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Published on: June 10, 2025

Hyperkalemia in Heart Failure Hospitalizations: An Underreported Contributor to Poor Outcomes and Higher Costs in

Roberto Pecoits-Filho1,2, Pedro Tulio Rocha3,4, Maristela Carvalho da Costa5

  • 1Arbor Research Collaborative for Health, Michigan - EUA.

Arquivos Brasileiros De Cardiologia
|May 28, 2026
PubMed

Insights

Hyperkalemia is severely underreported in Brazilian heart failure hospitalizations, despite increasing mortality and resource use. Improved coding is crucial for better patient outcomes and healthcare planning.

Area of Science:

  • Cardiology
  • Nephrology
  • Health Informatics

Background:

  • Hyperkalemia is linked to poor prognosis in heart failure (HF).
  • Accurate reporting of hyperkalemia in administrative data is crucial but often suboptimal.
  • Understanding coding practices for hyperkalemia in HF hospitalizations is essential for clinical management and resource allocation.

Purpose of the Study:

  • To evaluate the frequency of hyperkalemia International Classification of Diseases (ICD) coding during heart failure hospitalizations in Brazil.
  • To assess the clinical impact and resource utilization associated with coded hyperkalemia in heart failure patients.

Main Methods:

  • Analysis of 3,551,738 heart failure hospitalizations from the Brazilian DATASUS database (2008-2024).
  • Identification of hyperkalemia using ICD codes.
  • Logistic and Cox regression analyses to evaluate associations between hyperkalemia, comorbidities, outcomes, and resource utilization.

Main Results:

  • Only 0.014% of hospitalizations were coded for hyperkalemia.
  • Patients with coded hyperkalemia were older and had higher rates of comorbidities (CKD, diabetes, CVD).
  • Hyperkalemia was associated with significantly increased in-hospital mortality, ICU admissions, dialysis, longer ICU stays, and higher healthcare costs.

Conclusions:

  • Hyperkalemia is severely underreported in Brazilian heart failure hospitalizations.
  • Under-reporting masks the true clinical severity and resource burden associated with hyperkalemia.
  • Enhanced awareness and improved ICD coding practices for hyperkalemia are recommended to improve patient outcomes and healthcare planning.

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