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Kidney Week

Abstract: TH-OR068

Electrocardiographic Manifestations of Acute vs. Chronic Hyperkalemia

Session Information

Category: Fluid and Electrolytes

  • 902 Fluid and Electrolytes: Clinical

Authors

  • Powell, Joshua, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, United States
  • Karabon, Patrick J., Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, United States
  • Berman, Aaron D., Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, United States
  • Kellerman, Paul S., Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, United States
Background

Hyperkalemia from kidney failure may cause life-threatening arrhythmias. Patients with end-stage renal disease (ESRD) have been thought to better tolerate high potassium levels than those with acute hyperkalemia. Thus, we postulated that patients with chronic hyperkalemia from ESRD have fewer electrocardiography (ECG) changes and less arrhythmias than patients with acute hyperkalemia from acute kidney injury. This study aims to determine the incidence of ECG changes in all patients presenting with hyperkalemia, and tests for differences in the incidence of hyperkalemic ECG changes between chronic and acute hyperkalemic groups.

Methods

We reviewed 256 adult admissions to William Beaumont Hospital Royal Oak Emergency Center with primary or secondary diagnoses of hyperkalemia in patients with chronic hyperkalemia from ESRD, and patients with acute hyperkalemia without ESRD. Initial ECGs were assessed for hyperkalemic changes by a single blinded cardiologist. The overall incidence of ECG changes was measured, and differences between the two groups were assessed using unpaired t-tests, chi-square tests, and multivariate analysis with logistic regression.

Results

ECG changes attributed to hyperkalemia were seen in 32% of encounters. There was no difference in the incidence of ECG changes between chronic (ESRD) and acutely (non-ESRD) hyperkalemic patients. However, with univariate analysis, increased patient age (69.9 vs 61.7 years, p= 0.0003), increased serum potassium (7.05 vs 6.8, p= 0.0424), and history of ischemic heart disease (p= 0.03) increased the risk of ECG changes. Multivariate analysis additionally demonstrated that higher endogenous serum calcium levels were independently associated with less T-wave peaking (Odds ratio 0.68, p= 0.0235).

Conclusion

This study demonstrated no difference in ECG changes between acute and chronic hyperkalemic groups, thus did not support the hypothesis that clinical arrhythmias are less prevalent with chronic hyperkalemia. As expected, increasing age, increasing potassium levels, and prior ischemic heart disease predisposed patients to ECG changes. Although pharmacologic calcium is known to protect against hyperkalemic arrhythmias, this study is unique in finding less T-wave peaking with higher endogenous serum calcium levels, implying that higher nonpharmacologic calcium serum levels may be protective against arrhythmias.