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Abstract: PO2054

Time to Hyperkalemia Recurrence in 1 Year Among 103,155 US Veterans

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1300 Health Maintenance, Nutrition, and Metabolism

Authors

  • Hsiung, Jui-Ting, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Israni, Rubeen K., AstraZeneca, Wilminton, Delaware, United States
  • Wenziger, Cachet, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Atreja, Nipun, AstraZeneca, Wilminton, Delaware, United States
  • Ha, Connie, AstraZeneca, Wilminton, Delaware, United States
  • Anzalone, Deborah A., AstraZeneca, Wilminton, Delaware, United States
  • Kalantar-Zadeh, Kamyar, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
Background

Elevated serum potassium (sK) is commonly asymptomatic, but in a subset of patients, hyperkalemia (HK) is associated with worse outcomes and frequent recurrence. Whether the initial HK event was captured during a hospitalization may be associated with time to recurrence. Further characterizing time to recurrence in inpatient (INPT) and outpatient (OPT) settings may improve HK monitoring and treatment.

Methods

Among 3,958,837 US veterans that had a sK between 2004-2006, there were 589,019 that had an index HK event (sK >5.0 mEq/L) during this period where we could ascertain INPT/OPT status. We then identified patients who had a recurrent HK event 7-365 days after the index HK and had at least one normal sK ≤5.0 mEq/L in between events. We examined time to recurrence in 30-day intervals according to whether the index sK was INPT or OPT. Patients who’s INPT/OPT status at HK recurrence could not be ascertained were excluded.

Results

HK recurrence over one year occurred in 103,155/589,019 (17.5%) patients, or 17,215/51,262 (34%) and 85,940/537,757 (16%) of patients with index INPT and OPT events, respectively. The 103,155 patients with HK recurrence had a mean patient age of 68±11 years, consisted of 98% males, 14% African Americans, 56% diabetics, and 60% with estimated glomerular filtration rate <60 mL/min/1.73m2. In patients with HK recurrence, 50% (n=51,675) developed this event 6 months after the initial HK (table). Among patients who had an OPT index HK, 56% developed recurrence 6 months after index HK event. However, 51% of the patients who had an INPT index HK event developed recurrence within 60 days of the index HK.

Conclusion

A significant proportion of VA patients with HK developed another HK event within one year. Hospitalized patients with HK developed recurrence faster than patients in the OPT setting despite requiring 7 days between HK events and normalization of sK between events. This could be due to the fact that hospitalized patients are usually sicker or they were monitored more closely by the healthcare providers, therefore it is easier to catch HK recurrence in INPTs than OPTs.

Funding

  • Commercial Support –