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Abstract: SA-PO046

Clinical Determinants of Complicated Hyperkalemia in Hospitalized Patients

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational


  • Macedo, Etienne, University of California San Diego, San Diego, California, United States
  • Awdishu, Linda, UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences , La Jolla, California, United States
  • Mehta, Ravindra L., University of California San Diego, San Diego, California, United States

Hyperkalemia (HighK) is common in hospitalized patients and can be life-threatening. Preventive and management strategies differ based on patient presentation, underlying co-morbidities, concurrent medications and availability of health care resources. In this study we evaluated risk factors for complicated hyperkalemia and its association with patient course and outcomes during hospitalization.


Adult patients with at least 2 consecutive K>5mmol/L during a hospital stay were identified from electronic medical records (EMR). Data regarding patient location, comorbidities, medications in use prior to and after HighK detection and outcomes were extracted from the EMR. Complicated hyperkalemia(CK) was defined as reaching max K>6.5mmol/L, time to normalization of K levels>200 hours, death with K>5, more than 3 drugs prescribed for HighK treatment, need for ICU level care after HighK diagnosis and need for dialysis.


Of 91,709 patients hospitalized over 24 months, 9,391 (8%) had two K>5mmol/l, and in 1,203 (1.3%) these were consecutive. 47% of the HighK episodes were present at hospital admission; in ER (67%). CK occurred in 577 (47%) of patients and was more frequent in males 51% vs. 32% of females. 711 patients had acute kidney injury (AKI) and CK was more commonly seen in AKI 227 (39%) than in AKI in CKD patients 117 (20%), no AKI/CKD 106 (18%) or ESRD 97 (16%) patients. Most AKI patients, 63%, were using at least one drug associated with hyperkalemia development before AKI diagnosis.The most common diagnoses associated with CK were heart diseases, sepsis, hepatic failure/hepatorenal syndrome, and fluid overload. Most frequent drugs used to treat CK were calcium 58%, insulin/dextrose 49%, albuterol 17% and sodium bicarbonate 28%. Recurrence of HighK during hospitalization ocurred in 720 (60%), of whom 250 (21%) were discharged and 75 (6.2%) died with K>5mmol/l. Length of hospital stay (CK vs HighK 16 (7—32) vs 7 (3-12) days; p<0.001) and mortality (CK 123 (21.3%) vs HighK 39 (6.2%); p<0.001) were significantly higher in patients with CK.


HighK is common in hospitalized patients and associated with high mortality. Clinical and process of care factors can help determine patients with HighK who are at highest risk for complications. These data can be utilized to identify high-risk patients in order to improve patient care and reduce complications.


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