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Abstract: SA-PO435

Management of Hyperkalemia in Veterans with Advanced CKD

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 304 CKD: Epidemiology, Outcomes - Non-Cardiovascular


  • Fung, Enrica, Stanford University, Palo Alto, California, United States
  • Thomas, I-Chun, Stanford University, Palo Alto, California, United States
  • Kurella Tamura, Manjula, Stanford University, Palo Alto, California, United States

Hyperkalemia is a serious complication among patients with advanced chronic kidney disease. The frequency and success of hyperkalemia management strategies are not well described.


We assembled a national cohort of veterans with advanced CKD not on dialysis, defined by an outpatient eGFR ≤30 ml/min/1.73m2 and at least one episode of hyperkalemia (potassium ≥5.5meq/L), using administrative, laboratory and medication data from the Department of Veterans Health Affairs.


Among 76,021 veterans with advanced CKD, 25,227 (33.2%) had at least one episode of hyperkalemia during 5 years of follow-up. The majority of patients (57.3%) were on at least one medication that can potentiate hyperkalemia, and 18.1% were on two or more potentiating medications. Of these patients, 74.1% had drug discontinuation after the hyperkalemic episode, including 59.0% on RAAS blockade. Initiation of potassium lowering medications occurred in 30.6% of patients, with diuretic initiation being most common (23.7%), while 3% of patients received acute dialysis. Recurrence of hyperkalemia within 90 days occurred in 5.5% of the cohort, with those prescribed fludrocortisone, sodium polystyrene sulfonate, and those who discontinued NSAIDs having the highest frequency of recurrence (Table).


Among patients with advanced CKD and hyperkalemia, discontinuation of RAAS blockers and initiation of diuretics are the most common strategies employed to manage hyperkalemia. Recurrence of hyperkalemia is infrequent, but may occur more commonly with certain management strategies.

Management strategies and recurrence of hyperkalemia within 90 days (n, %)
MedicationsTotal cohortNo recurrenceRecurrence to K 5.5-6.5 meq/LRecurrence to K>6.5 meq/L
Initiation of    
Diuretics5968 (23.7%)5567 (93.3%)373 (6.3%)28 (0.5%)
Sodium bicarbonate1137 (4.5%)1060 (93.2%)71 (6.2%)6 (0.5%)
Fludrocortisone87 (0.3%)74 (85.1%)12 (13.8%)1 (1.1%)
Sodium polystyrene sulfonate2940 (11.7%)2636 (89.7%)284 (9.7%)20 (0.7%)
Initiation of any K lowering drug7727 (30.6%)7148 (92.5%)543 (7.0%)36 (0.5%)
Discontinuation of    
RAAS blockade5505 (59.0%)5057 (91.9%)426 (7.7%)22 (0.4%)
K sparing diuretics1990 (68.7%)1853 (93.1%)130 (6.5%)7(0.4%)
NSAIDs1538 (79.5%)1394 (90.6%)134 (8.7%)10 (0.7%)
K supplements4770 (81.5%)4408 (92.4%)339 (7.1%)23 (0.5%)
Discontinuation of any potentiating drug10719 (74.1%)9929 (92.6%)740 (6.9%)50 (0.5%)
Any medication change14358 (56.9%)13360 (93.0%)937 (6.5%)61 (0.4%)
No medication changes
10869 (43.1%)10486 (96.3%)368 (3.4%)15 (0.1%)


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