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Abstract: FR-PO309

Timing Is Everything: Decreasing Mortality in Severe Hyperkalemia

Session Information

Category: Fluid and Electrolytes

  • 902 Fluid and Electrolytes: Clinical


  • Alagusundaramoorthy, Sayee Sundar, University of Wisconsin, Madison, Wisconsin, United States
  • Gregory, Andrew, University of Wisconsin Madison School of Medicine and Public Heatlh, Eleva, Wisconsin, United States
  • Maursetter, Laura J., University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, United States
  • Singh, Tripti, University of Wisconsin, Madison, Wisconsin, United States

Hyperkalemia is a modifiable risk factor for sudden cardiac death; a leading cause of mortality in hemodialysis patients. There is lack of data in literature guiding the treatment of hyperkalemia in hospitalized end stage renal disease (ESRD) patients. The goal of this study was to determine if time to dialysis after severe hyperkalemia will influence mortality in hospitalized ESRD patients.


We conducted a retrospective study of all adult ESRD patients admitted to the hospital who had hemodialysis for severe hyperkalemia between January 2011- June 2017. Chart review was conducted to determine patient and treatment characteristics. Logistic regression analysis was performed to determine the factors that influenced mortality.


346 ESRD patients on hemodialysis admitted at our center had severe hyperkalemia during the study period. Mean serum potassium was 7mEq/L. In-hospital mortality in ESRD patients with severe hyperkalemia was 6.9%. Median time to dialysis after serum potassium result was 2.13 hours (25, 75 IQR 0.98, 4.9 hours). Time to dialysis after serum potassium result was associated with a significantly increased risk of mortality in this population (HR 1.007, 95% CI 1.002-1.012, p <0.0045) (Table 1). Logistic regression analyses also determined age, length of stay, serum creatinine and serum albumin level as significant predictors of in-hospital mortality (Table 1). Sex, race, history of diabetes and hypertension, serum potassium level and serum CO2 level did not influence in-hospital mortality in this cohort.


We conclude that early dialysis after serum potassium result in hospitalized ESRD patients with severe hyperkalemia is associated with decreased in hospital mortality.

Table 1: Risk factors for mortality in hospitalized ESRD patients with severe hyperkalemia
Risk FactorOdds Ratio (95%CI)p- value
Age, per 1 year1.07 (1.04-1.11)0.0001
Length of stay, per 1 day1.04 (1.02-1.06)0.0002
Serum Albumin, per 1 g/dL0.24 (0.07-0.76)0.02
Serum Creatinine, per 1 mg/dL0.72 (0.58-0.88)0.0018
Time from potassium result to dialysis, per 1 hour1.007 (1.002-1.012)0.0045