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. 2019 Mar 6;20(1):85.
doi: 10.1186/s12882-019-1250-0.

Epidemiology and health outcomes associated with hyperkalemia in a primary care setting in England

Laura Horne  1 , Akhtar Ashfaq  1 , Sharon MacLachlan  2 , Marvin Sinsakul  3 , Lei Qin  4 , Robert LoCasale  5 , James B Wetmore  6
Affiliations

Epidemiology and health outcomes associated with hyperkalemia in a primary care setting in England

Laura Horne et al. BMC Nephrol. .

Abstract

Background: Real-world incidence, clinical consequences, and healthcare resource utilization (HRU) of hyperkalemia (HK) remain poorly characterized, particularly in patients with specific comorbidities.

Methods: Data from the Clinical Practice Research Datalink and Hospital Episode Statistics databases were analyzed to determine incidence of an index HK event, subsequent clinical outcomes, and HRU in the English population. Factors associated with index HK in a primary care setting were also identified for those with an index HK event during the study period (2009-2013) and matched controls.

Results: The overall incidence rate of an index HK event was 2.9 per 100 person-years. Use of renin-angiotensin-aldosterone system inhibitors was strongly associated with HK (odds ratio, 13.6-15.9). Few patients (5.8%) had serum potassium (K+) retested ≤ 14 days following the index event; among those retested, 32% had HK. Following an index HK event, all-cause hospitalization, HK recurrence, and kidney function decline were the most common outcomes (incidence rates per 100 person-years: 14.1, 8.1, and 6.7, respectively), with higher rates in those with comorbidities or K+ > 6.0 mmol/L. Mortality and arrhythmia rates were higher among those with K+ > 6.0 mmol/L. Older age, comorbid diabetes mellitus, and mineralocorticoid receptor antagonist use were associated with HK recurrence. Relatively few patients received testing or prescriptions to treat HK following an event.

Conclusions: Severe index HK events were associated with adverse outcomes, including arrhythmia and mortality. Despite this, retesting following an index event was uncommon, and incidence of recurrence was much higher than that of the index event.

Keywords: Chronic kidney disease; Healthcare resource utilization; Hyperkalemia; Incidence.

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Conflict of interest statement

Ethics approval and consent to participate

All research undertaken using data obtained from the Clinical Practice Research Database (CPRD) is approved by, as appropriate, an ethics committee, a scientific committee, and the National Information Governance Board Ethics and Confidentiality Committee. The study protocol (protocol number: 16_217R2) was approved by the Independent Scientific Advisory Committee from the CPRD. The CPRD adheres to all applicable UK and European laws, National Health Service Guidelines, and other guidelines governing research. All CPRD data is anonymized, and additional compliance safeguards put in place include, but are not limited to, Charters, Privacy Enhancing Technologies, and legal arrangements, among others.

Consent for publication

Not applicable.

Competing interests

LH is a consultant to AstraZeneca and owns AstraZeneca stock. AA was a full-time employee of AstraZeneca at the time of study conduct. SM is an employee of Evidera who provides consultancy services to AstraZeneca. MS and LQ are employees and stockholders of AstraZeneca. RL was an employee of AstraZeneca and owned AstraZeneca stock at the time of the study conduct. JBW serves on the speakers’ bureau for OPKO Renal.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Incidence of index hyperkalemia event based on age and sex. Error bars show the 95% confidence interval (CI)
Fig. 2
Fig. 2
Healthcare resource utilization following an index hyperkalemia event in overall population and by hyperkalemia severity. (a) Proportion of patients with ≥ 1 laboratory test; (b) proportion of patients with ≥ 1 hospitalization; (c) proportion of patients with ≥ 1 outpatient visit; (d) proportion of patients with ≥ 1 specialist referral; and (e) proportion of patients with ≥ 1 prescription. a Or Clinical Practice Research Datalink diagnosis code in the absence of laboratory results. b Or Hospital Episode Statistics diagnosis code, regardless of serum potassium (K+) level
See this image and copyright information in PMC

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