Table 1.
Baseline Characteristics Among Patients With First Hospital‐Diagnosed HF Stratified by eGFR Category and Subsequent Incidence of Hyperkalemia
| Characteristics | eGFR Category, mL/min per 1.73 m2 a | Total | ||||||
|---|---|---|---|---|---|---|---|---|
| eGFR ≥60 | eGFR 45–59 | eGFR 30–44 | eGFR 15–29 | eGFR <15 | Dialysis | No eGFR Recorded | ||
| No. of patients with HF (row %) | 7679 (24.3) | 6931 (21.9) | 5800 (18.3) | 3707 (11.7) | 1166 (3.7) | 298 (0.9) | 6068 (19.2) | 31 649 (100) |
| Female sex | 2602 (33.9) | 3241 (46.8) | 3198 (55.1) | 2016 (54.4) | 612 (52.5) | 93 (31.2) | 3047 (50.2) | 14 809 (46.8) |
| Age, median (quartiles), y | 70 (60.2–79.0) | 78 (69.7–84.3) | 82 (74.6–87.0) | 83 (76.1–87.7) | 81 (73.5–86.4) | 70 (60.3–78.6) | 79 (71.5–85.4) | 78 (69.1–84.9) |
| Echocardiography performed before/at first HF admission | 5021 (65.4) | 4222 (60.9) | 3381 (58.3) | 2262 (61.0) | 735 (63.0) | 223 (74.8) | 2281 (37.6) | 18 125 (57.3) |
| HF as primary diagnosis | 2977 (38.8) | 2586 (37.3) | 2109 (36.4) | 1277 (34.4) | 412 (35.3) | 124 (41.6) | 2423 (39.9) | 11 908 (37.6) |
| Conditions underlying HFb | ||||||||
| Cardiomyopathy | 494 (6.4) | 312 (4.5) | 195 (3.4) | 124 (3.3) | 24 (2.1) | 12 (4.0) | 180 (3.0) | 1341 (4.2) |
| Valvular heart disease | 867 (11.3) | 947 (13.7) | 931 (16.1) | 629 (17.0) | 189 (16.2) | 51 (17.1) | 648 (10.7) | 4262 (13.5) |
| Myocardial infarction | 1506 (19.6) | 1513 (21.8) | 1406 (24.2) | 1034 (27.9) | 324 (27.8) | 99 (33.2) | 905 (14.9) | 6787 (21.4) |
| Ischemic heart disease | 2780 (36.2) | 2819 (40.7) | 2540 (43.8) | 1810 (48.8) | 530 (45.5) | 162 (54.4) | 2093 (34.5) | 12 734 (40.2) |
| Atrial fibrillation | 2393 (31.2) | 2585 (37.3) | 2243 (38.7) | 1426 (38.5) | 402 (34.5) | 81 (27.2) | 1964 (32.4) | 11 094 (35.1) |
| Other comorbidities | ||||||||
| Diabetes mellitus | 1222 (15.9) | 1162 (16.8) | 1225 (21.1) | 1007 (27.2) | 360 (30.9) | 107 (35.9) | 993 (16.4) | 6076 (19.2) |
| Chronic kidney diseasec | 59 (0.8) | 3524 (50.8) | 4579 (78.9) | 3224 (87.0) | 1068 (91.6) | 298 (100) | 243 (4.0) | 12 995 (41.1) |
| Hypertension | 3942 (51.3) | 4399 (63.5) | 4195 (72.3) | 2968 (80.1) | 955 (81.9) | 270 (90.6) | 2852 (47.0) | 19 581 (61.9) |
| Peripheral vascular disease | 566 (7.4) | 721 (10.4) | 768 (13.2) | 656 (17.7) | 254 (21.8) | 99 (33.2) | 609 (10.0) | 3673 (11.6) |
| Cerebrovascular disease | 948 (12.3) | 1155 (16.7) | 1229 (21.2) | 865 (23.3) | 294 (25.2) | 58 (19.5) | 940 (15.5) | 5489 (17.3) |
| Chronic pulmonary disease | 1315 (17.1) | 1301 (18.8) | 1156 (19.9) | 761 (20.5) | 205 (17.6) | 56 (18.8) | 1044 (17.2) | 5838 (18.4) |
| Peptic ulcer disease | 514 (6.7) | 582 (8.4) | 641 (11.1) | 514 (13.9) | 178 (15.3) | 54 (18.1) | 546 (9.0) | 3029 (9.6) |
| Any malignant disease | 963 (12.5) | 1052 (15.2) | 1035 (17.8) | 751 (20.3) | 246 (21.1) | 66 (22.1) | 665 (11.0) | 4778 (15.1) |
| Alcoholism‐related disorders | 775 (10.1) | 438 (6.3) | 372 (6.4) | 311 (8.4) | 121 (10.4) | 43 (14.4) | 360 (5.9) | 2420 (7.6) |
| Medical obesity | 577 (7.5) | 433 (6.2) | 370 (6.4) | 311 (8.4) | 124 (10.6) | 22 (7.4) | 322 (5.3) | 2159 (6.8) |
| Drug treatment before first HF diagnosis | ||||||||
| ACEis overall | 1588 (20.7) | 1625 (23.4) | 1516 (26.1) | 1109 (29.9) | 353 (30.3) | 93 (31.2) | 1146 (18.9) | 7430 (23.5) |
| Ramipril | 650 (8.5) | 652 (9.4) | 570 (9.8) | 440 (11.9) | 122 (10.5) | 39 (13.1) | 241 (4.0) | 2714 (8.6) |
| Enalapril | 437 (5.7) | 450 (6.5) | 440 (7.6) | 324 (8.7) | 109 (9.3) | 33 (11.1) | 284 (4.7) | 2077 (6.6) |
| Other ACEis | 422 (5.5) | 426 (6.1) | 422 (7.3) | 289 (7.8) | 92 (7.9) | 20 (6.7) | 600 (9.9) | 2271 (7.2) |
| ACEi/diuretic combination | 156 (2.0) | 175 (2.5) | 160 (2.8) | 118 (3.2) | 51 (4.4) | 4 (1.3) | 67 (1.1) | 731 (2.3) |
| ARBs overall | 647 (8.4) | 724 (10.4) | 756 (13.0) | 595 (16.1) | 215 (18.4) | 70 (23.5) | 396 (6.5) | 3403 (10.8) |
| Losartan | 271 (3.5) | 302 (4.4) | 308 (5.3) | 241 (6.5) | 95 (8.1) | 27 (9.1) | 193 (3.2) | 1437 (4.5) |
| Candesartan | 114 (1.5) | 123 (1.8) | 120 (2.1) | 93 (2.5) | 40 (3.4) | 32 (10.7) | 57 (0.9) | 579 (1.8) |
| Other ARBs | 93 (1.2) | 115 (1.7) | 119 (2.1) | 83 (2.2) | 30 (2.6) | 11 (3.7) | 61 (1.0) | 512 (1.6) |
| ARB/diuretic combination | 235 (3.1) | 232 (3.3) | 252 (4.3) | 223 (6.0) | 63 (5.4) | 6 (2.0) | 118 (1.9) | 1129 (3.6) |
| β Blockers | 2046 (26.6) | 2110 (30.4) | 1945 (33.5) | 1500 (40.5) | 491 (42.1) | 175 (58.7) | 1475 (24.3) | 9742 (30.8) |
| Spironolactone | 522 (6.8) | 595 (8.6) | 759 (13.1) | 618 (16.7) | 195 (16.7) | 7 (2.3) | 755 (12.4) | 3451 (10.9) |
| Potassium supplements | 1447 (18.8) | 1852 (26.7) | 2011 (34.7) | 1557 (42.0) | 457 (39.2) | 62 (20.8) | 2151 (35.4) | 9537 (30.1) |
| Loop diuretics | 1890 (24.6) | 2332 (33.6) | 2525 (43.5) | 2187 (59.0) | 734 (63.0) | 182 (61.1) | 2634 (43.4) | 12 484 (39.4) |
| NSAIDs | 1685 (21.9) | 1466 (21.2) | 1221 (21.1) | 904 (24.4) | 282 (24.2) | 28 (9.4) | 1490 (24.6) | 7076 (22.4) |
| Trimethoprim | 91 (1.2) | 140 (2.0) | 176 (3.0) | 168 (4.5) | 68 (5.8) | 3 (1.0) | 152 (2.5) | 798 (2.5) |
| Macrolides | 911 (11.9) | 808 (11.7) | 627 (10.8) | 463 (12.5) | 136 (11.7) | 41 (13.8) | 788 (13.0) | 3774 (11.9) |
| Hyperkalemia event >5.0 mmol/L | ||||||||
| Total with a first hyperkalemia event | 2706 (35.2) | 2884 (41.6) | 2823 (48.7) | 1985 (53.5) | 641 (55.0) | 167 (56.0) | 1134 (18.7) | 12 340 (39.0) |
| Time to event in patients with event, median, y | 0.53 | 0.43 | 0.19 | 0.08 | 0.07 | 0.17 | 3.91 | 0.34 |
| Potassium tests before first event, median | 9 | 9 | 7 | 5 | 6 | 8 | 7 | 8 |
| 1‐y Cumulative incidence, % (95% CI) | 21.3 (20.1–22.4) | 26.1 (24.7–27.5) | 35.0 (33.1–36.9) | 43.6 (40.8–46.5) | 48.1 (42.6–53.6) | 47.7 (36.8–58.5) | 2.8 (2.4–3.2) | 25.2 (24.5–25.8) |
| Incidence rate per 1000 person‐years | 125.7 | 189.3 | 325.5 | 569.8 | 786.2 | 827.4 | 58.5 | 178.0 |
| Hyperkalemia event >5.5 mmol/L | ||||||||
| Total with a first hyperkalemia event | 1135 (14.8) | 1365 (19.7) | 1472 (25.4) | 1177 (31.8) | 433 (37.1) | 129 (43.3) | 513 (8.5) | 6224 (19.7) |
| Time to event in patients with event, median, y | 1.13 | 0.87 | 0.47 | 0.16 | 0.08 | 0.25 | 4.29 | 0.61 |
| Potassium tests before first event, median | 16 | 13 | 11 | 8 | 8 | 11 | 12 | 11 |
| 1‐y Cumulative incidence, % (95% CI) | 7.1 (6.5–7.7) | 10.3 (9.5–11.1) | 15.7 (14.6–16.8) | 23.3 (21.5–25.1) | 30.4 (26.6–34.2) | 32.6 (24.7–40.4) | 1.0 (0.8–1.3) | 11.2 (10.8–11.6) |
| Incidence rate per 1000 person‐years | 42.7 | 68.5 | 123.9 | 234.4 | 367.9 | 465.9 | 24.4 | 72.5 |
| Hyperkalemia event >6.0 mmol/L | ||||||||
| Total with a first hyperkalemia event | 491 (6.4) | 593 (8.6) | 688 (11.9) | 603 (16.3) | 233 (20.0) | 81 (27.2) | 245 (4.0) | 2934 (9.3) |
| Time to event in patients with event, median, y | 1.50 | 1.30 | 0.70 | 0.22 | 0.09 | 0.38 | 4.48 | 0.84 |
| Potassium tests before first event, median | 20 | 16 | 13 | 9 | 8 | 14 | 17 | 14 |
| 1‐y Cumulative incidence, % (95% CI) | 2.7 (2.3–3.1) | 3.8 (3.4–4.3) | 6.7 (6.0–7.4) | 11.7 (10.5–12.9) | 15.7 (13.2–18.2) | 18.5 (13.1–23.9) | 0.4 (0.2–0.6) | 4.9 (4.7–5.2) |
| Incidence rate per 1000 person‐years | 17.5 | 27.3 | 51.4 | 102.1 | 161.2 | 213.8 | 11.4 | 31.7 |
Data are given as number (percentage) unless otherwise indicated. Percentages are based on the first row. ACEi indicates angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor II blocker; CI, confidence interval; eGFR, estimated glomerular filtration rate; HF, heart failure.
a
Patients categorized according to lowest measured eGFR before or on admission date with HF; presence of dialysis overrules any eGFR measurement result.
b
As present at the time of HF diagnosis.
c
Manifest chronic kidney disease was defined on the date of the second of 2 measurements >90 days apart of a creatinine value corresponding to an eGFR <60 mL/min per 1.73 m2 or on the first date of a hospital diagnosis.