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Kidney Week

Abstract: PO1124

Impact of Hyperkalemia and the Disruption of Emergency and Surgical Care

Session Information

Category: Fluid, Electrolyte, and Acid-Base Disorders

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


  • Slakey, Douglas P., Advocate Health Care Inc, Downers Grove, Illinois, United States
  • Ingle, Marybeth, Advocate Health Care Inc, Downers Grove, Illinois, United States
  • Agiro, Abiy, AstraZeneca UK Ltd, Cambridge, Cambridgeshire, United Kingdom
  • Schilling, Craig G., AstraZeneca UK Ltd, Cambridge, Cambridgeshire, United Kingdom
  • Pottorf, William, AstraZeneca UK Ltd, Cambridge, Cambridgeshire, United Kingdom
  • Khatib, Rasha, Advocate Health Care Inc, Downers Grove, Illinois, United States

Due to the increasing prevalence of kidney disease, hyperkalemia (HK) may be diagnosed with greater frequency in Surgical and Emergency Departments (ED). Despite this, specific guidelines do not exist and patients with elevated potassium (K+) are typically managed on a case by case basis.


An anonymous structured survey was emailed to (n=11,287) clinicians in the Advocate Aurora Health system regarding HK knowledge and treatment paradigms (n=237 responded). Survey was conducted from Feb to March 2021.


Nearly half (47%) of respondents treat > 10 HK patients annually, with most primary diagnosis of HK occurring in the ED (34%) and surgical (33%) setting. HK was considered a significant concern by 47% of respondents at a serum K+ level of 5.6-5.9 mEq/L and by 39% at K+ >6 mEq/L. Only 50% of respondents recognized RAASi medications as a potential risk factor for HK. IV fluids and kayexalate were the two most common treatments for HK. Limitations to pharmacological management included the need to monitor potassium, patient compliance, and time of onset. In the surgery survey, 66% felt that K+ more than 5.5. mEq/L on day of surgery will lead to cancelations and 52% believed pharmacologic agents having a shorter onset of action may reduce surgery cancellations and delays. Vascular (34%) and general (30%) surgeries were reported to be most impacted by HK. 82% stated urgent dialysis is difficult to arrange and admission is inevitable for dialysis.


The presences of HK creates challenges to ED or surgical clinical teams to manage and avoid cancellations. Standard treatment options for lowering serum K+ are limited due to time of onset and compliance considerations. Dialysis is difficult to arrange on short notice and almost always requires patient admission. In cases of emergent HK, newer K+ binding agents having a more rapid onset of action to lower serum K+, may reduce avoidable admission, surgical cancellation, and delay of surgery. More evidence-based care is needed in surgical settings to characterize patients at high risk for HK to prevent unnecessary surgical cancellation and limit health care costs.


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