kidney disease (CKD).
- Initial and recurrent hyperkalemia risk in older adults remains unclear.
- Older adults are particularly vulnerable to kidney function decline and associated complications.
Purpose of the Study:
- To investigate the initial and 1-year recurrent risk of hyperkalemia in older adults (≥66 years).
- To stratify hyperkalemia risk based on estimated glomerular filtration rate (eGFR) levels.
- To analyze the association between kidney function and hyperkalemia incidence and recurrence.
Main Methods:
- Population-based, retrospective cohort study in Ontario, Canada.
- Involved 905,167 individuals aged 66 years and older from 2008-2015.
- Serum potassium levels were analyzed, stratifying participants by eGFR (≥90, 60-89, 30-59, 15-29 mL/min/1.73 m²).
- Incident hyperkalemia (K ≥ 5.5 mEq/L) and 1-year recurrent risk were assessed using Cox proportional hazards and Andersen-Gill models, respectively.
Main Results:
- Hyperkalemia was identified in 2.1% of the cohort.
- Hyperkalemia risk and recurrence were inversely associated with eGFR, with significantly higher rates in lower eGFR categories (e.g., eGFR 15-29 mL/min/1.73 m² had HR 13.65 for incident and HR 12.98 for recurrent).
- Increasing urine albumin-to-creatinine ratio (ACR) also correlated with higher hyperkalemia risk.
- RAAS blockade was associated with a marginally higher risk of both initial and recurrent hyperkalemia.
- Approximately 1 in 4 hyperkalemia cases required hospitalization within 30 days.
Conclusions:
- Patients aged 66 and above with reduced kidney function (low eGFR) are at substantial risk for initial and recurrent hyperkalemia.
- These findings underscore the importance of vigilant monitoring of potassium levels in older adults with CKD.
- The study highlights the need for tailored management strategies to mitigate hyperkalemia risk in this vulnerable population.
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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