Abstract: SA-PO435
Management of Hyperkalemia in Veterans with Advanced CKD
Session Information
- CKD: Epidemiology, Outcomes - Non-Cardiovascular - II
November 04, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Chronic Kidney Disease (Non-Dialysis)
- 304 CKD: Epidemiology, Outcomes - Non-Cardiovascular
Authors
- 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
Background
Hyperkalemia is a serious complication among patients with advanced chronic kidney disease. The frequency and success of hyperkalemia management strategies are not well described.
Methods
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.
Results
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).
Conclusion
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, %)
| Medications | Total cohort | No recurrence | Recurrence to K 5.5-6.5 meq/L | Recurrence to K>6.5 meq/L |
| Initiation of | ||||
| Diuretics | 5968 (23.7%) | 5567 (93.3%) | 373 (6.3%) | 28 (0.5%) |
| Sodium bicarbonate | 1137 (4.5%) | 1060 (93.2%) | 71 (6.2%) | 6 (0.5%) |
| Fludrocortisone | 87 (0.3%) | 74 (85.1%) | 12 (13.8%) | 1 (1.1%) |
| Sodium polystyrene sulfonate | 2940 (11.7%) | 2636 (89.7%) | 284 (9.7%) | 20 (0.7%) |
| Initiation of any K lowering drug | 7727 (30.6%) | 7148 (92.5%) | 543 (7.0%) | 36 (0.5%) |
| Discontinuation of | ||||
| RAAS blockade | 5505 (59.0%) | 5057 (91.9%) | 426 (7.7%) | 22 (0.4%) |
| K sparing diuretics | 1990 (68.7%) | 1853 (93.1%) | 130 (6.5%) | 7(0.4%) |
| NSAIDs | 1538 (79.5%) | 1394 (90.6%) | 134 (8.7%) | 10 (0.7%) |
| K supplements | 4770 (81.5%) | 4408 (92.4%) | 339 (7.1%) | 23 (0.5%) |
| Discontinuation of any potentiating drug | 10719 (74.1%) | 9929 (92.6%) | 740 (6.9%) | 50 (0.5%) |
| Any medication change | 14358 (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%) |
Funding
- NIDDK Support