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Abstract: FR-PO647

Treatment of Hyperkalemia with Insulin: Comparative Evaluation of Patient Characteristics

Session Information

Category: Fluid and Electrolytes

  • 902 Fluid and Electrolytes: Clinical

Authors

  • Humphrey, Toby Jl, University of Cambridge, Cambridge, United Kingdom
  • Wilkinson, Ian, University of Cambridge, Cambridge, United Kingdom
  • Hiemstra, Thomas F., University of Cambridge, Cambridge, United Kingdom
Background

Hyperkalaemia (HK) is a comon and serious medical emergency and current standard of care consists of an insulin infusion. Here, we report characteristics of HK patients treated with insulin in a tertiary hospital in the UK, compared with HK patients not treated with insulin.

Methods

HK patients (at least 1 potassium measurement ≥6mmol/L) were identified from electronic health records of patients admitted to a tertiary hospital between April 2015 and August 2018. All HK patients treated with insulin (K-I) were identified and compared with HK patients not treated with insulin (K-noI). Categorical variables were compared by Χ2-test and continuous variables by Student's t-test or Mann–Whitney U-test. Associations with insulin treatment were explored using a mixed effects logistic regression model with insulin use as the dependent variable, odds ratios (OR) are reported with associated 95% confidence intervals.

Results

HK ≥6mmol/L was identified in 5,272 of 211,993 patients (1.9%) attending the Emergency Department. Of these, 1284 received insulin for HK (K-I). Compared to K-noI patients, K-I patients were older (72 years(59.5-84.5) vs 71(53-83), p<0.001), more likely to be diabetic (35% vs 25.2%,p<0.001) and have chronic kidney disease (CKD) (39.9% vs 18.6%, p<0.001). Median length of hospital stay was longer in K-I patients (11.7 days (4.9-24.7) vs. 6.0 (1.2-17.3), p<0.001). A higher proportion of K-I patients were taking ACE Inhibitors (30.1% vs 23.1%, p<0.001), Angiotensin-2-receptor blockers (12.3% vs 9.2%, p=0.001) or potassium-sparing diuretics (17.1% vs 9.6%, p<0.001).
In a mixed-effects logistic regression model, insulin treatment was associated with CKD (OR 2.4, 2.1-2.8), male sex (OR 1.6, 1.4-1.8), potassium-sparing diuretics (OR 1.6, 1.3-2.0) and hypertension (OR 1.3, 1.1-1.5). At the end of follow up, 575/1,284 patients (44.8%) in K-I vs 1,089/3,988 patients (27.3%) had died (p<0.001). In a logistic regression model adjusting for age, gender and co-morbidity, the risk of death remained higher in the K-I group (OR 1.9, 1.6-2.2). Exact cause of death was not assessed.

Conclusion

Patients that receive insulin for HK are older, more likely to be male and have hypertension, CKD, diabetes and exposure to medications that increase potassium than those that do not. Receiving insulin for HK is associated with longer hospital stay and a higher risk of death.

Funding

  • Commercial Support –