ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on X

Kidney Week

Please note that you are viewing an archived section from 2020 and some content may be unavailable. To unlock all content for 2020, please visit the archives.

Abstract: PO0968

Hyperkalaemia Risk and Mortality in Patients with Diabetes

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical


  • McEwan, Philip, 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
  • Tafesse, Eskinder, Global Health Economics, Astrazeneca, Gaithersburg, Maryland, United States
  • Badora, Karolina, Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
  • Sugrue, Daniel, Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
  • James, Glen, Global Medical Affairs, AstraZeneca, Cambridge, United Kingdom

Diabetes mellitus (DM) is associated with micro- and macrovascular complications, including chronic kidney disease (CKD) and cardiovascular events. Renin-angiotensin-aldosterone system inhibitors (RAASi) are recommended for the management of these conditions; however, their usage may increase the risk of hyperkalaemia (HK), a potentially fatal electrolyte imbalance.


Patients with type 1 or 2 DM aged ≥18 years were identified from linked primary and secondary care data from the UK Clinical Practice Research Datalink and Hospital Episode Statistics, respectively. DM and relevant complications/comorbidities (CKD; history of major adverse cardiovascular events [MACE] comprising arrhythmia, heart failure, myocardial infarction and stroke) were identified through READ codes recorded during the study period (2008–June 2018) or the five-year look-back period (2003–2007). Index date was the latter of 1st January 2008 or initial DM diagnosis. Event rates (adjusted for age and sex) of HK (serum potassium [SK+] ≥5.0 mmol/L; ≥5.5 and ≥6.0 mmol/L were also explored) and all-cause mortality (ACM) were estimated over the follow-up period (from index date to the first of: death, loss to follow-up, end of study). Accumulation of complications/comorbidities over time resulted in re-classification.


288,871 DM patients were included with a mean follow-up of 5.87 (standard deviation [SD] 3.23) years. Available follow-up (1,000 patient-years [PYs]) was 1,038 for DM; 149 for DM + CKD; 129 for DM + MACE and 89 for DM + CKD + MACE. ACM incidence increased in line with increasing comorbidity burden, to 146.73 per 1,000 PYs in the DM + CKD + MACE cohort. At the SK+ threshold of ≥5.0 mmol/L, the incidence of HK was highest in patients with CKD (779.27/635.26 per 1,000 PYs with/without MACE, respectively) and lower in patients without CKD (384.13/246.83 per 1,000 PYs with/without MACE, respectively). The same between-cohort pattern was observed at thresholds of ≥5.5 and ≥6.0 mmol/L. CKD and/or MACE was associated with higher levels of RAASi prescription (61.91% vs 74.86%–76.28%).


DM patients with CKD and/or MACE are at increased risk of HK and ACM. Routine monitoring of SK+ and prompt management of HK episodes could improve clinical outcomes in DM patients, particularly those with CKD and/or a history of MACE.


  • Commercial Support –