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Abstract: SA-OR034

Incidence and Outcomes of Hyperkalemia in Solid Organ Transplant Recipients

Session Information

Category: Fluid and Electrolytes

  • 902 Fluid and Electrolytes: Clinical

Authors

  • Yamada, Masaaki, University of Cincinnati, Cincinnati, Ohio, United States
  • Meganathan, Karthikeyan, University of Cincinnati, Cincinnati, Ohio, United States
  • Kaur, Taranpreet, University of Cincinnati, Cincinnati, Ohio, United States
  • Shah, Silvi, University of Cincinnati, Cincinnati, Ohio, United States
  • Govil, Amit, University of Cincinnati, Cincinnati, Ohio, United States
  • Thakar, Charuhas V., University of Cincinnati, Cincinnati, Ohio, United States
Background

Hyperkalemia is a serious complication resulting in a critical adverse event. Solid organ transplant (SOT) recipients can experience hyperkalemia contributed by both pathophysiological and medication related mechanisms. We examined incidence and outcomes of hyperkalemia in SOT recipients receiving acute care.

Methods

In a multi-center national sample (Cerner Health Facts database, 1/1/2000 to 6/30/2016), we examined patients with first hospitalization after transplant surgery or during the study period, whichever occurred earlier. Based on the peak potassium (K) level in mEq/L during the index admission, we classified K as normal ≤5.0, mild 5.1-5.5, moderate 5.6-6.0, and severe >6.0; hyperkalemia was defined as moderate or severe K groups. By logistic regression, we analyzed the effect of hyperkalemia and its severity on in-hospital mortality/hospice discharge and 30-day readmissions after adjustment for major confounders.

Results

Of the 14,684 SOT recipients, 65% kidney; 8% heart; 17% liver; and 10% other transplants. The cohort was 60% male with median age of 56 years (Q1, Q3, 45, 64) and median creatinine of 1.6 mg/dL (Q1, Q3, 1.2, 2.7). Overall, 16% experienced hyperkalemia (K levels: 69% normal; 15% mild; 8% moderate; 8% severe); frequency of hyperkalemia across organ type ranged between 13% and 17%. Overall in-hospital mortality was 2.6%; hyperkalemia group 6.1% vs. others 2.0% (p<0.001); mortality by K class was 1.6%, 3.7%, 5.4% and 6.8%, respectively (p<0.001). Hyperkalemia increased the risk of death [adjusted odds ratio (aOR), 3.1; 95% confidence interval (CI), 2.5-4.0]; compared to normal level, the severity of K class was associated with a graded increase in risk of death: mild K, aOR 2.2; 95% CI, 1.7-3.0; moderate K, aOR 3.4; 95% CI, 2.4-4.7; severe K, aOR 4.6; 95% CI, 3.3-6.2. There was a synergistic interaction between hyperkalemia and type of SOT, which was statistically significant (p=0.025). Hyperkalemia also increased risk of 30-day readmissions, 27% vs. others 18% (p<0.001); aOR 1.5; 95% CI, 1.4-1.7.

Conclusion

Hyperkalemia occurs in 1-in-6 SOT recipients during acute care; it is associated with a 3-fold increase in the risk of hospital mortality and 1.4-fold increase in the risk of readmission. Hyperkalemia prevention or treatment during acute care may improve patient survival in transplant recipients.

Funding

  • Clinical Revenue Support