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Randomized Controlled Trial
. 2010 Mar;3(2):253-60.
doi: 10.1161/CIRCHEARTFAILURE.109.899526. Epub 2010 Jan 26.

Hypokalemia and outcomes in patients with chronic heart failure and chronic kidney disease: findings from propensity-matched studies

C Barrett Bowling  1 , Bertram Pitt, Mustafa I Ahmed, Inmaculada B Aban, Paul W Sanders, Marjan Mujib, Ruth C Campbell, Thomas E Love, Wilbert S Aronow, Richard M Allman, George L Bakris, Ali Ahmed
Affiliations
Randomized Controlled Trial

Hypokalemia and outcomes in patients with chronic heart failure and chronic kidney disease: findings from propensity-matched studies

C Barrett Bowling et al. Circ Heart Fail. 2010 Mar.

Abstract

Background: Little is known about the effects of hypokalemia on outcomes in patients with chronic heart failure (HF) and chronic kidney disease.

Methods and results: Of the 7788 patients with chronic HF in the Digitalis Investigation Group trial, 2793 had chronic kidney disease, defined as estimated glomerular filtration rate <60 mL/min per 1.73 m(2). Of these, 527 had hypokalemia (serum potassium <4 mEq/L; mild) and 2266 had normokalemia (4 to 4.9 mEq/L). Propensity scores for hypokalemia were used to assemble a balanced cohort of 522 pairs of patients with hypokalemia and normokalemia. All-cause mortality occurred in 48% and 36% of patients with hypokalemia and normokalemia, respectively, during 57 months of follow-up (matched hazard ratio when hypokalemia was compared with normokalemia, 1.56; 95% CI, 1.25 to 1.95; P<0.0001). Matched hazard ratios (95% CIs) for cardiovascular and HF mortalities and all-cause, cardiovascular, and HF hospitalizations were 1.65 (1.29 to 2.11; P<0.0001), 1.82 (1.28 to 2.57; P<0.0001), 1.16 (1.00 to 1.35; P=0.036), 1.27 (1.08 to 1.50; P=0.004), and 1.29 (1.05 to 1.58; P=0.014), respectively. Among 453 pairs of balanced patients with HF and chronic kidney disease, all-cause mortality occurred in 47% and 38% of patients with mild hypokalemia (3.5 to 3.9 mEq/L) and normokalemia, respectively (matched hazard ratio, 1.31; 95% CI, 1.03 to 1.66; P=0.027). Among 169 pairs of balanced patients with estimated glomerular filtration rate <45 mL/min per 1.73 m(2), all-cause mortality occurred in 57% and 47% of patients with hypokalemia (<4 mEq/L; mild) and normokalemia, respectively (matched hazard ratio, 1.53; 95% CI, 1.07 to 2.19; P=0.020).

Conclusions: In patients with HF and chronic kidney disease, hypokalemia (serum potassium <4 mEq/L) is common and associated with increased mortality and hospitalization.

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Conflict of interest statement

Conflict of Interests

No authors have any conflicts of interest in relation to this manuscript.

Figures

Figure 1
Figure 1
Love plot displaying pre- and post-match absolute standardized differences for baseline covariates between patients with normokalemia (4–4.9 mEq/L) and hypokalemia (<4 mEq/L)
Figure 2
Figure 2
Kaplan-Meier plots for all-cause mortality by serum potassium levels
Figure 3
Figure 3
Association of hypokalemia (serum potassium <4 mEq/L) with all-cause mortality in subgroups of patients with chronic heart failure with chronic kidney disease
See this image and copyright information in PMC

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