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Hyperkalemia Associated With Poor Outcomes For Diabetes Patients

Increased risk for cardiac events, hospitalization clear predictors of death.

The results of the Danish population-based cohort study were presented by Reimar W Thromsen, MD, PhD, of Aarhus University, Copenhagen, Denmark, at the European Association for the Study of Diabetes (EASD) 2017 Annual Meeting.

Hyperkalemia, defined as elevated blood potassium above 5.0 mmol/L, is common in patients with diabetes and is an identifiable risk factor for clinicians to look for. It is associated with severe clinical outcomes, including cardiac outcomes, acute hospitalizations, and intensive care unit admissions, and is a clear predictor of death in patients with diabetes.

A total of 68,601 patients with a first-time prescription for a glucose-lowering agent were included in the study. Due to the scarcity of data in patients with diabetes who have hyperkalemia, researchers used linked individual data from hospital, prescription, and laboratory databases covering the population of Northern Denmark, which included approximately 30% of the country’s population during 2000-2012.

The study found approximately 16% of the patients developed hyperkalemia over a mean 3.4 year of follow up, 26% of the patients developed chronic kidney disease at the time diabetes medication was started, and the risk for developing hyperkalemia within the first year increased with worsening kidney function. Hyperkalemia recurrence was also common, with 43.6% experiencing a second hyperkalemia event within the first year. Of those, 56.6% had a third event, and of those, 64.6% had a fourth event. “So, previous hyperkalemia predicts future hyperkalemia, and the time between these events is typically short,” Dr. Thomsen commented.

In a second study phase, 11,208 patients with a first episode of hyperkalemia were compared with 11,127 patients with diabetes who do not have hyperkalemia that have matched age, gender, and diabetes duration. “One out of six patients with diabetes develops hyperkalemia; those with concomitant kidney disease and heart failure are at particularly increased risk,” the researchers observed.

Researchers also compared the outcomes 6 months prior to the hyperkalemia event to the outcomes 6 months after hyperkalemia event. Risk ratios before/after were 1.18 for outpatient, 1.67 for acute hospitalization, 1.78 for hospitalization for any cardiac diagnosis, and 6.27 for hospitalization with ICU admission. The results were further compared with patients with diabetes who do not have hyperkalemia. Researchers found the risk for hospitalization was 2.16-fold higher in those with hyperkalemia compared to those without hyperkalemia, the risk for hospitalization for any cardiac diagnosis increased nearly 4.73-fold higher, risk for hospitalization for cardiac arrest increased 6.59-fold, and risk for ICU admission increased 4.77-fold.

It is difficult to prove causality. There is an association between hyperkalemia and severe clinical outcomes. The increased risk for cardiac events and hospitalization make hyperkalemia a clear predictor of death in patients with diabetes.

Practice Pearls:

  • Hyperkalemia is associated with severe clinical outcomes, including cardiac events, acute hospitalization, and ICU admission.
  • One in six patients with diabetes who have hyperkalemia and those with concomitant kidney disease and heart failure are at particularly increased risk.
  • Factors predicting hyperkalemia in patients with diabetes include chronic kidney disease, heart failure, use of potassium-sparing diuretics (mostly spironolactone), use of potassium supplements, use of ACE inhibitors, use of angiotensin receptor blockers (ARBs), alcohol-related disease, and chronic pulmonary disease.

Reference:

Reimar Thromsen. Hyperkalaemia in patients with diabetes: incidence, risk factors, and clinical outcomes. A Danish population based cohort study. European Association for the Study of Diabetes. 2017 Sep 15.

Kay Lynn Tran, Doctor of Pharmacy Candidate: Class of 2018; LECOM College of Pharmacy