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Long-term mortality and trajectory of potassium easurements following an episode of acute severe hyperkalemia

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Long-term mortality and trajectory of potassium easurements following an episode of acute severe hyperkalemia

dc.contributor.author	Górriz Teruel, Jose Luis
dc.contributor.author	D'Marco, Luis
dc.contributor.author	Pastor González, Anna
dc.contributor.author	Molina Vila, Pablo
dc.contributor.author	González Rico, Miguel
dc.contributor.author	Puchades Montesa, María Jesús
dc.contributor.author	Sanchis, Irina
dc.contributor.author	Escudero, Verónica
dc.contributor.author	Estañ Capell, Nuria
dc.contributor.author	de la Espriella, Rafael
dc.contributor.author	Núñez, Eduardo
dc.contributor.author	Pallardó Mateu, Luis Manuel
dc.contributor.author	Núñez Villota, Julio
dc.date.accessioned	2022-06-15T15:28:27Z
dc.date.available	2022-06-15T15:28:27Z
dc.date.issued	2021
dc.identifier.citation	Górriz Teruel, Jose Luis D'Marco, Luis Pastor González, Anna Molina Vila, Pablo González Rico, Miguel Puchades Montesa, María Jesús Sanchis, Irina Escudero, Verónica Estañ Capell, Nuria de la Espriella, Rafael Núñez, Eduardo Pallardó Mateu, Luis Manuel Núñez Villota, Julio 2021 Long-term mortality and trajectory of potassium easurements following an episode of acute severe hyperkalemia Nephrology Dialysis Transplantation 37 522 530
dc.identifier.uri	https://hdl.handle.net/10550/83159
dc.description.abstract	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 m2, 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.
dc.language.iso	eng
dc.relation.ispartof	Nephrology Dialysis Transplantation, 2021, vol. 37, p. 522-530
dc.subject	Insuficiència renal crònica
dc.subject	Sang Coagulació Factors
dc.title	Long-term mortality and trajectory of potassium easurements following an episode of acute severe hyperkalemia
dc.type	journal article	es_ES
dc.date.updated	2022-06-15T15:28:27Z
dc.identifier.doi	10.1093/ndt/gfab003
dc.identifier.idgrec	154202
dc.rights.accessRights	open access	es_ES