Hyperkalemia in Hospitalized Patients: A Retrospective Cohort Study

Abstract

PURPOSE: Hyperkalemia is a potentially life-threatening metabolic disorder, which is caused by impaired potassium excretion by kidney, alteration of mechanisms that regulate movement of potassium across cells or a combination of both. The aim of our study was to evaluate the incidence of hyperkalemia among hospitalized patients; to determine the risk factors involved and the clinical course of these patients. METHODS: We reviewed medical records of all adult patients(age>18 years) admitted to our hospital in the years 2011-12 who had hyperkalemia(serum K+>5.1 meq/L) either at admission or developed it during their hospital stay. Patients with End stage renal disease on dialysis were excluded. RESULTS: Out of 15, 608 patients admitted during the mentioned time period, 408 patients (2.61%) had hyperkalemia. The mean age of our patients was 64+/-17 years with 57% males and 43% females. 283 patients (69.8%) had hyperkalemia at admission white the remaining 125(30.2%) developed it during the hospital stay. Mean serum potassium at the time of detection was 5.7+/-0.59 meq/L. Risk factors associated with hyperkalemia; Chronic Kidney Disease(52.2%), Acute kidney injury(62%), Diabetes Mellitus(42%), Metabolic Acidosis(45%), Tissue Necrosis(11%), Adrenal Insufficiency(9%), Recent blood transfusion(12%), were observed in majority of patients. Medications associated with hyperkalemia were Beta-Blockers(61%), Angiotensin-converting-enzyme(ACE) inhibitors/Angiotensin-1 Receptor blockers(32%), Aldactone/Eplerenone(17%), Heparin(15%), Potassium suppelemts(11%), Tacrolimus(8%), Trimethoprim(8%), Azole antifungals(10%), Non-steroidal anti-inflammatory drugs(NSAIDs, 6%), Digoxin(6%), Cyclosporine(3%) and Amiloride/triametrene(1%). Emergent treatments utilized to correct hyperkalemia were Cation-exchange resins(77.9%), Intravenous insulin(62%) and hemodialysis(12.2%). 33 patients(8%) died while the mean duration to correction in the remaining was 12 hours. CONCLUSIONS: Hyperkalemia is a common electrolyte abnormality among hospitalized patients and can be a cause of significant mortality. Several commonly used medications can disrupt potassium balance, especially in patients with risk factors associated with this disorder. Frequent laboratory monitoring for hyperkalemia should be done when prescribing these medications in such patients.