Hyperkalemia and Quality of Life

Patients with chronic kidney disease (CKD) are at increased risk for hyperkalemia; the risk increases with severity of disease in that patient population. Hyperkalemia may also be associated with quality of life, resulting in a greater risk of sudden cardiac death and hospitalization among patients receiving hemodialysis. There are few data available on the impact of hyperkalemia on the quality of life of dialysis-dependent patients with CKD compared with non–dialysis-dependent patients with and without hyperkalemia.

Eskinder Tafesse, PhD, and colleagues conducted an analysis of pooled data from the 2015 and 2018 Adelphi CKD Disease Specific Programmes and reported results of the analysis during a poster session at Kidney Week 2019. The poster was titled Assessing the Impact of Hyperkalemia on the Quality of Life of Dialysis Patients Compared with Non-Dialysis Patients: Results from a Real-World Study in the United States and European Union 5.

The Adelphi surveys collected data from physicians and patients with CKD in France, Germany, Italy, Spain, the United Kingdom, and the United States. Patients completed the Euro-Qol-5D-3L (EQ-5D) questionnaire and the EuroQol visual analog scale (EQ-VAS). Data on patient demographics, disease characteristics, and comorbidities were provided by physicians. Following adjustment for age, sex, estimated glomerular filtration rate, heart failure, and diabetes, a multiple linear regression analysis was performed for ED-5D utility and EQ-VAS to assess the association between non-dialysis dependent patients with hyperkalemia (potassium >5.0 mmol/L), dialysis-dependent patients without hyperkalemia (potassium 3.5-5.0 mmol/L), and dialysis-dependent patients with hyperkalemia to a reference group of non-dialysis-dependent patients without hyperkalemia (and their interaction).

Mean EQ-5D utility score was significantly lower among non–dialysis-dependent patients with hyperkalemia (n=176) than among non–dialysis-dependent patients without hyperkalemia (n=766): 0.788 versus 0.825; P=.039. Dialysis-dependent patients with hyperkalemia (n=100) reported an additional deterioration in mean EQ-5D utility scores compared with non–dialysis-dependent patients without hyperkalemia (0.755; P=.009), indicating poorer health status.

Non–dialysis-dependent patients with hyperkalemia (n=175) also had significantly poorer quality of life by EQ-VAS scores compared with non–dialysis-dependent patients without hyperkalemia (n=766): 64.7 versus 67.5; P=.048. Quality of life was further reduced in dialysis-dependent patients with hyperkalemia (n=100) compared with non–dialysis-dependent patients without hyperkalemia: 62.3 versus 67.5; P=.015.

In conclusion, the researchers said, “Hyperkalemia is associated with reduced EQ-5D health state utility scores in CKD patients. Dialysis-dependent patients with hyperkalemia experienced significantly greater negative impact on their quality of life compared with non–dialysis-dependent patients without hyperkalemia. New therapeutic options and effective management of hyperkalemia in dialysis-dependent CKD patients may positively improve quality of life in this population.”

Source: Tafesse E, Jackson J, Moon R, Milligan GR, Kim J. Assessing the impact of hyperkalemia on the quality of life of dialysis patients compared with non-dialysis patients: Results from a real-world study in the United States and European Union 5. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2019 (Abstract TH-PO235), November 7, 2019, Washington, DC.