Abstract: FR-PO307

Course and Outcomes of Hyperkalemia in Hospitalized Patients

Session Information

Category: Fluid and Electrolytes

  • 902 Fluid and Electrolytes: Clinical

Authors

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

Hyperkalemia (High K) is a common complication among hospitalized patients contributing to increased hospital stay and costs. In this study, we determined the incidence and severity of hyperkalemia and characterize its recognition, treatment, and complications in different hospital settings and patient populations.

Methods

Data regarding patient location, comorbidities, medications in use before/after High K detection and outcomes were extracted from the EMR of all adult patients with at least 2 consecutive K>5mEq/L during a hospital stay at an academic medical center. Need for ICU admission, dialysis, number of drugs to treat HighK, land ength of ICU/hospital stay were assessed during hospitalization. Mortality was recorded for the duration of the observation period.

Results

From January 1, 2013, to November 30, 2015, 133,807 hospitalized patients had at least one potassium assessment. Of these patients, 13,748 (10.3%) had at least one K≥ 5mEq/L, and 2,150 (1.6%) had two consecutive values, within 7 days, ≥ 5 mEq/L. Almost half of the highK episodes were present at hospital admission, and the majority of these cases were from the emergency room (ER) 497 (23%), ward 1318 (62.9%), and ICU 280 (13.4%). Of 1,815 patients with hyperkalemia diagnosis in the ward or ER, 225 (12%) were transferred to the ICU within 24 hours of hyperkalemia diagnosis. 126 (6%) patients that were dialyzed during hospital admission: 78 (61%) were ESRD, 22 (3.4%) AKI, and 104 (6.9%) AKI on CKD. The median length of hospital stay was 9 days and was higher in AKI patients 11 (4-22) vs. 9 (4-17) days in no AKI. Overall, the in-hospital mortality rate in patients with hyperkalemia diagnosis was 12%. Patients with AKI had a higher mortality rate (AKI; 122 (17%) vs. 159 (10%) no AKI). Within the study period interval, 29% of patients with a hyperkalemia episode died. Patients with no previous renal dysfunction showed a greater in-hospital mortality rate 179 (15%) than those with CKD stage 3-5 and ESRD, 67(11.3%) and 25 (6.8%), respectively.

Conclusion

HighK in hospitalized patients is associated with a high mortality rate and increases significantly over the period of observation. Presence of CKD and ESRD is not associated with worse outcomes, whereas development of AKI is associated with increased length of stay and mortality.

Funding

  • Commercial Support