Table 6.
Factors associated with hyperkalemia recurrence and other adverse clinical outcomes following an index hyperkalemic event
| Stepwise-adjusted odds ratio (95% CI) | ||||
|---|---|---|---|---|
| HK recurrence | Cardiac arrhythmia | All-cause hospitalization | Death | |
| Age range, years | ||||
| 18–29 | REF | REF | REF | REF |
| 30–39 | 1.30 (1.13–1.48) | 1.08 (0.58–2.02) | 0.96 (0.90–1.02) | 1.58 (0.92–2.71) |
| 40–49 | 1.85 (1.64–2.08) | 1.52 (0.88–2.62) | 0.90 (0.85–0.95) | 3.14 (1.95–5.08) |
| 50–59 | 2.29 (2.04–2.58) | 2.94 (1.74–4.96) | 0.98 (0.93–1.04) | 6.19 (3.87–9.90) |
| 60–69 | 2.73 (2.43–3.07) | 6.83 (4.08–11.43) | 1.15 (1.09–1.22) | 13.36 (8.39–21.27) |
| 70–79 | 3.23 (2.87–3.64) | 15.52 (9.28–25.96) | 1.42 (1.34–1.50) | 30.23 (19.00–48.11) |
| ≥ 80 | 3.45 (3.06–3.89) | 33.18 (19.82–55.56) | 1.77 (1.67–1.88) | 91.03 (57.21–144.86) |
| Sex | ||||
| Male | REF | REF | REF | REF |
| Female | – | 0.70 (0.65–0.75) | – | 0.87 (0.83–0.90) |
| Baseline laboratory values | ||||
| BUN | – | – | 1.50 (1.37–1.64) | – |
| eGFR | 0.99 (0.99–0.99) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) |
| Smoking status | ||||
| Current | 1.12 (1.08–1.15) | 1.22 (1.10–1.34) | 1.18 (1.15–1.21) | 1.86 (1.76–1.96) |
| Former | 1.07 (1.04–1.10) | 1.04 (0.97–1.11) | 1.09 (1.06–1.11) | 1.07 (1.02–1.11) |
| Never | REF | REF | REF | REF |
| Unknown | 1.04 (0.84–1.28) | 1.29 (0.79–2.12) | 0.99 (0.85–1.16) | 1.91 (1.53–2.37) |
| Comorbidity | ||||
| Hypertension | 1.23 (1.19–1.27) | 1.11 (1.03–1.19) | – | – |
| Hyperlipidemia | 1.04 (1.01–1.07) | 0.86 (0.80–0.93) | – | 0.79 (0.76–0.83) |
| Ischemic heart disease | 1.15 (1.11–1.18) | 1.42 (1.31–1.54) | 1.28 (1.25–1.31) | 1.12 (1.07–1.17) |
| Arrhythmia (including atrial fibrillation) | 1.10 (1.06–1.14) | – | 1.30 (1.27–1.34) | 1.33 (1.27–1.39) |
| Heart failure | 1.10 (1.03–1.17) | 1.32 (1.12–1.56) | 1.14 (1.08–1.20) | 1.38 (1.29–1.48) |
| Cerebrovascular disease | 1.04 (1.00–1.08) | 1.27 (1.16–1.40) | 1.18 (1.14–1.22) | 1.60 (1.53–1.68) |
| Peripheral artery disease | 1.10 (1.03–1.17) | 1.29 (1.11–1.50) | 1.31 (1.25–1.38) | 1.43 (1.32–1.54) |
| Diabetes (types 1 and 2) | 1.86 (1.81–1.91) | – | 1.08 (1.05–1.11) | 1.27 (1.21–1.33) |
| Chronic kidney disease | 1.19 (1.15–1.23) | – | 1.08 (1.05–1.11) | 1.09 (1.05–1.15) |
| Obstructive lung disease | 1.06 (1.03–1.09) | 1.36 (1.26–1.46) | 1.28 (1.25–1.31) | 1.36 (1.31–1.42) |
| Liver disease | 1.21 (1.15–1.28) | 1.47 (1.26–1.72) | 1.50 (1.44–1.56) | 2.01 (1.87–2.17) |
| Concomitant medication | ||||
| ACE inhibitor | 1.27 (1.23–1.31) | – | 0.90 (0.88–0.92) | 0.77 (0.74–0.80) |
| ARB | 1.16 (1.12–1.21) | – | 0.92 (0.89–0.95) | 0.66 (0.62–0.70) |
| MRA | 1.74 (1.64–1.85) | 1.36 (1.15–1.61) | 1.15 (1.10–1.22) | 1.23 (1.14–1.32) |
| Loop diuretics | 1.10 (1.06–1.15) | 1.78 (1.61–1.97) | 1.33 (1.28–1.38) | 1.87 (1.78–1.97) |
| Bendroflumethiazide | 0.90 (0.86–0.93) | 1.17 (1.06–1.30) | 0.96 (0.92–0.99) | – |
| Indapamide | 0.84 (0.75–0.94) | – | – | – |
| NSAID | 1.21 (1.17–1.25) | – | 1.30 (1.27–1.34) | – |
| Antibiotics | – | – | 1.57 (1.48–1.66) | 1.50 (1.38–1.65) |
| Serum K+ level during index HK event, mmol/L | ||||
| 5.0 to ≤ 5.5a | – | – | – | – |
| > 5.5 to ≤ 6.0 | 1.39 (1.33–1.44) | 1.07 (0.96–1.21) | 1.10 (1.06–1.13) | 1.41 (1.33–1.50) |
| > 6.0b | 1.34 (1.23–1.47) | 1.47 (1.18–1.83) | 1.63 (1.54–1.74) | 3.27 (3.02–3.54) |
aOr Clinical Practice Research Datalink diagnosis code in the absence of laboratory results
bOr Hospital Episode Statistics diagnosis code, regardless of serum K+ level
ACE angiotensin-converting enzyme, ARB angiotensin II receptor blocker, BUN blood urea nitrogen, CI confidence interval, eGFR estimated glomerular filtration rate, HK hyperkalemia, K+ potassium, MRA mineralocorticoid receptor antagonist, NSAID nonsteroidal anti-inflammatory drug, REF reference value