ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: FR-PO544

Impact of Hyperkalemia on Mortality in Patients With Advanced Kidney Disease With and Without Hemodialysis: Implications for Deferring Hemodialysis Initiation Under Value-Based Models

Session Information

Category: Fluid‚ Electrolyte‚ and Acid-Base Disorders

  • 1002 Fluid‚ Electrolyte‚ and Acid-Base Disorders: Clinical

Authors

  • Streja, Elani, University of California Irvine, Irvine, California, United States
  • Hsiung, Jui-Ting, University of California Irvine, Irvine, California, United States
  • Agiro, Abiy, AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, United States
  • Fawaz, Souhiela, AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, United States
  • Westfall, Laura, AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, United States
  • Oluwatosin, Yemisi, AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States
Background

The relationship between hyperkalemia (HK) and mortality in patients with stage 5 chronic kidney disease (CKD) or end-stage kidney disease (ESKD) with or without hemodialysis (HD) is not well established. This study examines the relationship between HK and all-cause mortality and whether it is dependent on HD initiation.

Methods

This retrospective cohort study of the United States (US) Veterans Affairs database identified 14,681 individuals initiating HD (HD cohort, N=5063) or with estimated glomerular filtration rate (eGFR) <10 mL/min/1.73m2 but not on HD (non-HD cohort, N=9618) who had at least one potassium (K+) measurement within 30 days of HD or eGFR index date and complete data for covariates. The association between HK (K+ >5.0 mEq/L) and all-cause mortality was analyzed by Cox regression analysis.

Results

In the total cohort, 8548 (58.2%) individuals had HK within 1 year prior to index (baseline HK). A greater proportion of the HD cohort than the non-HD cohort had baseline HK (69.6% and 52.3%, respectively). All-cause mortality rates within 1 year post-index in the HD and non-HD cohorts were 11.3% and 20.5%, respectively. After adjustment for baseline HK, demographic characteristics, comorbidities, medication use, and baseline eGFR, HD was associated with a 60% decrease in 1-year all-cause mortality compared with no HD (adjusted hazard ratio [aHR] 0.40; 95% CI 0.37–0.44; P<0.0001. In the total cohort, 1-year all-cause mortality rates for those with and without baseline HK were 21.9% and 11.0%, respectively. Baseline HK was associated with a 50% increase in 1-year all-cause mortality compared with no baseline HK (aHR 1.50; 95% CI 1.37–1.64; P<0.0001).

Conclusion

HK was a strong independent risk factor for all-cause mortality among patients with stage 5 CKD/ESKD with and without HD. Patients with stage 5 CKD/ESKD managed conservatively without HD likely have less control of HK than those receiving HD. These data may have important implications for the goal of deferring HD initiation under value-based models.

Funding

  • Veterans Affairs Support