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Abstract: PO1123

Prevalence and Recurrence of Hyperkalemia (HK) in Medicare Patients Admitted to Long-Term Care or Post-Acute Care (LTC/PAC) Settings

Session Information

Category: Fluid, Electrolyte, and Acid-Base Disorders

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

Authors

  • Neuenschwander, James F., Genesis HealthCare System, Zanesville, Ohio, United States
  • Silverstein, Alison R., Avalere Health, Washington, District of Columbia, United States
  • Teigland, Christie, Avalere Health, Washington, District of Columbia, United States
  • Powell, Dakota C., Avalere Health, Washington, District of Columbia, United States
  • Kumar, Shambhavi, Avalere Health, Washington, District of Columbia, United States
  • Dreyfus, Jill, Avalere Health, Washington, District of Columbia, United States
  • Zeng, Edric Y., Avalere Health, Washington, District of Columbia, United States
  • Agiro, Abiy, AstraZeneca Pharmaceuticals LP, Gaithersburg, Maryland, United States
  • Pottorf, William, AstraZeneca Pharmaceuticals LP, Gaithersburg, Maryland, United States
  • Peacock, William, Baylor College of Medicine, Houston, Texas, United States
Background

HK is a common electrolyte imbalance among elderly populations with comorbidities such as chronic kidney disease (CKD) and congestive heart failure (CHF). This study describes the prevalence and recurrence of HK in patients in the LTC/PAC setting.

Methods

This retrospective study used 100% Medicare Fee-For-Service data for patients age ≥65 with ≥1 LTC/PAC stay from 01/01/2017 to 11/30/2019; index date was admission date of first LTC/PAC stay. HK-related stay was defined as ≥1 HK diagnosis (ICD-10: E87.5) or evidence of potassium binder use during LTC/PAC stay or within 14 days pre-index. Baseline characteristics and prevalence of HK during 1 year of follow up among HK index stays were compared to non-HK index stays. HK index stays were stratified into 3 cohorts: CHF, CKD or end-stage renal disease (ESRD), and CHF+CKD/ESRD.

Results

Of 4,562,231 patients with ≥1 LTC/PAC stay, prevalence of HK during pre-index, index, or follow up periods was 14.7%. The final sample (4,081,103) excluded patients with an HK event only during follow up. Of the final cohort, 290,567 (7.1%) of index stays were HK-related. All-cause (HK-related) index stays consisted of 54.0% (46.8%) home health agencies, 27.8% (41.4%) skilled nursing facilities, 6.7% (8.8%) inpatient rehabilitation facilities, and 0.9% (3.1%) long term acute hospital settings. HK vs non-HK patients were more often male (43.0% vs 35.4%), Black (13.5% vs 8.0%), and dual eligible for Medicaid (34.2% vs 25%), with higher mean Charlson Comorbidity Index scores (6.19 vs 3.93) (all p<0.0001).

Mean annual HK events during follow up were highest in patients with CHF+CKD/ESRD (all patients=1.47; HK=6.98), followed by CKD (0.66; 5.53), and CHF (0.18; 3.00), with similar patterns across settings.

In the HK cohort, 34.5% had HK recurrence during follow up; 2.7% filled a potassium binder prescription during index LTC/PAC stay, and 4.3% did so within 1 year.

Conclusion

HK patients were more often non-White and low income, indicating possible disparities in care. Prevalence and recurrence of HK was high among patients with LTC/PAC stays, but few patients filled a potassium binder prescription, suggesting potential gaps in treatment during or after an LTC/PAC stay.

Funding

  • Commercial Support