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Abstract: PO2255

Liver Disease Is a Predictor of Recurrent Hyperkalemia

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Streja, Elani, VA Long Beach Healthcare System, Long Beach, California, United States
  • Hsiung, Jui-Ting, VA Long Beach Healthcare System, Long Beach, California, United States
  • Agiro, Abiy, AstraZeneca PLC, Cambridge, Cambridgeshire, United Kingdom
  • Brahmbhatt, Yasmin G., AstraZeneca PLC, Cambridge, Cambridgeshire, United Kingdom
  • Cooper, Kerry, AstraZeneca PLC, Cambridge, Cambridgeshire, United Kingdom
  • Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States
Background

Liver disease is not a well-established predictor for recurrent hyperkalemia (HK) independent of mineralocorticoid receptor antagonist (MRA) therapy, which is a common treatment in this population. This study explores the relationship between liver disease and recurrent HK independent of MRA therapy and Renin Angiotensin System Inhibitors.

Methods

In a cohort of 9,894,683 US veterans that had at least one potassium measurement between 0.5-8 mEq/L during year 2004 and 2018, we identified 2,169,401 patients who had a HK event (sK >5.0 mEq/L) and complete data on covariates and examined the association of possible predictors of HK recurrence within 1 year after index HK event. Liver disease was defined according to the presence of mild, moderate, or severe liver disease ICD 9/10 codes using 1 inpatient or 2 outpatient records in one year prior to index HK event. HK recurrence is defined as the 3rd or later potassium measurement after index HK measurement subsequent to one or more normal (≤5 mEqL) potassium measurement. Fine and Gray competing risk regression model was used to evaluate the association between liver disease and HK recurrence, where HK recurrence was the outcome and the competing event was all-cause mortality within 1 year after index HK occurrence. The model was adjusted for demographics, comorbid conditions, eGFR, RASi and MRA treatment and potassium supplementation.

Results

Among the 2,169,401 patients, 376,358 (17%) patients had HK recurrence within 1 year after index HK event. Out of 2,169,401 patients, 93,141 (4%) patients had liver disease within 1 year prior to index HK event and 26,846 (29%) of patients had HK recurrence within 1 year after index HK event. Patients with liver disease had a 39% higher risk of HK recurrence within 1 year after index HK event (hazard ratio [HR] [95% Cl]: 1.39 [1.37, 1.42]) in the fully adjusted model and was the 2nd strongest predictor after diabetes. Compared to patients without liver disease, patients with liver disease were younger, more likely to be African American, and had a higher Charlson Comorbidity Index.

Conclusion

In US veterans, liver disease is a predictor of 1 year HK recurrence independently of RAASi therapy. Further studies are needed to understand the possible cause underlying this association.

Funding

  • Commercial Support – AstraZeneca