Dyskalemias and Short-Term Healthcare Use in Patients with Advanced CKD

Patients with chronic kidney disease (CKD) are at increased risk for dyskalemias, possibly leading to arrhythmias that require emergent or in-hospital care. There are few data available of the association of dyskalemias with short-term hospital/emergency department (ED) visits among patients with advanced CKD.

Ankur A. Dashputre, MS, and colleagues, conducted an analysis to examine the association between dyskalemias and short-term hospital/ED visits in a patient population with advanced CKD. Results were reported in the Journal of Managed Care & Specialty Pharmacy [2021;27(1):1403-1415].

From a database of 102,477 US veterans who initiated dialysis between 2007 and 2015, the researchers identified 21,366 patients with two previous outpatient estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m² 90 to 135 days apart (the second eGFR was the index date) and at least one potassium value in the baseline period (1 year prior to index date) and one outpatient potassium value in follow-up (1 year after the index date but prior to initiation of dialysis).

The study examined the association of time-varying hypokalemia (potassium <3.5 mEq/L) and hyperkalemia (potassium >5.5 mEq/L) versus referent (3.5 to 5.5 mEq/L) with separate hospital and ED visits within 2 calendar days after each outpatient potassium value over the 1-year follow-up period from the index date. The exposure-outcome relationship, adjusted for confounders, was modeled using generalized estimated equations with binary distribution and logit link. Various subgroup and sensitivity analyses were conducted to test the robustness of the results.

Over the 1-year follow-up, 125,266 measurements of outpatient potassium were observed. Of those, 6.8% were classified as hyperkalemia and 3.7% were classified as hypokalemia. In the multivariable-adjusted model, the adjusted odds ratios (aOR) of 2.04 (95% confidence interval [CI], 1.88-2.21) for hyperkalemia and 1.66 (95% CI, 1.48-1.86) for hypokalemia were associated with significantly higher odds of hospital visits. Likewise, aORs of 1.83 (95% CI, 1.65-2.03) for hyperkalemia and 1.24 (95% CI, 1.07-1.44) for hypokalemia were associated with significantly higher odds of ED visits. The results were robust to subgroup and sensitivity analyses.

In conclusion, the researchers said, “In patients with advanced CKD, dyskalemias are associated with higher risk of hospital/ED visits. Interventions targeted at lowering the risk of dyskalemias might help in reducing the healthcare utilization and associated economic burden among patients with advanced CKD experiencing dyskalemias.”