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Kidney Week

Abstract: PO0968

Hyperkalaemia Risk and Mortality in Patients with Diabetes

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • 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
Background

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.

Methods

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.

Results

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%).

Conclusion

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.

Funding

  • Commercial Support