Hyperkalemia Increases Risk for Hospitalizations, Death in Diabetes Patients

Hyperkalemia was associated with worse clinical outcomes among patients with diabetes, according to the findings of a recent study.

The population-based cohort study included 76,942 individuals diagnosed with diabetes between 2000 and 2012 (47% of patients were female and the mean age was 62 years). Of whom, 18% had concomitant kidney disease, 6% had congestive heart failure, and 47% had hypertension. Patients with hyperkalemia were identified using laboratory reports and were compared with patients with diabetes but without hyperkalemia. Clinical outcomes, including acute hospitalization, cardiac diagnoses, ICU treatment, and death, were assessed.
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Over the mean 3.4 years of follow-up, 13,530 patients (17.6%) developed hyperkalemia, with an incidence rate of 42 persons per 1000 person-years. The risk for developing hyperkalemia increased with age and comorbidity burden. The median time to first hyperkalemia event was 2 years.

Patients with diabetes who developed hyperkalemia were more likely to have chronic kidney disease (odds ratio [OR] 2.4), chronic heart failure (OR 3), hypertension (OR 1.4), to use ACE-inhibitors (OR 1.3), K+ supplements (OR 1.9), and spironolactone (OR 3.2) compared with those without hyperkalemia.

In addition, 55% of patients with hyperkalemia experienced acute hospitalizations within the first 6 months following a hyperkalemia event compared with 32% of patients who experienced hospitalizations 6 months prior to a hyperkalemia event.

Within 6 months after a hyperkalemia diagnosis, the risk for any cardiac hospital diagnosis increased from 17% to 28%, the risk for admission to the ICU increased from 2% to 15%, and the risk for cardiac arrest increased from 0.1% to 0.7%. Likewise, the risk for mortality was 22% within 6-months following a hyperkalemia diagnosis.

Compared with those without hyperkalemia, patients with hyperkalemia had a 2.14-fold increased risk for any acute hospitalizations 6 months after diagnosis and a hazard ratio of 6.16 for death.

“One out of 6 patients with [diabetes] develops [hyperkalemia]; those with concomitant kidney disease and heart failure are at a particular increased risk,” the researchers concluded. “[Hyperkalemia] was found to be associated with severe clinical outcomes and mortality in a real-world population of patients with [diabetes].”

—Melissa Weiss

Reference:

Thomsen RW, Nicolaisen SK, Svensson E, et al. Hyperkalaemia in patients with diabetes: incidence, risk factors, and clinical outcomes. A Danish population based cohort study. Presented at: European Foundation for the Study of Diabetes Annual Meeting; September 12-15, 2017; Lisbon, PT.  Abstract 238.