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Hyperkalemia Is an Underestimated Risk Factor in COPD.

Jukka Mäenpää1, Isobel Anderson2, Caroline A Owen3

  • 1Chief Medical Office, Research & Development, Patient Safety Biopharma, AstraZeneca, Gothenburg, Sweden.

International Journal of Chronic Obstructive Pulmonary Disease
|March 20, 2025
PubMed
Summary

Hyperkalemia is a significant risk for patients with severe Chronic Obstructive Pulmonary Disease (COPD), especially those with declining kidney function or diabetes. Regular monitoring of potassium levels is crucial for these individuals.

Keywords:
angiotensin-converting-enzyme inhibitorcardiac arrhythmiaschronic kidney diseaserenin-angiotensin-aldosterone system inhibitorsserum bicarbonates

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Area of Science:

  • Pulmonology
  • Nephrology
  • Cardiology

Background:

  • Hyperkalemia is a known mortality risk factor in general patient populations.
  • The association between hyperkalemia and Chronic Obstructive Pulmonary Disease (COPD) is under-recognized.
  • Hyperkalemia may contribute to cardiovascular mortality during and after COPD exacerbations.

Purpose of the Study:

  • To investigate the prevalence and risk factors of hyperkalemia in patients with moderate-to-very severe COPD.
  • To explore the relationship between hyperkalemia and comorbidities like chronic kidney disease (CKD), diabetes mellitus (DM), and renin-angiotensin-aldosterone system (RAAS) inhibitor use in COPD patients.

Main Methods:

  • Retrospective analysis of a cohort of 7968 patients from two clinical trials with moderate-to-very severe COPD.
  • Assessment of associations between hyperkalemia and comorbidities including CKD, DM, and RAAS inhibitor use.

Main Results:

  • 6.4% of COPD patients experienced hyperkalemia, with increased prevalence in Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages 3 (6.8%) and 4 (8.0%) compared to GOLD 2 (5.3%).
  • Hyperkalemia risk significantly increased with decreasing renal function (OR=2.29 for moderate-to-severe impairment) and was associated with DM (OR=1.28) and Angiotensin-Converting-Enzyme inhibitor (ACEi) use (OR=1.25).
  • RAAS inhibitor use showed a significant association with hyperkalemia only in patients with normal renal function (OR=1.63).

Conclusions:

  • Severe and very severe COPD patients (GOLD 3 and 4) face a higher risk of hyperkalemia.
  • Decreasing kidney function, DM, and ACEi use are significant risk factors for hyperkalemia in COPD.
  • Regular serum potassium monitoring is recommended for COPD patients, particularly those with GOLD stages 3 and 4.