Long-term mortality and trajectory of potassium measurements following an episode of acute severe hyperkalaemia

Background Hyperkalaemia is a common condition in patients with comorbidities such as chronic kidney disease (CKD) or congestive heart failure (HF). Moreover, severe hyperkalaemia is a potentially life-threatening condition that is associated with a higher risk of adverse clinical events such as ven...

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Autores: Gorriz, Jose Luis, D'Marco, Luis, Pastor-Gonzalez, Anna, Molina, Pablo, Gonzalez-Rico, Miguel, Puchades, Maria Jesus, Sanchis, Irina, Escudero, Veronica, Estan, Nuria, de la Espriella, Rafael, Nunez, Eduardo, Pallardo, Luis, Nunez, Julio
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2022
País:España
Institución:INCLIVA
Repositorio:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
OAI Identifier:oai:incliva.fundanetsuite.com:p15496
Acceso en línea:https://incliva.portalinvestigacion.com/publicaciones/15496
Access Level:acceso abierto
Palabra clave:hyperkalaemia
longitudinal studies
mortality
post-discharge
potassium
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spelling Long-term mortality and trajectory of potassium measurements following an episode of acute severe hyperkalaemiaGorriz, Jose LuisD'Marco, LuisPastor-Gonzalez, AnnaMolina, PabloGonzalez-Rico, MiguelPuchades, Maria JesusSanchis, IrinaEscudero, VeronicaEstan, Nuriade la Espriella, RafaelNunez, EduardoPallardo, LuisNunez, Juliohyperkalaemialongitudinal studiesmortalitypost-dischargepotassiumBackground Hyperkalaemia is a common condition in patients with comorbidities such as chronic kidney disease (CKD) or congestive heart failure (HF). Moreover, severe hyperkalaemia is a potentially life-threatening condition that is associated with a higher risk of adverse clinical events such as ventricular arrhythmias and sudden cardiac death. Currently, data regarding the prognostic implications of chronic hyperkalaemia are available; however, information about the long-term clinical consequences after an episode of severe hyperkalaemia remains scarce. The objective of this study was to evaluate the association between the trajectory of potassium measurements in patients with acute hyperkalaemia and long-term all-cause mortality. Methods This is a retrospective observational study that included patients with acute severe hyperkalaemia [potassium (K) >6 mEq/L] without haemolysis in the emergency room of Dr Peset University Hospital in Valencia, Spain searching the lab database from January 2016 to March 2017. The multivariable-adjusted association of serum potassium with mortality was assessed by using comprehensive state-of-the-art regression methods that can accommodate time-dependent exposure modelling. Results We found 172 episodes of acute hyperkalaemia in 160 patients in the emergency room. The mean +/- standard deviation age of the sample was 77 +/- 12 years and 60.5% were males. The most frequent comorbidities were CKD (71.2%), HF (35%) and diabetes mellitus (56.9%). Only 11.9% of the patients were on chronic dialysis. A quarter of the patients did not have previous CKD, making hyperkalaemia an unpredictable life-threatening complication. During the acute episode, mean potassium and estimated glomerular filtration rate (eGFR) were 6.6 +/- 0.6 (range 6.1-9.2) mEq/L and 23 +/- 16 (range 2-84) mL/min/1.73 m(2), respectively. After a median (interquartile range) follow-up of 17.3 (2.2-23.7) months, 68 patients died (42.5%). Recurrences of hyperkalaemia (K >5.5 mEq/L) were detected in 39.5% of the patients who were monitored during follow-up. We found that previous potassium levels during an acute severe hyperkalaemia episode were not predictors of mortality. Conversely, the post-discharge longitudinal trajectories of potassium were able to predict all-cause mortality (overall P = 0.0015). The effect of transitioning from hyperkalaemia to normokalaemia (K >5.5 mEq/L to K <= 5.5 mEq/L) after the acute episode was significant, and inversely associated with the risk of mortality. Conclusions Potassium levels prior to a severe hyperkalaemic event do not predict mortality. Conversely, following an episode of acute severe hyperkalaemia, serial kinetics of potassium trajectories predict the risk of death. Further evidence is needed to confirm these findings and clarify the optimal long-term management of these patients.OXFORD UNIV PRESS2022info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://incliva.portalinvestigacion.com/publicaciones/15496NEPHROLOGY DIALYSIS TRANSPLANTATIONISSN: 09310509ISSNe: 14602385reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVAinstname:INCLIVAInglésinfo:eu-repo/semantics/openAccessoai:incliva.fundanetsuite.com:p154962026-06-07T16:35:31Z
dc.title.none.fl_str_mv Long-term mortality and trajectory of potassium measurements following an episode of acute severe hyperkalaemia
title Long-term mortality and trajectory of potassium measurements following an episode of acute severe hyperkalaemia
spellingShingle Long-term mortality and trajectory of potassium measurements following an episode of acute severe hyperkalaemia
Gorriz, Jose Luis
hyperkalaemia
longitudinal studies
mortality
post-discharge
potassium
title_short Long-term mortality and trajectory of potassium measurements following an episode of acute severe hyperkalaemia
title_full Long-term mortality and trajectory of potassium measurements following an episode of acute severe hyperkalaemia
title_fullStr Long-term mortality and trajectory of potassium measurements following an episode of acute severe hyperkalaemia
title_full_unstemmed Long-term mortality and trajectory of potassium measurements following an episode of acute severe hyperkalaemia
title_sort Long-term mortality and trajectory of potassium measurements following an episode of acute severe hyperkalaemia
dc.creator.none.fl_str_mv Gorriz, Jose Luis
D'Marco, Luis
Pastor-Gonzalez, Anna
Molina, Pablo
Gonzalez-Rico, Miguel
Puchades, Maria Jesus
Sanchis, Irina
Escudero, Veronica
Estan, Nuria
de la Espriella, Rafael
Nunez, Eduardo
Pallardo, Luis
Nunez, Julio
author Gorriz, Jose Luis
author_facet Gorriz, Jose Luis
D'Marco, Luis
Pastor-Gonzalez, Anna
Molina, Pablo
Gonzalez-Rico, Miguel
Puchades, Maria Jesus
Sanchis, Irina
Escudero, Veronica
Estan, Nuria
de la Espriella, Rafael
Nunez, Eduardo
Pallardo, Luis
Nunez, Julio
author_role author
author2 D'Marco, Luis
Pastor-Gonzalez, Anna
Molina, Pablo
Gonzalez-Rico, Miguel
Puchades, Maria Jesus
Sanchis, Irina
Escudero, Veronica
Estan, Nuria
de la Espriella, Rafael
Nunez, Eduardo
Pallardo, Luis
Nunez, Julio
author2_role author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv hyperkalaemia
longitudinal studies
mortality
post-discharge
potassium
topic hyperkalaemia
longitudinal studies
mortality
post-discharge
potassium
description Background Hyperkalaemia is a common condition in patients with comorbidities such as chronic kidney disease (CKD) or congestive heart failure (HF). Moreover, severe hyperkalaemia is a potentially life-threatening condition that is associated with a higher risk of adverse clinical events such as ventricular arrhythmias and sudden cardiac death. Currently, data regarding the prognostic implications of chronic hyperkalaemia are available; however, information about the long-term clinical consequences after an episode of severe hyperkalaemia remains scarce. The objective of this study was to evaluate the association between the trajectory of potassium measurements in patients with acute hyperkalaemia and long-term all-cause mortality. Methods This is a retrospective observational study that included patients with acute severe hyperkalaemia [potassium (K) >6 mEq/L] without haemolysis in the emergency room of Dr Peset University Hospital in Valencia, Spain searching the lab database from January 2016 to March 2017. The multivariable-adjusted association of serum potassium with mortality was assessed by using comprehensive state-of-the-art regression methods that can accommodate time-dependent exposure modelling. Results We found 172 episodes of acute hyperkalaemia in 160 patients in the emergency room. The mean +/- standard deviation age of the sample was 77 +/- 12 years and 60.5% were males. The most frequent comorbidities were CKD (71.2%), HF (35%) and diabetes mellitus (56.9%). Only 11.9% of the patients were on chronic dialysis. A quarter of the patients did not have previous CKD, making hyperkalaemia an unpredictable life-threatening complication. During the acute episode, mean potassium and estimated glomerular filtration rate (eGFR) were 6.6 +/- 0.6 (range 6.1-9.2) mEq/L and 23 +/- 16 (range 2-84) mL/min/1.73 m(2), respectively. After a median (interquartile range) follow-up of 17.3 (2.2-23.7) months, 68 patients died (42.5%). Recurrences of hyperkalaemia (K >5.5 mEq/L) were detected in 39.5% of the patients who were monitored during follow-up. We found that previous potassium levels during an acute severe hyperkalaemia episode were not predictors of mortality. Conversely, the post-discharge longitudinal trajectories of potassium were able to predict all-cause mortality (overall P = 0.0015). The effect of transitioning from hyperkalaemia to normokalaemia (K >5.5 mEq/L to K <= 5.5 mEq/L) after the acute episode was significant, and inversely associated with the risk of mortality. Conclusions Potassium levels prior to a severe hyperkalaemic event do not predict mortality. Conversely, following an episode of acute severe hyperkalaemia, serial kinetics of potassium trajectories predict the risk of death. Further evidence is needed to confirm these findings and clarify the optimal long-term management of these patients.
publishDate 2022
dc.date.none.fl_str_mv 2022
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://incliva.portalinvestigacion.com/publicaciones/15496
url https://incliva.portalinvestigacion.com/publicaciones/15496
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv OXFORD UNIV PRESS
publisher.none.fl_str_mv OXFORD UNIV PRESS
dc.source.none.fl_str_mv NEPHROLOGY DIALYSIS TRANSPLANTATION
ISSN: 09310509
ISSNe: 14602385
reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
instname:INCLIVA
instname_str INCLIVA
reponame_str r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
collection r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,812429

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