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Abstract: PO1448

The Relationship Between Comorbidities and Hyperkalaemia in Patients with CKD

Session Information

Category: Fluid, Electrolyte, and Acid-Base Disorders

  • 902 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • Tafesse, Eskinder, Global Health Economics, AstraZeneca, Gaithersburg, Maryland, United States
  • James, Glen, Global Medical Affairs, AstraZeneca, Cambridge, United Kingdom
  • Sugrue, Daniel, Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
  • Hurst, Michael A., Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
  • Hoskin, Louise, Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
  • Badora, Karolina, Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
  • McEwan, Philip, Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
Background

Hyperkalaemia (HK) is common in patients with chronic kidney disease (CKD) due to the role the kidneys play in maintaining normal potassium (K+) homeostasis. The presence of comorbidities in patients with CKD may further increase HK risk. Therefore, this study explored the incidence of HK in CKD patients with different comorbidities.

Methods

A retrospective cohort study was conducted using primary and secondary care data from the UK Clinical Practice Research Datalink and linked Hospital Episode Statistics, respectively. Eligible patients had non-dialysis dependent CKD, with or without resistant hypertension (RHTN); heart failure (HF) or diabetes (type 1 or type 2) recorded between January 2003 – June 2018. Patients were grouped according to CKD severity (stage 3a, 3b, 4 and 5) and follow-up time was partitioned based on their current status. Crude rates of HK per 1,000 patient-years were analysed for each group and the data was further categorised according to HK-defining serum K+ thresholds: ≥5.0, ≥5.5 and ≥6 mmol/L.

Results

In total, 229,350 patients with CKD stage 3+ contributed to follow-up, including 514, 250, 114 and 39 thousand patient years in the CKD only, RHTN, diabetes and HF cohorts, respectively. Declining renal function was consistently associated with increasing incidence of HK at all K+ thresholds. Additionally, within the same CKD stage, comorbidities were also consistently associated with an increase in HK incidence. Patients in the diabetes cohort were consistently at the greatest risk of HK, with a significant (α = 0.05) increase in risk of HK (defined at ≥5.0 mmol/L) compared with other comorbid groups. Conversely, patients without any comorbidities were at the lowest risk of HK, regardless of CKD stage and HK threshold.

Conclusion

In patients with CKD, comorbidities – specifically HF, diabetes, and RHTN – increase the risk of HK. This risk increases as renal function declines. As such, CKD patients, particularly those with comorbidities, may benefit from additional monitoring for HK.

Funding

  • Commercial Support